[The description of meniscopathy in the sense of German occupational disease No. 2102 : Results of an interdisciplinary working group]. / Das Krankheitsbild im Sinne der Berufskrankheit 2102 Meniskopathie : Ergebnisse einer interdisziplinären Arbeitsgruppe.

On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

[Cancer through the handling of biological agents]. / Krebsdurch den Umgang mit Biostoffen.

In March 2012, the International Agency for Research on Cancer (IARC), an agency of the World Health Organization (WHO) issued a list. It lists 108 agents for which there is sufficient evidence of a carcinogenic effect in humans, depending on the cancer site. The vast majority of these actions can take place in the workplace. What is new in the list, in addition to the long-known cancer-causing chemical and physical agents now biomaterials have been added, such as hepatitis B virus, hepatitis C virus, Human papilloma virus, Helicobacter pylori. This paper gives an overview on the basis of identifying carcinogenic agents and can be displayed in certain cancer site and occupational exposure occupational diseases according to the occupational disease regulation.

Occupational exposure to dioxins by thermal oxygen cutting, welding, and soldering of metals.

This paper focuses on one aspect of occupational dioxin exposure that is novel and unexpected. Exposures in excess of the German threshold limit value of 50 pg international toxicity equivalent (I-TEQ)/m3 are very frequent, unpredictable, and sometimes very high--up to 6612 pg I-TEQ/m3--during thermal oxygen cutting at scrap metal and demolition sites. The same procedure involving virgin steel in steel trade and mass production of steel objects gave no such evidence, even though no final conclusions can be drawn because of the low number of samples analyzed. Low dioxin exposures during inert gas electric arc welding confirm previous literature findings, whereas soldering and thermal oxygen cutting in the presence of polyvinyl chloride give rise to concern. The consequences of occupational dioxin exposure were studied by analysis of the dioxin-blood concentration, the body burden, of men performing thermal oxygen cutting at scrap metal reclamation and demolition sites, in steel trade and producing plants as well as for industrial welders and white-collar workers. The results concerning body burdens are in excellent agreement with the dioxin exposure as characterized by dioxin air concentration in the workplace. The significant positive correlation between duration and frequency of performing thermal oxygen cutting at metal reclamation and demolition sites expressed in job-years and dioxin body burden speaks for the occupational origin of the observed overload after long times. The results reported here lead to consequences for occupational health, which are discussed and require immediate attention.

Occupational risk factors for lung cancer: a case-control study in West Germany.

BACKGROUND: The aim of this study is to evaluate carcinogens and occupations suspected to cause lung cancer and to generate new hypotheses about occupational risks. METHODS: In a hospital-based study 1004 incident lung cancer cases and the same number of population controls matched for region, sex and age were interviewed between 1988 and 1993 for their smoking and occupational history. Exposure assessment was based on 33 job-specific supplementary questionnaires. Conditional logistic regression was used to calculate odds ratios (OR) and to control for smoking and occupational asbestos exposure. RESULTS: Lifelong prevalence of exposure to asbestos was 20.5% for exposure of more than 940 lifetime working hours among controls, corresponding to an OR of 1.62 (95% confidence interval [CI] : 1.28-2.05) that was reduced to 1.45 after adjustment for smoking (P < 5%). Statistically elevated risks after adjustment for smoking and asbestos were seen in metal production and processing workers, transportation workers and freight handlers, in the rubber and plastics industry, in metal production, in engine and vehicle building, and installation. Significantly increased OR after adjustment for smoking and asbestos that deserve further attention were seen in plastics processing workers (OR = 3.49), and sheet and structural metal workers (OR = 2.01 and 2.37, respectively). CONCLUSIONS: The results of the study confirm previously described occupational risks. Because of the possibility of controlling for occupational asbestos exposure, the study gives clear indications for prevention and further research.

Occupational and environmental hazards associated with lung cancer.

In a hospital-based case-control study 194 lung cancer cases, 194 hospital controls, and 194 population controls were interviewed for their smoking, occupational, and residential history by trained interviewers, using a standardized questionnaire. In order to include many different environmental exposures, case ascertainment took place in seven different hospitals with catchment areas ranging from rural to highly industrialized. Lung cancer risk strongly increases with cumulative cigarette dose, reaching an odds ratio (OR) of 16.19 (95% confidence limits (CL): 5.10, 51.33) for male smokers of more than 40 pack-years and an OR of 19.99 (95% CL: 4.98, 80.24) for female smokers of more than 20 pack-years. For the quantification of occupational exposure to known carcinogens of the lung a novel approach was developed which accumulates exposure information obtained by supplemental questionnaires through an automatic procedure. The OR for the highest exposure group in males was 2.7 (95% CL: 1.23, 5.78). Significantly increased risks were observed in the metal industry, particularly in smelter and foundry workers (OR 4.8, 95% CL: 1.15, 20.16) and in turners (OR 2.2, 95% CL: 1.05, 4.75). In the construction industry the risks were particularly high in road construction workers (OR 3.7, 95% CL: 1.06, 13.20) and in unskilled construction workers (OR 2.7, 95% CL: 1.24, 5.76). The risks in these occupational groups increased with duration and with latency. Quantification of air pollution was done on a county basis by time period. An index based on emission data for sulphur dioxide was compared to a semiquantitative index, which included additional information on ambient air pollution. After adjustment for smoking and occupational exposures an OR of 1.01 (95% CL: 0.53, 1.91) for an emission index and of 1.16 (95% CL: 0.64, 2.13) for a semiquantitative index was obtained.

Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices.

Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S83-S95. In a lung cancer study in Northern Germany the asbestos exposure assessment obtained from detailed supplementary questionnaires (SQ) was compared to the assessment obtained by the application of two job exposure matrices (JEM) to the job history. The study includes 391 incident male cases and the same number of controls from the general population, matched by sex, age, and region. Almost 16% of the subjects are considered as never having been exposed to asbestos and 24% are classified as certainly exposed according to both of the JEM, the corresponding percentages of the SQ-method being 68% and 32%. Sixty percent are considered by the JEM as having an intermediate probability of exposure. In general, the agreement between the different methods is better when the exposure definition is restricted to definite exposures, the corresponding Kappa statistic being 0.67 for the comparison between both JEM and 0.44/0.39 between the JEM and the SQ. The positive agreement between SQ and JEM (reference) increases from 12% and 17% for subjects with low probability of exposure to 61% and 69% for those with definite exposures. A ranking according to cumulative exposure shows some dose-response relationship for each of the three methods with a smoking-adjusted OR in the highest category of 1.85 (95% CI: 1.01-3.38) for the SQ method and 2.47 (95% CI: 1.40-4.37) and 2.94 (95% CI: 1.73-4.99) for the two JEM. The results are discussed with reference to the conceptual differences between the methods and their potential scope in future studies.

Retrospective assessment of asbestos exposure--II. At the job level: complementarity of job-specific questionnaire and job exposure matrices.

Retrospective assessment of asbestos exposure--II. At the job level: Complementarity of job-specific questionnaire and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S96-S105. The assessments of asbestos exposure by two a priori job exposure matrices (JEM) and by a job-specific questionnaire (SQ) are compared at job level. The data used for the comparison were generated by an ongoing case-control study on lung cancer in a region of northern Germany with a relatively high past prevalence of asbestos exposure. Among job periods assessed as unexposed by either JEM, 96% are recognized as such by the SQ. Discrepancies between the SQ and JEM were observed in jobs rated potentially exposed by the JEM. Despite varying estimates, the JEM and SQ were consistent as regards the relative classification of job periods by probability of exposure. The concordance of the methods, estimated by Kappa statistics, was stronger for the two JEM than for either of the JEM and the SQ. The identification of specific occupation/industry combinations in which discrepancies were most frequent and the comparison with expert ratings in some jobs yield insights into the sources of the disagreement between the methods. The misclassification of exposure by the JEM usually results in an overestimation of exposure. This is essentially related to loss of information due to the use of job codes as surrogates for job task descriptions and to the insufficiency of published data on asbestos exposure in different industries. As regards the SQ, two main sources of potential loss of sensitivity were identified: 1) possible omission of indirect sources of exposure by this method, 2) possible incompleteness of the SQ. The present comparison of methods of asbestos exposure assessment does not allow any one approach to be considered superior to another. Indeed, as proposed by Ahrens et al. in Part I of the study, both should be used to ensure optimal epidemiological performance.

Occupational risk factors for symptomatic lumbar disc herniation; a case-control study.

BACKGROUND: Previous studies mostly did not separate between symptomatic disc herniation combined with osteochondrosis/spondylosis of the lumbar spine and symptomatic disc herniation in radiographically normal intervertebral spaces. This may at least in part explain the differences in the observed risk patterns. AIMS: To investigate the possible aetiological relevance of physical and psychosocial workload to lumbar disc herniation with and without concomitant osteochondrosis/spondylosis. METHODS: A total of 267 cases with acute lumbar disc herniation (in two practices and four clinics) and 197 control subjects were studied. Data were gathered in a structured personal interview and analysed using logistic regression to control for age, region, nationality, and diseases affecting the lumbar spine. Cases without knowledge about osteochondrosis/spondylosis (n=42) were excluded from analysis. Risk factors were examined separately for those cases with (n=131) and without (n=94) radiographically diagnosed concomitant osteochondrosis or spondylosis. RESULTS: There was a statistically significant positive association between extreme forward bending and lumbar disc herniation with, as well as without concomitant osteochondrosis/spondylosis. There was a statistically significant relation between cumulative exposure to weight lifting or carrying and lumbar disc herniation with, but not without, concomitant osteochondrosis/spondylosis. Cases with disc herniation reported time pressure at work as well as psychic strain through contact with clients more frequently than control subjects. CONCLUSIONS: Further larger studies are needed to verify the concept of distinct aetiologies of lumbar disc herniation in relatively younger persons with otherwise normal discs and of disc herniation in relatively older persons with structurally damaged discs.

DNA damage in mononuclear blood cells of metal workers exposed to N-nitrosodiethanolamine in synthetic cutting fluids.

In 28 smoking and 37 non-smoking male metal workers from 7 small to medium sized plants the genotoxic effect caused by the occupational exposure measured as DNA single strand breaks in the peripheral mononuclear blood cells was investigated. Metal workers using synthetic cutting fluids are possibly exposed to the carcinogenic N-nitrosodiethanolamine (NDELA). In this investigation NDELA was detected in the air of the working halls in a concentration up to 1000 ng/m3 and in the cutting fluids in a concentration up to 135 mg/l (mean values per plant). Workers staying in rooms with a mean concentration of NDELA in the air of about 1 microgram/m3 revealed two times more DNA strand breaks than workers staying in an environment with less than 50 ng/m3 of NDELA (p < 0.01). Non-smoking workers with more than 4.5 h contact to cutting fluids per day showed an 1.5 times higher mean level of DNA strand breaks than their nonsmoking colleagues having had less than 4.5 h contact to cutting fluids (p < 0.02). Also workers having had work place-related complaints showed a statistically significantly higher level of DNA strand breaks compared to workers with no or no work place-related complaints. No significant correlation was obtained between the extent of DNA damage and the estimated extent of skin contact or the concentration of NDELA found in the cutting fluids. Therefore, for workers in this investigation NDELA incorporated by inhalation is probably more relevant for genotoxic damage than NDELA resorbed by skin. An increased level of DNA damage was found in metal workers depending on the concentration of NDELA in the air of the work places. However, without further investigations it cannot be excluded that also other concomitant agents in the environment were responsible for the observed genotoxic effect.

Single-strand breaks in deoxyribonucleic acid in fire fighters accidentally exposed to o-nitroanisole and other chemicals.

OBJECTIVES: The aim of the study was to detect single-strand breaks in deoxyribonucleic acid (DNA) in mononuclear blood cells of fire fighters exposed to o-nitroanisole and other substances released into the environment during an accident in a chemical plant. METHODS: The level of DNA single-strand breaks in mononuclear blood cells was detected by alkaline elution. The results were compared for 16 fire fighters who worked in a contaminated area for about 8 h and two reference groups (one of fire fighters who had not worked in the contaminated area, group I, and one of persons without any apparent occupational exposure to genotoxic substances, group II). RESULTS: The mean normalized elution rate (nER) 19 d after the accident was slightly but statistically significantly (P < 0.05) higher for the exposed fire fighters [mean 1.48 +/- 95% confidence interval (95% CI) 0.21] than for reference group I (mean 1.21 +/- 95% CI 0.21) or reference group II (mean 1.17 +/- 95% CI 0.18). No statistically significant difference was found between reference groups I and II. Another analysis was performed three months after the first. The level of DNA single-strand breaks (mean nER 1.12 +/- 95% CI 0.11) was no longer increased in comparison with the levels of the reference groups. CONCLUSIONS: DNA single-strand breaks were increased in fire fighters exposed to o-nitroanisole and other substances. In comparison with the extent of DNA strand breaks found in other occupational groups the increase was only moderate. The observed decrease in DNA single-strand breaks to the reference level in exposed fire fighters three months later suggests a DNA repair mechanism for DNA single-strand breaks caused by o-nitroanisole.

Dose response relationship between occupational PAH exposure and lung cancer--an overview.

Epidemiologic cohort and case-referent studies have shown an increased risk of lung cancer among various PAH-exposed occupations, such as coke, coal gas and aluminium production workers, road pavers, roofers and chimney sweeps. In different cohort studies, a positive dose response relationship between PAH exposure time and lung cancer have been described. On some workers, a relationship was found between coal for pitch volatiles (CTPV) and the risk of lung cancer. A doubling dose for lung cancer of > 20 [(mg CTPV/m3) years] or > 100 [micrograms BaP/m3) years] has been found among coke and aluminium production workers. Acknowledgement of lung cancer as an occupational disease is proposed after a cumulative dose of > 20 [(mg CTPV/m3) years] or > 100 [micrograms BaP/m3) years].

[Occupational diseases of the spine in health care professions-- epidemiologic and insurance aspects (I). 1. Review of internationally publicized studies]. / Berufliche Wirbelsäulenerkrankungen bei Beschäftigten im Pflegeberuf epidemiologische und versicherungsrechtliche Aspekte (I). Teil 1: Ubersicht über international publizierte Studien.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

[Occupational spinal diseases in employees of nursing services--epidemiological and legal insurance aspects (III). 3: Intervertebral disk-induced diseases of the lumbar spine in health care employees--expert assessment and prevention]. / Berufliche Wirbelsäulenerkrankungen bei Beschäftigten im Pflegeberuf--epidemiologische und versicherungsrechtliche Aspekte (III). Teil 3: Bandscheibenbedingte Erkrankungen der Lendenwirbelsäule bei Beschäftigen im Gesundheitsdienst-Begutachtung und Prävention.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

[Amendments of occupational laws in Germany and consequences for occupational health]. / Gesetzesänderungen und ihre Auswirkungen auf die Arbeitsmedizin.

German legislation with respect to occupational health during recent years is reviewed. Discussed is the occupational safety law and related legislation as the hazardous substances act and the biological hazard act, the occupational health and safety act and the social act VII. Most improvements of occupational standards in Germany are induced by regulations of the European Union. Furthermore initiatives of the federal government and the federal states according to an amendment of the social act VII and the occupational health and safety act, which would induce a reduction of social standards, are discussed. The role of occupational medicine in companies by some of the above mentioned laws is improved. On the other hand the situation of occupational physicians in companies, universities and other agencies is characterized by budget cuts, reduction of occupational standards and loss of importance.

[Radiological diagnosis of lumbar prolaps with quantitative and morphological criteria]. / Die radiologische Befundung des lumbalen Bandscheibenvorfalls nach quantitativen und morphologischen Kriterien.

PURPOSE: The present study examines the differences of radiological diagnosis of lumbar prolaps with quantitative and morphological criteria. Advantages and disadvantages of both methods were analysed. METHOD: Concerning the "Deutsche Wirbelsäulenstudie" (DWS) 286 male and 278 female patients between 25 and 70 years of age undergoing clinical or ambulant therapy for radicular symptoms and the diagnosis of a lumbar prolaps in CT and/or MRT were integrated into our study. Actual MRT and CT pictures of the patients' lumbar spine were analysed by an independent radiologist (primary radiologist). Radiological diagnosis was concerned with quantitative and morphological criteria. Radiological images of 100 selected patients were reexamined by another radiologist (secondary radiologist). On the basis of these results, the interobserver reliability (kappa) was calculated. RESULTS: In 95.2% of all segments a prolaps was seen with quantitative and morphological criteria, in 4.5% a prolaps was analysed with quantitative and in 0.3% a prolaps was seen with morphological criteria. The radiological diagnosis of prolaps by quantitative criteria was confirmed by the operative findings. Many prolapses with lateral localisation were seen in these cases. Therefore radiological diagnosis on the basis of morphological criteria could be difficult. For both radiological methods similar interobserver reliabilities were calculated. To sum up both radiological methods are even equivalent. It is also possible to graduate the diagnosis with quantitative criteria. Detrimental effects of quantitative criteria could be difficulties in measurement with non-digital images. CONCLUSION: Besides several recommendations in the international literature on the radiological analysis of prolaps with morphological criteria, diagnosis with quantitative criteria is also an effective method.

Asbestos exposure and malignant lymphomas--a review of the epidemiological literature.

There has been a significant number of case reports on the occurrence of lymphomas in people previously exposed to asbestos. This raises the question of whether corresponding results are available from analytical epidemiological studies. In the present review of the epidemiological literature, we describe the results of the six cohort and 16 case-control studies that - according to our research - were published up to 1999 and, directly or indirectly. shed light on the above question. In summarizing the results of these studies, we have distinguished between non-Hodgkin lymphoma (NHL), chronic lymphatic leukemia (CLL) and plasmocytoma/ multiple myeloma (MM). A causal relationship between asbestos exposure and the subsequent development of lymphomas cannot be derived from the available results. However, since quite a number of studies and the combined analysis indicate a (weakly) increased risk, this question should be considered directly in future epidemiological studies. Such studies should address separately the various sub-entities, employing the latest internationally agreed classification, and should also use the latest methods of quantifying exposure.

Lung cancer risk and welding--preliminary results from an ongoing case-control study.

In a hospital-based case-control study, 391 male cases or primary lung cancer and the same number of controls--matched by sex, age, and region--were personally interviewed for their job and smoking histories. The data reported reflect the midpoint of a study aiming at a total of 1,000 cases. One objective of the study was to assess confounding by asbestos exposure in what was thought to be a welding-associated risk. While the odds ratios (OR) increased steeply with cumulative exposure to tobacco smoke and were raised also for lifelong asbestos exposure of over 4,100 working hours (OR = 1.91), the effect of welding exposure was reduced after adjustment for smoking and exposure to asbestos. Furthermore, no consistent dose-response relationship could be shown in relation to welding hours. Therefore the present study supports the hypothesis that some, if not all, of the excess risk of welders observed in the literature may be due to the exposure to asbestos. The finding that the subgroup of employees in the aircraft industry showed an increased odds ratio of 2.14 after adjustment for smoking and exposure to asbestos deserves further attention. This suggests the need for further research on the role of berryllium-containing alloys, which has been suggested by other authors.