Evaluation of musculoskeletal discomfort using item response theory: creation of a scale based on the self-reported pain symptoms.

This study aims to build a scale for musculoskeletal discomfort based on the self-reported musculoskeletal pain by individuals. For this, methods such as factorial analysis and item response theory were used. A sample of 1821 workers of a footwear industry participated in this study. The scale consists of four levels ranging from mild to maximum discomfort. In mild discomfort (level 60), pain symptoms are rare or frequent in regions such as cervical and trapezoidal area, low back, shoulders, wrists, ankles and feet. At level 70, rare or frequent symptoms affect regions of the upper and lower limbs. At level 80, frequent symptoms become common in the trunk and in most of the upper and lower limbs. At level 90, the symptoms become daily in elbows, thighs and knees. The scale showed signs of validity and proved useful for studies in ergonomics. Practitioner Summary: Methods such as factor analysis and item response theory were used to build a four-level musculoskeletal discomfort scale that can be useful to complement the screening process for workers with musculoskeletal pain. The scale shows signs of accuracy, in addition to validity and reliability. Abbreviations: WMSD: work-related musculoskeletal disorders; CTT: classic test theory; IRT: item response theory; KMO: Kaiser-Meyer-Olkin; PR: pain rarely; PO: pain often; PE: pain everyday; DIF: differential item functioning.

Occupational lung diseases in the 21st century: the changing landscape and future challenges.

PURPOSE OF REVIEW: Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century. RECENT FINDINGS: Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians. SUMMARY: The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.

Cancer surveillance among workers in plastics and rubber manufacturing in Ontario, Canada.

OBJECTIVE: Occupational exposure to agents in plastics and rubber manufacturing has been associated with elevated risk of certain cancers. We sought to evaluate cancer risk among workers employed in occupations and industries with these exposures as part of an ongoing surveillance programme in Ontario, Canada. METHODS: The Occupational Disease Surveillance System (ODSS) cohort was established using workers' compensation claims data and includes 2.18 million workers employed from 1983 to 2014. Workers were followed for site-specific cancer diagnoses in the Ontario Cancer Registry through 2016. Cox proportional hazard models were used to estimate adjusted HR and 95% CI. RESULTS: We identified 81 127 workers employed in plastics and rubber manufacturing industries or materials processing and product fabricating occupations. Compared with all other women in the ODSS, those in materials processing occupations had an elevated rate of lung cancer (HR 1.38, 95% CI 1.20 to 1.58) that was not observed among men. An elevated rate of breast cancer was observed among female labourers (HR 1.36, 95% CI 1.01 to 1.82) and moulders (HR 1.47, 95% CI 0.91 to 2.37) in plastics and rubber product fabricating occupations. Overall, elevated rates were observed for oesophageal, liver, stomach, prostate and kidney cancer in job-specific subgroups, including mixing and blending, bonding and cementing, and labouring. There was little evidence of association for lymphatic or haematopoietic cancers. CONCLUSIONS: Findings for lung and breast cancer in women are consistent with other studies and warrant further attention in Ontario. Given the relatively young age at end of follow-up, surveillance in these workers should continue as the cohort ages.

Occupational Rhinitis: Classification, Diagnosis, and Therapeutics.

PURPOSE OF REVIEW: Occupational rhinitis (OR), an inflammatory disease of the nose, refers to any nasal symptoms reported to be work-related. The purpose of this review is to provide a current overview of the classification, diagnosis, and treatment of OR. RECENT FINDINGS: Occupational rhinitis (OR) can further be classified into allergic or non-allergic depending on the causative agent(s) and pathogenesis. Presenting symptoms are similar to non-OR including nasal congestion, anterior and posterior rhinorrhea, sneezing, and nasal itching. Despite its high prevalence in a spectrum of workplaces, OR is under reported as it is often considered a nuisance rather than a potential precursor to occupational asthma (OA). The diagnosis of OR is obfuscated as it is difficult to determine if this condition was caused by environmental determinants in or outside the workplace. Furthermore, workers may have a pre-existing history of allergic or non-allergic rhinitis leading the clinician and worker to overlook inciting agents in the workplace. In this case, a diagnosis of OR is still possible depending on the exposures but must be differentiated from work-exacerbated rhinitis. Further complicating the diagnosis of OR is the lack of evidence-based research focused on this condition as it is often trivialized due to the perception that it has an insignificant impact on the worker's health. The reality is that OR can have a significant impact on the worker's quality of life and is associated with a number of comorbidities including occupational asthma, recurrent sinusitis, headaches, eustachian tube dysfunction, and sleep disorders similar to non-occupational rhinitis. However, one significant difference between these disorders is that workers diagnosed with OR are eligible for worker's compensation. Treatment of OR involves avoidance of the inciting agent(s) and medications similar to those used to treat non-OR conditions. This review summarizes recent progresses on the etiology, risk factors, diagnosis, and therapy of OR. In addition, suggested areas of further research with potential targets for modifications in the workplace environment as well as therapeutic interventions will be discussed.

Occupational and work-related disease underestimated and linked to temporary disability through Primary Health Care Services.

AIM: To estimate the occupational disease linked to temporary incapacity (not work-related illness). BACKGROUND: The under-reporting of occupational disease is a recognized problem in Europe. METHODS: Cross-sectional study conducted in Spanish adult population using periods of temporary incapacity recorded in primary care during 2015. Rates of occupational disease were estimated using the García & Gadea study. RESULTS: A total of 130,771 episodes of temporary incapacity were studied from 91,448 people, and 56,092 were women (61.3%). The overall prevalence rate was 2,096 and was higher in women (2,504) than in men (1,665) (p < 0.001). It was estimated that 6,580 (7.2%) could be suffering from an occupational disease. Musculoskeletal complaints were the commonest, affecting 75,165 people (82.2%). For the binary logistic regression, the dependent variable was the existence or lack of incapacity due to a musculoskeletal pathology. Age acts as a protective factor (adjusted OR = 0.978). The periods off work due to musculoskeletal complaints are lower in the first quarter of the year [OR > 1; p < 0.001]. CONCLUSIONS: 7.2% of the population was estimated to be off work due to an occupational disease. This estimate reflects the well-known under-reporting of occupational diseases which are dealt with by the Public Health System instead of specialized clinics. IMPLICATIONS FOR NURSING MANAGEMENT: The interdisciplinary role of the occupational health nurse makes it an adequate professional to detect the cases of occupational diseases in primary care settings. Occupational Health Nursing has been recognized by the managers as the most suitable professionals to carry out the screening of occupational diseases in Primary Care.

Association of derived patterns of musculoskeletal disorders with psychological problems: a latent class analysis.

BACKGROUND: Musculoskeletal symptoms often occur in more than one anatomical site. The present study aimed to define specific patterns of multisite musculoskeletal disorders and examine how these patterns are related to common psychological problems. METHODS: Using the data from an interview-based health survey of 358 samples of the industrial manufacturing male employees, we derived major patterns of musculoskeletal complaints using latent class analysis and investigated its association with psychological problems score extracted from depression, anxiety, and stress measured by Depression/Anxiety/Stress Scale (DASS-21). Musculoskeletal disorders were assessed by Nordic Musculoskeletal Questionnaire (NMQ). The statistical analysis was carried out by Mplus 8. RESULTS: Complaints in the lower back (42.1%) and neck (30.7%) had the highest prevalence, and in the hip (15.0%) and ankle (12.2%) the lowest. Three major patterns of musculoskeletal disorders were extracted using latent class analysis. Class 1 (12.9%) was characterized by a high rate of complaints in upper musculoskeletal sites, such as the neck, shoulder, and joints; class 2 (38.2%) was identified by a higher rate of complaints in the lower and upper back; and class 3 (48.9%) was marked by low rates of complaints in all musculoskeletal sites. After adjustment for confounding variables and specifying class 3 as the reference, it turned out that there was a statistically significant association between the psychological problems score and the chance of being in class 1 (OR = 2.47, 95% CI 1.66-3.68), but not a significant association with the chance of being in class 2 (OR = 1.51, 95% CI 0.83-2.72). CONCLUSION: Musculoskeletal disorders can be summarized in the latent class-derived patterns in the adult study population and provide additional prognostics. Common psychological problems are significantly associated with the type of musculoskeletal disorder patterns. The findings in this study could be useful for dealing with prevention and treatment programs.

Cancer mortality and incidence following external occupational radiation exposure: an update of the 3rd analysis of the UK national registry for radiation workers.

BACKGROUND: This study provides direct evidence of cancer risk from low dose and dose rate occupational external radiation exposures. METHODS: Cancer mortality and incidence were studied in relation to external radiation exposure in the National Registry for Radiation Workers. A cohort of 167,003 workers followed for an average of 32 years was analysed using Poisson regression methods. RESULTS: Mortality and incidence risks were significantly raised for the group of all malignant neoplasms excluding leukaemia (ERR/Sv mortality = 0.28; 90%CI: 0.06, 0.53, ERR/Sv incidence = 0.28; 90%CI: 0.10, 0.48) but with narrower confidence bounds compared with the previous analysis of this cohort reflecting the increased statistical power from the additional 10 years of follow-up information. The linear trends in relative risk for both mortality and incidence of these cancers remained statistically significantly raised when information relating to cumulative doses above 100 mSv was excluded (ERR/Sv mortality = 1.42; 90%CI: 0.51, 2.38 and ERR/Sv incidence = 1.18; 90%CI: 0.47, 1.92). CONCLUSIONS: This study improved the precision of the cancer risk estimates seen in the third analysis of the NRRW cohort. The overall results remain consistent with the risk estimates from the Life Span Study and those adopted in the current ICRP recommendations.

Frostbite in the Norwegian Armed Forces. / Frostskader i Forsvaret.

BAKGRUNN: Det finnes lite forskning på forekomst av frostskader, både sivilt og militært. Prognosen og tidsforløpet ved slike skader har ikke tidligere vært undersøkt i større kohorter. MATERIALE OG METODE: Deltagerne var personer registrert i Forsvarets helseregister med kulde- og frostskade i tidsrommet 1.1.2010-31.12.2014. Data om diagnostikk, forløp og behandling ble innhentet fra i alt 460 personer ved hjelp av et spørreskjema. Svarprosenten på undersøkelsen var 66. RESULTATER: 397 av 460 personer (86,3 %) som var registrert med frostskade i Forsvarets helseregister bekreftet at de hadde hatt en kulde- og frostskade. 123 av 397 personene som svarte (30,1 %) anga at de hadde hatt blemmer, noe som gir mistanke om at de hadde pådratt seg annengrads frostskade. 225 av 397 (56,7 %) anga at de hadde hatt frostskade, men ikke blemmer. De aller fleste fikk frostskaden under feltøvelse/vinterøvelse (81,1 %), og ⅔ av de som pådro seg skader var vernepliktige. Langt de fleste hadde skader på fingre/hender eller tær/føtter (96,0 %). To av tre (69,8 %) hadde fortsatt plager fra sin frostskade mer enn to år etter skadetidspunktet. FORTOLKNING: Mange i militæret pådrar seg frostskader under tjenestegjøring. En femdel anga kroniske helseplager som påvirker arbeidsevnen. Kunnskap om forekomsten av frostskader hos militært mannskap er viktig for Forsvarets videre skadeforebyggende arbeid.

Capture and coding of industry and occupation measures: Findings from eight National Program of Cancer Registries states.

BACKGROUND: Although data on industry and occupation (I&O) are important for understanding cancer risks, obtaining standardized data is challenging. This study describes the capture of specific I&O text and the ability of a web-based tool to translate text into standardized codes. METHODS: Data on 62 525 cancers cases received from eight National Program of Cancer Registries (NPCR) states were submitted to a web-based coding tool developed by the National Institute for Occupational Safety and Health for translation into standardized I&O codes. We determined the percentage of sufficiently analyzable codes generated by the tool. RESULTS: Using the web-based coding tool on data obtained from chart abstraction, the NPCR cancer registries achieved between 48% and 75% autocoding, but only 12-57% sufficiently analyzable codes. CONCLUSIONS: The ability to explore associations between work-related exposures and cancer is limited by current capture and coding of I&O data. Increased training of providers and registrars, as well as software enhancements, will improve the utility of I&O data.

Evaluation of a state based syndromic surveillance system for the classification and capture of non-fatal occupational injuries and illnesses in New Jersey.

BACKGROUND: This preliminary study evaluates a real-time syndromic surveillance system to track occupationally-related emergency room visits throughout New Jersey. METHODS: Emergency Department (ED) chief complaint fields were evaluated from 79 of 80 hospitals in NJ in 2014, using work-related keywords and ICD-9 E-codes, to determine its ability to capture non-fatal work-related injuries. Sensitivity analysis and descriptive statistics, were used to evaluate and summarize the occupational injuries identified. RESULTS: Overall, 11 919 (0.3%) possible work-related ED visits were identified from all ED visits. Events with the greatest number of ED visits were slips, trips, and falls (1679, 14%). Nature of injury included cuts, lacerations (1041, 9%). The part of the body most affected was the back (1414, 12%). This work-related classifier achieved a sensitivity of 5.4%, a specificity of 99.8%, and a PPV of 2.8%. CONCLUSIONS: This evaluation demonstrated that the syndromic surveillance reporting system can yield real-time knowledge of work-related injuries.

[Investigation on standard application of industrial dust hazard classification].

Objective: To investigate the application and effectiveness evaluation of the standard of GBZ/T 229.1-2010 in practice, and to explore the applicability, aiming to provide technical evidence for the revision of GBZ/T 229.1-2010. Methods: There were 2 questionnaire surveys carried out in the study, including general survey and specific survey. Databases were established and data were input with Excel 2010 and Epidata version 3.1 software. SPSS version 19.0 software was used for data cleaning and statistical analysis. Results: The general survey received 100 questionnaires, with 43 from facilities and 57 from professional expertise. There were 59 questionnaires from occupational health technical service organizations held by government, and 11 from colleges and universities. The leading three jobs using GBZ/T 229.1-2010 were the occupational hazards evaluation for constructive project (69.0%) , lecturing/training (55.0%) , occupational hazards monitoring (50.0%) , respectively. The high frequency used contents of GBZ/T 229.1-2010 were the fourth part "classification" (67.0%) , the fifth part "the principles of classification management" (59.0%) , annex A "the correct use instructions" (52.0%) , respectively. In the results of feasibility, scores of the fourth part "classification" , the fifth part "the principles of classification management" , annex A "the correct use instructions" were 3.07, 3.03, 3.23, respectively. The parts needed to be modified as priories were the fourth part "classification" (22.0%) , the fifth part "the principles of classification management" (13.0%) , annex A "the correct use instructions" (12.0%) . The specific survey received 15 questionnaires, with 12 from the employers and 3 from occupational health technical service organizations. The awareness rate of GBZ/T 229.1-2010 among occupational health professionals was 83.3%. Classification results in the employers were used for guidance on improvement measures (66.7%) , health surveillance and monitoring (58.3%) , certification for occupational health and safety management system (33.3%) , occupational disease diagnosis (33.3%) , and personal protective equipment issued (33.3%) , etc. In the results of feasibility, scores of the content of free SiO(2), occupational exposure ratio, physical labor intensity level, classification of industrial dust, principles of classification management, annex A "the correct use instructions" were 5.00, 4.33, 5.00, 5.00, 3.67, 3.67, respectively. Conclusion: GBZ/T 229.1-2010 indicates that the standard is feasible and practical. But there are still some problems, such as classification of different kinds of industrial dusts at workplace, and the interaction of occupational exposure to industrial dusts and other hazards at workplace, etc.

[Primary and occupational morbidity among adult population of Moscow].

The authors studied two types of morbidity among adults of Moscow over 2012-2014 - primary and occupational. Findings are that those levels in the city are significantly lower than the general in Russia. Over the studied period, the structure of both types of morbidity did not change, but there was a tendency to decrease both in total and in main entity classes of general and occupational diseases.

Acquired Color Vision Defects and Hexane Exposure: A Study of San Francisco Bay Area Automotive Mechanics.

Occupational exposure to solvents, including n-hexane, has been associated with acquired color vision defects. Blue-yellow defects are most common and may be due to neurotoxicity or retinal damage. Acetone may potentiate the neurotoxicity of n-hexane. We present results on nonhexane solvent and hexane exposure and color vision from a cross-sectional study of 835 automotive repair workers in the San Francisco Bay Area, California (2007-2013). Cumulative exposure was estimated from self-reported work history, and color vision was assessed using the Lanthony desaturated D-15 panel test. Log-binomial regression was used to estimate prevalence ratios for color vision defects. Acquired color vision defects were present in 29% of participants, of which 70% were blue-yellow. Elevated prevalence ratios were found for nonhexane solvent exposure, with a maximum of 1.31 (95% confidence interval (CI): 0.86, 2.00) for blue-yellow. Among participants aged ≤50 years, the prevalence ratio for blue-yellow defects was 2.17 (95% CI: 1.03, 4.56) in the highest quartile of nonhexane solvent exposure and 1.62 (95% CI: 0.97, 2.72) in the highest category of exposure to hexane with acetone coexposure. Cumulative exposures to hexane and nonhexane solvents in the highest exposure categories were associated with elevated prevalence ratios for color vision defects in younger participants.

[Guidelines for the use of the International Classification of Radiographs of Pneumoconioses of the International Labour Office (ILO): Substantial changes in the currrent edition]. / Wytyczne stosowania Miedzynarodowej Klasyfikacji Radiogramów Pylic Pluc Miedzynarodowego Biura Pracy (ILO) ­ istotne zmiany w obecnie obowiazujacej edycji.

The International Classification of Radiographs of Pneumoconioses is the scheme worked out by the International Labour Office in Geneva (ILO), to register radiographic chest abnormalities in a well-ordered, reproducible and comparable way. It is used for diagnosing abnormalities caused by dust exposure. Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses contain detailed information and recommendations on how to use the classification, as well as how the chest X-ray examination should be performed and recorded. To facilitate the diagnosis of observed abnormalities the classification is completed by the set of standard radiograms illustrating typical irregularities referring to lungs and pleura, included in the classification. The article presents the key information on classification and the most important amendments adopted in the 2000 and 2011 ILO guidelines revisions. These changes refer to radiographs quality assessment, the way of presenting abnormalities registered in standard radiographs (QUAD set, digital images) and registration of failures not related to dust exposure. Particularly important complements result from the development of radiological imaging techniques. They are concerned about the classification of radiographic images of the chest recorded digitally. Med Pr 2016;67(6):833-837.

Job coding (PCS 2003): feedback from a study conducted in an Occupational Health Service / Codage d'emplois (PCS 2003) : retour d'expérience d'une étude menée en service de santé au travail.

Aim: To examine the quality of manual job coding carried out by occupational health teams with access to a software application that provides assistance in job and business sector coding (CAPS). Methods: Data from a study conducted in an Occupational Health Service were used to examine the first-level coding of 1,495 jobs by occupational health teams according to the French job classification entitled "PSC- Professions and socio-professional categories" (INSEE, 2003 version). A second level of coding was also performed by an experienced coder and the first and second level codes were compared. Agreement between the two coding systems was studied using the kappa coefficient (κ) and frequencies were compared by Chi2 tests. Results: Missing data or incorrect codes were observed for 14.5% of social groups (1 digit) and 25.7% of job codes (4 digits). While agreement between the first two levels of PCS 2003 appeared to be satisfactory (κ=0.73 and κ=0.75), imbalances in reassignment flows were effectively noted. The divergent job code rate was 48.2%. Variation in the frequency of socio-occupational variables was as high as 8.6% after correcting for missing data and divergent codes. Conclusions: Compared with other studies, the use of the CAPS tool appeared to provide effective coding assistance. However, our results indicate that job coding based on PSC 2003 should be conducted using ancillary data by personnel trained in the use of this tool.

[The notion of occupational skin disease. Medical and legal aspects]. / Zum Begriff der beruflichen Hautkrankheit. Medizinische und rechtliche Aspekte.

The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers, dermatologists should be familiar not only with the medical definition, but also with these different legal definitions of skin disease.

[UV-irradiation-induced skin cancer as a new occupational disease]. / UV-Licht-induzierter Hautkrebs als neue Berufskrankheit.

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 > 4 cm(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.

[The essentials of workplace analysis for examining occupational disability claims]. / Berufskundliche Grundlagen für die Beurteilung der Berufsunfähigkeit (I).

The insurance branch that covers the risk of occupational disability ranks among the most important private entities for offering security as far as the limitation or loss of one's ability to work is concerned. The financial risk of the insurer, the existential concerns and expectations of the claimant, as well as the legal framework and the need for a careful interdisciplinary evaluation, necessitate a professional review and assessment of the facts conducted with a sense of both responsibility and sensitivity. Carefully deliberated and sustainable decisions benefit both insurers and the insured. In order to achieve this, an opinion is required in many--and especially the more complex--cases from an external medical expert, which in turn can only be plausible and conclusive when based on a comprehensive review of the claimant's working environment and its particular (and often unique) requirements. This article is intended to increase the reader's understanding of the coherencies of workplace analysis and medical assessments, as required by insurance law and legislation. In addition, the article delivers valuable clues and guidance, both for medical experts and claims managers at insurance companies. Primarily, the claimant's occupation, as conceived in the terms and conditions of the insurance companies, is explained. The reader is then introduced to the various criteria to be considered when a claimant has several jobs at the same time, is self-employed, could be transferred to another job, is simply unable to commute to the workplace, or is prevented from working due to legal restrictions related to an illness. The article goes on to address the crucial aspect of how the degree of disability is to be measured under different circumstances, namely using the quantitative and the qualitative approach. As a reliable method for obtaining the essential data regarding the claimant's specific working conditions, which are required by both the medical expert and the insurance company's claims manager, the reader is provided with an insider's insights into on-site workplace analysis. The value of this pragmatic and proven method is subsequently demonstrated when the article addresses the often decisive part of the medical expert's assessment. In its conclusion the article points out the importance of workplace analysis to the entire process of evaluating occupational disability claims and the effort and monies to be saved by attaching value to thorough workplace analysis at an early stage.

[Ultrasound examination in diagnosis and classification of occupational myofibrosis (lecture)].

Based on comparative analysis of contemporary clinical and instrumental investigations, the authors justify advantage of ultrasound examination in diagnosis of occupational myofibrosis. Results of ultrasound application helped to specify a classification of occupational myofibrosis according to the disease severity, that considerably increases efficiency of examining connection between the disease and occupation.