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PubMed1981

[Medical prevention in exposure to lead].

The action of lead on the intermediary metabolism, especially on the synthesis of heme, the red blood cell pigment, is well documented. Therefore biological monitoring of lead exposed persons by means of the urinary metabolites of porphyrin metabolism is very valuable. Biological monitoring through the urinary metabolite - aminolevulinic acid (ALAU) has been put to extensive use for over ten years by the Swiss National Accident Insurance Fund (Suva). At present there are over 3000 workers in 100 factories which are periodically screened for this metabolite. Urinary analyses are carried out at regular intervals of 2, 4 or 6 months according to the lead exposition with additional medical examinations once or twice a year. Due to biological monitoring, technical improvements and personal hygiene there have been no further lead poisoning recently in industrial plants supervised by Suva.

Aminolevulinic Acid↗
PubMed1981

[Place of occupational medicine in the Swiss health service].

Occupational medicine represents an important section of public health. It still has to be developed in Switzerland. Every physician needs basic knowledge of medicine of labour. In addition, specialists in occupational medicine must be trained and employed in enterprises and in authorities of industrial supervision. A concept is needed for training, knowledge developing and specializing in occupational medicine. For this purpose, institutes of occupational medicine must be established in all medical faculties. The government will decree the employment of occupational physicians in enterprises, according to the new accident insurance law. The industrial physician shall be integrated in the system of medical care as an imperative professional supplement, according to the new principles issued in 1981 of the association of Swiss physicians.

National Health Programs↗
PubMed1987

[The significance of dust in the evaluation of the potential health risk in chemical industry plants].

According to statistics, occupational diseases (and respiratory disorders in particular) are rare. Occupational disease accounted for only 1.5% of all job-related disabilities registered with the Swiss Accident Insurance Institute (SUVA) in 1984. Skin disorders (37.1%) are the leading form of occupational disease, followed by disturbances of the locomotor apparatus (36%) arising from physical causes. Pneumoconiosis (quartz, asbestos) accounts for 2.8% of cases. Chronic disorders of the respiratory tract brought about by irritant or toxic gases are buried away under the heading of 'chronic poisoning' (7.8%). Bronchitis caused by organic dust (0.3%) is listed under 'other disorders' (13.9%). It is shown that, depending on the type of chemical manufacturing involved, major significance is attached to the role of dust as a potentially dangerous substance and thus to monitoring and prevention at source. Attention is particularly drawn to the hazard posed by lipophilic dust (aromatic amines, organic phosphates, etc.) which can easily pass through intact skin and penetrate into the body unnoticed. Uptake of toxic agents through the skin is not registered by the devices used to test air quality, but can only be ascertained by detection of toxic substances or metabolites in the urine or the blood (biological monitoring). Finally, it is pointed out that--in general--MAC or BEI limits have not been stipulated for biologically active dust, with the exception of a few values for insecticides. The 'general upper limit' of 6 mg/m3 for inert dust is of no use in the monitoring of dust from biologically active products.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗
PubMed1986

[Biological monitoring at the work site].

Exposure to industrial chemicals is assessed by ambient monitoring (external exposure/dose), by health surveillance (detection of adverse biological/health effects in exposed workers) and by biological monitoring (evaluation of the internal exposure of the organism to a chemical agent). Objectives, principal advantages and limitations of biological monitoring are discussed; the programs of biological monitoring as a part of the health surveillance of Swiss workers guided by the Swiss National Accident Insurance Fund are briefly summarized.

Air Pollutants, Occupational↗
PubMed1999

[Pilot study on hairdresser eczema].

From 1990 to 1992 the allergy profile of 1042 prospective hairdressers (personal and family history, atopic skin, serum IgE, patch and prick tests) was determined and their occupational suitability was evaluated. Up to 1997 a follow up of 375 hairdressers was obtained by way of questionnaires, re-examination, official reports and expert opinions of the social accident insurance. The frequency of initial eczema was 30%. A change of occupation on account of hairdresser eczema was documented in 11%. The prognostic evaluation of occupational suitability proved to be unsatisfactory. In this longitudinal study, the frequency of pre-occupational skin symptoms increased from 13 to 18%. The other atopic criteria indicated no uniform tendency. There was a significant increase in nickel allergy from 18.7 to 45.5% resulting partly from sensitization after entering the occupation and partly from an increase in nickel allergy at time of entry. Both atopic skin and pre-occupational nickel allergy increase the risk of hairdresser eczema, it is not so great as to justify dissuading such young people from entering the profession.

Adolescent↗
PubMed2006

[Toxic anosmia and rhinitis due to occupational solvent exposure].

A patient's case report documents the development of anosmia and rhinitis caused by occupational exposure to organic solvents, including tetrahydrofuran, cyclohexanone, acetone and other ketones. Physicians should inquire about possible mucosal irritation or prenarcotic symptoms during exposure. If an occupational disease is assumed, notification must be sent to the Institution for Statutory Accident Insurance and Prevention (Berufsgenossenschaft). Some diseases, for example olfactory disorders due to chemical mixtures, are not included in the German list of occupational diseases. In this case, a special law (Sozialgesetzbuch VII) regulates compensation.

Adult↗
PubMed2004

[Expert opinion problems in the evaluation of osteomyelitis].

Cases of osteomyelitis can be differentiated according to hematogenous (endogenous), and post-traumatic (exogenous) forms. Both types can lead to considerable permanent damage or recur even after a fairly long time. In the formulation of an expert opinion to assess cases of osteomyelitis, the foremost question concerns a possible error in treatment or clarification of a connection to a postulated trauma. The present article describes aspects of expert opinions on cases of osteomyelitis of the long bones, spinal column, and in children. In addition to potential claims for compensation for harm caused by permanent damage, other conceivable sequelae such as fistula carcinoma or amyloidosis are relevant for expert opinions. In contrast, substantiated clarification of the causality of a triggering traumatic event is essentially important for recognition of claims against accident insurance companies.

Child↗
PubMed2005

[Mountain biking. Cool way to enjoy nature with side effects].

Mountain biking grew from a trend to a serious branch of sport. This article presents the different subspecialties within the sport, the injury rates and the types of injuries among high-class and recreational bikers. The experiences made during several years as a team physician of top athletes as well as the statistics from the Swiss accident insurance company SUVA are the basis for the data presented. The issue of mountain bike-related concussions is particularly discussed since this type of injury is a point of increasing concern in the recent sports traumatology literature.

Bicycling↗
PubMed2001

Uranium mining in Germany: incidence of occupational diseases 1946-1999.

OBJECTIVES: In East Germany, uranium mining was performed on a large scale for approximately 45 years (1946-1990). In particular, the poor working conditions during the post-war years until 1955 led to a high level of occupational diseases. The present study gives an overview of the occurrence of occupational diseases during the mining period as well as after uranium mining was stopped in 1990. METHODS: The number of occupational diseases which occurred during the mining period was calculated from the files of the former Wismut SDAG. Although exposure to uranium ceased after 1990, new cases of occupational diseases were recognized after that date. These were recorded by the German Federation Of Institutions For Statutory Accident Insurance And Prevention (HVBG). RESULTS AND CONCLUSIONS: Today, more than 35,000 cases of occupational diseases are known, and many more are expected. About two-thirds of them are lung diseases: 16,376 cases of silicosis/silicotuberculosis and 7,695 cases of bronchial carcinomas. The increase in the number of recognized occupational diseases is shown and discussed against the background of changes in criteria for recognition and in working conditions as well as the duration of the latency period.

Bronchial Neoplasms↗
PubMed2005

Host factors in occupational diisocyanate asthma: a Swiss longitudinal study.

OBJECTIVE: To investigate the usefulness of surrogates for individual susceptibility to organic diisocyanates in occupational asthma. SUBJECTS: 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. METHODS: 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. RESULTS: 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. INTERPRETATION: 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.

Adult↗
PubMed2005

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries.

OBJECTIVE: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. METHODS: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. RESULTS: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal worker's pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. CONCLUSION: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.

Adult↗
PubMed1998

The Service for the Organization of Postexposure Medical Examinations: ODIN.

In Germany, occupational contact with carcinogenic substances is regulated by very strict legislation. Thus, alongside strict implementation of agreement 139 of the International Labour Organization (ILO), legislation governing the medical monitoring and care of employees in the form of specialist preventive medical examinations is also in force. It is extremely important that medical preventive care should continue after employment involving contact with carcinogenic substances has ceased, since there is often a long delay before occupationally induced carcinosis develops. The German Service for the Organization of Postexposure Medical Examinations (ODIN) was established by the statutory German accident insurance institutions to ensure that early detection examinations continue to be performed into the employee's later life. Such preventive examinations can significantly enhance the success of cancer treatment by detecting malignancy in its early stages. The registration by ODIN of data concerning exposure to hazardous substances also has the function of preserving evidence required for possible compensation claims by victims of occupational illnesses. In the longer term, ODIN data may help us to explain the relationship between exposure to hazardous substances and the incidence of carcinosis.

Carcinogens↗
PubMed2006

Medical-legal issues in headache: penal and civil Italian legislation, working claims, social security, off-label prescription.

Primary headaches can be considered simultaneously as symptom and disease itself, while secondary headaches are expressions of a pathological process that can be systemic or locoregional. Because of its subjective features, headache is often difficult to assess and quantify by severity, frequency and invalidity rate, and for these reasons it has often been implicated in legal controversies. Headache has seldom been considered in the criminal law, except when it represents a typical symptom of a disease whose existence can be objectively assessed (i. e. raised intracranial pressure). Therefore, in civil legislation it is not yet coded to start claiming for invalidity compensation. In particular, one of the most debated medical-legal questions is represented by headaches occurring after head injury. Headache is often the principal symptom at the beginning of several toxic chronic syndromes, with many implications, especially in working claims, and, more recently, it may be referred to as one of the most frequent symptoms by victims of mobbing (i. e. psychological harassment in the workplace). The National Institute for Industrial Accident Insurance (INAIL) scales (instituted by the law 38/2000) mention the "Subjective cranial trauma syndrome" and give an invalidity rate evaluation. With reference to other headache forms, no legislation really exists at the present time, and headache is only considered as a symptom of a certain coded disease. Requests for invalidity social pension and the question of off-label prescriptions (drug prescription for a disease, without formal indication for it) are other controversial matters.

Disability Evaluation↗
PubMed1996

"Doctor, when can I drive?': a medical and legal view of the implications of advice on driving after injury or operation.

In view of the increasing medicolegal implications of advice given to patients, in particular the apparent increasing frequency of requests for advice about whether patients are fit to drive, a review was made of the literature, the law and the views of the major motor insurers. A patient should be advised when it is not safe to drive. If he disregards this advice and drives, he would be breaking the law and would not be covered by his insurance. Whilst recovering from an injury or an operation, a patient may not be as physically able as before but he may still be fit enough to drive. When it is considered that the patient's disability is more than about 3 months he should be advised to inform his insurers and to act in accordance with their response. On the other hand, when it is felt that the patient's disability is short-term, he should be advised that he is fit to drive but that he should be careful during the early stages. Provided that the patient feels safe to drive and drives carefully, he should be acting within the law, and should be covered by his existing insurance. In doubt, the patient should contact the Driver, Vehicle and Licensing Centre and his insurers and act accordingly. Doctors should record their advice in the patient's notes and should remember that the patient may be driving vehicles other than a car.

Automobile Driving↗
PubMed1984

No-fault insurance for vaccine related injuries. Jeffrey O'Connell proposes an alternative insurance scheme for vaccine-injury victims.

Under tort law in effect throughout most of the western world, a party injured by adverse effects from a vaccine can be paid under a legal claim only by proving the manufacturer or its product faulty. If successful, the claimant would be paid not only for his medical expense and wage loss but for his pain and suffering. But proving (a) the defendant's conduct or product faulty and (b) the monetary value of nonmonetary loss (pain and suffering) is usually so complex that many injury victims are paid not at all, or only a fraction of their losses in settlement, only after long delay, and only after lawyers on both sides are paid large amounts of insurance dollars in litigation costs.

Athletic Injuries↗
PubMed1998

Are we selecting the right patients for treatment of localized prostate cancer? Results of an actuarial analysis.

OBJECTIVES: To determine our accuracy in selecting patients with at least a 10-year life expectancy for aggressive treatment of localized prostate cancer. METHODS: The medical records of 261 consecutive patients who underwent radical retropubic prostatectomy were submitted to the actuarial division of American General Life and Accident Insurance Company (AGLA) for estimation of life expectancy, excluding the diagnosis of prostate cancer. Survival curves were generated from predicted individual survivals. In patients with less than a 10-year life expectancy, AGLA provided us with the basis for assigning suboptimal survival rates. RESULTS: The mean life expectancy for the group was 15.2 years. Two hundred ten men (80%) were projected to have a life expectancy of more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who were older than or equal to 70 and 75 years of age, respectively. Coronary artery disease and diabetes mellitus were the most common coexisting medical conditions that adversely affected risk as single disease entities. CONCLUSIONS: Although clinicians do not estimate life expectancy with the scientific exactitude of an actuary, the ability to assess the patient in person and assimilate pertinent medical information in a less rigid format yields similar results. Selection of men for definitive treatment of localized prostate cancer should be based on the inherent aggressiveness of the disease and the health of the individual and should not be limited by specific age cutoffs. Populations of men undergoing radical prostatectomy are younger and healthier than those in reported series of watchful waiting for prostate cancer.

Actuarial Analysis↗