[Limitations in using international occupational disease statistics for comparative analysis]. / Ograniczenia w wykorzystywaniu miedzynarodowych statystyk chorób zawodowych do analiz porównawczych.

The comparability of international statistical data on the incidence of occupational disease is discussed. The examples of some countries served to present the reasons why the relevant data available in publications cannot be often used as a frame of reference to comparative studies. The problem results mainly from different definitions of the term "occupational disease" as they frequently include in their context also these pathologies which are numbered among work-related diseases. In addition, the authors highlighted the steps undertaken by international organizations (World Health Organization, International Labour Organization, and European Union) to unify both the diagnostic procedures and the system of collecting and publishing of statistical data on occupational diseases.

[Health effects of occupational diseases diagnosed in Poland during the years 1990 and 1994]. / Zdrowotne skutki chorób zawodowych stwierdzonych w Polsce w latach 1990 i 1994.

The study was carried out on the material of 15,136 occupational diseases that accounted for 71.9% and 65.6% of all cases detected in 1990 and 1994, respectively. The analysis focused on the selected health effects of occupational diseases, such as sickness absenteeism, the transfer to other workposts, the percentage of health impairment and related single recompensation as well as disability pension. The study helped to draw many conclusions of great value, and disclosed major pathologies and their causes responsible for the range of related health effects. Long-term sickness absenteeism, high percentage of health impairment and related consequences for the country's economy (single recompensations and growing number of disability pensions paid due to occupational diseases), and low proportion of transfers to safe workposts were most striking among the effects in question. The study also contributed to initiating the establishment of the data base and the development of the system for data collection and analysis of information on health effects of occupational diseases in Poland.

[Data processing computer system for evaluation of health effects due to occupational diseases diagnosed in Poland]. / Komputerowy system analizy danych do oceny skutków zdrowotnych wywolanych chorobami zawodowymi stwierdzanymi w Polsce.

General consequences of occupational diseases for both employees and the country's economy have been known for many decades. Nevertheless there were no legal instruments and financial means to carry out studies leading to a comprehensive evaluation of health effects induced by occupational diseases diagnosed in Poland. Only recently, the legal basis has been provided by the revision of the regulations on occupational diseases (Official Journal of the Ministry of Health and Social Welfare no 9, heading 51, 1989), and the financial means allocated according to the Governmental Strategic Programme (SPR-1) for the years 1995-1998. The objectives of the study and the results obtained have been presented in another publication. Here the authors concentrated on some aspects of data collection and their analysis. An essential element in the establishment of data base on health effects of occupational diseases was its integration, namely the number of diagnosed occupational disease had to correspond with the entity in the Register of Occupational Diseases. Such an approach helped to avoid including in the base all metrical data, as information on effects of occupational diseases was collected exclusively for persons with detected and diagnosed occupational disease, which had to be previously placed in the Register of Occupational Diseases. The correctness of data input and the data analysis were carried out outside the Paradox system. The analysis of histograms of characteristics under study and the explanation of departing values were employed to evaluate the freedom from bias, and the statistical package for social sciences (SPSS) was used to analyse the data.

[Morbidity of occupational diseases in Poland in the years 1994-1996]. / Zapadalnosc na choroby zawodowe w Polsce w latach 1994-1996.

The authors analysed all cases of occupational diseases diagnosed in Poland over the last three years. The following variables were considered: age, gender of patients, duration of exposure to factors inducing occupational disease, nosologic units, and the types of work places by the European Activity Classification and their localization by voivodships. The obtained results helped to formulate the following conclusions: 1. The number of occupational diseases in the period under study ranged annually between 11,156 and 11,320 cases. The incidence rates (number of cases/100,000 employed) fell within 116-131. 2. The general incidence of occupational diseases was shaped by: hearing impairment, chronic diseases of voice organs, communicable and invasive diseases, pneumoconioses, skin diseases, vibratory syndrome and poisoning. 3. The majority of diagnosed diseases occurred at least after 10 years of occupational exposure to causal factor. 4. The highest incidence of occupational diseases by the European Activity Classification was observed in mining and quarrying, manufacture, education and health services. 5. The analysis of the occupational disease incidence in individual work places indicated a number, however small, of enterprises which are a major source of these diseases.

Mortality among different occupational groups of workers with pneumoconiosis: results from a register-based cohort study.

A mortality cohort study was carried out on 11,224 men with pneumoconiosis diagnosed during the period 1970-1985. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and included 7,065 coal miners, 924 employees of underground work enterprises, 1,796 workers of the metallurgical industry and iron and nonferrous foundries, as well as 1,439 refractory materials, china, ceramics, and quarry workers. The cohort was traced up to the end of 1991. The mortality of all groups enrolled in the study, as compared with that of general male population of Poland, showed a statistically significant excess of overall mortality (SMRs ranging from 105; 95% confidence interval [CI]: 100-110 to 136; CI: 121-153) as well as a great excess of deaths from diseases of the respiratory system (SMRs from 383; 95% CI: 345-424 to 588; 95% CI: 457-744). In workers of the metallurgical industry, foundries, and those from refractory materials, china, and ceramics manufacturing plants as well as quarries, a statistically significant excess of deaths from infectious diseases (mostly tuberculosis) was found (SMRs: 503; 95% CI: 364-677 and 286; 95% CI: 177-437, respectively). Mortality from lung cancer was significantly elevated only in the group of metallurgical industry and iron and nonferrous foundry workers (SMR: 159; 95% CI: 124-201). In the remaining subcohorts, no significant excess of deaths from lung cancer was noted. The study does not support the hypothesis on the role of exposure to crystalline silica in the induction of lung cancer. Significantly lower mortality was seen for diseases of the circulatory system (SMR: 89; 95% CI: 82-96), hypertensive disease (SMR: 63; 95% CI: 38-98), cerebrovascular disease (SMR: 79; 95% CI: 62-99), atherosclerosis (SMR: 79; 95% CI: 66-93), and injuries and poisonings (SMR: 50; 95% CI: 38-64) in coal miners. In addition, lower mortality was noted for cerebrovascular disease (SMR: 56; 95% CI: 32-91) and injuries and poisonings (SMR: 34; 95% CI: 17-61) in metallurgical industry and iron and nonferrous foundry workers.

Mortality among coal miners with pneumoconiosis in Poland.

A mortality cohort study was carried out on 7,065 coal miners with pneumoconiosis first diagnosed during the years of 1970-85. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and followed up through to the end of 1991. The general male population of Poland was considered as a reference group. The PYRS-3 programme was used to identify, by means of standardized mortality ratios (SMRs), total and selected cause-specific mortality. An analysis revealed significantly elevated total mortality (SMR = 105; 95% confidence interval (CI): 100-110) in the whole cohort of coal miners. The risk of selected cause-specific mortality was significantly enhanced due to diseases of the respiratory system among which pneumoconiosis predominated (SMR = 383; 95% CI: 345-424). While mortality from all diseases of the circulatory system (SmR = 89; CI: 82-96), arterial hypertension (SMR = 63; 95% CI: 38-98), cerebrovascular diseases (SMR = 79; 95% CI: 62-99), atherosclerosis (SMR = 79; 95% CI: 66-93), and injury in poisoning (SMR = 50; 95% CI: 38-64) was significantly lower. The risk of death from malignant neoplasm of lung in the whole study population as well as in individual groups and categories of coal miners with pneumoconiosis, which varied in the risk of pneumoconiosis and the level of exposure to ionizing radiation, was not increased.

Mortality pattern in men with pneumoconiosis in Poland.

Mortality study was carried out on the cohort of 11,224 men with coal workers' pneumoconiosis or silicosis diagnosed during the period 1970-1985. The cohort was selected from the register of occupational diseases and was traced up to the end of 1991. The general male population of Poland was a reference group. The study showed small but significant excess of total mortality (SMR = 115; p < 0.01). The analysis of death causes revealed an elevated mortality from infectious diseases, among which tuberculosis was most prevalent (SMR = 212; p < 0.01) and from pneumoconioses predominant in diseases of the respiratory system, (SMR = 426; p < 0.01) and lung cancer (SMR = 116; p < 0.01). The comparison of the prevalence of smoking in the population under study with that in the reference general male population of Poland indicated that this habit is mostly responsible for the excess of lung cancer deaths. This finding contradicts the hypothesis that there is a causal relationship between exposure to dusts containing crystalline silica, pneumoconiosis and lung cancer.

Pneumoconioses in Poland.

This article deals with the analysis of the epidemiological situation in Poland in the purview of the incidence of pneumoconioses in the past 32 years. During that period pneumoconioses (mainly in coal workers and arc welders) made 17% of all occupational diseases and proved to be the most common pathology among occupational diseases of the respiratory system. The average age of the majority of persons who developed pneumoconioses was over 40 years and duration of exposure--20 years. Almost a half of them was granted disability pensions and average health impairment was assessed at 41%.

Occupational diseases in Poland during the years 1984-1992.

The authors present the results of analysis of data on occupational diseases in Poland during the years 1984-1992. The statistical material covers 86,871 cases of various diseases. Among them hearing lesions, vocal organ diseases, contagious and invasive diseases, pneumoconioses, dermatoses, vibration syndrome, poisonings and chronic bronchitis proved to be most common. In Poland, among the etiological factors, noise, industrial dusts, hepatitis virus, chromium and its compounds, lead and its inorganic compounds, carbon disulphide and carbon monoxide pose the highest risk. Apart from the statistics concerning the number of cases of occupational diseases according to sex, age, exposure duration, national economy branches and regions (voivodeships), the article presents, for the first time, some consequences of occupational diseases, such as granting disability pensions and/or indemnity depending on the per cent of health impairment.

[Guidelines concerning criteria for confirming occupational diseases]. / Wskazówki dotyczace zasad stwierdzania chorób zawodowych.

The authors shared their comments on the criteria for diagnosing occupational diseases operating nowadays in our country. This work has been inspired by an increasing number of inaccuracies observed in medical certificates sent to the Nofer Institute of Occupational Medicine in Lodz. It is believed that explanations presented in this paper will assist local sanitary inspectorates in taking proper decisions after receiving reports on clinical diagnoses of occupational diseases.

[Causes of mortality among workers exposed to inorganic dust containing crystalline silica]. / Przyczyny umieralnosci osób zawodowo narazonych na pyly nieorganiczne zawierajace krystaliczna krzemionke.

The authors briefly comment on the characteristics and results of recent epidemiological studies devoted to the reasons of mortality in persons exposed to dusts containing crystalline silica. The most important data concerning these studies are presented in the table accompanied by an author commentary which discusses results obtained by various authors and justification behind this subject in Poland.

Case-referent study on skin cancer and its relation to occupational exposure to polycyclic aromatic hydrocarbons. II. Study results.

The study was performed on a group of 376 males suffering from skin cancer and on two control groups, 752 males each, matched according to age. Referents were randomly sampled from the general population as well as from hospital wards and dermatological out-patient clinics. The analysis of occupational exposure to different products containing polycyclic aromatic hydrocarbons produced data which indicated an increased risk of skin cancer in persons exposed to mineral oils (odds ratio = 1.46; 95% confidence interval; 1.06-2.05). In the case of exposure to sources of polycyclic aromatic hydrocarbons other than mineral oils, no significant increase in skin cancer risk was noted.

Case-referent study on skin cancer and its relation to occupational exposure to polycyclic aromatic hydrocarbons. I. Study design.

The authors present the first stage of a case-referent study conducted in order to confront a hypothesis which suggests the existence of an important casual relationship between the exposure to polycyclic aromatic hydrocarbons and skin cancer. The investigated group consisted of patients suffering from skin cancer, while control groups comprised individuals from the general population and patients from hospital departments and dermatological outpatient clinics. The present paper deals with the characteristics of cases and their referents, ways of selecting examinees, a method of data collecting (history of a patient in the form of a questionnaire), the work of interviewers and the information concerning localization and histopathological forms of diagnosed skin cancers, as well as reasons for not examining all persons.

[Effect of night shift work on health status]. / Wplyw pracy nocnej na stan zdrowia.

Presented in the paper are opinions on night work. The authors submit not only their own views but also those of other researchers. The material points to considerable hazards of the night work, including specific negative health effects. However, it could hardly be defined who is more harmed by the night shift--women or men, except for its probable contribution to reproduction disturbances in women. Genetic effects are not clear--they call for further studies. Apart from the negative effects of the night shift upon health, family and social life, the paper deals with the issues of minimising those adverse effects, including some examples of preventive measures.

[Problems of the evaluation of occupational exposure in epidemiologic case-control studies]. / Problemy oceny zawodowej ekspozycji w epidemiologicznym badaniu kliniczno-kontrolnym.

The paper presents issues concerning collecting and assessing data on occupational exposure in case-referent studies. The authors discuss different opinions and methods for obtaining relatively trustworthy and valuable information regarding this subject. The system of combining data on profession and kind of exposure (the so-called occupational exposure system) and the method for constructing a job exposure matrix are paid much attention. Complexity of problems discussed, the absence of reliable methods and standardized instruments for case-referent study all require every caution in interpreting the data obtained in this type of examination.

[Analysis of formal and substantial errors in the diagnosis of occupational diseases in Poland 1985-1987]. / Analiza bledów formalnych i merytorycznych popelnianych w rozpoznawaniu i stwierdzaniu chorób zawodowych w Polsce w latach 1985-1987.

Formal and substantial errors in the diagnosis and certification of occupational diseases during 1985-1987 were analysed. The evaluation was based on occupational disease certificates obtained from the Regional Sanitary-Epidemiological Station and registered at the Institute of Occupational Medicine in Lódz. Most errors were related to misnaming of diseases, certifying some diseases as occupational though they are not included in the mandatory list of occupational diseases, or--qualifying specific health disorders under improper items on the list. The problem of erroneous diagnoses in analysed years applied mainly to diseases of the voice organ (error percentage from 15 to 20%) and motor organs (error percentage from 10 to 16%). In addition, the information on the type of aetiological factors of diseases and evaluation of occupational exposure was found to be deficient.

[Occupational diseases in Poland 1984-1985]. / Choroby zawodowe w Polsce w latach 1984-1985.

The authors have analysed occupational diseases cases that occurred in Poland during 1984-1985. Personal notification of the diseases, sent over to the Institute of Occupational Medicine in Lódz from Provincial Sanitary--Epidemiological Stations, constitute sources of information. The analysis covers the morbidity data in age and sex groups, involving territorial and branch differentiation. At the same time some causes affecting occupational diseases incidence in Poland are presented along with evaluation of the value of the obtained information.

Occupational exposure to cadmium and kidney dysfunction.

Investigations were carried out in an alkaline battery factory. The study group consisted of 102 persons and the control group of 85 persons. Cadmium in blood (Cd-B) and cadmium in urine (Cd-U), as well as beta 2-microglobulin (B2-M), retinol binding protein (RBP), amino acids in urine were determined. Exposure to cadmium was high; Cd-B and Cd-U concentrations were higher than recommended, 10 micrograms/l and 10 micrograms/g creat. In 65% and 56% of workers, respectively. Excretion of B2-M and RBP in urine was higher than the accepted upper limits of 380 and 130 micrograms/g creat. in about 20% of the workers. A significant correlation was observed between: log Cd-U.log Cd-B (r = 0.85), log B2-M.log RBP (r = 0.66), log Cd-U.log B2-M (r = 0.52), and log Cd-U.log RBP (r = 0.55). To evaluate the admissible period of occupational exposure to cadmium, an integrated exposure index (Cd-B x years of exposure) is proposed. According to the dose-response relationship, an increase of low molecular protein excretion in urine can be expected in 10% of the cases at Cd-U amounting to 10 to 15 micrograms/g creat. and Cd-B x years of about 300 to 400.