Occupational Diseases In Germany Research Articles

Neue Versorgungsformen in der Dermatologie

Occupational dermatoses (OD) are the most frequent occupational diseases in Germany and amount to more than 25% of all suspected occupational diseases. Preventive measures have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept in wet work occupations. If employees are in danger of loosing their job due to a severe OD, intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2-3 weeks of in-patient treatment plus intensive health-pedagogic counselling, followed by 3 consecutive weeks (or longer) of out-patient treatment by the local dermatologists ("Osnabrueck model"). Each patient will stay off work for a total of at least 6 weeks to allow full barrier-recovery. It could be shown that 2/3 of the patients successfully remained in their workplaces because of TIP. TIP reveals remarkable pertinent options for interdisciplinary disease management in severe OD in all risk professions. In Germany recently, a multi-centre study was started which will further standardise such preventive measures and evaluate their long-term success.

Asbestos consumption, asbestos exposure and asbestos-related occupational diseases in Germany

Like in most industrial countries, asbestos is a leading cause of occupational diseases, especially malignant diseases, in Germany. Following the increased consumption of asbestos after World War I, the recognition of asbestos related diseases developed. At the end of the 1930s, Germany was the first country to accept lung cancer in combination with asbestosis as an occupational disease and to initiate the endeavor for reduction of asbestos dust exposure. Nevertheless after World War II the usage of asbestos increased dramatically. The ban of asbestos first came into force in 1993. Until this time several hundreds of thousands of workers had inhaled asbestos and the number of asbestos related diseases increased. In this review the history and current status on asbestos consumption, asbestos exposure and asbestos related occupational diseases in Germany is presented.

Skin cancer and occupational disease

Although it is universally accepted that UV light exposure can cause malignant skin tumors, UV-induced skin cancers are not recognized as an occupational disease in Germany. Exposure to natural or artificial UV light occurs in many work places, so that the induction of occupational skin cancers is certainly plausible. In recent years, a special clause in the occupational disability rules has recognized some cases of UV-induced skin cancers. We discuss the nature of occupational UV exposure, explore preventative measures and review the data regarding occupational UV-induced skin tumors. After evaluating recent publications, we conclude that for squamous cell carcinoma the epidemiological proof of an at least doubled risk (RR >2) due to occupational UV radiation can be given. The clear dose response relationship supports these epidemiological findings. For the individual risk assessment, an attributive UV radiation >40% due to occupational factors must exist. Under those circumstances, squamous cell carcinoma should be recognized and compensated as an occupational disease.

Empfehlungen zur Begutachtung von Berufsdermatosen - Erläuterungen anhand von Beispielen aus dem Baugewerbe

Berufsbedingte Hauterkrankungen sind seit Jahren zahlenmäßig der Spitzenreiter unter den Berufskrankheiten; mehr als ein Viertel aller gemeldeten BK-Verdachtsfälle an die zuständigen Versicherungsträger beziehen sich auf den versicherungsrechtlichen Tatbestand der BK 5101 der BKV. Die gewerbedermatologische Begutachtung zur BK 5101 stellt aufgrund der versicherungsrechtlichen Bedingungen an den Gutachter erhöhte Anforderungen. Um die wesentlichen Aspekte der Qualität berufsdermatologischer Gutachten sowie eine weitestgehende Gleichbehandlung der zu Begutachtenden zu gewährleisten, wurden entsprechende Empfehlungen erarbeitet. Diese werden im vorliegenden Beitrag beispielhaft anhand von Fallkonstellationen aus der Baubranche erläutert.

Polyneuropathy and encephalopathy caused by organic solvents and mixed solvent solutions. Occupational medicine and neurologic aspects of a new occupational disease

Solvent induced polyneuropathy and encephalopathy have been acknowledged quite recently as occupational diseases in Germany. For compensation first of all the diagnosis has to be proven. For differential diagnosis other known causes as well as non-organic mental diseases must be taken into consideration. The causality between proven exposures and diagnosed disease has at least to be probable. To evaluate causation extensive experience of the experts is needed. In this context scientific criteria regarding neurotoxicity of the solvent, duration of exposure, individual aspects of non-occupational influences, time course of the disease are important within a through synoptic evaluation. Possibilities and limitations of sensitive diagnostic measures such as neurographic, neuropsychologic and neuroimaging examinations are discussed. The prognosis of toxic polyneuropathy and encephalopathy is in general favorable if exposure has stopped. Additionally, adequate therapy and rehabilitation measures are supportive for a good prognosis.

The Role of Combination Effects on the Etiology of Malignant Nasal Tumours in the Wood-Working Industry: Most Recent Findings and Analysis of 147 Indemnified Cases of Adenocarcinomas

Adenocarcinomas of the nose are regarded as an occupational disease in Germany and other European countries, and workers exposed to oak or beech wood-dust in the course of their work receive compensation if they incur adenocarcinoma of the nose. This has prompted a joint research project to record the functional and morphological changes of the nasal mucosa and/or paranasal sinus of 149 exposed subjects and 33 controls in accordance with a defined occupational exposure. To ensure the quantitative and qualitative reliability of the exposure data, 1,349 measurements at the company workplace were taken and analyses of 614 wood samples performed; parallel to this, the genotoxic effects of the most important substances used in the wood-working industry were tested. Apart from this, latency periods and morbidity rates in Germany were investigated. Partial findings of this research projects have been evaluated by the International Agency for Research on Cancer (IARC). According to these evaluations and the findings presented here, the following points can be made: i ) Morphological changes in the nasal mucosa after exposure to wood-dust resulted in an increase in cylindrocellular hyperplasias and, in functional terms, a tendency towards improved nasal clearance was observed. Chromium and formaldehyde, on the other hand, tended to give rise to an increase in the number of squamous metaplasias. This might explain the preference for the histological types of adenocarcinoma among subjects exposed to wood-dust. ii ) In tissue samples more dysplasias were found among those exposed to oak and beech wood-dust. Subjects exposed to wood preserving agents had dysplasias only if they were simultaneously exposed to oak and beech wood-dust. The latter effect did not quite reach the level of significance ( p =0.07) on account of the low numbers of cases. iii ) The investigation of genotoxic effects showed that oak and beech contain genotoxic substances that can be dissolved by means of ethanol and cyclohexane; they also showed that 3 out of 8 wood preservatives, 5 out of 16 stains, and 2 out of 11 paints from the wood-working industry are genotoxic too. Apart from this, lindane and PCP have proved to be genotoxic in the nasal cells of rats and human beings. Analysis of 614 wood samples from wood-preserving agents showed that almost 73% contained agents of this type, even in woods described by the companies as being guaranteed free of wood preservatives. iv ) According to an analysis of 147 cases accepted since 1985 as a pensionable occupational illness by the Holz-Berufsgenossenschaft (an industrial compensation society for employees in the wood-working industry), the disease was much more apparent in small companies where there is multi-factorial exposure, than in large companies where the exposure factor tends to have a single component. This points to the combined effects of hardwood dusts and chemicals as being the cause. v ) According to published findings, the incidence of the disease in England seems to be on the decline. In Germany, increasing latency periods also point to a decline in the number of cases, although both countries have only very recently introduced effective prevention measures against exposure to wood-dust. This also leads to the assumption that wood-dusts cannot be the only cause of this type of cancer. vi ) These findings tally with the evaluation by the IARC confirming the special part that hardwood dusts play in the development of nasal cancer. The findings presented here also indicate combined effects as being the cause of this type of cancer. This hypothesis cannot be confirmed until the conclusion of long-term animal experiments, currently being conducted, to test how the effects of chemicals such as lindane, PCP, and chromate compare with use of oak wood-dust.

Occupational Health Aspects of Uranium Mining in Thuringia and Saxony: An Historical View

Abstract Mining activities in Saxony can be traced back to the year 1168. Silver, bismuth, cobalt, nickel, and tungsten have all been extracted since then in several hundred mines in the ore mountain region of Saxony. W. Beyer published a paper in 1523 suggesting that “Joachimstal miners' disease” was caused by silica and arsenic. Other early publications, by Paracelsus, Agricola, Scheffler, Henckel, and Halting and Hesse, led to the characterization of “Schneeberg lung disease” as cancerous, but it was recognized as an occupational disease in Germany only in 1925. Radium emissions and radiation were the suspected causes. The Soviet authorities reopened old silver mines in Saxony in 1945, thus initiating mining activity that made East Germany the world's third largest uranium producer. Some 400,000 to 600,000 miners were employed in Saxony from 1945 until uranium production ceased after the reunification of Germany in 1990. To date, more than 11,000 resulting cases of bronchial carcinoma have been awarded...

Occupational health regulation

Occupational health regulation

Hepatitis A as an occupational hazard

Few studies have been carried out to evaluate the role of hepatitis A virus (HAV) as an occupational hazard. Our analysis of data on occupational diseases in Germany showed that hepatitis A ranks as third among infectious occupational diseases. Morbidity based on the frequency of compensation (15.2%) was in the same range as that observed for hepatitis B (19.7%). In another study, data were collected on anti-HAV prevalence among 2293 hospital workers in southwest Germany. Anti-HAV prevalence of hospital staff responsible for patient care and that of the general population were comparable, while food-handlers under the age of 30 years had a higher degree of anti-HAV prevalence. When an evaluation of anti-HAV prevalence data was carried out on persons younger than 30 years who comprised subsets of the medical staff, the relative risk was: charwomen 4.2, food-handlers 2.49, and paediatric nurses 1.84, showing that they had higher prevalence rates than nurses 1.25, physicians 1.09 and laboratory assistants 0.93. Vaccinations for the prevention of hepatitis A should therefore reach individuals that have an increased occupational risk: food-handlers, health care workers in infectious diseases and paediatrics, medical staff in laboratories handling stool samples, medical charwomen and, according to previously published work, staff of day care centres and sewerage workers.