[Occupational injuries and prolonged sick listings during the period 1989-93]. / Yrkesskader og langtidssykmeldinger i perioden 1989-93.

Norway lacks reliable data on the magnitude and development of occupational injuries. Each year about 25,000 occupational injuries and 2,000 occupational diseases are reported to the Labour Inspection. These constitute only one-third of all expected injuries and accidents related to the work environment. The aim of this study was to estimate the magnitude of occupational injuries in Norway causing long-term certification of illness. There was a 35% reduction in the incidence of occupational injuries in Norway from 1990 to 1993. The reduction applies to men and women combined, all age groups and most counties. The distribution of characteristics by age, sex, diagnosis and place of residence corresponds well with previous, limited studies. Injuries, especially fractures, account for approximately 70 per cent of the occupational injuries. Possible explanations for the decrease in incidence could be preventive efforts, a tighter labour market, a change from primary and secondary to tertiary industry, and the overall reduction in long-term certification of illness in Norway from 1990 to 1993.

[Use of occupational disease benefits]. / Bruk av yrkesskadetrygd ved yrkessykdom.

Persons with pleuramesothelioma were studied to find out the share receiving occupational injury benefit from the National Insurance Scheme. This disease, caused by inhaling asbestos, was chosen because it has been estimated that between 70 and 80 per cent of persons with pleuramesothelioma fulfil the criteria for compensation. During the period 1970-93, 662 men and 104 women were recorded as having this disease. Up to June 1996, the National Insurance Administration had considered the cases of only 163 men, and no women. A further 25-30 patients may have filed claims with the local national insurance office. This implies that, overall, maximum one third of those entitled to occupational injury benefit have received it. The fraction would probably be even lower in the case of diseases where the association with occupation is less certain. It is recommended that national disease registries, such as the Cancer Registry, should report possible cases of occupational disease to the National Insurance Administration.

[Malignant pleural mesothelioma in Norway 1960-1992]. / Malignt pleuralt mesoteliom i Norge 1960-92.

The incidence of malignant pleural mesothelioma among men in Norway increased about eightfold from 1960 to 1992. A similar rise in incidence has been observed in many countries with large consumption of asbestos during the last 50 years. The causal relationship between malignant mesothelioma and previous exposure to asbestos is well established. The investigation shows incomplete notification to the Labour Inspection as compared with the number of cases recorded by the Cancer Registry. Patients may therefore lose compensation both from the National Insurance Administration and as authorized by the new Occupational Injury Insurance Act of 1990. Asbestos was prohibited in Norway in 1985. Owing to the long latency time, about 30-40 years, the rise in incidence will probably continue for the next 20 years or more. Strict preventive precautions are important in order to prevent a "third wave" of asbestos-related diseases in the future.

Trends in mesothelioma incidence in Norway 1960-1988.

The age and sex related trends in incidence of malignant mesothelioma and trends in notification of mesothelioma to the Labour Inspection between 1960-88 are investigated. For men, the age-adjusted incidence rate increased from 0.4 per 100,000 in the period 1960-69 to 1.4 per 100,000 in the period 1980-88. The number of mesotheliomas notified to the Labour Inspection increased from only 4 in the period 1960-69 to 165 in the period 1980-88. The incidence rate among women was unchanged, about 0.1 per 100,000.

Carbon disulfide exposure and neurotoxic sequelae among viscose rayon workers.

In Norway's only viscose rayon plant, carbon disulfide (CS2) concentrations in ambient air usually were between 30 and 50 mg/m3 during the first 23 years of production. From 1970/1971 until the factory was closed in 1982, corresponding values were 10-25 mg/m3. Through all of these years, high peak exposures of CS2 and H2S occurred. In 1986, 16 of the 24 men still at work in 1982 and with at least 10 years' experience in the spinning room agreed to participate in this study. Clinical neurological examination demonstrated abnormalities in 15; neuropsychological tests showed impairments of probable organic origin in 14. Thirteen had cerebral atrophy demonstrated by cerebral computed tomography (CT). Electromyography (EMG) was abnormal in six, neurography in 11. Regional cerebral blood flow measurements indicated flow asymmetries in eight, whereas Doppler investigation of the extracranial carotid and vertebral arteries, electroencephalography (EEG), and evoked response investigations were mostly normal. Based on these results and the exposure data, a diagnosis of CS2-induced encephalopathy was reached in eight workers; another six had an encephalopathy in which CS2 exposure was regarded as a partial cause. Correspondingly, seven had a neuropathy probably caused by CS2 exposure alone; in three others, CS2 was found to be the partial cause of a neuropathy. This indicates that long-term, relatively moderate exposure to CS2 in association with high peak exposures to CS2 and H2S involves a substantial risk of developing neurotoxic disease.

[Health damage caused by asbestos and other mineral fibers]. / Helseskader av asbest og andre mineralfibrer.

Occupational exposure to asbestos is associated with malignant tumors in the lung and malignant mesothelioma in the pleura and peritoneum. Tumors at other sites have also been reported. The benign asbestos-related disorders are asbestosis and pleural fibrosis, effusion and plaques. Chronic bronchitis may be associated with previous asbestos exposure. Fiber dimensions and durability are main factors for carcinogenicity. For practical reasons, long and thin fibers like asbestos should be considered carcinogenic. The diagnosis of asbestos-related disease is based upon information on occupational exposure. Analysis of lung fiber burden supports information given by the occupational history and gives valuable information on dose-response and dose-effect relationships. Building materials with good maintainance of the surfaces do not release asbestos fibers, whereas materials subject to mechanical stress should be replaced by nonasbestos-containing materials to avoid the stipulated very low increase in cancer risk.

Occupational exposure and regional variation of malignant mesothelioma in Norway, 1970-79.

This investigation is based on a study of 117 men and 24 women with malignant mesothelioma registered by the Cancer Registry of Norway, 1970-79. The age-adjusted incidence rate in men for each county varied from 1.7 to 13.3 per million per year. Eighty-two percent of the men revealed possible occupational asbestos exposure. They were evenly distributed between counties with high and low mesothelioma incidence. Only 17% of the women had possible occupational asbestos exposure. Total lung fiber concentration was analyzed with scanning electron microscopy in 65 men and 13 women. The median lung fiber concentration in men was 2.4 million per gram of dried tissue (range less than 0.4-490), in women 1.0 million per gram (range less than 0.4-41), and in male controls less than 0.4 million per gram (range less than 0.4-4.8). The median year of first exposure was 1937 (range 1909-60) for men from counties with a high incidence rate and 1945 (range 1938-59) for men from counties with a low incidence rate. The counties with a high compared to a low incidence rate of malignant mesothelioma, 1970-79, showed an apparent difference in the percentage of population employed in industry in 1946. The regional variation in the incidence of malignant mesothelioma in men is mainly attributable to the proportion of population exposed to asbestos in industry per county prior the 1950s and the time since exposure started.(ABSTRACT TRUNCATED AT 250 WORDS)

Fiber concentration in lung tissue of patients with malignant mesothelioma. A case-control study.

The risk of malignant mesothelioma associated with low-level asbestos exposure is an important unresolved issue today. We have analyzed the asbestos fiber concentration in lung tissue from 14 cases of malignant mesothelioma and 28 case-matched controls by scanning electron microscopy. The cases represent 86% of all mesotheliomas recorded by the Cancer Registry of Norway from the county of Hordaland between 1970 and 1979. Based on 1 million fibers per g of dried tissue as an indicator of cumulated asbestos exposure, the odds ratio (relative risk) was 8.5 (95% confidence limits, 2.3-31.1). Assuming that the risk of malignant mesothelioma is related to mineral fiber concentration in lung tissue, it is concluded that a fiber concentration exceeding 1 million fibers per g of dried tissue is associated with an increased risk of malignant mesothelioma. Furthermore, the results are consistent with a no-threshold response.

Analysis of asbestos fibers and asbestos bodies in tissue samples from human lung. An international interlaboratory trial.

In order to compare methods of counting asbestos fibers in lung tissue, seven laboratories participated in an interlaboratory trial in which tissue samples from five human lungs were analyzed. In some laboratories, fiber concentrations were assessed with the light microscope and, in others, with either scanning or transmission electron microscopes. Within each laboratory the ranking of the results was similar, but there were marked differences in the absolute values obtained by the different laboratories. It is concluded that the laboratories participating in this trial appear to produce internally consistent results, but there is difficulty in directly comparing results from one laboratory to the next.

Occupational asbestos exposure, lung-fiber concentration and latency time in malignant mesothelioma.

Mineral fiber concentration in lung tissue was analyzed by scanning electron microscopy in 73 males with malignant mesothelioma and in 36 referents who died of cardio- or cerebrovascular diseases. The investigation showed apparent differences in the median lung-fiber concentration between occupational groups with different levels of asbestos exposure, as judged from their occupational history. Thus the mineral fiber content in human lung tissue provides a useful indicator of cumulative asbestos exposure. There was also a statistically significant difference between the median lung-fiber concentration among mesothelioma cases with unlikely or unknown occupational asbestos exposure and the reference group. The latency times in 42 of the cases with definite or probable occupational asbestos exposure showed a log-normal distribution with a median of 37 years and a range of 19-68 years. No statistically significant correlation was found between the logarithm of the latency time and the logarithm of the lung-fiber concentration.

Medico-legal aspects of malignant mesothelioma.

The object of this investigation was to discuss medico-legal aspects of malignant mesothelioma in relation to social insurance legislation for occupational injuries and diseases in Norway. During the period 1960-79 the Cancer Registry of Norway recorded a total of 155 men and 35 women with malignant mesothelioma. However, only 21 men and no women were notified to the National Insurance Institution as occupational disease cases before 31 December 1979, in spite of the well established causal association between occupational asbestos exposure and the disease. The investigation is based on these 21 patients. The long latency period from first asbestos exposure until appearance of the disease and the short survival were evident in this study. Furthermore, the legislation and provisions for occupational injuries and diseases in Norway are obviously intended for occupational accidents, and consequently the legal assessment of patients with malignant mesothelioma was complicated. For those notified, the delay in notification was considerable, and only 50% were notified before death. Delay in the claim procedure was also substantial, and few patients survived the claim procedure period. The decisions were not consistent, particularly decisions regarding "the year of injury" and appeared to have been more restrictive during recent years. One of the 21 cases was not accepted as occupational disease, because domestic exposure was considered more probable than occupational exposure.

A striking deposition of mineral particles in the lungs of a farmer: a case report.

The object of this study was to analyze mineral particles in lung tissue from a farmer who underwent lobectomy due to a lung tumor and relate these analytical findings to occupational exposure and histopathological and clinical diagnoses. Despite no clear evidence of previous occupational dust exposure, heavy deposits of birefringent particles and slight pulmonary fibrosis were found during histopathological examination. Extracts from the lung tissue were analyzed by electron microscopy and X-ray microanalysis for mineral particles. The major components of the dust were identified as mica, talc, and silica. Minor components included asbestos fibers and rutile fibers. Some of these fibers were coated by ferroproteins. Mica, quartz, feldspars (plagioclase), and rutile fibers were found in the soil from the farmer's potato storehouse. Based on these findings it is assumed that the slight pulmonary fibrosis is probably caused by the different mineral particles deposited.

Fibre type and concentration in the lungs of workers in an asbestos cement factory.

The predominant asbestos fibre type used in the production of asbestos cement is chrysotile. The use of asbestos in relation to fibre type in a Norwegian asbestos cement plant during 1942-80 was 91.7% chrysotile, 3.1% amosite, 4.1% crocidolite, and 1.1% anthophyllite respectively. Electron microscopy and x ray microanalysis of lung tissue samples of asbestos cement workers who had died of malignant pleural mesothelioma or bronchogenic carcinoma showed a completely inverse ratio with regard to fibre type. The percentage of chrysotile asbestos in lung tissue varied between 0% and 9% whereas the corresponding numbers for the amphiboles were 76% and 99%. These differences are discussed with respect to the behaviour of different fibre types in the human body and to the occurrence of malignant mesothelioma in this asbestos cement factory.

Inorganic fibers in lung tissue from patients with pleural plaques or malignant mesothelioma.

The concentration of inorganic fibers in the lungs of patients with malignant mesothelioma and pleural plaques has been compared to that of patients without cancer or chronic respiratory diseases. The fiber concentrations have been determined by scanning electron microscopy and given as number of fibers per gram of dried tissue. A statistically significant difference in inorganic fiber content was found between the different groups.

Scanning electron microscopy and x-ray microanalysis of mineral deposits in lungs of a patient with pleural mesothelioma.

Scanning electron microscopy of lung tissue, ashed at low temperature, and obtained from an insulation worker who had died of pleural mesothelioma, showed the presence of numerous inorganic particles and fibres. A regional variation in fibre concentration in different tissue samples was found, and the size distribution of naked fibres and asbestos bodies was determined. By energy dispersive x-ray microanalysis the fibres were identified mainly as amphibole asbestos. This method also showed the presence of particles containing titanium and of fragments of diatom shells. Despite a mean concentration of 33 x 10(6) fibres per gram of dry tissue no significant lung fibrosis was found.