[Analysis of disease burden of welder's pneumoconiosis in Jiangsu Province].

Objective: To investigate the current status of disease burden and its influencing factors among welder's pneumoconiosis patients, and provide scientific basis for taking targeted intervention measures. Methods: From June 2022 to June 2023, the patients with welder's pneumoconiosis in Jiangsu Province were selected from 1956 to 2020 as the research objects, and disability adjusted life years (DALY) were used as the comprehensive index to study the disease burden. The direct and indirect economic losses caused by the diseases were calculated, and the factors affecting the disease burden were discussed by multiple linear regression method. Results: A total of 974 cases of welder's pneumoconiosis were reported in Jiangsu Province, the cumulative loss of DALY was 6300.73 person-years, and the per capita loss was 6.47 person-years. Among them, the healthy life years lost due to disability (YLD) was 6156.50 person-years (97.71%) , and the healthy life years lost due to premature death (YLL) was 144.23 person-years (2.29%) . Multiple linear regression analysis showed that the main factors affecting DALY were disability grade, diagnostic age, pneumoconiosis grade and length of dust exposure (P<0.05) . The total economic loss caused by 974 welder's pneumoconiosis patients was 1831838160.18 yuan, and the per capita loss was 1880737.33 yuan. Among them, the direct economic loss was 970917563.75 yuan (53.00%) , and the indirect economic loss was 860920596.43 yuan (47.00%) . Conclusion: Welder's pneumoconiosis causes serious disease burden to patients, and at the same time causes huge economic losses to individuals and society, which seriously hinders the development of society. Taking effective control measures to prevent the incidence of welder's pneumoconiosis is the key to reduce the disease burden.

Workers' compensation for occupational respiratory diseases.

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

Workers' Compensation for Occupational Respiratory Diseases

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

[Analysis of state costs of the social security benefits provided to the insured presenting with lung cancer and pulmonary diseases caused by external factors]. / Ocena wielkosci obciazen panstwa swiadczeniami z systemu ubezpieczen spolecznych dla ubezpieczonych chorych na nowotwory ukladu oddechowego i choroby pluc wywolane czynnikami zewnqtrznymi.

UNLABELLED: Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. THE AIM: To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. MATERIAL AND METHODS: The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. RESULTS: Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. CONCLUSIONS: Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the results of the performed analyses indicate that data on the social insurance money allow to comprehensively evaluate the health status of the insured men and women as well as their quality of life and therapeutical, rehabilitational and prophylactic needs. These data can and should, therefore, be utilized in both clinical practice and for accomplishment of the public health tasks.

[Subject analysis of direct medical cost on pneumoconiosis patients with electronic records in an iron & steel enterprise].

OBJECTIVE: To study the distribution of the direct medical cost for the pneumoconiosis and to provide the clue for the trauma insurance. METHODS: 936 cases including 109,530 records were divided into several groups by the stages of pneumoconiosis and categories of the cost. The groups (stage I, stage II, stage I with tuberculosis and stage II with tuberculosis) were analyzed by descriptive statistics and non-parameter test. RESULTS: The medical cost of out-patient clinic was between 476.7 and 2307.9 yuan per patient per year. The hospitalization medical cost of stage I and II ranged from 3207.1 yuan to 7787.3 yuan per patient per year. There was no difference between stage I and II in statistically significant (P>0.05). CONCLUSION: The lower and upper inter-quartile range of the total medical cost per patient per year is from 3207.1 yuan to 7787.3 yuan. In the categories of the hospitalization cost, drugs and bed fees attain a higher proportion.

[Analysis of direct medical cost on pneumoconiosis patients with questionnaires in an iron & steel enterprise].

OBJECTIVE: To study the distribution of the direct medical cost for the pneumoconiosis and provide a clue for the compensation. METHODS: According to the electronic records for the medical cost of pneumoconiosis, 237 patients were investigated with questionnaires. Their medical cost was described by disability levels, types of work, the categories of tuberculosis, ages and length of work. RESULTS: In the 237 cases of questionnaires, there were 161 cases with complications, accounting for 67.9%, and the proportion of the emphysema in the complication cases was 21.1%. The proportion of the disability level IV for pneumoconiosis patients was about 55.7% in all cases. Their total medical cost ranged from 3946.5 yuan RMB to 8819.3 yuan RMB per patient per year, and the median was 6954.2 yuan RMB per patient per year. CONCLUSION: The disability levels can be considered as the standard for the pneumoconiosis compensation to a certain extent.

[The evaluation of the pneumoconiosis cases, whose liability times being expired, applied to the Social Security High Health Committee between the years 1998-2001]. / Sosyal Sigorta Yüksek Saglik Kuruluna 1998-2001 yillari arasinda basvuran yükümlülük süresi sona ermis pnömokonyoz olgularinin degerlendirilmesi.

This study was planned with the aim to evaluate the pneumoconiosis cases which applied to Social Security High Health Committee between January 1st 1998 and December 31st 2001 for their liability times to be extended. It was a retrospective and descriptive study. Of the 1108 files, only 1068 of them are taken into evaluation with 96.4% of the participation due to the lacking data of some files. The data entry and analysis was done by using SPSS. All of the applicants were male. Most of them applied in 1998 (41.1%, 439 cases) and in 2000 (36.6%, 391 cases). Their average working years were 23.51+/ 0.25. Their average year's of age being diagnosed as pneumoconiosis was 61.81+/-0.8. Of the all cases 764 (72.1%) were diagnosed within the first 10 years after the legal liability time. At this point to reach more conclusive results further epidemiologic studies are required including the factors (the concentration of the dust in the work place besides the physical properties of the dust, the exposure time to the dust and individual properties) affecting the formation of pneumoconiosis. However, even with these findings it is been concluded that the legal time being 10 years in use now for determination of the liability time for the pneumoconiosis cases should be lengthened. It is been also concluded that with the cooperation of other organizations the protocols consisting the issues about the diagnosis criteria of the pneumoconiosis cases, the treatment plan, the determination of disability ratio, liability time, the examinations before getting the job and while working periodically, assessment of the work place risks should be made. Considering the average age being 61.81 for the workers who retired after working dusty work places, carrying the pneumoconiosis risk, they should be checked in regular intervals.

The fox guarding the chicken coop: monitoring exposure to respirable coal mine dust, 1969-2000.

Following passage of the Coal Mine Health and Safety Act of 1969, underground coal mine operators were required to take air samples in order to monitor compliance with the exposure limit for respirable dust, a task essential for the prevention of pneumoconiosis among coal workers. Miners objected, claiming that having the mine operators perform this task was like "having the fox guard the chicken coop." This article is a historical narrative of mining industry corruption and of efforts to reform the program of monitoring exposure to coal mine dust. Several important themes common to the practice of occupational health are illustrated; most prominently, that employers should not be expected to regulate themselves.

Occupational lung diseases among former goldminers in two labour sending areas.

OBJECTIVES: To compare and contrast the prevalence of pneumoconiosis in two groups of former migrant mineworkers in southern Africa, and to examine the effectiveness of the South African compensation system for occupational lung diseases. DESIGN: Comparison of two cross-sectional studies and follow-up data on compensation results. SETTING: The village of Thamaga, Botswana and the rural area of Libode, Eastern Cape, South Africa. SUBJECTS: Two hundred and thirty-four former underground mineworkers in Thamaga, and 238 in Libode. MAIN OUTCOME MEASURES: Prevalence and severity of pneumoconiosis, prevalence of radiological signs of tuberculosis (TB), Medical Bureau for Occupational Diseases (MBOD) certification committee decisions, and compensation results. RESULTS: Prevalence of pneumoconiosis > or = 2/1 was 15.4% in Libode and 13.6% in Thamaga. Significantly more Libode than Thamaga subjects (51.1% versus 29.0%) reported past TB treatment. Radiological signs of pulmonary TB were also more prevalent in Libode (33.3% v. 23.9%). Twenty-six per cent of Libode men and 16.1% of Thamaga men were certified with compensable disease. Libode payments were finalized within 30 months, whereas Thamaga cases only began receiving payments 52 months after medical examination, with 11 cases still pending 66 months after medical examination. CONCLUSION: There was a high prevalence of pneumoconiosis in both study groups. Many men were eligible for compensation but were previously uncompensated. The higher rate of compensable disease in the Libode group may relate to the higher prevalence of TB, as well as more active follow-up by the study group, including a large number of appeals. Socio-political changes in South Africa between 1994 and 1996 may also have influenced compensation results.

[Occupational activities and allergic respiratory manifestations]. / Activité professionnelle et manifestations respiratoires allergiques.

The authors review aspects of occupational asthma that are important for the practitioner. Insurance problems are dealt with in the light of local regulations. Detailed chapters are devoted to baker's asthma (various aeroallergens), to plastic workers and painters (isocyanates) and to respiratory diseases among farmers. Finally, a list of other occupations in which asthma typically occurs is given. The responsibility of practitioners in charge of young patients about to choose their future profession is underlined.

Health costs of occupational disease in New York State.

Occupational diseases and deaths are costly events. They are responsible for: 1) direct medical costs; 2) indirect costs, resulting from lost production, foregone opportunities, and diminished investment; and 3) non-economic costs, including pain and suffering, disrupted careers, and devastated families. To develop a partial estimate of the total costs of occupational disease in New York State, we have examined four categories of illness: occupational cancer, chronic respiratory disease and the pneumoconioses, cerebrovascular and cardiovascular disease, and end-stage renal failure. We base our partial estimate on the human capital approach to the costs of these illnesses. Using the best measures available, including both incidence and prevalence statistics, mortality records, and a variety of financial data, we employ two cost accounting techniques of the human capital approach, the incidence method, and the prevalence method. Our analysis shows that these four occupational illnesses are costing New York over $600 million per year. This figure is a pragmatic but conservative, lower-bound estimate of the relative magnitude of total economic costs of occupational disease in New York State. The largest proportion of these costs (80%) is due to occupational cancer. The failure of the health care system to recognize the costs of occupational disease precludes recognition of the economic benefits which would result from preventing these illnesses. This study, it is hoped, will stimulate advances in epidemiological and economic approaches to resolve this important measurement problem.