Occupational Diseases In Germany Research Articles

Diagnosis and management of work related musculoskeletal disorders as occupational diseases in Germany

This article introduces the occupational disease diagnosis of work-related musculoskeletal disorders such as lumbar and spinal injuries in Germany, and focuses on the research and standard values of the maximum pressure tolerance of intervertebral discs. This article mainly introduces the dose model limits and their applications proposed by the Mainz Dortmund Dosis model (MDD), the judgment of the German Social Court (Bundessozialgericht, BSG), and the German Spinal Research Re evaluation (Deutsche Wirbels ulentudieⅡ, DWSⅡ) ; X-ray manifestations and measurements of intervertebral disc injury; Problems in actual cases and diagnosis. In order to provide reference and inspiration for the occupational diseases diagnosis of work related musculoskeletal disorders in China.

Diagnostics of IgE-mediated occupational allergies: Between reality, requirements, and opportunities.

Occupational skin and respiratory allergies are among the most common occupational diseases in Germany. The identification of the allergy trigger is essential for the recognition of an occupational allergy as well as for effective individual prevention. However, occupational type I allergens are among the "rare" allergens and the possibilities of guideline-compliant diagnosis using quality-tested skin test solutions is becoming increasingly difficult due to the reduction in commercially available test allergens. In order to guarantee meaningful diagnostic workup for all affected insured persons with suspected occupational type I allergies and to ensure this in the future, a durable optimization, standardization, and availability of allergy tests for occupational allergic diseases is urgently required. The need for action has been recognized by the German Social Accident Insurance (DGUV), and steps to eliminate the diagnostic gaps have been initiated by a joint research project at the Institute for Prevention and Occupational Medicine of the DGUV (IPA) and the Paul Ehrlich Institut (PEI). The evaluation of alternative methods for the production of standardized test allergen solutions can also be used for newly emerging allergens in the workplace. New allergen sources at workplaces and thus also sensitization and allergies among employees can be expected as a result of changes in work processes and the introduction of new technologies and/or working materials, which are also introduced in connection with climate change and the concept of sustainability.

The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper

ZusammenfassungAsbestverursachte maligne Mesotheliome gehören in Deutschland mit etwa 1000 jährlichen Neuerkrankungen zu den häufigen arbeitsbedingten Krebserkrankungen. Die Prognose ist oftmals schlecht, da die Erkrankung lange symptomlos bleibt und deshalb meist erst als Zufallsbefund in bereits fortgeschrittenen Stadien diagnostiziert wird.Die deutsche gesetzliche Unfallversicherung (DGUV) hat in den letzten Jahren erhebliche Anstrengungen unternommen, eine Vorverlagerung des Diagnosezeitpunkts zu erreichen, um die Erkrankung möglichst in Frühstadien zu detektieren. Die aus diesen Bestrebungen resultierenden neuen medizinisch-wissenschaftlichen Erkenntnisse zeigen, dass die Kombination der Biomarker Calretinin und Mesothelin in einer Hochrisikogruppe die Vorverlegung der Diagnose um bis zu 12 Monaten ermöglicht.Die Diagnose eines Mesothelioms im Frühstadium wird idealerweise von der individuell bestmöglichen Therapie gefolgt. Die Standardtherapie basiert auf operativer Entfernung des Tumors und Chemotherapie, ergänzt um Strahlentherapie und Psychoonkologie. In den letzten Jahren wurden einige neue Therapieansätze entwickelt. Die Übersicht stellt den aktuellen Stand der Therapie des Mesothelioms, basierend auf den internationalen Leitlinien und neuen Studien, dar.

Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach.

In 2017, ovarian cancer due to asbestos exposure was designated a new, and thereby the first, gynaecological occupational disease in Germany. Asbestos is a naturally occurring mineral fibre with an annual usage in Germany of 160 000 – 180 000 metric tonnes in the 1960s and 1970s. The carcinogenicity of asbestos for the target organs lungs, larynx, pleura including pericardium, and peritoneum including tunica vaginalis testis has been clearly established for many years. Recent meta-analyses of data from cohort studies have demonstrated that the risk of ovarian cancer roughly doubles in women with occupational exposure to asbestos. Since the group of people with double the risk of developing lung cancer due to work-related asbestos exposure has a 2.25-fold increased risk of mortality from ovarian cancer on average, work-related ovarian cancer has been assigned the same recognition requirements as in occupational lung (and laryngeal) cancer. Thus, gynaecologists must obtain a thorough history of occupational exposure to asbestos, even if it may have taken place long in the past. The law mandates that suspected such cases must be reported to the Statutory Accident Insurance carrier or the State Occupational Safety and Health Agency.

Abolition of the obligation to cease an occupation for acknowledgment of an occupational skin disease: Backgrounds and perspectives.

The occupational disease skin No.5101 ("severe or recurrent skin diseases that have forced the patient to refrain from all activities that were or could be the cause of the development, aggravation or resurgence of the disease") is the most frequently notified occupational disease in Germany. Since 1936, the medical-objective obligation to refrain from risky work activities, which has been necessary for the recognition of this occupational disease, was intended to delimit trivial diseases, facilitate the determination of occupational causality and promote prevention. The abolition of the legal obligation to refrain from risky work activities as a criterion for the recognition of the occupational disease 5101 as of 01.01.2021 has significant effects on the occupational dermatological care and expert assessment of this occupational disease. For less severe occupational skin diseases, however, the preventive dermatologist's procedure established since 1972 will continue to apply.

Occupational rhinitis.

Occupational rhinitis (OR) has so far received little attention even though it shares common pathophysiological features and trigger factors and is closely associated with occupational asthma (OA). Work-related exposure to certain substances, such as animal dander, is considered to be the main factor for the development of OR. The new EAACI definition of OR stresses the causal relationship between workplace exposure and onset of rhinitis symptoms as opposed to previous definitions that mainly focused on a temporal relationship between workplace exposure and occurrence of nasal symptoms. Also, it has been suggested to use the term “work-related rhinitis” for classifying the different forms of rhinitis associated with the workplace. These forms can be subdivided into allergic or non-allergic OR, which is due to causes and conditions related to a particular work environment, as well as work-exacerbated rhinitis, which is defined as a pre-existing rhinitis exacerbated by exposure at the workplace. Even though taking a detailed patient history is especially important when it comes to diagnosing OR, the gold standard for confirming the diagnosis is nasal provocation testing. Best possible symptomatic relief and prevention of development of OA constitute the main therapeutic objectives in OR. Treatment options consist of total avoidance of trigger substances (main goal), reduction of exposure to certain substances, and pharmacotherapy. Furthermore, it is important to note that allergic OR is an occupational disease in Germany (Berufskrankheit No 4301) and needs to be reported to health authorities.

Diagnosis and administration of occupational diseases in Germany

职业病在德国主要由职业同行公会（Berufsgenossenschaft, BG）负责职业病的防治及赔偿，政府劳动保护部门参与。在诊断上，首先报告疑似病例；报告后，BG逐一地来做认定、治疗、康复和赔偿。部分病例需要进行病因的调查、医学鉴定、劳动能力测定。劳动就业能力损失超过一定的量，患者可获资金赔偿。个人对诊断有异议，可法律上申诉，由法院判决。文中除诊断过程外，还罗列了疑似职业病、认可职业病、法律原因不能认可的职业病、以及"视同职业病"的一些数据分析，以便了解德国对职业病的诊断和管理。.

Relations between vital capacity, CO diffusion capacity and computed tomographic findings of former asbestos-exposed patients: a cross-sectional study

BackgroundAsbestos-related lung diseases are one of the leading diagnoses of the recognized occupational diseases in Germany, both in terms of their number and their socio-economic costs. The aim of this study was to determine whether pulmonary function testing (spirometry and CO diffusion measurement (DLCO)) and computed tomography of the thorax (TCT) are relevant for the early detection of asbestos-related pleural and pulmonary fibrosis and the assessment of the functional deficiency.MethodsThe records of 111 formerly asbestos-exposed workers who had been examined at the Institute for Occupational and Maritime Medicine, Hamburg, Germany, with data on spirometry, DLCO and TCT were reviewed. Workers with substantial comorbidities (cardiac, malignant, silicosis) and/or pulmonary emphysema (pulmonary hyperinflation and/or TCT findings), which, like asbestosis, can lead to a diffusion disorder were excluded. The remaining data of 41 male workers (mean 69.8 years ±6.9) were evaluated. The TCT changes were coded according to the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) by radiologists and ICOERD-scores for pleural and pulmonary changes were determined. Correlations (ρ), Cohens κ and accuracy were calculated.ResultsIn all 41 males the vital capacity (VC in % of the predicted value (% pred.)) showed only minor limitations (mean 96.5 ± 18.0%). The DLCO (in % pred.) was slightly reduced (mean 76.4 ± 16.6%; median 80.1%); the alveolar volume related value (DLCO/VA) was within reference value (mean 102 ± 22%). In the TCT of 27 workers pleural asbestos-related findings were diagnosed whereof 24 were classified as pulmonary fibrosis (only one case with honey-combing). Statistical analysis provided low correlations of VC (ρ = − 0.12) and moderate correlations of DLCO (− 0.25) with pleural plaque extension. The ICOERD-score for pulmonary fibrosis correlated low with VC (0.10) and moderate with DLCO (− 0.23); DLCO had the highest accuracy with 73.2% and Cohens κ with 0.45. DLCO/VA showed no correlations to the ICOERD-score. The newly developed score, which takes into account the diffuse pleural thickening, shows a moderate correlation with the DLCO (ρ = − 0.35, p < 0.05).ConclusionsIn formerly asbestos-exposed workers, lung function alterations and TCT findings correlated moderate, but significant using DLCO and ICOERD-score considering parenchymal ligaments, subpleural curvilinear lines, round atelectases and pleural effusion in addition to pleural plaque extension. DLCO also showed highest accuracy in regard to pulmonary findings. However, VC showed only weaker correlations although being well established for early detection. Besides TCT the determination of both lung function parameters (VC and DLCO) is mandatory for the early detection and assessment of functional deficiencies in workers formerly exposed to asbestos.

Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany.

Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.

Medical expert opinion on occupational diseases - theroleofmedicalexperts

Not every disease which relates to work qualifies as an occupational disease according to German law. As there is a legal duty for doctors to report occupational diseases, doctors should know in which case a disease fulfils the requirements to be notified as occupational disease. This article gives an introduction to the legal framework applying to occupational diseases in Germany. It describes different types of occupational diseases and the requirements for a recognition. Expert opinions given by medical experts often are necessary to determine whether a disease can be recognized as occupational disease. Medical experts examine whether a disease was caused by a specific exposure at the workplace. Occupational diseases can lead to an impairment of earning capacity. Medical experts provide help with assessing such an impairment of earning capacity. This article provides useful information for medical experts as to the legal requirements for rendering medical expert opinions in court procedures, administrative procedures concerning occupational diseases.

Outdoor workers' perceptions of skin cancer risk and attitudes to sun-protective measures: A qualitative study.

ObjectivesSince January 2015, squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural ultraviolet irradiation (UVR) is recognized as occupational disease in Germany. Interventions which improve the sun protection behavior of outdoor workers are urgently needed. When developing preventive interventions, the attitudes of target groups need to be taken into consideration. Therefore, outdoor workers’ perceptions and attitudes were investigated.MethodsSeven guided, problem‐centered qualitative interviews with healthy male outdoor workers were conducted. A qualitative content analysis was used to analyze the data.ResultsWe found an underestimation of the perceived skin cancer risk in the seven outdoor workers and heterogeneous attitudes toward the usage of sun‐protective measures. Participants stated that the feasibility of technical sun‐protective measures depends on the size of the working area. While using a headgear seemed common, none of the participants stated using additional neck protection. Wearing long‐sleeved shirts and long trousers were considered problematic. The interviews revealed important requirements for sun‐protective clothes, especially in terms of different materials. Although the usage of sunscreen was common, our interviewees seemed to apply it wrongly.ConclusionRisk perceptions of outdoor workers and their attitudes toward sun protection measures may influence the factual UV protection behavior in the workplace. Structures to facilitate the implementation of technical and organizational sun‐protective measures seem to be necessary. Educational interventions and clear instructions which are tailored to the individual needs and attitudes of outdoor workers are required to improve the UV protection behavior and to avoid common mistakes.

Nichtmelanozytärer Hautkrebs

Non-melanoma skin cancer (NMSC) is the most common malignancy of the light-skinned population with an enormous socioeconomic impact. Historically known as incurable under the term noli me tangere (transl. do not touch me), today various non-melanocytic cutaneous neoplasms are grouped as NMSC. The most common of these, basal cell carcinoma, squamous cell carcinoma and actinic keratoses as carcinomas in situ, are increasingly called keratinocyte carcinoma. Today, the pathogenesis and risk factors of NMSC are relatively well understood, which has led to multiple treatment options, the recognition of NMSC as an occupational disease in Germany and a variety of prevention approaches. Although there is largely general consensus in the dermatological world, knowledge of affected high-risk groups in NMSC and prevention is still very low. The development of target group-oriented awareness and prevention campaigns are therefore urgently needed.

New developments in occupational dermatology.

Occupational skin diseases according to BKNo. 5101 - "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease" - is the most commonly reported notifiable occupational diseases in Germany. Following the optimization of measures of primary, secondary, and tertiary prevention, today most individuals affected are able to continue their profession. With the revision of the German ordinance on occupational diseases (BKV) in January 2015, skin cancer caused by UV irradiation was added to the list of occupational diseases. The new occupational disease (BK)5103 is defined as "squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV irradiation". In this context, "multiple" signifies the occurrence of either more than five individual actinic keratosis lesions over the course of 12 months or the presence of field cancerization of >4cm(2) . In the following review, important aspects of this new occupational disease will be highlighted and discussed.

An approximation of occupational lifetime UVR exposure: algorithm for retrospective assessment and current measurements

Since non-melanoma skin cancer (NMSC) has been adopted as an occupational disease in Germany, in any single suspected case a retrospective estimation of the outdoor workers' occupational UVR exposure is mandatory. The aim of this study was to introduce the recent German standard procedure as a mathematical algorithm for retrospectively estimating individual occupational UVR lifetime exposure. In addition, to present results of exemplary on-the-job UVR dosimetry measurements on outdoor workers during their various occupational activities. These dosimetry data form the basis of the mathematical model for UVR exposure estimation. On-the-job personal dosimetry in various outdoor professions was conducted using the GENESIS-UV measurement system for individual UVA/UVB exposure assessment. The algorithm is derived from the results of these pars pro toto exemplary dosimetric measurements. For retrospective UVR lifetime estimation in suspected cases, a standardized patient interview serves as input and delivers all necessary information for using the algorithm. With defined factors, an individual adjustment is achieved. Inserting the data derived from the patient interview, the algorithm shows to be feasible to calculate the lifetime UVR exposure retrospectively. As an example, an assessment for a 67-year-old agricultural teacher with three distinct occupational UVR exposure episodes is calculated. The presented algorithm has proven to facilitate the anamnestic procedure to estimate the lifetime UVR dose of exposed outdoor workers. With a recently developed computer-based tool, standardized interviews of suspected workers with NMSC become simple. UVR dose as well as matching of requirements for recognition as an occupational disease in an individual worker are calculated automatically. Furthermore, with ongoing on-the-job measurements, a database is created to continuously adjust the algorithm's reference values for the various UVR-exposed occupations. In addition, a job exposure matrix UVA/UVB is created as a pivotal tool for improved health and safety of outdoor workplaces and prevention of occupational actinic damage to the skin.

Task-Specific Dystonia in Professional Musicians. A Systematic Review of the Importance of Intensive Playing as a Risk Factor.

Focal dystonia in professional musicians is a movement disorder that manifests itself during playing. It is a multifactorial condition in which a genetic predisposition and exogenous factors both play a role. Evidence suggests that intensive playing is a risk factor for the development of task-specific dystonia in professional musicians. This review is based on pertinent publications (1950-2013) retrieved by a systematic search in medical and musicological databases. The references of the retrieved publications were also considered in the search. 16 articles with clinical information on a total of 1144 affected musicians were reviewed systematically. Their overall quality was intermediate to poor, and a meta-analysis was therefore not possible. The Bradford Hill criteria were applied to study a possible causative link between intensive playing and musician's dystonia. Musician's dystonia generally arises after at least ten years of intensive playing (corresponding to roughly 10 000 hours of practice). An association was found between the affected limb and the type of instrument: the limb that is subject to the greatest fine motor demands is the one most commonly affected. The average age of onset is 28 to 44 years. The Bradford Hill causality criteria indicate that intensive playing is related to the development of musician's dystonia. In particular, the association of the type of instrument with the site of dystonia supports this thesis. The findings imply that task-specific dystonia in professional musicians should be included in the list of occupational diseases in Germany.

UV-irradiation-induced skin cancer as a new occupational disease

With the revision of the German Ordinance on Occupational Diseases, skin cancer due to UV irradiation was amended as a new occupational disease to the list of occupational diseases in Germany. The new occupational disease BK 5103 has the following wording: "Squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural UV irradiation". Actinic keratoses are to be considered as multiple according to this new occupational diseases if they occur as single lesions of more than five annually, or are confluent in an area > 4cm(2) (field cancerization). It is estimated that more than 2.5 million employees are exposed to natural UV irradiation due to their work (outdoor workers) in Germany and therefore have an increased risk of skin cancer. In this article the medical and technical prerequisites which have to be fulfilled for this new occupational disease in Germany are introduced.

Occupational skin cancer due to UV-irradiation--Analyses of notified cases as "virtually-certain" occupational disease in Germany between 2005 and 2011.

UV-induced skin cancer is not yet included in the German ordinance on occupational diseases and can only be notified and recognized acknowledged as "virtually-certain" occupational disease. The objective of the study was to analyze notified and acknowledged cases of occupational skin cancer due to UV-irradiation in Germany between 2005 and 2011. All notified cases of occupational skin cancer due to UV-irradiation have been analyzed which have been registered by the German Statutory accident insurance as of May 2012 were analyzed. The data analyze was descriptive stratified annually for presenting time trends.Data analysis was descriptive, stratified by year to defect time trends. Notified cases have increased annually with a total of 548 registered cases of occupational skin cancer induced by UV-irradiation between 2005 and 2011, and 74 recognized acknowledged cases. In 56 cases the procedure was not yet finished. Squamous cell carcinoma (SCC) and in-situ squamous cell carcinoma (actinic keratosis, Bowen's disease) were most frequent and have been the most frequentlyobserved in 333 notified cases. and between 15.6 % and 24.9 % have been recognizedof cases with SCC and actinic keratosis were recognized, respectively. 184 patients with basal cell carcinoma were notified but only 6.5 % recognized acknowledged and only 3 cases with exclusive basal cell carcinoma. Out of 50 notified patients with Mmelanoma only one was recognizedacknowledged. The results are in good agreement with the proposal of the German Minister of labor to establish UV-induced skin cancer as a new occupational disease.

Carpal Tunnel Syndrome as an Occupational Disease

Carpal tunnel syndrome (CTS) has been listed since 2003 in the European Union's list of occupational diseases. In 2001, it took sixth place in frequency among all occupational diseases recognized in the European Union. It was not listed as an occupational disease in Germany until July 2009, when the medical expert advisory panel of the German Federal Ministry of Labour and Social Affairs issued an evaluative paper supporting its listing. We selectively reviewed the literature on the potential causation of CTS by occupational activities. Repetitive manual work tasks involving flexion and extension at the wrist, forceful grip with the hand, and/or vibrations of the hand and arm, such as are induced (for example) by hand-held vibrating tools, can damage the median nerve and cause CTS. A combination of these exposures has been found to raise the risk of CTS with a more than additive effect. Harmful exposures arise in a wide variety of occupations; in judging whether a particular case of CTS is of occupational origin, the physician has to consider the actual manual tasks performed by the patient, rather than merely the job title. Working at a computer keyboard seems not to raise the risk of CTS. The causation of CTS by occupational activities, either alone or in combination with other factors, has been well documented by epidemiological data and is pathophysiologically plausible. In Germany, a physician who diagnoses carpal tunnel syndrome in an employee with a relevant, damaging occupational exposure is required to report the case to the German Social Accident Insurance.

Implications of latency period between benzene exposure and development of leukemia—A synopsis of literature

From numerous epidemiological studies it is evidenced that risk after exposure to a carcinogen varies with time and there has been an increasing discussion about the temporal variation in case of smoking, ionizing radiation and various chemical carcinogens. The results of several independent epidemiologic studies of occupational cohorts with benzene exposure and the development of leukemia will be presented in order to find common aspects. In this context the data of 537 confirmed cases of leukemia as an occupational disease in Germany during the time period 1978–2007 will be presented. It is concluded that the epidemiologic findings are consistent and demonstrate a smaller or even absent risk of leukemia 10–15 years after exposure to benzene has been stopped. Temporal changes in relative risk highlights the importance of examining the relationship between follow-up time and risk estimates as part of the risk assessment process.

Aktualisierung der Hinweise zur Begutachtung holzstaubassoziierter sinunasaler Adenokarzinome (BK 4203)

Adenocarcinomas of the nasal cavity and the paranasal sinuses after occupational exposure to sawdust from oak and beech have been listed as occupational diseases in Germany since 1988. Given that modes of treatment have changed, we analyzed the guidelines based on the recommendations of Hartung et al. for developing an expert assessment on reduced earning capacity. A retrospective analysis of 43 cases which had been evaluated between March 1994 and February 2007 for an occupational disease #4203, in the Ear-Nose-Throat clinic of the Münster University Hospital, Germany. Following the guidelines of Hartung et al., it was impossible to formally classify 21 of 43 cases (48.8 %) in an unambiguous manner. This was primarily due to the assessment of the results of radiotherapy, either adjuvant or therapeutic, as well as the grading of postoperative dysfunction in the area of the sinuses operated on (Rhinitis, Ozaena). Suggestions for a revision of the classification system include a modified assessment of radiotherapy as well as evidence for grading post-therapeutic inflammations of the sinus operated on based on the need for further care. These changes enable all cases in question to be classified unambiguously. The use of the revised guidelines is recommended for expert assessment of adenocarcinomas of the nasal cavity and the paranasal sinuses caused by wood dust.