National Accident Insurance Research Articles

Injury risk in foreign workers: a proposal for a prevention plan in South Tuscany

Abstract Background There are nearly 2.3 million foreign workers in Italy, many of whom hold low-skilled and heavy jobs that expose them to greater safety risks. The aim of the study is to analyze data on the accident phenomenon by using information flows from the national work accident insurance institute, in order to ensure a safe and inclusive work environment. Methods The total number of foreign workers’ accidents in the South Tuscany during the five-year period 2017-2021 was quantified. General injury trend was assessed, breaking down the events by province (Siena, Arezzo, Grosseto), year of occurrence and severity. We analyzed the events by nationality of the injured ones and by severity of compartment. Results A total of 38,254 occupational accidents were recorded, of which 6,172 (16.13%) occurred to foreign workers. Compared to the incidence of foreigners residing in the reference territory, the accident figure is 16.13% out of the 10.5% resident population. The majority involve people from Eastern Europe (60.8%). The most representative nationalities are: Romania (1,477 events), Albania (1,022), Morocco (404), Macedonia (341), Kosovo (264), Tunisia (190) and India (170). Romanian workers are the population most affected by occupational injuries in Southeast Tuscany with 1,477 events. Agriculture is the predominant sector with 17.7% of total injuries. Conclusions Information flows on foreign workers’ accidents is the starting point for specific design of prevention plans (supervision, assistance, research, information and training, awareness raising) aimed at reducing specific accident risk factors. Language and cultural differences represent an element of possible conditioning of risk perception, which must be considered in an effective design of safety training courses for foreigners. Key messages • The study of accident information flows of foreign workers provides the basis for specific design of prevention plans in order to reduce accident risk factors. • Language and cultural differences must be considered in an effective design of safety training courses for foreigners.

Factors influencing pain medication and opioid use in patients with musculoskeletal injuries: a retrospective insurance claims database study

Opioid use is only recommended in selected cases of musculoskeletal (MSK) injuries. We assessed factors associated with increased opioid use in MSK injuries. In a retrospective analysis of over four million workers with MSK injuries using the Swiss National Accident Insurance Fund (Suva) database, we analyzed risk factors by multivariate logistic regression. Injury severity was associated with pain medication, opioid, and strong opioid use. Whereas fractures, contusions, and ruptures had higher odds for any pain medication use, increased odds for strong opioids were observed in fractures, superficial injuries, and other injuries. Injuries of the shoulders, elbow, chest, back/spine, thorax, and pelvis/hips showed high odds for opioid use (odds ratio (OR) > 2.0). Injuries of the shoulders had higher odds for strong opioid use (OR 1.136; 95% CI 1.040–1.241). The odds for using strong opioids increased from 2008 OR 0.843 (95% confidence interval (CI) 0.798–0.891) to 2018 OR 1.503 (95% CI 1.431–1.578), compared to 2013. Injury severity, type of injury, and injured body parts influenced the use of pain medication and overall opioid use in musculoskeletal injuries. Strong opioids were more often used in fractures but also in superficial and other minor injuries, which indicates that other factors play a role when prescribing strong opioids.

A Comparison of Injuries in Different Non-Professional Soccer Settings: Incidence Rates, Causes and Characteristics

Background: There is a lack of data regarding the epidemiology of soccer injuries and the particular accidents in specific non-professional soccer populations. The aim of this study was to analyse incidence, causes and characteristics of soccer injuries, taking into account different settings of organised (amateur) and non-organised soccer. Methods: A random sample of persons who had sustained an injury while playing soccer and reported this injury to the Swiss National Accident Insurance Fund (Suva) was retrospectively consulted. 705 injuries were analysed involving three main settings (soccer games, soccer training, non-organised soccer) and different amateur soccer leagues. Results: Knee injuries (p=0.01) and head injuries (p=0.005) were observed more frequently in games than in non-organised soccer. Injuries caused by contact with an opponent and foul play occurred more frequently in games than in training (p<0.001) or non-organised soccer (p≤0.001). Injury incidence was substantially higher for players of 30+/40+ leagues (18.7 injuries per 1000 hours) than for players of other leagues (1st-3rd amateur leagues: 8.5, p=0.002; 4th-5th amateur leagues: 9.4, p=0.007; female leagues: 8.2, p=0.006; junior leagues: 6.7, p<0.001). Conclusion: With respect to injury characteristics, causes and injury incidence, essential differences between various non-professional soccer settings exist suggesting that a more specific approach in injury prevention may generate positive effects.

Injury burden differs considerably between single teams from German professional male football (soccer): surveillance of three consecutive seasons.

The purpose of this study was to analyse unique injury data of the national statutory accident insurance for the two highest divisions in German male football (Bundesliga and 2. Bundesliga) over three consecutive seasons regarding inter-season, inter-division and inter-team differences. This was a prospective observational open cohort study over the seasons 2014/2015, 2015/2016 and 2016/2017. Every acute injury that was registered by clubs or physicians with the German statutory accident insurance for professional athletes (VBG) as part of occupational accident reporting and that led to time loss and/or to medical attention, was included. The complete sample consisted of 1449 players. The study covered 2663.5 player seasons with an observed match exposure of 69,058h and a projected training exposure of 529,136h. In total, 7493 injuries were included. The overall incidence rate was 12.5 (± 0.28) injuries per 1000 exposure hours, which translated into match and training rates of 47.0 (± 1.62) and 8.02 (± 0.24) injuries per 1000h, respectively. Findings of 2.7 injuries per player and season underline the need of effective preventive approaches. Higher injury incidences in seasons after international tournaments suggest an increasing risk of injury with increasing number of matches. However, large differences between the single teams from the same division indicate that a reduction in the injury burden is generally possible. Continuing the presented injury surveillance might be helpful to identify injury trends in the future and to evaluate the effectiveness of preventive approaches under real-life conditions. Level II.

Occupational injuries and diseases in fish farming in Finland 1996-2015.

The agriculture, forestry and fishing industry sector has high rates of occupational injuries. Fishing has globally particularly high occupational fatality rates, but injuries and illnesses to people working in its sub-sectors, aquaculture and fish farming, are not well understood. This study characterised injuries and occupational diseases to fish farmers and people employed on fish farms in Finland using national employment and accident insurance (workers' compensation) data. A total of 392 injuries and 18 occupational diseases were compensated during 1996 to 2015 to fish farmers and people employed on fish farms in Finland. The average injury rate was 3.2 injuries per 100 employed persons with no significant trend over time. Two of the injuries were fatal. Injured persons were primarily male (87.2%), in 45-54 year age group (39.1%), and working in coastal areas (49%). Com- mon injury characteristics included: incident type: slips, trips, and falls (37%); location: building, structure or ground level surface (28%); injured body part: hand or finger (25%); type of injury: dislocation, sprain, strain (35%); and lost worktime: 1 to 2 weeks (26.9%). Seven out of 18 occupational diseases occurred to women, most resulting in cumulative trauma from fish processing. The injury rate in fish farming corresponds to rate in all industries combined in Finland, and is higher than the rate in available Nordic statistics on fish farming. Fish farming injuries could be reduced further by slip resistant surfaces, protection of hands and fingers and ergonomics in processing.

Costs resulting from nonprofessional soccer injuries in Switzerland: A detailed analysis

BackgroundSoccer injuries constitute an important public health problem and cause a high economic burden. Nevertheless, comprehensive data regarding injury costs in nonprofessional soccer are missing. The aim of this study was to determine which groups of nonprofessional soccer athletes, injury types, and injury situations caused high injury costs. MethodsA cross-sectional, retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund (Suva). One year after the corresponding accident, every injury was linked to its costs and to the answers obtained in the interview about injury setting, injury characteristics, and injury causes. Finally, the costs of 702 injuries were analyzed. ResultsThe average cost of an injury in nonprofessional soccer amounted to €4030 (bias-corrected and accelerated 95% confidence interval (BCa 95%CI): 3427–4719). Persons aged 30 years and older experienced 35% of soccer injuries but accounted for 49% of all costs. A total of 58% of all costs were the result of injuries that occurred during amateur games. In particular, game injuries sustained by players in separate leagues for players aged 30+/40+ years led to high average costs of €8190 (BCa 95%CI: 5036–11,645). Knee injuries accounted for 25% of all injuries and were responsible for 53% of all costs. Although contact and foul play did not lead to above-average costs, twisting or turning situations were highly cost relevant, leading to an average sum of €7710 (BCa 95%CI: 5376–10,466) per injury. ConclusionNonprofessional soccer players aged 30 years and older and particularly players in 30+/40+ leagues had above-average injury costs. Furthermore, the prevention of knee injuries, noncontact and nonfoul play injuries, and injuries caused by twisting and turning should be of highest priority in decreasing health care costs.

Injuries in formal and informal non-professional soccer – an overview of injury context, causes, and characteristics

The objective of this study is to analyse context, causes, and characteristics of injuries in non-professional soccer. Therefore, a retrospective telephone survey was carried out with persons who were injured while playing soccer and who reported this accident to the Swiss National Accident Insurance Fund (Suva). Based on these data, an analysis of 708 soccer injuries was performed. The findings show that 30.1% of the injuries occurred during informal soccer play, and 75.4% of the injured persons were soccer club members. 53.0% of all injuries were caused by contact and 29.5% by foul play. Foul play was not associated with injury severity. With respect to injury severity, twisting/turning and being tackled by an opponent were identified as the most influental injury causes. Moreover, the risk of being severely injured was particularly high players of the 30+/40+ amateur leagues. In conclusion, the findings highlight that 30+/40+ league players are a major target group for the prevention of severe soccer injuries. Soccer clubs may constitute an appropriate multiplier for implementing prevention strategies such as fair play education, healthy play behaviours, and prevention programmes. Finally, a better understanding of injury situations leading to severe injuries is needed to improve injury prevention.

Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work

PurposeThe dynamic intraligamentary stabilization (DIS) technique is based on a different treatment approach than ACL reconstruction in that it intends to promote self-healing of the ligament. It is only recommended for acute injuries (<21days). The purpose of the present study was to compare DIS and ACLR with respect to the extent of work incapacity, revision rates, secondary arthroscopies, and treatment costs during recovery. MethodsThe study was a post-hoc analysis of prospectively collected data in the Swiss National Accident Insurance Fund (SUVA) database. All registered DIS cases treated until 31 December 2012 were included in the study. ACLR cases were matched to DIS cases using a propensity score approach and analysed in a follow-up period of 2 years after injury. Paired Student’s T-test and the Chi-square test were used to compare the outcome measures. ResultsAll 53 DIS patients were matched to an ACLR pair. The mean time period from injury to surgery was 14days for DIS and 50days for ACLR (p<0.001). Overall work incapacity was 13% for DIS and 17% for ACLR resulting in a difference of nearly 1 month of absence from work (p=0.03). The course of postoperative work incapacity was very similar between the groups, while the work incapacity prior to surgery lower in the DIS group. We found no difference in treatment costs, secondary arthroscopies and revision rates. ConclusionDIS patients benefited from nearly one month shorter absence from work than ACLR patients. This difference is likely related to the early surgical timing that is recommended for DIS. Since no differences were found between DIS and ACLR in terms of treatment costs, secondary arthroscopies and revision rates, the study supports the choice of DIS as an additional treatment option for acute ACL injuries. Further comparative studies are proposed to improve the evidence about optimal timing and best practice in ACL treatment.

Not all are equal: modifiers of the effect of poor sleep quality on work injuries

Introduction Sleep problems are a well known risk factor for work injuries but vulnerable populations most at risk are not clear. The aim of this study was to investigate whether potential susceptible factors modify the association between sleep quality and risk of work injury. Materials and methods A hospital-based case-control study including 180 cases and 551 controls was conducted at the University Hospital Basel, Switzerland, from December 1st 2009 and June 30th 2011. Data was collected on work injuries, sleep quality measured by the Pittsburgh sleep quality index (PSQI), and potential confounders. Adjusted odds ratios and 95% confidence intervals for the association between sleep quality and work injury were estimated in multivariate logistic regression analyses in all participants and after stratification by age, gender, job risk, work shift, daily sleep and hours worked per week. Results Poor sleep quality is significantly associated with work injury ( p = 0.025). The association between poor sleep quality and work injury was significantly higher for workers older than 30 yrs (OR>30 0.91 vs. OR > 30 1.30, p = 0.006), sleeping more than 7 h a day (OR 7 0.82, p = 0.048), and working 50 h or more per week (OR =501.81, p Conclusion Older age, short daily sleep, and long working hours may be susceptible factors for sleep quality related work injuries. Acknowledgements We would like to thank Roland Bingisser, Selina Durrr, Sabrina Maier, Amar Mehta, Roland Muller, and Stefanie Zogg for their scientific contribution. We acknowledge support from the Swiss National Accident Insurance Institution (Suva).

Iatrogenic nerve injury in a national no-fault compensation scheme: an observational cohort study

Iatrogenic nerve injury causes distress and disability, and often leads to litigation. The scale and profile of these injuries has only be estimated from published case reports/series and analyses of medicolegal claims. To determine the current spectrum of iatrogenic nerve injury in New Zealand by analysing treatment injury claims accepted by a national no-fault compensation scheme. The Accident Compensation Corporation (ACC) provides national no-fault personal accident insurance cover, which extends to patients who have sustained a treatment injury from a registered healthcare professional. Nerve injury claims identified from 5227 treatment injury claims accepted by the ACC in 2009 were analysed. From 327 claims, 292 (89.3%) documenting 313 iatrogenic nerve injuries contained sufficient information for analysis. Of these, 211 (67.4%) occurred in 11 surgical specialties, particularly orthopaedics and general surgery; the remainder involved phlebotomy services, anaesthesia and various medical specialties. The commonest causes of injury were malpositioning (n = 40), venepuncture (n = 26), intravenous cannulation (n = 21) and hip arthroplasty (n = 21). Most commonly injured were the median nerve and nerve roots (n = 32 each), brachial plexus (n = 26), and the ulnar nerve (n = 25). At least 34 (11.6%) patients were referred for surgical management of their nerve injury. Iatrogenic nerve injuries are not rare and occur in almost all branches of medicine, with malpositioning under general anaesthesia and venepuncture as leading causes. Some of these injuries are probably unavoidable, but greater awareness of which nerves are at risk and in what context should facilitate the development and/or wider implementation of preventive strategies.

Neurological outcome, working capacity and prognostic factors of patients with SCIWORA

Retrospective case review. In the present study, the neurological outcome, retirement and prognostic factors of patients with spinal cord injury without radiographic abnormality (SCIWORA) were evaluated. Swiss national work accident insurance database. The medical histories of 32 patients who were insured by the Swiss Accident Insurance Fund (SUVA) and had SCIWORA between 1995 and 2004 were evaluated thoroughly. Moreover, all available magnetic resonance imaging (MRI) scans were evaluated. At the last follow-up, none of the patients had complete spinal cord injury, only 4 patients had severe deficits and 12 patients had normal motor and sensory function in the neurological examination. However, only 7 out of 32 patients had returned to full-time work and 10 out of 32 patients were fully retired. Both the presence of spinal cord change (ρ=0.51) and higher maximum spinal cord compression (ρ=0.57) in MRI scan correlated with the likelihood for retirement; older age (ρ=0.38) and physical load of work (ρ=0.4) correlated with retirement to a lesser extent. Although the neurological outcome of SCIWORA is mostly good, the retirement rate is high. Presence of spinal cord change and severity of cord compression are the best predictors for the degree of retirement.

Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players

Background: In Switzerland, the national accident insurance company registered a total of 42 262 soccer injuries, resulting in costs of approximately 145 million Swiss francs (~US$130 million) in 2003. Research on injury prevention has shown that exercise-based programs can reduce the incidence of soccer injuries. Purpose: This study was conducted to assess the implementation and effects of a countrywide campaign to reduce the incidence of soccer injuries in Swiss amateur players. Study Design: Cohort study; Level of evidence, 3. Methods: All coaches of the Schweizerischer Fussballverband (SFV) received information material and were instructed to implement the injury prevention program “The 11” in their training of amateur players. After the instruction, the coaches were asked to rate the quality and the feasibility of “The 11.” Before the start of the intervention and 4 years later, a representative sample of about 1000 Swiss soccer coaches were interviewed about the frequency and characteristics of injuries in their teams. Teams that did or did not practice “The 11” were compared with respect to the incidence of soccer injuries. Results: A total of 5549 coaches for amateur players were instructed to perform “The 11” in the training with their teams. The ratings of the teaching session and the prevention program were overall very positive. In 2008, 80% of all SFV coaches knew the prevention campaign “The 11” and 57% performed the program or most parts of it. Teams performing “The 11” had an 11.5% lower incidence of match injuries and a 25.3% lower incidence of training injuries than other teams; noncontact injuries in particular were prevented by the program. Conclusion: “The 11” was successfully implemented in a countrywide campaign and proved effective in reducing soccer injuries in amateur players. An effect of the prevention program was also observed in the population-based insurance data and health-care costs.

An investigation into methods to develop indicators to measure injury related impairment

ObjectiveTo investigate whether valid indicators of injury-related impairment could be developed based on data from a New Zealand national no-fault accident insurance scheme.DesignThe feasibility of (1) developing impairment related indicators...

Management of knowledge gaps: concept representation of things we don't know.

Suva (Swiss National Accident Insurance Fund) is the most important carrier of obligatory accident insurance in Switzerland. Its medical division supports doctors working in inpatient and outpatient care with comprehensive case management and with conciliar advice. The Suva hospitals provide inpatient rehabilitation. In 2002, Suva started the InWiM project. InWiM is an acronym and stands for "Integrierte Wissensbasen der Medizin", which can be translated as "Integrated Knowledge Bases in Medicine". Information retrieval within InWiM is achieved by means of the MeSH Index (Medical Subject Headings), the thesaurus of the United States National Library of Medicine (NLM). InWiM has now been extended towards the management not only of publications but also of areas where sound knowledge is missing, so called "knowledge gaps": Knowledge gaps are indexed with MeSH terms in a similar way to publications. This improves knowledge management: In particular it is possible to search and find knowledge gaps and solutions covering the same or a similar topic, thus allowing adequate collating and it prevents duplication of work. Furthermore, literature search strategies for the NML are predefined and do not need every time to be reinvented from scratch.

Nanoparticle Usage and Protection Measures in the Manufacturing Industry—A Representative Survey

Addressing the risks of nanoparticles requires knowledge about release into the environment and occupational exposure. However, such information currently is not systematically collected; therefore, this risk assessment lacks quantitative data. The goal was to evaluate the current level of nanoparticle usage in Swiss industry as well as health, safety, and environmental measures, and the number of potentially exposed workers. A representative, stratified mail survey was conducted among 1626 clients of the Swiss National Accident Insurance Fund (SUVA), which insures 80,000 manufacturing firms, representing 84% of all Swiss manufacturing companies (947 companies answered the survey for a 58.3% response rate). The extrapolation to all Swiss manufacturing companies results in 1309 workers (95% confidence interval [CI]: 1073 to 1545) potentially exposed to nanoparticles in 586 companies (95% CI: 145 to 1027). This corresponds to 0.08% of workers (95% CI: 0.06% to 0.09%) and to 0.6% of companies (95% CI: 0.2% to 1.1%). The industrial chemistry sector showed the highest percentage of companies using nanoparticles (21.2%). Other important sectors also reported nanoparticles. Personal protection equipment was the predominant protection strategy. Only a few applied specific environmental protection measures. This is the first nationwide representative study on nanoparticle use in the manufacturing sector. The information gained can be used for quantitative risk assessment. It can also help policymakers design strategies to support companies developing a safer use of nanomaterial. Noting the current low use of nanoparticles, there is still time to proactively introduce protective methods. If the predicted “nano-revolution” comes true, now is the time to take action. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a pdf file containing a detailed description of the approach to statistical analyses, English translation of the questionnaire, additional information for Figure 1, and additional information for the SUVA-code.]

Internationale Expertennetzwerke und nationale Sozialstaatsgeschichte: Versicherung der Silikose in Deutschland und der Schweiz (1900–1945)

International Networks of Expertise and National History of the Welfare State: The Insurance of Silicosis in Germany and Switzerland (1900–1945) The article examines the role of international expert networks for the history of national welfare states. It focuses, as an exemplary case, on the insurance of silicosis, a severe industrial disease most common among miners and metal workers, comparing Switzerland and Germany. Both countries accepted silicosis as an industrial disease, to be insured as an occupational illness by the national institutions for accident insurance, only comparably late in the 1920s, long after countries like Britain and South Africa. The article argues that the process of recognising silicosis as a case to be insured under national accident insurance schemes was not triggered through bilateral learning processes (for example contacts between Swiss and British institutions) but rather by an alliance of national, international and transnational actors. In particular, international organisations like the International Labour Office (ILO) and transnational networks like the International trade union of stone workers were crucial for the recognition process. The article highlights the main factors for granting silicosis the status of an occupational illness; it also examines the early years of the insurance regime in which the influence of the ILO and international trade unions gradually vanished.

Air castle of the South: WSM and the making of Music City

Started by the National Life and Accident Insurance Company in 1925, WSM became one of the most influential and exceptional radio stations in the history of broadcasting and country music. WSM gave Nashville the moniker “Music City USA” as well as a rich tradition of music, news, and broad-based entertainment. With the rise of country music broadcasting and recording between the 1920s and ‘50s, WSM, Nashville, and country music became inseparable, stemming from WSM’s launch of the Grand Ole Opry, popular daily shows like Noontime Neighbors, and early morning artist-driven shows such as Hank Williams on Mother’s Best Flour. Sparked by public outcry following a proposal to pull country music and the Opry from WSM-AM in 2002, Craig Havighurst scoured new and existing sources to document the station’s profound effect on the character and self-image of Nashville. Introducing the reader to colorful artists and businessmen from the station’s history, including Owen Bradley, Minnie Pearl, Jim Denny, Edwin Craig, and Dinah Shore, the volume invites the reader to reflect on the status of Nashville, radio, and country music in American culture.

An Overview of New Zealand's Trauma System

Patterns of trauma and trauma systems in New Zealand are similar to those in Australia. Both countries have geographical considerations, terrain and distance, that can cause delay to definitive care. There are only 7 hospitals in New Zealand that currently manage major trauma patients, and consequently, trauma patients are often hospitalized some distance from their homes. The prehospital services are provided by one major provider throughout the country, with a high level of volunteers providing these services in the rural areas. New Zealand has a national no-fault accident insurance system, the Accident Compensation Corporation, which funds all trauma-related healthcare from the roadside to rehabilitation. This insurance system provides 24-hour no-fault personal injury insurance coverage. The Accident Compensation Corporation provides bulk funding to hospitals for resources to manage the care of trauma patients. Case managers are assigned for major trauma patients. This national system also has a rehabilitation focus. The actual funds are managed by the hospitals, and this allows hospital staff to provide optimum care for trauma patients. New Zealand works closely with Australia in the development of a national trauma registry, research, and education in trauma care for patients in Australasia (the islands of the southern Pacific Ocean, including Australia, New Zealand, and New Guinea).

Beurteilung der Eignung im Rahmen des UVG – Nichteignungsverfügung / bedingte Eignungsverfügung

In order to prevent the development or aggravation of an occupational disease or an occupational accident risk lying in an individual employee the Swiss National Accident Insurance Fund (Suva) based on the Swiss Law on Accident Insurance is entitled to prohibit certain activities that have proven to be hazardous to the individual (declaration of "unsuitability" (DOU) or rarely declaration of conditional suitability). Occupational skin and respiratory diseases are the most frequent disorders, and flour; cement, isocyanates and hairdressing substances the most important occupational factors requiring a DOU. This measure also provides financial security to the employee for up to 4 years by the accident insurer in cooperation with the unemployment insurance. For retraining and occupational rehabilitation a special state insurance, the Invalidity insurance is responsible.

Host factors in occupational diisocyanate asthma: a Swiss longitudinal study

To investigate the usefulness of surrogates for individual susceptibility to organic diisocyanates in occupational asthma. All new cases declared to the Swiss National Accident Insurance Company (SUVA) for establishment of a case for compensable occupational disease during 1993. Sixty-nine persons, of whom three were women, were suspected of having occupational asthma due to isocyanates. Of these, 47 subjects fulfilled the criteria to be accepted as an occupational disease case. All subjects were studied clinically and gave a blood sample for the phenotyping of their alpha-antitrypsin status and for immunological studies. The subjects were also given a peroral dose of caffeine for the determination of their N-acetylation capacity. Finally, those with an occupational disease were subjected to the methacholine provocation test. Forty-four persons with occupational disease, out of 47, were heterozygous antitrypsin carriers and/or slow acetylators of primary amines. In the bronchial provocation with methacholine, 12 of these subjects had an unaltered response and seven had a mild reaction, 13 a moderate one and 15 a severe reaction. The study confirms the finding that slow N-acetylators are susceptible to asthma from exposure to common diisocyanate monomers at work. The same applies to heterozygous antitrypsin-phenotype carriers. Thus, the use of these markers may reinforce the diagnostic procedure, but they cannot completely replace the immunological tests.