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Background: While some studies have been published about the prognosis of the meningitic and encephalitic course of tick-borne encephalitis (TBE), only few data exist about the long-term prognosis of TBE myelitis. The aim of the present prospective study therefore was to investigate such patients over a period of 10 years., Method: In Baden-Württemberg between 1994 and 1999, 731 patients fell ill with TBE. Of them 81 (11%) suffered from encephalomyelitis. All patients were asked to participate in this study, 57 of whom agreed. Individual impairments were measured by allocating single scores for the paresis of the extremities or cranial nerves, ataxia, impaired consciousness, respiratory paralysis and defective hearing. The total impairment was measured at follow-up investigations at 1, 3, 5 and 10 years., Results: A total of 11 patients (19%) recovered, 29 (51%) suffered from persisting pareses or other impairments and 17 (30%) died 1-10 years after the acute disease. The most important ameliorations occurred during the first year after the acute disease; thereafter, improvements were lesser and more seldom. The clinical findings after 5 and 10 years correlated well with the status of the acute disease (r=0.8, p<0.01) allowing one to hazard a prognosis at the first presentation. The best restitution was seen for ataxia, impairment of consciousness, double vision, urinary retention and mild paresis of only one extremity (4/5). Patients with tetraparesis and simultaneous occurrence of respiratory paralysis and/or dysphagia, dysarthria or paresis of the neck muscles had the worst prognosis., Conclusion: A myelitic course of TBE is associated with the chance to recover in only about 20% of patients. Clinical deficits do not always correlate to findings in magnetic resonance tomography but to observations in postmortem studies.

Objective: It was the aim of this study to estimate effects of depression on permanent disability and death in a statutory health insurance population., Methods: Data from 128,001 clients were used with a mean follow up of 6.4 years. Excess risks were calculated with Cox regression models adjusted for age, gender, education and job classification., Results: Outpatient treatment for depression was associated with an elevated relative risk for permanent disability, but inpatient treatment even more so. Life table analysis suggests higher risks of early retirement for males who get ill early in life. Depression treated solely in an outpatient setting may be associated with lower mortality early in life, but this was only significant for women., Conclusions: Outpatient treatment should include an emphasis on occupational functioning, but also a gender-specific approach is needed., (© Georg Thieme Verlag KG Stuttgart · New York.)

The European Union plans to harmonize the aviation requirements, in particular the flight crew licensing requirements. On 23 May 2007, the German Federal Ministry of Transport, Building and Urban Affairs published the Flight Crew Licensing Requirements, which are based on the Joint Aviation Requirements, Flight Crew Licensing 3, Amendment 5. These guidelines also list the examination methods to be used for testing the medical fitness of pilots. In this Amendment some examinations which were part of the routine tests before JAR-FCL3 became effective have been deleted, e.g. the exercise ECG. This article presents two cases from the autopsy material of the Institute of Legal Medicine in Hanover and discusses the problems associated with the new examination guidelines.

Background: Laryngeal cancer as an occupational disease in the rubber industry is under subject of continuous epidemiological research because of the lack of stable statistical data., Method: Epidemiological studies published in the period between 1982 and 2006 were analysed in regard of the risks employment and laryngeal carcinoma. 23 own cases of medical expert opinion and the documentation of the German Occupational Cooperatives were analysed., Results: A significant statistical correlation between a specific exposition to cancerogenics in the rubber industry and a development of laryngeal carcinoma could not be found in the literature, still there is evidence for an increased mortality. It points to asbestos, talcum, dust as one risk factor., Conclusion: Recognition and compensation for laryngeal carcinoma according to [section sign] 9 Abs. 2 SGB VII is possible after intense individual investigation, although up to now no clear statistical evidence for the coincidence between employment in the rubber industry and general could be proven.

After a brief introduction into the basics of head and neck oncology, the current review focusses on potential predictive markers and predisposing factors for these kinds of cancers. Furthermore, prognosis and degree of disability of cancer patients are commented on. With a survival rate of approximately 50%, the prognosis of head and neck carcinomas seems rather good, but it is in fact unsatisfactory. Since the treatment of advanced head and neck cancers is often accompanied by profound functional (articulation, phonation, respiration, and deglutition) and aesthetic impairment, it repeatedly leads to a high degree of disability and occupational invalidity. Furthermore, special limitations of head and neck cancer patients are discussed as well as the consequences they may have on the qualification for certain jobs.

Head and neck cancer can be caused by the occupational contact with cancerogenic substances, which contribute to the formation of cancer. The knowledge about those cancer entities which are frequently found under similar circumstances and working conditions, helps for getting compensation and alternatively for a realistic view when other influences--particularly lifestyle factors like smoking, alcohol and nutrition--have mainly contributed for the origin of the cancer disease. Our knowledge increases and therefore it is helpful from time to time to keep up to the state-of-art of cancer genesis. This article has two parts: part I deals with occupational cancer diseases, which are listed in a decree of the German government and part II deals with the cancer diseases, which could likely be caused by occupational factors according to latest scientific findings and are not yet listed.

Background: Malignant neoplasmas of the paranasal sinuses are rare and present usually in advanced tumor stage due to the lack of early clinical symptoms., Patients and Methods: In the last 10 years, 63 patients with paranasal malignancies were treated at the Department of Otolaryngology, Head and Neck Surgery of the University of Würzburg. 33% of the patients showed an occupational exposition (wood-processing or metal industry). At the time of the first visit to our institution 95% of the patients presented with an extensive disease, staged T3 and T4. Adenocarcinoma (24%), squamous cell carcinoma (22%) and malignant melanoma (19%) were the most common histologies. Surgery combined with radiotherapy was the treatment strategy in 55 patients (87%)., Results: Patients with a complete surgical resection showed a higher 5-year-survival rate (77%) than patients with an incomplete resection (56%). In 38% (n=21) of the patients treated with surgery and radiotherapy, a local recurrence of the tumor was observed. This recurrence localised in the skull base and/or the orbita/periorbita occurred most frequently in the first (46%) or the second year (31%)., Conclusion: The prognosis of malignant paranasal tumors depends mainly on the control of the local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve a continuous remission.

In our country liver diseases are frequent and have many different causes. They can often develop into cirrhosis of the liver with mortality beetween 13.5% and 24.5%. Hepatitis B and C-viral infections frequently play a significant role in the recognition of an occupational disease in the case of medical staff, with histological criteria of major importance in this respect. A consequence of cirrhosis of the liver may be the development of hepatoencephalopathia of varying degrees of severity. As it is then likely that a patient will no longer be able to drive motor vehicles, it is important that attending physicians inform their patients accordingly. Liver transplants are an acknowledged method of treatment in the therapy of advanced liver cirrhosis. Rehabilitation shortly after transplantation is highly important to help ensure a speedy return to work. Surprisingly, reintegration is more difficult in patients suffering from alcohol related liver disease than in those with non-alcohol-related liver disease.

The practical use of the legally required documentation of occupational diseases is demonstrated by a case of asbestos-related pleural mesothelioma. During the mandatory inquest before cremation, information of manifest pleural mesothelioma had been relayed to the widow of the patient, and an investigation for a possible occupational disease was performed. Reconstruction of the case showed that in the course of 3 months at least 13 physicians had been involved in in-hospital as well as ambulatory therapeutic measures. Until death, none of them informed the trade association about a suspected occupational disease in accordance with BK 4105 of the codex of occupational diseases, although the diagnosis of manifest pleural mesothelioma had been histologically confirmed already 10 weeks prior to the death of the patient. This case demonstrates obvious and evident deficiencies in applying the Code of Social Law VII, which requires physicians to report occupational diseases. In addition, it shows the importance of the post-mortem examination as a control function before cremation.

In retrospective epidemiological cohort studies the mortality rate of a cohort exposed to certain agents under investigation is compared to the mortality rate of the general population. In Germany, vital status of the cohort is followed up via local population registries. Cause of death of deceased members of the cohort is obtained from death certificates by local health authorities. Since storage time for death certificates is short in some Federal German states, causes of death cannot be obtained if death occurred before storage deadline. Recently it became possible to obtain the cause of death from regional statistical offices. Initial co-operation has been established with the statistical offices of North Rhine Westphalia and Berlin. For a cohort study in the chemical industry, the initially low proportion of causes of death obtained from local health authorities (44.8 %) was increased by 30 % to 74.0 % after obtaining ICD coded causes of death from two regional statistical offices. Further advantages of this new data source are reduction in duration of inquiry time and of overall cost.

Head- and neck-cancer is a multifactorial disease. Besides major risk factors like alcohol and tobacco consumption, occupational factors play a significant role. At present it is estimated that in western industrial nations about 4 to 10% of all head- and neck-cancer cases are caused by occupational exposures. Combined exposures to occupational and non-occupational risk factors as well as the interaction of different occupational agents may have a synergistic effect on the cancer risk. It is very likely that the cancer risk due to occupational factors is modulated by host factors like DNA repair capacity and enzymatically controlled activation and inactivation of carcinogens.

1. There are three kinds of work-related diseases: officially recognised occupational diseases; occupational diseases; work-related but unspecific diseases. 2. These unspecific diseases occur more often than would be by mere chance, among certain professional groups. 3. Cancer mortality may increase as a result of occupational cancer-promoting factors, whereas the overall mortality may be unaffected. 4. In such cases, the mortality of other diseases not related to the occupation, is diminished ("vicarious mortality"). 5. The overall cancer mortality is probably not greatly increased by professional influences. This mortality is nearly constant in males and tends to decrease in females. 6. A strong inequality of mortality rates has been found in various occupational groups. The reason for these discrepancies is unknown. 7. Mortality is most strongly related to the mental demands made on individuals by their profession. 8. Death through accidents is six times more frequent in the general population compared with job-related accidents. 9. Health hazard due to occupation is low in relation to mortality, but marked in work-related diseases.

Often, it is the question to the medical expert, if there is a causality in the lawful sense from professional effort or psychical stress to acute coronary death or acute myocardial infarction. Following the German social law the connection has to be probably. Probability is well defined juridically opposite to possibility. The medical expert has to answer if the physical or psychical stress has caused the fatality or not more than manifested. Here are discussed arguments that the atheromatosis of the coronary vessels has much more importance than the manifestation of acute death or myocardial infarction caused by spasmus. There is no evidence for the existence of spastic genesis without any arteriosclerotic focus.

During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts.

4578 persons who died suddenly from natural reason were dissected in the Center of Legal Medicine of the University of Frankfurt am Main between 1979 and 1988. Among those were 2542 with sudden cardiac death. In 776 cases a relation between the occupation and the danger of dying of a sudden cardiac death could be proved. All the others had to be eliminated of the statistics, either because they were already retired when they died or because the occupation couldn't be found out. Altogether 142 different occupations were registered. A great percentage of the dissected people were construction workers, members of the safety duty and the transportation business and managers. Also butchers, bakers and cooks appeared quite often in the exploration, but never a shoemaker or a theologist.

Life expectancy in Germany has increased considerably during the 20th century. Simultaneously a considerable change in occupational structure has occurred. Keeping the occupational impact on mortality in mind, the question arises as to what extent the mortality decrease can be contributed to changes in occupation. Based on cohort data this question is analysed with the result that a considerable impact on life expectancy is confirmed. The impact of changes in occupational structure on life expectancy is greater for men than for women. This can be explained by the fact that men benefit from the improvements of general living conditions associated with occupational status, as well as from improved working conditions.

The implications for the prevention of cancer and for health promotion at work is illustrated with two examples from an analysis of cancer mortality by occupation of Swiss men, 1979-1982. The classical approach of industrial medicine to the reduction of pollutants via legislative, technical and informative measures is applied in the case of sinonasal carcinoma and pleural mesothelioma that is increased with furniture-makers. The fact that a comparable cancer mortality pattern linked to miscellaneous factors like smoking, asbestos, cement dust, alcohol, chemicals, nutrition etc. is observed for the various jobs of the building industry, requires an extensive health promotion effort uniting industrial medicine with organizational and individual approaches.

Using graphical representations to compare undistorted information it was attempted to bridge the gap between medicine and concerned risk-groups. Age-standardized mortality rates in 1979-1983 for 55 occupational groups (in 11 categories) of males aged 35 to 74 years were computed and compared to the Swiss national average; simultaneously the quantitative importance and the total mortality without accidents is shown for each occupational group: as an example the figure for lung cancer is reproduced. The elevated total mortality in the upper tertile of occupational groups is significantly explained by an increased risk of dying from circulatory or respiratory diseases, liver cirrhosis or malignancies of the lung, oropharynx, oesophagus or stomach. Foreseeable decrease of high-risk occupational groups will result in a further decline in mortality due to stomach cancer and cerebrovascular diseases in Switzerland.

The additional legal rulings governing access to personal data for epidemiological research are the medical professional secrecy regulators and the federal statistics law. These permit access to personal data only if the individual has given his or her informed constant. Beyond this, both laws contain clauses governing the transfer of anonymous data for research and science. Thus anonymized data may be transferred on request to authorized persons or institutions, such as a physician or the regional statistics office. Finally, a custodian model is presented which provides further possibilities for research in occupational medicine and epidemiology within this very restrictive legal framework.

The epidemiological studies dealing with the effect of man-made mineral fibres are evaluated. They serve as an example for the possibilities and also the limitations of epidemiology. The factors are discussed, which complicate this evaluation. Criteria are mentioned which can be used the demonstrate no effect of the exposure. Finally some methods are proposed which can improve the use of epidemiology especially in occupational medicine.

A retrospective mortality study on male pest control workers of the German Democratic Republic (GDR) was undertaken to evaluate the association of exposure to pesticides and development of malignant tumors. The cohort encompassed 1,214 male subjects with at least 5 years pest control work between 1945 and 1980. Informations on causes of death and cancer cases were obtained from death certificates and the cancer registry form. As control cohort for the standardized mortality ratios (SMR) served the general male population of the GDR. The SMR of 133 for the category of malignant tumors in the pesticide exposed cohort was significantly elevated. Among the other causes of death categories the SMR was less than 100. The tumor excess was statistically significant for the following tumor sites: esophagus, SMR = 430 (4 observed vs. 0.9 expected); stomach, SMR = 180 (14 observed vs. 7.8 expected) and skin melanoma, SMR = 588 (2 observed vs. 0.3 expected). Mortality from stomach cancer showed a linear rising trend by number of years licensed (less than 10 years, SMR = 118; 10-19 = 160; greater than 19 years, SMR = 260). The data suggest an etiological link between the pesticide exposure and increased mortality of esophagus cancer, stomach cancer and skin melanoma.

Issuing from shift work specific respectively occupation specific characteristics of mortality and morbidity the author refer to a possible context between lifetime occupational activity and special forms of aging. It is out the examination of the postulated context within the bounds of gerontological study of Halberstadt.

In a cohort study on 324 asbestos cement workers an increased risk of lung cancer was observed in comparison to cement workers (O/E = 1.7, p less than 0.05). 10 out of 17 deaths from lung cancer occurred after age 65, stressing the need for screening after retirement. In a pilot study on 198 asbestos cement workers we tried to adjust the screening intensity to individual risk (esp. for respiratory and gastrointestinal diseases) by use of history (exposure, smoking, etc.) and results of earlier examination. We found relations between smoking and respiratory symptoms, smoking and parameters of flow-volume-curves, smoking and radiological signs of early pneumoconiosis. Possibilities for early detection and intervention are discussed.

This article presents the conditions necessary for the use of mortality statistics to investigate occupational cancer risks. These include the use of various data sources (linked files for verification of death certificate items, cancer registries for histological information) and the consideration of trends and cohort effects. In such a way, arguments for or against specific causal relations between occupation and disease can be gained.

The 55 profession groups, fully enclosing the male population of Switzerland, can be adjoined to a cancer risk category, according to their absolute and proportional mortality rate from 1979 to 1983 (age standardized for 35- to 74-years old). Lung-cancer mortality is for all building trade professions, even for building engineer and truck drivers, three times higher as for professions asking school-leaving examination. The carcinoma of the superior digestion tract and the bladder follow this falling incidence, while the opposite, profession specific falling incidence being shown by colon and rectum cancers and by the tumours of the lymphatic tissue and the prostata. Deduction of the results is cancer prevention: this should be carried out by a general, profession-orientated furtherance.

The study is based on 3990 men and women exposed to asbestos dust for at least three years at their place of work, and prospectively and epidemiologically examined since 1 January, 1977. By 31 December, 1983, 336 had been registered as having died. Calculation of standard mortality rates indicates that the incidence of malignant tumour as cause of death was much higher than in the general population of the FRG, that of fatal mesothelioma about 100 times as high. Standard mortality rate for lung cancer was increased by 48% and 175%, respectively, depending on whether exposure to asbestos dust had ended after (subgroup I) or before (subgroup II) 1 January, 1972. Proportional mortality rate of 43% of tumours at all locations, with about 14% lung cancer and about 9% fatal mesothelioma cases in subgroup II, approaches the internationally recognized frequency of asbestos-associated tumours.