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Contemporary forms of occupational diseases are often characterized by many body systems involved, with response of specific and nonspecific effects. Due to observed transformation in character and course of the main occupational entities, specifying the new clinical classifications, new "List of Occupational Diseases" adapted to ICD-10, by specialists remains topical.
Occupational diseases and deaths are costly events. They are responsible for: 1) direct medical costs; 2) indirect costs, resulting from lost production, foregone opportunities, and diminished investment; and 3) non-economic costs, including pain and suffering, disrupted careers, and devastated families. To develop a partial estimate of the total costs of occupational disease in New York State, we have examined four categories of illness: occupational cancer, chronic respiratory disease and the pneumoconioses, cerebrovascular and cardiovascular disease, and end-stage renal failure. We base our partial estimate on the human capital approach to the costs of these illnesses. Using the best measures available, including both incidence and prevalence statistics, mortality records, and a variety of financial data, we employ two cost accounting techniques of the human capital approach, the incidence method, and the prevalence method. Our analysis shows that these four occupational illnesses are costing New York over $600 million per year. This figure is a pragmatic but conservative, lower-bound estimate of the relative magnitude of total economic costs of occupational disease in New York State. The largest proportion of these costs (80%) is due to occupational cancer. The failure of the health care system to recognize the costs of occupational disease precludes recognition of the economic benefits which would result from preventing these illnesses. This study, it is hoped, will stimulate advances in epidemiological and economic approaches to resolve this important measurement problem.
Most of the occupational diseases are related to air pollution at the work place. The distribution of gases and vapours and their human absorption are briefly described. The deposition of particles is a function of their physical properties, of the pattern of the respiratory airways and of pulmonary ventilation parameters. Several defence mechanisms also play a role. Illustrative examples are given of occupational diseases caused by solvents, carbon monoxide, metals, dusts (silicosis, asbestosis, pneumoconiosis due to dust of hard metals), allergens and carcinogens. The importance of prevention is emphasized.
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During 1984-1991, 188 dentists referred for consultation to the Outpatient Department of Occupational Diseases, Institute of Occupational Medicine in connection with suspected occupational disease of musculo-skeletal system were examined. In total, 122 (64.9%) cases of the occupational diseases were diagnosed, among which chronic inflammation of humeral bone epicondyles (61.5%) and periarticular shoulder inflammation (25.4%) dominated. Claims associated with spondylosis and discopathies were decided to be rejected, as those changes are frequent in the general population and according to the legal regulations currently in force, are not included among occupational diseases resulting from the occupational work.
The Czech National Registry of Occupational Diseases was founded in 1991 with the intention of restoring the information system on occupational diseases, which had collapsed in 1990, following deep societal changes brought about by the revolution in 1989. During the ten years of its existence, the Czech National Registry of Occupational Diseases proved to be a reliable information system providing valid data on occupational diseases. The completeness and quality of data stored in the Registry are being controlled by trained personnel. The information is available on-line for competent authorities. This makes it possible to monitor the situation regarding the incidence and the structure of occupational diseases, and to signal arising problems so that effective preventive measures can be taken immediately. Currently, the Registry contains information on approximately 30,000 cases of occupational diseases. A decreasing trend of yearly reported occupational diseases is evident. This fact must be interpreted cautiously. It may reflect the decreasing number of persons working at occupational risk and/or the improvement of hygienic situation at workplaces. However, in addition to these positive changes, the underreporting of occupational diseases in the Czech Republic is highly probable. Workers with an occupational disease feel handicapped at the labor market and seek to avoid the label. Furthermore, effectiveness of the Czech occupational health care system, which is still in the period of restructuring, is far from being perfect.
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The paper is aimed at presenting the incidence of occupational diseases in Poland. The analysis was performed on the basis of the information included in 'occupational disease certificates'. All sanitary and epidemiological stations throughout the country are committed to send these certificates to the Central Register of Occupational Medicine in The Nofer Institute of Occupational Medicine in Lódź. The incidence of occupational diseases during the three recent years (1996-97-98) was the subject of a thorough analysis. In all, 11,318, 11,685 and 12,017 cases of occupational diseases, respectively were registered over those three years. The corresponding rates were 116.0, 116.9 and 117.3, respectively per 100,000 people employed. In 1998, diseases of the voice organ predominated (30.4%) of all occupational diseases) and they were followed by hearing impairment (28.2%), infectious and parasitic diseases (9.9%), pneumoconioses (8.2%), dermatoses (6.4%), vibratory syndrome (2.9%) and poisoning (2.5%). These disease categories constituted over 88% of all occupational diseases registered in that year. Diseases of the voice organ which showed the greatest growth dynamic were mainly diagnosed among teachers. Neither in the United States nor in the member states of the European Union, this pathology is included into the list of occupational diseases. In view of high rates of its incidence in our country it has become one of essential problems of occupational medicine. In Poland, particular attention is paid to infectious and parasitic diseases among which hepatitis occupies the first place (65%), mostly among health service workers. The decrease in hepatitis incidence observed in the 1990s has been due to an intensive vaccination programme in this group of workers. The incidence of occupational hepatitis became rather stable and accounted for 940 cases per year, however the incidence of hepatitic C increased at the same time. Lower rates of incidence of 'classic' occupational diseases, such as poisoning, pneumoconioses or vibratory syndrome are a positive observation. It is also interesting to note that the rate of occupational diseases diagnosed in advanced stage has also diminished. When analyzing occupational diseases one should bear in mind that the majority of pathologies already diagnosed result from long-term effect of exposure to harmful factors. In all, 93% of cases of occupational diseases emerged after a ten-year exposure. The highest rates, taking account of sections of activity, were found in mining and quarrying, health service, agriculture, hunting and forestry.