Search

In Poland, the use of asbestos was banned in 1997 and asbestos plants have been closed since then. Despite their closure, cases of asbestos-related occupational diseases among former asbestos workers are still being recorded in the Central Register of Occupational Diseases. Between 2001 and 2014, there were 2726 asbestos-related illnesses, classified and reported as diseases associated with occupational exposure to asbestos. In 2000, Poland introduced a programme called Amiantus, targeted at former asbestos-processing plant workers. The programme provided periodic medical examinations to workers and free access to medications for treatment of asbestos-related illnesses. Introduction of the programme provided additional data to generate a reliable estimation of the number of asbestos-related occupational diseases, including cancer. The average latency period for asbestosis, lung cancer and mesothelioma is about 40 years so there may still be some health impact to former workers necessitating follow-up. We present the Polish experience of implementing a medical examination programme for asbestos-exposed workers and provide a list of activities to consider when planning for such a programme.

Background: The aim of the annual analysis of the incidence of occupational diseases in Poland is to evaluate the extent of the incidence and to identify its causes as well as activities involving factors that are harmful or annoying to such an extent that they result in occupational diseases., Material and Methods: Occupational diseases reporting forms supplied to the Central Register of Occupational Diseases were used as the study material., Results: In 2014, there were 2351 cases of occupational diseases recorded, i.e., 16.5 cases per 100 thousand of employees. The most numerous categories comprised infectious or parasitic diseases (borreliosis), pneumoconiosis, voice disorders and hearing loss (in total 79.7% of cases). The main causative factors of occupational diseases were as follows: industrial dust containing free silica, tick-transmitted Borrelia spirochete, and the way the work is done, including excessive vocal effort, and noise. The highest incidence per 100 thousand workers were recorded in mining and quarrying (296), manufacturing (24.9), education (24.6), agriculture and forestry (24.2) sectors., Conclusions: Compared with the previous year, there was a slight increase in the number of cases of certified occupational diseases (6.2%), primarily due to the increased incidence of Lyme disease. The incidence of voice disorders among teachers continues to vary considerably in individual provinces (0-11.3/10 000), reflecting the use of non-uniform diagnostic and certification methods. Med Pr 2016;67(3):327-335., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: The study's objective is to present epidemiological situation concerning the incidence of occupational diseases among farmers in Poland., Material and Methods: All 3438 cases of occupational diseases diagnosed among farmers and obligatorily reported to the Central Register of Occupational Diseases (covering all the national territory and all the cases of occupational diseases diagnosed in Poland after 1970) over the years 2000-2014 were subjected to analysis., Results: The annual incidence in the analyzed period ranged 5-14 per 100 000 farmers. The analysis showed that about 90% of pathologies were induced by the biological agents. Almost every third pathology due to biological agents had allergic origin. Infectious and parasitic diseases accounted for 62% of the cases. Among them the diseases carried by ticks (93%) - borreliosis (85.8%) and tick-borne encephalitis (7.2%) were the most frequent ones. The age of farmers, in the case of whom bronchial asthma and allergic rhinitis were diagnosed, was significantly higher than the age of remaining employees of the national economy, in which these occupational diseases were recognized., Conclusions: The study indicates the necessity to introduce periodic health examinations programs focusing on agricultural workers to monitor health and well-being and improve working conditions and the working environment. Med Pr 2016;67(2):163-171., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Asbestos dust is one of the most dangerous pneumoconiotic and carcinogenic agents. The aim of this study was to assess the occurrence of asbestosis and pleural mesothelioma, depending on asbestos consumption and the type of manufactured products, among former asbestos workers in Poland., Material and Methods: The study subjects included employees of 18 large state-owned asbestos processing enterprises operating in the Polish market in 1945-1998. The study is based on data obtained from asbestos company records and the Central Register of Occupational Diseases data on the cases of asbestosis and mesothelioma for the period from 1970 till 2012 as well as data from Amiantus Programme. The analysis was performed for 5 sectors comprising plants classified according to the products manufactured and applied production technology., Results: In the study period, 2160 cases of asbestosis and 138 cases of mesothelioma were reported. The plants processed a total of about 2 million tons of asbestos, including about 7.5% of crocidolite. Total asbestosis consumption was a strong predictor of the rate of asbestosis incidence (R2 = 0.68, p = 0.055). The highest risk occurrence of asbestosis was observed in the production of textiles and sealing products. Mesothelioma occurred only in plants where crocidolite had been ever processed., Conclusions: Total asbestos consumption was a strong predictor of the rate of asbestosis incidence. The observation confirms the relationship between exposure to crocidolite and the occurrence of mesothelioma, regardless of the manufactured products, and suggests the absence of such a link for the total volume of asbestos consumption.

Background: The paper presents the incidence of occupational diseases in Poland (2013)., Material and Methods: Occupational disease reporting forms, supplied to the Central Register of Occupational Diseases, were used as the study material. The incidence was specified in terms of rates per 100 000 employed people., Results: The number of new cases was 2214 with the incidence rate of 15.6. The downward trend recorded over several years continues; compared to 2012, the number of new cases decreased by 7.8%. Exposure to dusts (35% cases), mostly inorganic (carbon, asbestos, and industrial dusts containing free crystalline silica) was the most common cause of occupational diseases. Among the organic dusts allergenic effects of flour and vegetable dusts predominated. Every 3rd case of occupational disease was attributable to physical agents, mainly the way the work is done, excessive vocal effort and noise. The sections of national economy with the highest incidence comprised mining and quarrying (271.1), manufacturing (24.3), education (22.4), agriculture, forestry, hunting and fishing (21.0), human health and social assistance (20.5)., Conclusions: The decreased incidence of 'traditional' diseases observed over the recent 15 years and the analysis of the 2013 incidence indicate a need to revise the Polish list of occupational diseases by exposures found in the modern work environment. Particular attention should be paid to conditions prevailing in workplaces with high exposures to industrial dusts containing free crystalline silica. A considerable variation in the incidence of voice disorders in teachers between individual voivodeships (provinces) points to the need for harmonization of the standards of preventive, diagnostic and certification procedures.

Introduction: The number of occupational diseases (OD) recorded in Poland in the 1990's rapidly increased, and the number of recognized cases has steadily decreased until now. Hence, it was decided to demonstrate the trends of selected pathologies which in Poland are "underestimated" in comparison to other countries. The presented data may constitute a basis for further research into the dependence of OD on socio-economic factors., Materials and Methods: Occupational Disease Reporting Forms, completed and sent obligatorily by the state health inspectors to the Central Register of Occupational Diseases were used as source documents for analysis. This work analyzes changes in the incidence of chronic poisonings, asbestosis, voice organ diseases, cancers, viral hepatitis, asthma and the musculoskeletal disorders over the years 1998-2011., Results: In 1998, the total number of registered diseases reached the maximum - 12,017 cases, which fell in the subsequent years to 2,562 cases in 2011. During that period, the incidence rate decreased by 6 cases per year per 100,000 employees. A considerable decrease, exceeding 90% of cases, was observed in voice organ disorders, hearing loss, chronic poisonings and viral hepatitis. The abovementioned changes, as well as improved detection of asbestos-related diseases through implementing a medical examination program of former asbestos processing plant workers, are advantages of the current situation in the epidemiology of OD. However, the disadvantages include underestimation, in comparison to other countries, of asthma, cancer and pathologies of the musculoskeletal system., Conclusion: The reported data indicates the need to assess the occupational fraction of the underestimated pathologies present in the work environment in Poland, as well as the need for studies aimed at clarifying the effect of systemic factors on identifying their occupational background.

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2012., Material and Methods: The work was based on the data from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2012. The data comprised information on nosologic units, gender and age of patients, duration of occupational exposure, sections of the national economy and voivodeships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed people., Results: The number of occupational diseases accounted for 2402 cases. The incidence rate was 23 cases per 100 000 paid employees. In spite of the general decline in the number of cases, the incidence of infectious and parasitic diseases increased by 8.6%. The highest incidence was noted for infectious and parasitic diseases (6.8/100,000), pneumoconioses (5.5/100,000), hearing loss (2.1/100,000), diseases of: the peripheral nervous system (2/100,000), voice disorders (1.9/100,000) and the musculoskeletal system pathologies (1.1/100,000). The pathologies specified above accounted in total for 84% of all occupational diseases. The industrial sectors of the national economy characterized by the highest incidence included mining and quarrying (288.3/100,000) and manufacturing (27.8/100,000). The highest incidence was recorded in the Silesian (46.2/100,000) and the lowest in the Opolskie (4.2/100,000) voivodeships., Conclusions: The downward trend in the incidence of occupational diseases continues. Different incidence of voice disorders among teachers in individual provinces suggests that uniform preventive, diagnostic and certification standards are missing.

Introduction: The purpose is to present the incidence of occupational diseases and their causal factors in the sections and divisions of the national economy in Poland., Material and Methods: The analysis is based on the cases of occupational diseases obligatorily reported in 2009-2011 from all over the country to the Central Register of Occupational Diseases. Data is presented as absolute numbers and average annual incidence rates per 100 000 persons employed in NACE-classified sections and divisions., Results: 'lhe average annual incidence of occupational diseases was 20.6 cases per 100 000 of employed people. The highest rates were recorded in mining and quarrying (337.8), the production of metals (169.8), non-metallic mineral products (81.6), motor vehicles and transport equipment (59.7), chemicals (30.1). Specific situation in which high incidence rate is due to a single discase prevails in forestry, where tick-borne diseases represent 96.3% of all recorded cases, in education, where chronic voice disorders account for 96.5% of cases, and in human health and social work activities, where infectious diseases with the dominant hepatitis C represent 68.2% of the cases. Tlhe most common causes of occupational diseases in sections and industrial divisions with the highest incidence included: industrial dust, noise and vibration. In the manufacturing industry asbestos was the cause of 20.5% of occupational diseases and 55% of occupational cancers., Conclusions: Careful monitoring of working conditions and implementing health prevention programs should be exercised in sections and divisions of the national economy where a high risk of occupational diseases has been found.

Objectives: Environmental exposure of the general population to asbestos in Poland is mainly due to degradation of very popular asbestos-cement products and the resultant release of the elementary asbestos fibres into the ambient air. Assessments of environmental pollution by asbestos were based on the volume of the raw material used, amount of manufactured asbestos products, and measuring the concentration of fibres in the air., Material and Methods: Under the governmental program intended to remove asbestos, measurements of the concentration of asbestos fibres were performed in 2004-2010 in all provinces of Poland. Considering that potential sources of asbestos dust emissions were present in residential areas, 1634 sampling sites were designated. From 2 to 4 air samples were collected at each sampling site. A total of 5962 samples were collected during seven years. A single dose of air collected by 25 mm 0.8 μm pore Sartorius filter was 1,300 litres. The fibres were counted using optical microscopy with phase contrast (PCM) on a polarizing microscope (PLM) at a total magnification of 600×.; method was adapted to determine the concentration of asbestos fibres in non-occupational environment., Results: Mean concentration of asbestos fibres was 492 f/m(3) (95% CI: 467-518). In 82% of the sampling sites, the mean concentrations did not exceed 800 f/m(3). As much as 25.8% of the samples were found to be below the detection limit of the method. Estimated mean concentrations of fibres in different provinces ranged from 146 (95% CI: 106-203) to 709 f/m(3) (95% CI: 591-851). In the areas affected by former asbestos-processing plants, mean concentration was 732 f/m(3) (95% CI: 527-1016) and was significantly higher than levels recorded in other areas of Poland., Conclusion: Asbestos consumption per capita and the recorded moderate levels of asbestos fibres concentration in atmospheric air point to a relatively low level of environmental asbestos pollution in Poland.

The presentation addresses current problems of health risk and health effects associated with exposure to asbestos, including data on historical exposure and on currently valid occupational exposure limits. The quantity and types of the raw material used for the production of various asbestos products have also been discussed in relation to the particular types of asbestos-induced occupational diseases. The authors describe the medical care system for former asbestos workers and those currently exposed during removal of asbestos-containing products. The national system for medical certification of occupational asbestos-related diseases and the compensation procedure have been outlined as well. According to the parliamentary Act of 1997, importing, manufacture and sale of asbestos and asbestos-containing materials are prohibited in Poland. Thus, the assessment of asbestos exposure and the monitoring of health conditions of workers at asbestos-processing plants have become irrelevant. However, the delayed health effects attributable to past exposure continue to be the matter of concern for public health. Likewise, the environmental pollution from asbestos waste landfills in the vicinity of asbestos-processing plants (where high levels of asbestos fibre in ambient air have been recorded) will continue to be a serious public health problem. Presently, two programmes aimed at minimising the adverse effects of asbestos on population health are underway. One of them is the governmental programme for "Elimination of asbestos and asbestos-containing products used in Poland, 2002-2032". The programme was updated in 2009 to cover the workers contracted to perform demolition works and provide protective covers to asbestos waste landfills. This will be the exposed group who need prophylactic health care. The other is a programme of prophylactic examinations for former asbestos workers and is referred to as the AMIANTUS programme. Both programmes have been briefly described.

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2010., Material and Methods: The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2010. The data comprised information on nosologic units, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodeships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed persons., Results: The number of occupational diseases diagnosed in 2010 accounted for 2933 cases. The incidence rate was 28.3 cases per 100 000 paid employees. The highest incidence rates were noted for pneumoconioses (7.6/100,000), infectious and parasitic diseases (7/100 000), hearing loss (3.2/100,000) and chronic voice disorders (3.1/100,000). As many as 77% of patients affected by occupational diseases had been exposed to harmful agents for longer than 20 years. In industrial sectors of the national economy, the highest incidence rate was noted in mining and quarrying (368.2/100,000). Taking into account geographic distribution of occupational diseases, the highest incidence was recorded in the Silesian and the lowest in the Mazovian voivodeships (79.7 and 9.7 cases per 100 000 employed persons, respectively)., Conclusions: A decrease of 213 (6.8%) cases of occupational diseases and a decrease of 5.4% in their incidence rate over previous year were noted. The greatest drop in the number of cases was noted in chronic voice disorders (of 302 cases--48.5%) and the greatest rise in pneumonioses (of 156 cases--24.6%).

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2009., Material and Methods: The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2009. The data comprised information on nosologic units, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodeships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed persons., Results: The number of occupational diseases diagnosed in 2009 accounted for 3146 cases. The incidence rate was 29.9 cases per 100 000 paid employees. The highest incidence rates were noted for infectious and parasitic diseases (8.4/100 000), pneumoconioses (6.0) and chronic voice disorders (5.9). As many as 78% of patients affected by occupational diseases had been exposed to harmful agents for longer than 20 years. In industrial sectors of the national economy, the highest incidence rate was noted in mining and quarrying (297.5/100 000). Taking into account the geographic distribution of occupational diseases, the highest incidence was recorded in the Silesian and the lowest in the Mazovian voivodeships (respectively 54 and 7.5 cases per 100 000 employed persons)., Conclusions: A decrease of 400 (11.3%) cases of occupational diseases and a decrease of 13.8% in their incidence rate over previous year were noted. The greatest drop in the number of cases was noted in infectious and parasitic diseases (of 168 cases, i.e. 23%).

Background: The aim of the analysis was to report statistical data on the incidence of occupational diseases among health and social workers in Poland in 1994-2008., Material and Methods: All cards certifying that a case of occupational disease had been diagnosed in a patient belonging to this occupational group, received by the Central Register of Occupational Diseases from all Polish Sanitary Epidemiological Stations, were used as the basis of this report. The data are presented in absolute values and in terms of incidence rates. In the analysis disease categories, voivodships and occupations were taken into account., Results: In 1994-2008, as many as 14,272 cases of occupational diseases were diagnosed in health care workers. Mean annual incidence rate was 104.5 cases per 100 thousand workers. Contagious and parasitic diseases were most frequent (57.6% of cases). Other diseases were evidently less frequent: chronic vocal organ disorders (13.5%), dermal diseases (10.3%), musculoskeletal (8.1%) and peripheral nervous system diseases (4.4%) and vibration syndrome (1.7%). The contribution of all other occupational diseases was 5.3%. Viral hepatitis and tuberculosis were dominating in the contagious/parasitic category, accounting for 72.1% and 22.9%, respectively. The incidence analyzed by occupation showed the highest rate of total occupational diseases among dentists (33.5 cases per 10,000), while the incidence of contagious/parasitic diseases was highest among nurses and midwives (6.9 cases per 10,000)., Conclusions: The incidence of occupational diseases in total and in the most frequent categories continued to decrease, except for viral hepatitis C, which showed only a slightly upward trend. There was a remarkable difference in the incidence of viral hepatitis between individual voivodships of Poland.

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2008., Material and Methods: The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2008. The data comprised information on nosologic units, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodeships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed persons., Results: The number of occupational diseases diagnosed in 2008 accounted for 3546 cases. The incidence rate was 34.7 cases per 100,000 paid employees. The highest incidence rates were noted for infectious and parasitic diseases (9.4/100,000), chronic voice disorders (7.9) and pneumoconioses (6.8). As many as 77.9% of patients affected by occupational diseases had been exposed to harmful agents for longer than 20 years. In industrial sectors of the national economy, the highest incidence rate was noted in the coal mining industry (416.3 cases per 100,000). The highest incidence rates were recorded in the Lubelskie (75.5), Silesian (66.3) and Podlaskie (60.7) voivodeships., Conclusions: An increase of 261 (7.9%) cases of occupational diseases and an increase of 3.6% in their incidence rate over the previous year were noted in 2008. The greatest increase was noted in infectious and parasitic diseases (of 285 cases, i.e. 42.5%) and chronic diseases of the locomotor system (of 22 cases i.e. 22.4%).

Bronchial asthma has been specified as a separate category of pathologies caused by occupational environment in the late 2002 into the list of occupational diseases. The number of cases of occupational asthma recorded during the five-year period (2003-2007) when the statistical data was collected and processed equalled 521; of those, 70.6% cases were recorded in men. The contribution of asthma to the overall number of occupational pathologies was 2.9%, while the incidence was 1.1 per 100 thousand paid employees. The number of new cases per year showed a falling trend. In 2007, it was by 38.8% lower than in 2003. Flour dust was the most frequent cause of asthma (51.2% cases), followed by other dusts of vegetable and animal origin (27.1%). Among chemical agents, disinfectants were most frequently quoted as the cause (3.3%). Over half (51.6%) of the asthma cases were diagnosed in people processing or selling food products. Of those, nearly all (99.3%) developed asthma due to contact with flour dust at the workplace. Most of that group (92.9%) were bakers and pastry cooks. Farmers were the second most numerous group of asthmatic workers (25.9%); of those, 93.3% developed asthma by contact with dusts of plant and animal origin and mites found in those dusts.

Background: The whole spectrum of disorders of the hematopoietic tissue, eye and skin induced by ionizing radiation covers complex pathologies termed as a postirradiation syndrome, as well as various malignancies. The aim of this work is to present the data on incidence of occupational diseases with ionizing radiation as a causative agent., Materials and Methods: The work is based on the data compiled from "Occupational Diseases Reporting Forms" for the years 1971-2006 collected in the Central Register of Occupational Diseases. The incidence of certified occupational diseases with ionizing radiation as a causative agent is expressed in absolute numbers and the rate per 100 000 employees. The data comprise information on disease entities, gender, age, exposure duration and the branch of national economy., Results: In total, 599 diseases (0.2% of all occupational diseases) were diagnosed as those induced by ionizong radiation. Annual incidence rates per 100,000 employees fell within the range of 0.0-0.7. Miners formed the major (51.9%) occupational group affected by ionizing radiation. They were followed by health care (34.3%) and construction (6.4%) workers. Cancers made over 50% of pathologies located at 28 sites. These included cancers of lung (59.2%), skin (10.0%) and hematopoietic tissue (8.7%). Almost all (99.35) diseases recorded in the mining industry were cancers. Non-cancer diseases were more frequent in health care workers, among them postradiation cataract occupied the first place., Conclusions: A great deal of reported cancer sites give rise to controversy in terms of the cause-effect association with ionizing radiation exposure and also due to incomplete data on exposure level. Postradiation cancers among health care workers have not been registered over recent years, which means that occupational exposure surveillance carried out for many years proves to be effective. Distant effects of exposure to ionizing radiation, revealed in workers of no longer existing uranium mine, appeared to be a particular problem. These were cancers certified up to the year 2003 in persons with documented employment in that mine during the post-war period.

Background: The objective of this work was to investigate the association between occupational exposure and lung cancer risk based on a case-control study., Material and Methods: The study of 414 primary lung cancer cases, recorded in the Lódź industrial center in the years 1998-2002, was carried out under the international multicentre case-control study, coordinated by the International Agency for Research on Cancer (IARC). The control group, composed of individuals who did not report any tobacco-related diseases or other cancers, were matched by gender and age. Data on lung cancer risk factors were derived from a questionnaire survey on life styles and occupational exposure. The detailed information on the occupational history of all the study subjects and exposure to lung carcinogens was collected and subsequently assessed by occupational hygienists. Logistic regression was used in the data analysis. Confounders, such as age, gender, education, diet and cigarette smoking were controlled in the analysis., Results: A total of 88 case patients and 79 controls had been employed in occupations and industries associated with the evidenced or suspected risk of lung cancer development. The corresponding odds ratio was 0.71 (95%CI: 0.48-1.06). The study population was mostly exposed to organic dust, lubricating oil mist, sand, mild steel dust, organic solvents and abrasives dust., Conclusions: The present study provides evidence that occupational exposure in the investigated Lódź industrial center is responsible for a moderate increase in lung cancer risk among exposed persons. However, only a small fraction of the study population was exposed to well documented carcinogens.

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2007., Material and Methods: The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2006. The data comprised information on nosologic units, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed persons., Results: In 2007, 3285 cases of occupational diseases were diagnosed. The incidence rate was 33.5 cases/100 000 paid employees. The highest incidence rates were noted for chronic voice disorders (8.1/100 000), pneumoconioses (7.1), infectious and parasitic diseases (6.8) and hearing loss (2.6). As many as 77.3% of patients affected by occupational diseases had been exposed to harmful agents for more than 20 years. In industrial sectors of the national economy, the coal mining industry showed the highest incidence rates (404.1 cases/100 000). The highest incidence rates were recorded in the Lubelskie (73.1), Silesian (68.4), Swietokrzyskie (66.5) and Małopolskie (60.7) voivodships., Conclusions: Compared with 2006, the number of cases of occupational diseases increased by 156 cases (5%), the incidence rate increased by 2.1%. The greatest rise was noted in infectious and parasitic diseases (by 68 cases, 11.3%) and chronic diseases of peripheral nervous system (by 50 cases, 46.3%). At the same time the number of hearing loss cases apparently decreased (by 43 cases, 14.6%).

Background: The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2006., Material and Methods: The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2006. The data comprised information on individual diseases, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodships (provinces). The incidence was specified in terms of the number of cases per 100,000 paid employees and per 100,000 employed persons., Results: In Poland, the number of occupational diseases diagnosed in 2006 accounted for 3129 cases. The incidence rate was 32.8 cases per 100,000 paid employees. The highest incidence rates were noted for chronic disorders of the voice organ (8.0 per 100,000), pneumoconioses (7.0), contagious and parasitic diseases (6.3) and permanent bilateral hearing loss (3.1 per 100 000). As many as 75.8% of patients affected by occupational diseases had been exposed to harmful agents for longer than 20 years. In industrial sectors of the national economy, the highest incidence was noted among workers employed in the mining industry (309.1 cases per 100,000 paid employees), particularly in coal mining (366.8). The highest incidence rates were recorded in the Lubelskie (73.7), Silesian (70.2) and Swietokrzyskie (62.6) voivodships., Conclusion: The incidence of occupational diseases in Poland continues to abate. A downward trend is primarily due to a lower number of cases of hearing loss, diseases of pleura or pericardium induced by asbestos dust, skin diseases, and intoxications with chemical substances. However, an increase in the number of cases of chronic diseases of the voice organ was revealed.

Objectives: Current situation in the epidemiology of occupational diseases is a resultant of many contributing factors, such as occupational exposures of the working population, social and economic conditions, medical measures, legislation, and ongoing changes in the national economy., Materials and Methods: This work is based on the information compiled from reporting forms on occupational diseases gathered in the Central Register of Occupational Diseases run by the Nofer Institute of Occupational Medicine, Lódź, Poland., Results: A systematic downward trend in the number of occupational diseases has already been observed over several years. In 1998, as many as 12 017 cases were recorded (117.3 per 100,000 workers), while in 2005, this number was reduced to 3249 (34.8 per 100 000). In 2005, the highest incidence rates were noted for chronic voice disorders, pneumoconioses, infectious and parasitic diseases, hearing loss, and skin diseases. The observed decrease in occupational pathology is associated with continued transformations in the national economy. Changes in the nature and level of occupational exposures have influenced the profile of occupational pathologies. Medical preventive measures, such as vaccinations covering high-risk groups have contributed to the reduced incidence of occupational diseases. For example, the number of cases of occupation-related viral hepatitis was seven times lower in 2005 than in 1993. The 2005 data show that over 50% of occupational diseases were diagnosed in workers employed outside industry., Conclusions: Changes taking place on the labor market, new technologies and most of all transfer of the workforce from industry to the service and administration sectors, will certainly affect the profile of occupational and work-related pathologies. In the present-day environment, the work-related stress has become a dominant factor.

Background: The aim of this paper was to present basic statistical data on occupational diseases diagnosed and certified in 2005., Materials and Methods: This work is based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2005. The data comprised information on individual diseases, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodships (provinces). The incidence was specified in terms of the number of cases per 100,000 paid employees and per 100,000 employed persons., Results: In Poland, the number of occupational diseases diagnosed in 2005 accounted for 3249 cases. The incidence rate was 34.8 cases per 100,000 paid employees. The highest incidence rates were noted for: chronic disorders of the voice organ (7.3 per 100,000), pneumoconioses (7.2), infectious and parasitic diseases (6.6) and permanent bilateral hearing loss (3.6). As much as 73.0% of patients affected by occupational diseases had been exposed to harmful agents for more than 20 years. In the industrial sectors of the national economy, the highest incidence was noted among workers employed in the mining industry (281.7 cases per 100,000 paid employees), particularly in coal mining (325.2). The highest incidence rates were recorded in the Podlaskie (87.3), Lubelskie (82.1), and Silesian (66.3) voivodships. CONCLUSION The incidence of occupational diseases in Poland continues to abate. The downward trend is primarily due to a lower incidence of chronic diseases of the voice organ and hearing loss. However, an increased number of cases of infectious and parasitic diseases, mainly borreliosis, was revealed.

Objectives: The study on mortality from cancer among workers of an asbestos plant manufacturing asbestos yarn, cloth, cords, packings, stuffing, brake linings and asbestos-rubber sheets was launched in the 1980s. The present paper discusses the results of further tracing of asbestos workers of the same plant., Materials and Methods: The study cohort covered 4497 workers employed at the asbestos plant in 1945-1980. The follow-up of the cohort continued until 31 December 1999. Deaths by causes were analyzed using standardized mortality ratio (SMR) calculated by the person-years method. The mortality pattern of the general population of Poland was used as reference., Results: The availability of the cohort was 93.1% (2805 men and 1382 women were traced). Mortality from malignant neoplasms in total (281 deaths among men, SMR = 118, 95%CI: 105-133 and 135 deaths among women, SMR = 159, 95%CI: 133-188) as well as that from lung cancer (102 deaths among men, SMR = 126, 95%CI: 103-153 and 18 deaths among women, SMR = 259, 95%CI: 153-409) were significantly higher than in the general population. Unlike earlier stages of analysis, the present study revealed an increased risk of pleural mesothelioma (2 deaths among men, SMR = 510, 95%CI: 62-1842 and 3 deaths among women, SMR = 2033, 95%CI: 419-5941). Mortality analysis among workers with asbestosis and in those without diagnosed asbestosis, did not reveal direct association between the risk of asbestos-induced lung cancer and previously diagnosed asbestosis., Conclusions: The prolonged cohort tracing showed an increased risk of asbestos-related cancers. It concerned mainly workers hired by the plant between 1945-1955, when the working condition were most strenuous.

Background: Our annual analysis of the epidemiology of occupational diseases is intended to indicate morbidity categories characterized by the highest risk of developing pathologies associated with working conditions and to assay variations in the frequency of those pathologies, depending on occupational exposure, medical factors, social and economic circumstances, legal regulations, and ongoing transformation of the national economy., Materials and Methods: This work is based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2004. The data comprised information on individual diseases, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodships (provinces). The incidence was specified in terms of the number of cases per 100,000 paid employees and per 100,000 employed persons., Results: In Poland, the number of occupational diseases diagnosed in 2004 accounted for 3790 cases. The incidence rate was 41.0 cases per 100,000 paid employees. The highest incidence rates were noted for: chronic disorders of the voice organ (9.5 per 100 thousand), pneumoconioses (8.1), contagious and parasitic diseases (5.8), permanent bilateral hearing loss (5.5) and skin diseases (2.0). As much as 72.4% of patients affected by occupational diseases, had been exposed to harmful agents for longer than 20 years. In the industrial sectors of the national economy, the highest incidence was noted among workers employed in the mining industry (328.9 cases per 100,000 paid employees), particularly in coal mining (380.1). The highest incidence rates were recorded in the Lubelskie (122.0 cases) and Silesian (85.6 cases per 1000 workers) voivodships., Conclusions: The incidence of occupational diseases in Poland continues to abate. The downwards trend is primarily due to a lower incidence of hearing loss and chronic diseases of the voice organ.

Background: The aim of this paper is to present current data on the incidence of occupational cancer in Poland., Materials and Methods: This work is based on the information collected from forms reporting cases of occupational diseases in 1995-2003, received by the Central Register of Occupational Diseases run by the Nofer Institute of Occupational Medicine, Łódź, Poland. During that period, 1124 cases of cancer were registered., Results: Occupational cancer was diagnosed in 125 people per year on the average. The occupational cancer cases made 1.4% of all occupational diseases. In individual years, the contribution of occupational cancer showed the upward trend. The most frequent tumor sites were: lung (51.6%), larynx (18.9%), pleura (7.6%), urinary bladder (6.0%), lymphatic and hemopoietic tissues (3.9%), skin (3.7%). Asbestos was specified as a causal factor of every third case (32.8% of reported cases) of occupational cancer: 38.9% of lung tumors, 25.6% of larynx tumors and all pleural mesotheliomas. Occupational exposure to polycyclic aromatic hydrocarbons and ionising radiation was responsible for 10.8% of tumors each. Polycydic aromatic hydrocarbons were recorded as a causal factor of 15.4% of pulmonary, 10.6% of laryngeal, 12.8% of dermal, and 11.4% of lymphatic and hemopoietic tissue tumors, while ionising radiation for 12.8% of pulmonary, 23.1% of dermal, and 22.7% of lymphatic and hemopoietic tissue cancers. Males formed the majority (90.5%) of patients with diagnosed occupational cancer. Pulmonary (52.7%) and laryngeal (20.1%) cancers were the most frequent tumors in men. Among women, pulmonary cancer also occupied the first place (41.1%) and was followed by pleural mesothelioma (21,5%)., Conclusions: The proportion of malignant tumors in the overall number of occupational diseases shows the upward trend. Due to long latency period of the disease, the recorded cases reflect exposures of long time ago.

Background: Data on occupational diseases constitute an important element of the bulk of information on the health of workers as well as on the sanitary conditions prevailing in their work environment. Yearly records of the incidence of occupational diseases, and the annual analyses of the incidence data render it possible to identify high-risk groups, so that preventive measures can be taken to reduce the risk of the resultant pathologies., Methods and Materials: This work is based on the information included in the "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2003. The forms specified the diagnosed disease, patient's age and gender, period of occupational exposure to agents responsible for the disease development, branch of the national economy and the region of the country. The incidence was specified in terms of indices per 100 000 paid employees., Results: A total of 4365 cases of occupational diseases were diagnosed in Poland in 2003. The incidence rate was 46.6 cases per 100 000. The highest rates were recorded for chronic vocal organ diseases (11.7), pneumoconiosis (8.6), bilateral permanent hearing loss (7.9), contagious or parasitic diseases (5.9) and skin diseases (2.3). In 60.7% of patients with diagnosed occupational disease, the period of exposure to a relevant harmful agent was over 20 years. The highest incidence of occupational diseases was recorded in the mining industry in general (372.5 cases per 100 000) and in the coal mining industry in particular (439.4 cases per 100 000 paid employees)., Conclusions: In 2003, the incidence of occupational diseases continued to decrease in Poland. This downward tendency has been observed since 1999. A lower number of cases of hearing loss, contagious or parasitic diseases, chronic voice disorders and of skin diseases mostly contributed to the general decrease in the incidence of occupational diseases.

Background: The aim of this work was to determine the prevalence of tobacco smoking among workers of an asbestos processing plant., Materials and Methods: Records of medical consultations and prophylactic examinations performed at the Outpatient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Łódź, Poland, covering the period of over 40 years, were the source of information about 1353 workers (802 men and 551 women). The employment duration of the majority (85.6%) of workers was 10 years or more., Results: In the study population, only about one third (33.7%) of workers declared themselves as non-smokers, 42.9% of workers were current smokers and 23.4% ex-smokers. Smoking was significantly more frequent among men (57.1% of current and 27.2% of ex-smokers) than among women (22.3% and 17.8%, respectively). The largest percentage of current smokers (79.7% of men and 60.3% of women) was found in the age group below 40 years. Comparison of standardized values of smoking parameters showed a larger proportion of smokers in the study group than in the general population in Poland (45.2% vs. 38.7%). However, the workers started smoking at somewhat older age (22.0 yr vs. 20.1 yr), smoked less cigarettes per day (15.2 vs. 20.7) and continued smoking for somewhat shorter period (20.8 yr vs. 23 yr)., Conclusions: A high proportion of tobacco smokers among workers of asbestos processing plant shows a low efficiency of anti-smoking programs carried out in this population. This highlights the need to take more effective measures in this group of workers who are already exposed to a very harmful agent.

The main goal of the study was to analyze thoroughly the results of a cohort study. Such an analysis renders it possible to eliminate certain neoplasms as those not related to the observed exposure. The cohort study was carried out in a group of workers, covering 11,342 persons (5472 men and 5870 women), employed for at least one year during the years 1945-1985 in a rubber footwear plant. The cohort study was continued until the end of December 1997. Of all the sites of malignant neoplasms observed in the cohort, significant, exposure-related excess mortality was found to be due to malignant neoplasms of larynx and lung in men, and malignant neoplasms of gallbladder and lung in women. For these neoplasms, the values of observed risk among those exposed were significantly higher than among non-exposed. Moreover, in a certain interval of employment duration, an increase in risk rates with increasing duration of employment under exposure was observed, which suggests the presence of dose-response relationship. For all these sites, a relevant trend was shown by the RR values calculated in relation to the group of persons non-exposed but employed in the same plant. The internal reference group used to calculate RR values allowed to eliminate the effect of confounding variables, which is not always possible when the general population is used as the reference group.

The aim of the work was to analyze the incidence of occupational asbestosis. The analysis covered all cases of asbestosis reported to the Central Register of Occupational Diseases during the years 1970-2001. The cases were classified by patients' gender, age, place of employment, duration and magnitude of exposure to asbestos dust. In all, 1779 cases of asbestosis were registered, including 1200 male cases. During the period under study, a growing number of diagnosed cases were observed (from several cases in the early 1970s to several dozens in the 1990s). During the period of 32 years, the average incidence was 0.5 cases per 100,000 employees, and asbestosis contributed in 5.4% to all occupational pneumoconioses. The majority of asbestosis cases was diagnosed in workers employed in the plants of asbestos processing (38.3%) and asbestos-cement products, followed by foundries (13.1%) and shipyards (10.5) workers. The mean age of asbestosis patients was 55 years, and the average duration of employment under exposure to asbestos was about 21 years. The data recorded in the certificates of occupational disease show that asbestos dust concentrations at workplaces ranged from 1.4 to 38.3 mg/m3 (median, 3.8 mg/m3). Shipyard workers were exposed to the highest (Me = 8.0 mg/m3) and asbestos-cement workers to the lowest (Me = 2.8 mg/m3) concentrations.

The aim of the study was to assess the health risk of workers performing specific jobs in the process of the rubber footwear production by defining the cause and length of temporary work disability, as well as mortality causes and level. The analysis was carried out in the groups of workers performing the following jobs: mixing, mill operation, pressing and vulcanizing (A); semi-product preparation and calendaring (B); finishing and sorting (C); production of polyvinyl chloride footwear (D); and auxiliary works (E). The sickness absence study covered all workers (208 men and 315 women) employed in a large rubber footwear company and performing all above-listed jobs in 1995. Standardized sick days ratio was used to analyze the risk of temporary work disability. Mortality rate was estimated on the basis of the results of the cohort study performed in the same company among workers who had worked at least three months during the years 1945-1985. The follow-up continued until 31 December 1997. The present study included sub-cohorts composed of 5628 men and 7197 women, performing jobs listed above. The results of both studies indicated the enhanced risk of cardiovascular diseases among workers employed in the basic phases of the production process. The increased risk of the diseases of the digestive system was observed in men and women employed in: finishing, sorting and packing of the products (group C); in men involved in mixing, pressing and vulcanizing (group A); and in women engaged in auxiliary works (group E). In addition, the enhanced risk of sickness absence due to the diseases of the respiratory, digestive, or genitourinary systems was related to the enhanced risk of death from malignant neoplasms in a given site. The analysis showed that the temporary work disability may be regarded as a parameter useful in early assessment of health effects of the work environmental hazards.

The work environment of the rubber industry company, producing various types of tires, was assessed and the workers of the plant were included in a cohort study of mortality. Concentrations of twenty chemical substances at 137 workposts were measured by employees of the plant laboratory and the sanitary and epidemiological station in 1981-1996. The mean values and concentration ranges were determined by departments and workposts. The excess of threshold limit values was analyzed. The workposts with exposure to agents possibly carcinogenic to humans were identified. The analysis performed will render it possible to calculate doses of cumulative exposure to given compounds among workers covered by the epidemiological study.

The study aimed at assessing cancer risk in a cohort of workers employed in the rubber tire production. The cohort consisted of 17,747 workers (11,660 men and 6087 women) employed in a rubber tire plant for at least three months during the years 1950-1995. The cohort follow-up was completed on December 31, 1995. Deaths by causes were analyzed using standardized mortality ratio (SMR) calculated by the person-years method. The mortality pattern of the general population of Poland was used as the reference. The study indicated significantly lower total mortality in the cohort (men: SMR = 72; women: SMR = 62) as compared to the general population, which is an example of a well known "healthy worker effect". The number of deaths from malignant neoplasms was also lower than expected (men: SMR = 67; women: SMR = 64). Only in a very small sub-cohort of men involved in dosing and mixing of raw material for the production of rubber, an excess of total mortality (SMR = 104) and from all cancers (SMR = 115) was found. Mortality from all neoplasms was enhanced (SMR = 108) in the sub-cohort of women employed in the technical service work area. When analyzing individual cancer sites in men of the whole cohort or sub-cohorts, the observed number of deaths from cancers of the lip, tongue, pharynx, stomach, gallbladder, pancreas, peritoneum, articular cartilage, connective tissue, skin, testis, prostate, bladder, kidney, brain, as well as from Hodgkin's disease, multiple myeloma and leukemia was larger than the expected number. Among women the excess mortality was due to cancers of the large myeloma and leukemia. The SMR calculated for these sites were statistically insignificant. The cohort under study was "young" and thus relatively small numbers of deaths were recorded. The excess mortality, based quite frequently on single cases of selected cancer sites, cannot be regarded as a basis for final conclusions. Nevertheless, the fact that these observations are in agreement with the findings of other authors who carried out studies in the rubber industry of other countries justifies the need to follow-up this cohort in the future.

This paper describes a cohort study of the mortality among workers employed in one of Polish tyre plants. The scope of the study was limited to the analysis of mortality from main disease categories. Mortality from particular cancer sites will be discussed in a separate publication. The cohort comprised 17,747 workers (11,660 men and 6,087 women) employed during the years 1950-95 for at least three months in the tyre plant. As of 31 December 1995, the follow-up of the cohort was completed. A detailed analysis of mortality by causes was carried out using standardised mortality ratio (SMR) calculated by the person-years method. The general population of Poland was used as the reference. The results indicated general mortality significantly lower in the cohort (men: SMR = 72; women: SMR = 62), than in the reference population. The number of observed deaths from main disease categories was also lower than those expected. The analysis by specific causes revealed significant excess of deaths, due to hypertensive disease among men (36 deaths, SMR = 142; 95% CI: 99-197). SMRs were also calculated in sub-cohorts identified by activities performed (preparatory works: production of tyres and inner tubes; maintenance; storage; others). General mortality in sub-cohorts was similar to that in the total cohort. After analysis by causes of death, some non-significant excess mortality could be observed. It was very small or it applied only to single cases of death. Excess mortality from hypertensive disease in male maintenance workers (21 deaths, SMR = 262; 95% CI: 162-400) was the only exception. The absence of adverse health effects pronounced by significant excess mortality should be attributed to a relatively short period of exposure among the majority of the followed-up workers (over 58% of workers in the cohort employed in the plant for a period shorter than five years) and to their young age. Almost 56% of workers in the cohort were born in the 1950s or later which means that at the end of the follow-up they were not older than 45 years. In order to complete the final mortality assessment the follow-up should continue.

To assess mortality rate among workers occupationally exposed to asbestos, cohort studies were carried out in two asbestos cement plants operating since the 1960s. Asbestos cement sheets for roofing and siding have been manufactured there, using mostly chrisotile, and since 1985 also crocidolite for pressure pipes. In all, the cohort comprised 3,220 workers, including 2,616 male workers. Subject to consideration were the workers employed for at least three months in the period between the onset of the production and 1980. The vital status of the subjects was traced up to 31 December 1991. The availability of the cohort was 96.8%. Workers' mortality was analysed using standardized mortality ratio (SMR). The reference group was the general population of Poland. In the male cohort, 385 cases of death were recorded. Statistically significant excess of mortality from large intestine cancer (7 cases, SMR = 264) and pleural mesothelioma (5 cases, SMR = 2846) was found. In male workers who died from pleural mesothelioma the work history ranged from 12 to 26 years. An excess mortality from pleural mesothelioma was also noted among the female workers (2 cases, SMR = 11,275). No malignant neoplasms of other locations produced significant excess mortality either in the male or female workers.

The cohort consisted of persons found on the payroll of one of the Lódź cotton plants in 1964-1993 who were employed in the plant for at least 10 years. Death risk by causes was analysed using standardised mortality ratios (SMRs) calculated by the person-years method. The general population of Poland was used as the reference. In all, 7892 people were observed. As of December 31, 1995, the follow-up was completed for 7545 people (2852 men and 4693 women), i.e. the availability of the cohort was 95.6%. A total of 2069 deaths were recorded; the information on the cause of death was available for 97% of the subjects. In the male cohort, the level of the general mortality was the same as in the general population (SMR = 99). However, there was a significant increase in the number of deaths from diseases of the digestive system (SMR = 142) and larynx cancer (SMR = 188). The analysis of the results by production departments revealed in the weaving department significantly higher mortality from atherosclerosis (SMR = 141), peritoneal carcinoma (SMR = 1057) and melanoma (SMR = 677); and in the spinning department the increased risk of the hypertensive disease (SMR = 239), atherosclerosis (SMR = 175), and Hodgkin's disease (SMR = 768). Mortality in the female cohort was lower than that in the general population (SMR = 88). None of the disease groups or tumour sites caused statistically significant excess deaths either in the total cohort or in subcohorts selected according to departments. Special attention was paid to the chemical processing departments where chemicals used could contribute to the increased risk of death from cancer. Our analysis did not reveal any significant increase either in the total cohort of the workers employed in those departments or in the cohorts analyzed by duration of employment. Our results confirm the lower risk of lung cancer in the analysed group as compared with that in the general population. The numerous, but statistically insignificant increases in the incidence of malignant tumours at some specific sites detected in the subcohorts, distinguished according to the duration of employment or department, confirm the reported findings on the incidence of oral cavity, nose, throat, and larynx tumours among people exposed to harmful agents in the cotton industry.

The cohort method was used in the study. A retrospective observation covered 4.556 males with occupational disease, manifested by lead poisoning, diagnosed during the years 1970-1992. Mortality risk analysis by causes was based on standardized mortality ratios (SMRs) calculated by person-years method. Their statistical significance was assessed by means of the test based on Poisson distribution. The general adult male population was adopted as the reference population. The state of the cohort as of 31 December 1992 was considered. The cohort accessibility was 95.6%. The study revealed increased total mortality among lead poisoned males (670 deaths; SMR = 108; 95% CI: 100-116). Significant excess mortality was observed in diseases of the digestive system (37 deaths; SMR = 148; 95% CI: 104-204), including chronic hepatitis and cirrhosis (19 deaths; SMR = 173; 95% CI: 104-270); malignant neoplasms of respiratory and intrathoracic organs (82 deaths; SMR = 135; 95% CI: 107-168), including malignant neoplasm of larynx (13 deaths; SMR = 213; 95% CI: 113-364). In the subcohort with high exposure, death risk was significantly enhanced in comparison to the general population (153 deaths; SMR = 129; 95% CI: 109-151). In addition, significant excess of malignant neoplasms was observed (43 deaths; SMR = 151; 95% CI: 109-203) including liver (4 deaths; SMR = 419; 95% CI: 114-1073) and respiratory and intrathoracic organs tumors (21 deaths; SMR = 175; 95% CI: 108-268).

A mortality cohort study was undertaken among Polish pulp and paper workers. This paper concentrates on neoplasms mortality among men and women employed continuously for at least one year in the factory producing sulphate pulp, paper board and paper products. A retrospective observation carried out till 31 December 1995 covered 10,460 workers employed during the years 1968-1990. The cohort accessibility was 99%. Cancer risk was evaluated on the basis of standardized mortality ratio (SMR) calculated according to the person-years method. The general population of Poland was the reference population. The results of a 23-year cohort observation, published earlier, showed a lowered overall mortality from all causes and from all malignant neoplasms, and a significant excess of death from peritoneum and prostate cancer among pulp mill male subcohort. The conclusion was drawn that a 'young' cohort and relatively short follow-up period might have affected the results. The results presented in this paper, obtained after further five years of observation showed in the male cohort an excess of deaths from cancer of respiratory tract and peritoneum (lung SMR = 122, nasal cavities SMR = 587, peritoneum SMR = 562). An approximate correction for smoking habits resulted in only 4 decreased risk estimates for lung cancer, indicating a small positive confounding effect of smoking in this material. In female cohort an excess of brain cancer was found (SMR = 355). Only the excess mortality from cancers of nose, lung and peritoneum was coherent with the exposure to higher concentrations of wood dust, pulp, paper and board dust. It may support a hypothesis that these factors as well as dust pollutants, not yet identified in this study, may be considered as one of the risk factors contributing to the incidence of neoplasms of these sites.

The paper presents data on cancer risk, especially pleural mesothelioma and lung cancer, among the workers of asbestos cement plant who living in the vicinity of the plant, were also environmentally exposed to asbestos. In 1959 an asbestos cement factory was founded in the rural area of south-eastern Poland. Apart from chrysotile asbestos, crocidolite was used till 1985 chiefly for the manufacture of pressure pipes. The blue asbestos made up 15% of the mean annual tonnage of the processed asbestos. It was found that soon after asbestos production had started the process wastes were made available to local community, particularly to the workers of that factory. For over twenty years asbestos wastes of all kinds, both wet (process sludge) and dry (from pipe and sheet grinding) were exploited for the hardening of roads, paths, farmyards and sports fields and as construction material components. For the evaluation of cancer risk due to occupational exposure to asbestos a cohort of 1,526 workers employed in this factory was observed till the end of 1996. The cohort availability was 95.6%. Standardized mortality ratio (SMR) was calculated using the man-years method. The reference population was the general population of Poland. The results of the study demonstrated a statistically significant increase in the risk of a) pleural mesothelioma--over an 80-fold excess among males and over a 200-fold one among females; b) lung cancer in females--over a 6-fold excess; c) colon cancer in males--over a 3-fold excess. In the 1990 ten new cases of pleural mesothelioma in the cohort were reported. As compared to other asbestos-cement cohorts in Poland, observed at the same time, this cohort presented a very high risk of pleural mesothelioma. The analysis of 16 cases of pleural mesothelioma found in the cohort from 1987 to 1997 revealed 4 cases with very short employment period (3.5 months-5 years) including two cases with relatively short latency period (11-12 years). In order to find explanation of these findings, additional investigations were made. The epidemiological study indicated that all these persons were at the same time subject to non-occupational exposure associated with massive utilization of commonly available asbestos-cement wastes as road surface material.

During the years 1970-1996, 8,414 cases (8,176 among men and 238 among women) of lead poisoning, recognised as occupational disease, were registered with the peak in 1972-1976 (500-800 cases per year). An in-depth analysis of 7,893 (men) reported in the period between 1970 and 1992 revealed that repeated poisonings in the same person were observed quite frequently. Among 4,556 men poisoned by lead during the period under study, in every third men the disease was diagnosed at least twice. Almost half of men with occupational lead poisoning received the occupational disease certification after the exposure lasting less than five years. The majority of persons poisoned by lead (64.3%) were employed in plants located in the Katowice voivodship. More than half of men with occupational lead poisoning (54.1%) was exposed to maximum concentrations of lead, exceeding MAC values by two hundred times. A diminishing number of occupational lead poisoning observed during the 1990s does not reflect a real-level of occupational exposure. The majority of cases reported apply to large plants or industrial complexes where the prevention of poisonings is rather well organised. But dispersed small production and service enterprises, where acute cases of poisoning may lead to irreversible organic changes create a great problem. One of the prerequisites for effective prevention of occupational lead poisoning is to identify and to make a complete inventory of workplaces where lead occurs, as well as to identify workposts hazardous to worker's health, and to monitor lead concentrations in the air.

The analysis of the incidence of malignant neoplasms, recognised as occupational disease, in Poland during the years 1971-94 was based on occupational disease certificates sent obligatory to the Nofer institute of Occupational Medicine (Lódz) by all sanitary and epidemiological stations under the Ministry of Health and Social Welfare and the Polish State Railways. During the period study 1118 occupational neoplasms were diagnosed, including 1042 cases (93.2%) of neoplasms in males. Among males malignant Ineoplasms of lung (36.1%), larynx (25.5%), bladder (14.7), skin (6%), lymphatic and haematopoietic tissue (3.4%) and pleura (2.9%) were most common. The rate occupational neoplasms in the total number of neoplasms registered accounted for 0.11% in males and 0.01% in females. PAH (29.1%), asbestos dust (18.8%), ionizing radiation (13.8%), chromium and its compounds (13.5%) and benzidine (9.8%) belong to the most frequent causes of malignant neoplasms in males, and ionizing radiation (31.5%) and asbestos dust (30.3%) in females. The number of neoplasms recognised as occupational disease is very low. Underestimation of occupational neoplasms is very common throughout the world, but it is particularly high in Poland if we take the incidence of pleura mesothelioma as an example. This is mainly due to: (1) the lack of clinical and morphological specificity of occupationally induced neoplasms; (2) a long latency; (3) the influence of other factors confounding the effect of occupational exposure; (4) a relatively small number of occupational carcinogens identified thus far; (5) limited knowledge of occupational carcinogens and criteria for occupational disease certification, and unsatisfactory interviewing skills among doctors who diagnose cancer disease. The identification of a harmful factor and the size of exposure to it, belongs to the weakest point in certifying the occupational background of the disease. The essential conclusions presented stress the urgent need for establishing the system facilitating the diagnosis and certification of occupational neoplasms.

Mortality among workers in the Polish pulp and paper industry was evaluated in a cohort study of 10,460 workers who had been employed continuously for at least one year, between 1968 and 1990 in the factory producing sulphate pulp, paper, board and paper products. Three subcohorts were formed according to the work areas. A standardized mortality ratio (SMR) analysis was used to compare death rates for each group exposed with Polish national rates. Mortality from all causes and from all malignant neoplasms, both in the female and in male cohorts was lower than that observed in the general population. In the pulp male subcohort a significantly elevated risk of death from peritoneum cancer (2 obs, SMR = 2,530) and prostate cancer (4 obs, SMR = 854) was recorded, although overall mortality from all causes and from all malignant neoplasms was lower than expected. The excess of deaths from neoplasms in other sites was statistically nonsignificant in all subcohorts. This study did not confirm the excess mortality from lung, stomach and lymphatic cancers found by other authors. The "young" cohort and a relatively short follow-up period (23 years) might have affected the results.

After five successive years of observation the authors present a verified evaluation of the delayed health effects in the pulp and paper industry workers (with particular regard to mortality from malignant neoplasms). The cohort studied consisted of 10,460 workers employed for at least 12 months between 1967 and 1990 in the plants manufacturing sulfate pulp, paper, board and paper products. Subjects were assigned to three subcohorts according to the work areas: 1. pulp mill workers; 2. paper mill workers (paper and board as well as their products); 3. other workers. The workers were enrolled in the subcohort if they were employed for at least one year in one of these departments. One subject could be included in more than one subcohort. The vital status of the cohort was determined through a variety of sources over an observation period of 28 yrs (1967-95). Mortality data were analysed in terms of cause-specific standardized mortality ratios (SMRs) with expected deaths count based on the national mortality rates in Poland. The results of a twenty three-year cohort observation, published earlier, showed the lowered overall mortality (explained by a "healthy worker effect") and the excess of deaths from malignant neoplasms for some sites (peritoneum, prostate, brain). Due to a small number of deaths recorded, kind of exposure and its duration, were left out of the analysis. The results presented in this paper, obtained after five successive years of the male cohort observation, showed an excess of deaths from cancers of the respiratory tract and peritoneum. In the female cohort an excess of brain cancers was found. Only an excessive mortality from malignant neoplasms of the respiratory system was coherent with the exposure to higher concentrations of wood, paper and board dust. An excess mortality from diseases of the circulatory system was found in both males and females employed in paper production.

A cohort study was carried out in order to evaluate the cancer risk in the asbestos-cement industry workers. The cohort consisted of workers employed in four asbestos-cement plants. One of those plants was established in 1924, the other three in the 1960s and 1970s. Currently only two of these plants continue their production. The plants used mainly chrysotile asbestos as well as crocidolite and amosite. Amphibolite asbestos was used before the mid-nineteen eighties in production of pressure pipes utilising about 15% of the total quantity of asbestos used. The measurements of the asbestos fibre concentration at work-sites have been taken occasionally since the mid 1980s, thus, the determination of a cumulative dose for individual persons in the cohort and the evaluation of the dose-effect relationship were not feasible. It could only be supposed that the concentrations at the preparatory work-site during first years of the plants' operation accounted for several tens fibres/cm3 in the production that employed the dry method. The cohort consisted of workers employed in the plant for at least three months between beginning of the plant during the post-war period, and 1980, that is during the period when amphibolite asbestos was in use. The retrospective observation was completed on 31 December 1991. The analysis of the death risk by causes was based on a standardized mortality ratios (SMRs) calculated using the person-years method. Statistical significance of SMRs was assessed by means of Poisson distribution one-sided test. The general population of Poland was used as the reference population to estimate the death risk. The cohort comprised 4,712 persons (3,563 males and 1,149 females). Of this number 4,500 persons (3,405 males and 1,095 females) were followed. The cohort availability were 95.5%. Male mortality, both total (473 deaths; SMR = 83) and due to malignant neoplasms (108 deaths; SMR = 86) was lower than in the general population. An excess of deaths from neoplasm of the pleura was by about 23 times higher (5 deaths; SMR = 2,288) and from neoplasm of the large intestine by two times higher (7 deaths; SMR = 214). Among females (41 deaths; SMR = 50) death risk was lower than in the reference population. At a low level of total mortality from neoplasms (13 deaths; SMR = 52) a statistically significant excess of deaths from neoplasm of the pleura (2 deaths; SMR = 2,112) was observed. In the plants investigated the analysis revealed a considerably diversified mortality from asbestos-related neoplasms. The incidence of pleura mesothelioma should be attributed to the use of considerable quantities of crocidolite asbestos and high concentrations of fibres in the air in plants II and IV, particularly during the first years after their establishment. In view of a long period of latency the excess of this neoplasm can be expected till 2020.

Malignant pleural mesothelioma is subject of special interest for environmental epidemiologists due to its proven cause-effect relationship with the exposure to asbestos dust, particularly crocidolite. The paper discusses the prevalence trends and geographical distribution of pleural mesothelioma in Poland based on the death rate analysis. In 1993 the crude death rate for that neoplasm was found to be 4.48 per 1 million for men and 3.14 per 1 million for women. While interpreting the numerical data, such aspects were considered as the problems with histopathological diagnosis of pleural mesothelioma; the long latency period of 30-40 years; and consequently, the possibility that for the male population the results may have been affected by other causes of death owing to its relatively short average lifespan. The volume and types of asbestos used in Poland were also taken into account.

A cohort study was designed to evaluate the risk of death from malignant neoplasms among pulp and paper workers. This paper presents the evaluation of death risk among workers engaged only in the production of paper, paperboard and paper products. The cohort study covered 1,322 males and 1,914 females employed for, at least, one year in a big pulp and paper mill during the period 1968-90. The study of exposure to harmful factors revealed that concentrations of paper and paperboard dusts in this mill exceeded hygienic standards. The analysis of death risk by causes and gender of those under study was based on standardized mortality rate (SMR) calculated using the method of person-year observation. The general population of Poland was used as reference. The results do not confirm excess mortality from lung, stomach and hematopoietic cancers in paper mill workers reported by other authors. However, an elevated risk of bladder cancer in males (SMR = 491, two deaths) and brain cancer in females (SMR = 353, two deaths) was observed. Both SMR values were not statistically significant. Because of small number of deaths, risk according to exposure and latency was not evaluated.

The authors present the results of cancer risk evaluation in the cohort of men occupationally exposed to chrysotile asbestos dust in the plant involved in the production of asbestos packings, uneven fabric, yarn, cords, asbestos and rubber cardboards and friction materials. A retrospective observation, carried out till 31 December 1990, covered 2,403 men employed during the years 1945-73. The cohort accessibility accounted for 90.5%. Cancer risk was evaluated on the basis of standardized mortality ratio (SMR) calculated according to the person-years method. A slightly higher mortality from malignant neoplasms was found in the cohort than in the general population (160 deaths; SMR = 108). A significant excess mortality applied only to one site, namely large intestine (9 deaths; SMR = 232). In the subcohort of workers exposed to a high dose of asbestos dust, a significant increase in total cancer risk was revealed (30 deaths; SMR = 150), including neoplasm of stomach (8 deaths; SMR = 223), large intestine (3 deaths, SMR = 582) and liver (3 deaths, SMR = 373). No significant increase in mortality from lung cancer was observed.

A mortality cohort study was carried out on 2,291 workers, including 169 women, with chronic occupational CS2 poisoning diagnosed during the years 1970-90. Information on vital status was available for 98.2% as of December 31, 1992. Mortality assessment was based on the standardized mortality ratio using the person-years method. The general population of Poland was the reference population. The number of subjects who died during the period of observation accounted for 658 men and 21 women. The analysis of mortality in male subjects showed statistically significant excess of deaths from the circulatory system diseases (SMR = 139), in this from ischaemic heart disease (SMR = 137), cerebrovascular disease (SMR = 188) and colon cancer (SMR = 233). Over a two-fold increased risk of death from diseases of the nervous system and sense organs, although statistically insignificant, was also observed. Among women a statistically significant risk of death from atherosclerosis was noted (SMR = 286). An elevated risk of death from the circulatory system diseases and from ischaemic disease (IHD) agrees with the results of some other cohort studies carried out in the viscose rayon workers. The increased mortality from malignant neoplasms is an unusual finding in cohorts of workers exposed to CS2. Our own data reported here showed a significantly increased mortality from colon cancer (9 cases). All these cases were noted in workers of the two oldest rayon plants and they require a detailed analysis. Further survey is also needed to elucidate the excess of deaths from the nervous system and sense organs diseases.

The study covered 72 persons (39 females and 33 males), engaged in the production of dyes and varnishes, and exposed to mixtures of organic solvents which contain benzene C-9 and C-10 alkyl derivatives. For females--length of employment accounted for mean = 15.9 years and cumulative exposure index for mean = 12.11, and for males - mean = 16.4 years and mean = 12.17, respectively. The study results applying to the group exposed were compared with the results of the controls matched according to gender, age and work shifts. Clinical examination indicated that among complaints the following manifestations predominated: headache, dizziness, increased emotional excitability, memory and concentration disturbances, hypersomnia during a day and mood instability. Subjective symptoms were more frequently observed in females. Neurological examination revealed no organic changes neither in the central nor in the peripheral nervous system. Certain anomalies were noted in EEG and visual evoked potential (VEP) examinations which may indicate pre-clinical changes in the nervous system.