[Financial compensation for asbestosis patients]

Asbestosis in the Netherlands is a rare work-related form of pulmonary fibrosis caused by long-term, intensive exposure to asbestos. It can have a great impact on patients' quality of life and life expectancy even 20-30 years after initial exposure. The Dutch Institute of Asbestos Victims (IAS) mediates between the victims and their employers or former employers about payment of compensation. Liability procedures against a previous employer are long and stressful. Since 1 April 2014 it has, therefore, been possible to receive financial aid from the state. The IAS and the Netherlands Asbestosis Panel determine who is eligible for this. In this article we look in detail at the conditions for, and the process of, application for this financial aid. Since the introduction of this arrangement, more than 250 asbestosis victims have applied for aid; so far, 65 applicants have met the required conditions.

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.

Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011

BACKGROUND

Asbestosis and silicosis are debilitating pulmonary conditions resulting from inhalation of asbestos fibers or silica dust.

PURPOSE

We provide a descriptive analysis of asbestosis and silicosis hospitalizations in North Carolina to assess trends over a 10-year period.

METHODS

Events were defined as inpatient hospital discharges during the period 2002-2011 with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 501 or 502. Using statewide discharge data for 2002-2011, we calculated asbestosis and silicosis hospitalization rates in North Carolina (by demographics, hospital length of stay, cost, and payment type) and compared them with national rates.

RESULTS

In North Carolina, average annual age-standardized hospitalization rates for asbestosis and silicosis were 71.2 hospitalizations per 1 million residents and 6.2 hospitalizations per 1 million residents, respectively. Rates for asbestosis and silicosis decreased significantly (less than .01 for both conditions) between 2002 and 2011, by 46% and 67%, respectively. Men had significantly higher rates than women (less than .01), more than half of hospitalizations were among persons aged 65-84 years, and Medicare was the predominant payment source. The highest silicosis rates by county were clustered in Western North Carolina; no geographic patterns were observed for asbestosis. The estimated average annual cost statewide for these hospitalizations was $10,170,417 for asbestosis and $886,143 for silicosis.

LIMITATIONS

ICD-9-CM misclassification and duplicate hospitalization records may have biased the observed rates of asbestosis and silicosis.

CONCLUSIONS

Decreases in hospitalization rates in North Carolina may be due to misdiagnosis, underreporting, or the declining use of asbestos in industries. Obtaining complete exposure histories at diagnosis is useful for continued public health surveillance.

Asbestos in Scotland

This paper outlines the asbestos hazard in Scotland and draws upon a systematic oral history project to analyze from the workers' perspective the nature of exposure, the limitations of government regulatory initiatives, and the ramifications of contracting asbestos-related diseases for sufferers and their families. Current issues are investigated, stressing the agency of workers, trade unions, sympathetic local councils, and, especially, the victims' pressure groups. The occupational and environmental health threats of asbestos in Scotland remain significant, although recent E.U.- and U.K.-based decisions to ban further use of asbestos together with active campaigning by local activist groups have helped to reduce them. Mesothelioma mortality rates remain high, due to historic exposures, and much work remains to be done to reduce the number and plight of asbestos-exposed workers.

Asbestos-related occupational cancers compensated under the Industrial Accident Compensation Insurance in Korea

Compensation for asbestos-related cancers occurring in occupationally-exposed workers is a global issue; this is also an issue in Korea. To provide basic information regarding compensation for workers exposed to asbestos, 60 cases of asbestos-related occupational lung cancer and mesothelioma that were compensated during 15 yr; from 1993 (the year the first case was compensated) to 2007 by the Korea Labor Welfare Corporation (KLWC) are described. The characteristics of the cases were analyzed using the KLWC electronic data and the epidemiologic investigation data conducted by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety and Health Agency (KOSHA). The KLWC approved compensation for 41 cases of lung cancer and 19 cases of mesothelioma. Males accounted for 91.7% (55 cases) of the approved cases. The most common age group was 50-59 yr (45.0%). The mean duration of asbestos exposure for lung cancer and mesothelioma cases was 19.2 and 16.0 yr, respectively. The mean latency period for lung cancer and mesothelioma cases was 22.1 and 22.6 yr, respectively. The major industries associated with mesothelioma cases were shipbuilding and maintenance (4 cases) and manufacture of asbestos textiles (3 cases). The major industries associated with lung cancer cases were shipbuilding and maintenance (7 cases), construction (6 cases), and manufacture of basic metals (4 cases). The statistics pertaining to asbestos-related occupational cancers in Korea differ from other developed countries in that more cases of mesothelioma were compensated than lung cancer cases. Also, the mean latency period for disease onset was shorter than reported by existing epidemiologic studies; this discrepancy may be related to the short history of occupational asbestos use in Korea. Considering the current Korean use of asbestos, the number of compensated cases in Korea is expected to increase in the future but not as much as developed countries.

Compensation of asbestos victims in France

The alarming development of pathologies linked to asbestos led to the creation in France of two funds to indemnify the victims of asbestos-related illnesses: the FCAATA (Fund for asbestos workers who take early retirement), which compensates for their reduced life expectancy, and the FIVA (Indemnification fund for asbestos victims) which ensures full compensation for harm suffered by asbestos victims.

Asbestos-related disease in South Africa: the social production of an invisible epidemic

South Africa was the third largest exporter of asbestos in the world for more than a century. As a consequence of particularly exploitative social conditions, former workers and residents of mining regions suffered--and continue to suffer--from a serious yet still largely undocumented burden of asbestos-related disease. This epidemic has been invisible both internationally and inside South Africa. We examined the work environment, labor policies, and occupational-health framework of the asbestos industry in South Africa during the 20th century. In a changing local context where the majority of workers were increasingly disenfranchised, unorganized, excluded from skilled work, and predominantly rural, mining operations of the asbestos industry not only exposed workers to high levels of asbestos but also contaminated the environment extensively.

Asbestosis in an asbestos composite mill at Mumbai: a prevalence study

BACKGROUND

Of an estimated 100,000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment.

METHODS

The study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings.

RESULTS

Of 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant.

CONCLUSION

We found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.

Mortality, morbidity, and asbestosis in New Zealand: the hidden legacy of asbestos exposure

AIMS

To examine the morbidity and mortality patterns of patients with asbestosis in New Zealand to determine (more fully) the overall health impact of past exposure to asbestos.

METHODS

Individual mortality, cancer and hospital records for all New Zealand men diagnosed with asbestosis between 1974-2001 were examined. Mortality data were analysed for time trends, cause of death, and occupation. Trends for patients diagnosed with asbestosis were compared with those diagnosed with lung cancer. Hospital discharge data for men with asbestosis were examined to determine reasons for hospitalisation, resource utility, and recent hospitalisation trends.

RESULTS

Death rates for New Zealand males dying with asbestosis increased between 1974-1999. Only 17% of deaths of males dying with asbestosis were directly attributed to this cause; the remainder were attributed to other non-malignant and malignant respiratory disease. Deaths from asbestos-related lung disease were grossly underestimated. Death certificates of men dying with asbestosis were found in all major occupational groups. Trends in hospital discharges may provide additional information for the overall modelling of the current epidemic of asbestos related disease.

CONCLUSION

The number of men dying with asbestosis in NZ has increased in line with mesothelioma. There is some indication that asbestosis prevalence may have peaked for the most serious cases of asbestosis. Some level of asbestos exposure, as indicated by asbestosis, may be present in all major occupational groups.

Asbestosis in the Republic of Croatia

Croatians have been exposed to asbestos in the shipbuilding and asbestos-cement industries since 1945. The first cases of asbestosis were reported in 1961; 317 cases were recorded from 1990 to 2000. The Croatian Cancer Registry recorded 248 malignant pleural mesotheliomas between 1991 and 1997, two thirds of which were attributable to occupational exposures to asbestos. The Croatian Asbestosis Patient Association was founded in 1998 to help victims. Croatian law defines the employer's responsibility for work-related health damage and compensation, but average legal proceedings for asbestosis claims take about seven years. Croatian law does not ban the manufacture and import of asbestos. Croatia as a transitional country is subject to socioeconomic pressures. Future approaches to the asbestos issue will depend on revised regulations, which are expected to conform to recommendations of the European Union by 2005.

The epidemic of asbestos-related diseases in New Zealand

New Zealand is a small country with a big asbestos disease problem. The lack of action on warnings in the 1960s and 1970s has led to epidemics of mesothelioma and asbestosis, which can be clearly documented via the death and cancer registers. In addition, an uncertain number of lung cancers due to asbestos exposure has occurred. The epidemic started in the 1980s, and will eventually have cost the lives of at least 2000 to 3000 workers. Prevention against ongoing exposures from asbestos installed in buildings is essential, and another key issue for New Zealand is to ensure that fair workers' compensation is provided to all victims of asbestos diseases.

The Swedish experience with asbestos: history of use, diseases, legislation, and compensation

After World War II, large quantities of asbestos were imported to Sweden and used in construction and ship building. In 1976, the use of asbestos was for practical purposes prohibited. Today, the only exposures are environmental, from asbestos in place and when buildings are demolished or rebuilt, and there are very strict rules for such work. Consequently, it is assumed that the asbestos-related diseases will gradually disappear from society, but due to the long latency time, about 100 mesotheliomas still occur every year in Sweden, and so far there is no certain sign of a decrease in incidence. Compensation is from the state via general insurance and consists basically of compensation for lost income and medical costs.

Asbestos, asbestos-related diseases, and compensation claims in The Netherlands

In The Netherlands the number of asbestos-related diseases is increasing. An age-cohort model predicts a steep rise in pleural mesothelioma deaths up to 490 cases per year among men, with a total death toll close over 12,000 cases during 2000-2028. In the past decade the number of compensation claims for asbestos-related diseases has more than doubled, with increasingly verdicts in favor of claimants. In addition to the medical information, information about the state of the art of preventive measures in different periods of time plays a decisive role in these claims. The use of asbestos in The Netherlands, the occurrence of asbestos-related diseases, the national asbestos regulations, and the position of the claimants in asbestos lawsuits in The Netherlands are reviewed.

Asbestos victims support groups in England: a Manchester and Merseyside perspective

The development, functions, and effectiveness of asbestos victims' support groups in Manchester and Merseyside, England, are described.

The Dutch Institute for Asbestos Victims

The primary goal of the Dutch Institute for Asbestos Victims is to compensate mesothelioma victims who have been exposed to asbestos in the workplace, while they are still alive, by acting as a neutral mediator between these victims and their (former) employers or their insurers. Representatives of victims, employees, employers, and insurers have agreed to cooperate in the formation and operation of the Institute. The process of reaching a financial settlement has been collectivized, standardized, pacified, and institutionalized. The difficulty of awarding compensation while victims are still alive has led to the Advance Payment Scheme.

Collaborative research, participatory solutions: research on asbestos in Kuruman, South Africa

The 1998 South African National Asbestos Summit proposed a post-apartheid asbestos policy for the country. In the areas of environmental rehabilitation, health care, and compensation, it envisioned connecting asbestos mitigation to participatory development. In 2001, the Asbestos Collaborative, an international and interdisciplinary team, conducted follow-up research on the recommendations of the 1998 Summit, researching environmental, health, and compensation issues through consultation of documents and interviews with officials in urban areas and with people in Kuruman, a former crocidolite-mining site with high rates of asbestos-related disease. In Kuruman, local opinion supported the recommendations of the Asbestos Summit, insisting that policies to mitigate the problem of asbestos must also address poverty. In the wake of the 2001 research, a new organization, the Asbestos Interest Group (AIG), has been founded to facilitate grassroots participation in asbestos issues. One success of the AIG has been the settlement of a lawsuit by former workers against the former mining company in Kuruman.

Asbestos and the future of mass torts

Asbestos was once referred to as a ‘miracle mineral’ for its ability to withstand heat and it was used in thousands of products. But exposure to asbestos causes cancer and other diseases. As of the beginning of 2001, 600,000 individuals had filed lawsuits for asbestos-related diseases against more than 6,000 defendants. 85 firms have filed for bankruptcy due to asbestos liabilities and several insurers have failed or are in financial distress. More than $54 billion has been spent on the litigation -higher than any other mass tort. Estimates of the eventual cost of asbestos litigation range from $200 to $265 billion. The paper examines the history of asbestos regulation and asbestos liability and argues that it was liability rather than regulation that eventually caused producers to eliminate asbestos from most products by the late 1970s. But despite the disappearance of asbestos products from the marketplace, asbestos litigation continued to grow. Plaintiffs' lawyers used forum-shopping to select the most favorable state courts techniques for mass processing of claims, and substituted new defendants when old ones went bankrupt. Because representing asbestos victims was extremely profitable, lawyers had an incentive to seek out large numbers of additional plaintiffs, including many claimants who were not harmed by asbestos exposure. The paper contrasts asbestos litigation to other mass torts involving personal injury and concludes that asbestos was unique in a number of ways, so that future mass torts are unlikely to be as big. However new legal innovations developed for asbestos are likely to make future mass torts larger and more expensive. I explore two mechanisms - bankruptcies and class action settlements - that the legal system has developed to resolve mass torts and show that neither has worked for asbestos litigation. The first, bankruptcy by individual asbestos defendants, exacerbates the litigation by spreading it to non-bankrupt defendants. The second, a class action settlement, is impractical for asbestos litigation because of the large number of defendants. As a result, Congressional legislation is needed and the paper discusses the compensation fund approach that Congress is currently considering.

Justice for asbestos victims and the politics of compensation: the French experience

This paper presents the history of asbestos mining and manufacture in France, the strategies of the multinational asbestos firms to become major international participants, the failures of occupational health and safety that allowed an epidemic of asbestos-related diseases to occur, and the important social movement of the victims of asbestos exposure. The asbestos industry thrived in France until the health effects of asbestos exposure were made public. At that time, the industry had already moved its mining and manufacture to developing countries, where they were able to take advantage of limited regulation and enforcement of occupational and environmental laws. The author analyzes the compensation systems that were approached with varying degrees of success by the victims of asbestos exposure. France banned all manufacture and use of asbestos in 1997, and in the years that have followed, it has enjoyed many successes in achieving compensation for asbestos victims.

Asbestos in Belgium: use and abuse

It took 50 years for Belgium to recognize asbestosis; mesothelioma and lung cancer were recognized as occupational diseases caused by asbestos in 1982 and 1999, much later than in neighboring countries. Only salaried workers can claim compensation from the Occupational Diseases Fund. The right to reparation is thus denied to most victims because many have been self-employed: mechanics, electricians, painters, roofers, carpenters, plumbers, etc. Compensation was also denied to people who became ill through exposures to the workclothes of family members or pollution from asbestos factories near their homes. The main obstacles facing asbestos victims are legal and judicial. For instance, an employer is not liable, even for gross negligence. Victims are not allowed to claim if 20 years have passed since their exposures to asbestos. Changes in Belgian legislation are sorely needed.

Cape Plc: South African mineworkers' quest for justice

Communities in South Africa, especially those in Limpopo and Northern Cape, have been decimated by the mining operations of Cape Plc. South African victims of asbestos-related disease have only recently begun to be awarded (modest) compensation settlements through litigation, as a result of collective efforts on their behalf. The tortuous case of Cape, which knowingly exposed thousands of innocent people, especially black workers, to damaging environmental concentrations of asbestos, is detailed. After fierce and prolonged skirmishing in the courts, a decision in favor of the claimants allowed the case to be tried in the English High Court. Cape reached a settlement agreement with the claimants in 2001, but was unable to meet its terms. Renewed litigation in 2002 resulted in the signing of three new settlement agreements in 2003. These have yet to be put into effect, but it is hoped that the recent developments represent a turning point in the fortunes of South African asbestos victims.

Apportionment in asbestos-related disease for purposes of compensation

Workers' compensation systems attempt to evaluate claims for occupational disease on an individual basis using the best guidelines available to them. This may be difficult when there is more than one risk factor associated with the outcome, such as asbestos and cigarette smoking, and the occupational exposures is not clearly responsible for the disease. Apportionment is an approach that involves an assessment of the relative contribution of work-related exposures to the risk of the disease or to the final impairment that arises for the disease. This article discusses the concept of apportionment and applies it to asbestos-associated disease. Lung cancer is not subject to a simple tradeoff between asbestos exposure and smoking because of the powerful biological interaction between the two exposures. Among nonsmokers, lung cancer is sufficiently rare that an association with asbestos can be assumed if exposure has occurred. Available data suggest that asbestos exposure almost invariably contributes to risk among smokers to the extent that a relationship to work can be presumed. Thus, comparisons of magnitude of risk between smokers and nonsmokers are irrelevant for this purpose. Indicators of sufficient exposure to cause lung cancer are useful for purposes of establishing eligibility and screening claims. These may include a chest film classified by the ILO system as 1/0 or greater (although 0/1 does not rule out an association) or a history of exposure roughly equal to or greater than 40 fibres/cm3 x y. (In Germany, 25 fibres/cm3 x y is used.) The mere presence of pleural plaques is not sufficient. Mesothelioma is almost always associated with asbestos exposure and the association should be considered presumed until proven otherwise in the individual case. These are situations in which only risk of a disease is apportioned because the impairment would be the same given the disease whatever the cause. Asbestosis, if the diagnosis is correct, is by definition an occupational disease unless there is some source of massive environmental exposure; it is always presumed to be work-related unless proven otherwise. Chronic obstructive airways disease (COAD) accompanies asbestosis but may also occur in the context of minimal parenchymal fibrosis and may contribute to accelerated loss of pulmonary function. In some patients, particularly those with smoking-induced emphysema, this may contribute significantly to functional impairment. An exposure history of 10 fibre x years is suggested as the minimum associated with a demonstrable effect on impairment, given available data. Equity issues associated with apportionment include the different criteria that must be applied to different disorders for apportionment to work, the management of future risk (eg. risk of lung cancer for those who have asbestosis), and the narrow range in which apportionment is really useful in asbestos-associated disorders. Apportionment, attractive as it may be as an approach to the adjudication of asbestos-related disease, is difficult to apply in practice. Even so, these models may serve as a general guide to the assessment of asbestos-related disease outcomes for purposes of compensation.

[Compensated cases for asbestosis. A geographical analysis by Italian provinces]

During 1995-1999 among cases compensated by Italian National Institute for Insurance of Occupational Accidents (INAIL), asbestosis was classified as the second occupational disease after hypoacusia with the 7% of total cases. The present study describes the geographical distribution of 1.483 cases in men, notified to INAIL (and subsequently confirmed) during 1984-1992. Age-standardised incidence rates were calculated for the 93 Italian provinces. In addition, standardised incidence ratio (SIR) were computed, comparing the number of observed cases to the number of expected cases on the basis of age specific rates in the large geographical Italian areas (Northeast, Northwest, Centre and South and islands). Empirical Bayes estimates applying the Poisson-Gamma model were also estimated. The geographical distribution of standardised incidence ratios revealed a high excess risk for the province of Gorizia, Livorno, Massa Carrara, La Spezia, Trieste, Alessandria, Caltanissetta and a lower, but still significant, excess risk for the province of Siracusa, Ancona, Napoli, Genova, Reggio Emilia, Brindisi, Bergamo, Arezzo, Taranto, Pavia, Messina, Lecco and Varese. This study suggests the possibility to use the insurance files on asbestosis in order to estimate risks in Italy and to compare geographical clusters. Identification of provinces with significant excess number of compensated cases for asbestosis underscore the need for more detailed surveys aimed to detect conditions correlated with asbestos exposure and identifying persisting environmental pollution. Detailed enquiries are needed in particular in those provinces where excesses cannot be explained by current knowledge on circumstances of the presence of asbestos in the workplace.

Global asbestos justice: South African asbestos victims win right to sue Cape PLC in U.K. courts

A ruling by Britain's House of Lords in July 2000 opened the doors of the English courts to foreign plaintiffs injured by the overseas operation of British companies and their subsidiaries. The ruling authorized 3,000 South African asbestos victims to continue their case in the U.K. courts against the multinational British company Cape PLC, which produced both raw asbestos and asbestos products in South Africa. The Lords sided with the asbestos victims in refusing to transfer the case to South Africa, as requested by Cape. This decision was a reversal of fortune for Cape and has implications for other British multinationals that may be called upon to defend their overseas actions domestically.

[Social impact of screening and of medical surveillance on people exposed to asbestos]

A medical screening program has collective and individual impact. The collective benefit of medical screening for people exposed to asbestos would be financial (better compensation of occupational diseases related to asbestos). The cost of compensation would be attributed to the special assurance fund for occupational diseases. A medical screening of asbestos diseases would set an example for other Public health problems. It would be important for admission of social damage for the French nation. For individuals, social benefits would be better (compensation during work stop and annuities). But screening can have a negative psychological impact for asymptomatic persons. Persons exposed to asbestos and patients with asbestos diseases are able to quit their job for anticipated retirement. Is it a benefit for patients with mesothelioma or lung cancer? It is a very important benefit for asbestosis. The risk is to change the objective of medical screening into a social screening. The financial and medical benefits of screening for hyaline plaques is very poor. Awarding social damage is important for individuals.

[Diagnosis of malignant pleural mesothelioma and asbestosis]

The incidence of malignant mesothelioma, the main consequence of exposure to asbestos, will increase considerably in the Netherlands in the coming decades. In the next 35 year, some 20,000 people will die from malignant mesothelioma. The diagnosis of malignant pleural mesothelioma in practice is based on histological examination in about 80%, on cytological examination in 15% and on other forms of examination, e.g., high resolution computer tomography (HRCT), in 6% of the cases. Using a combination of various noninvasive methods, such as anamnesis, physical and röntgenologic examination, HRCT and spirometry, the diagnosis of asbestosis is made erroneously in 5% of the patients examined. With regard to allowance of financial compensation to patients with pleural mesothelioma and asbestosis, a part is played by the fact that views differ internationally concerning the criteria on which the diagnosis should be based. For mesothelioma cytologic and histologic examination are the most important. For asbestosis, the Health Council considers HRCT as crucial, if necessary supplemented by histological examination, plus a history of exposure to asbestos and pulmonary dysfunction. In mesothelioma cytological and histological examination are the most important.

[Asbestos-associated occupational lung diseases. Role of the pneumology unit in screening and compensation]

The application of new decrees concerning the protection of individuals against sanitary risks linked to the various possible expositions to asbestos dusts is leading to a growing involvement of pulmonologists in diagnosis procedures not only for active workers regularly examined via the occupational medicine healthcare system, but also for those who are no longer, the unemployed or retired previously exposed to asbestos fibres. The present chapter presents and comments the revised guidelines about the compensation procedures for occupational diseases, and provides useful recommendations for establishing the records leading to their medical assessment. It emphasises the importance of a close cooperation between pulmonologists and radiologists in order to avoid radiation overdosing, which could increase the risk of lung cancer, as much as possible.

[Cause-specific mortality of asbestos-cement workers compensated for asbestosis in the city of Bari]

The cause-specific mortality of 233 asbestos cement workers employed by the Fibronit company in Bari and compensated for asbestosis was investigated. Cohort members were enrolled on 31.12.1979 and followed through 30.4.1997; follow-up was completed for 98.3% of study subjects, and causes of death were ascertained for 96.6% of deceased subjects. Observed mortality was contrasted to that expected according to cause-sex-age- and calendar time-specific rates of the population resident in the Apulia Region. All causes observed mortality exceeded expected value (SMR: 117, 87 observed), due to a significant' increase in pneumoconiosis (SMR: 11238, 14 observed) and malignant neoplasms (SMR: 163, 38 observed)). A significant decrease of circulatory diseases was found (SMR: 64, 18 observed). Among cancer deaths, the following sites showed a significant excess: lung (SMR: 206, 17 observed), pleura (SMR: 2551, 4 observed), mediastinum (SMR: 2367, 2 observed) and peritoneum (SMR: 2877, 2 observed). The excess mortality due to asbestosis, respiratory cancer and peritoned neoplasms can be causally attributed to occupational asbestos exposure.

Compensation for occupational lung disease in non-mining industry

The course from claim submission (by the National Centre for Occupational health (NCOH)) to compensation (by the Workmen's Compensation Commissioner (WCC)) in 56 cases of occupational disease (OD) was traced. Success rates were determined and the procedural factors which affect claim outcomes isolated. Of note are the 22% of claims which remained unresolved 3 years after submission. The long latent period of ODs causes difficulty in obtaining the employer's corroborating documentation; this was found to be a major factor in the non-resolution of claims. Active intervention by the NCOH resulted in claim resolution for an additional 9%. These findings support the proposal that the WCC establish a network of access points for workers where assistance from trained staff is available. It is further recommended that the WCC accept substitutes for the employer's documentary proof in cases where this is unobtainable.

Asbestosis in New Jersey

A survey was conducted of 1,079 individuals reported by New Jersey hospitals to the New Jersey State Department of Health. Forty-eight percent of the respondents indicated that they had not received financial compensation for their work-related disease; 415 different sources of exposure to asbestos were identified.

Asbestos and health in the Third World: the case of Brazil

Almost all of the asbestos used in Brazil is mined by an enterprise wholly owned by two European multinational companies, which also produce and market over two-thirds (by weight of asbestos) of the products made from asbestos. About 80 percent of the asbestos used in Brazil is finally consumed in the form of asbestos cement: for roof tiles and roofing panels, wall-board, and domestic and industrial water tanks. A survey of consumer literature and advertising printed by Eternit, S.A., and Brasilit, S.A., disclosed no mention of a potential danger from exposure to asbestos dust, and no recommendations for cutting down exposure to that dust. The situation at smaller, Brazilian-owned firms is reputed to be disastrous from the standpoint of workers' exposure to asbestos dust at the point of production. At a large asbestos-cement manufacturing plant owned by Eternit, however, exposure to asbestos dust (according to company records) seemed to be kept under 2.0 fibers per cc., the present standard for the United States.

Medicolegal aspects of asbestos for pathologists

The two principal legal remedies available to victims of asbestos-related disease are (1) claims for benefits under workers' compensation laws and (2) suits for damages under the laws of products liability. The medicolegal issues and the part of the consulting pathologist as medicolegal consultant and expert witness in each of these legal proceedings are essentially the same.