[Bone disease as an occupational disease in heavy industry].
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The table elaborated for estimating the diminution of earning capacity has proved useful. A questionnaire programme revealed that classification of occupational dermatological disorders becomes a problem as soon as insurance-legal factors have to be considered.
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For decades hand-held instruments have been widely used in foundries for material densening and cast after treatment, which introduce a vibration into the hand-arm-system. Over a period of several years this effect may cause both degenerative changes of bones and joints and damages to peripheral nerves and vessels. The present paper gives a summary and differentiated analysis of job-related lesions caused by vibration of parts of the body on foundry-typical workshop places from 1972 to 1986.
Many occupational diseases which are compensable are of interest in epidemiological studies. In addition, diseases of interest which are not compensable may be discovered during the evaluation of eligibility for compensation. Certain peculiarities of the group of workers who seek compensation (those who receive compensation and those who do not) may make the selection of an appropriate control group difficult. In two recent studies, problems associated with finding controls for cases with a compensable disease and a disease discovered during the evaluation of eligibility for compensation pointed out some of these potential biases. This paper describes the results obtained using different control groups for these studies, proposes reasons for differences in the results and suggests steps which can be taken to ensure the validity of a control group in such studies.
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Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.
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Occupational diseases in Connecticut were identified using reports to the Workers' Compensation Commission, Connecticut OSHA, Vital Statistics, and the Tumor Registry. There were 93 identified fatalities from occupational disease in 1995, and 90 in 1994, approximately three times the number of traumatic occupational fatalities. Identified fatalities were predominantly from asbestos-related diseases, including mesothelioma and asbestosis. Most occupational diseases are not readily identifiable with current reporting mechanisms. Based on national estimates, these figures are considered to be an underestimate of the true burden of occupational disease. Increased awareness and reporting of occupational diseases is needed to properly identify and prevent these common conditions.
Arteriopathies of occupational diseases predominate in the upper limbs and are usually expressed as Raynaud's phenomenon ("white finger"), sometimes complicated by digital gangrene. Hand-arm vibration disease, hypothenar hammer syndrome, exposure to silica even without silicosis and vinyl chloride intoxication are the principal causes of occupational diseases acknowledged as such by the laws. In a personal series of 60 patients with complicated upper limb arteriopathies, 25% had a recognized occupational disease. Since December 1992, Erasmus' syndrome and systemic scleroderma due to silica without silicosis have been accepted in France as being occupational diseases. The therapeutic problems are discussed, notably the surgical indications in hypothenar hammer syndrome, the possible medical treatments of finger necrosis occurring in Erasmus' syndrome and, in particular, the role played by spinal cord neurostimulation.
The number of urothelial tumors of the lower urinary tract caused by occupational exposure is expected to markedly exceed the number of diseases which are actually compensated. The German compensation system for diseases is explained using the example of disease number 1301 which applies to bladder diseases due to aromatic amines. A standard procedure for the evaluation of the percentage of disability ("MdE") caused by tumors of the urinary bladder is presented. Important working areas which are associated with an elevated tumor risk of the lower urinary tract are mentioned. Cancerogenic aromatic amines can also be liberated in the human organism from soluble, i. e. bioavailable, azo dyes by reductive cleavage. Therefore, as a first step, a detailed work history (starting from the beginning of apprenticeship) must be obtained in all cases of urothelial tumors because of the very long latency time of tumors of the urothelium which can be up to fourty years and higher.
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