Risk of fatal and non-fatal occupational injury in foreign workers in Spain

STUDY OBJECTIVE: In the past decade, Spain has experienced dramatic growth of its immigrant population. Available information on the occupational conditions of foreign workers is scarce. This study aims to add to this information by describing occupational injuries in foreign workers in Spain. Design, setting, PARTICIPANTS: Data were analysed from the 2003 Ministry of Labour and Social Issues registry of non-fatal and fatal occupational injury in insured workers. The population at risk was estimated from the Social Security Affiliation Registry as of 31 December 2003. Comparing Spanish with foreign workers and also considering age and sex, incidence rates and relative risks, and their confidence intervals at 95%, were calculated within each population group. MAIN RESULTS: In women and in men, and in every age group, foreign workers had an increased risk of non-fatal and fatal occupational injury compared with Spanish workers. The differences were especially notable in foreign women workers and in older workers. CONCLUSIONS: Many factors probably combine to cause the differences found in this study. Better data collection on the situation of foreign workers is needed to understand these facts and apply appropriate public health solutions.     

Incidence of occupational asthma by occupation and industry in Finland

BACKGROUND: Systematic research on occupation or industry-specific incidence of occupational asthma (OA) is sparse. We calculated the incidence of notified OA by occupation, industry and causative agent in Finland for the years 1989-95. METHODS: The numbers of cases of reported OA were retrieved from the Finnish Registry of Occupational Diseases for the population between 20 and 64 years of age. The numbers of employed workers were retrieved from Statistics Finland. Incidence rates were calculated for each occupation, industry and the total workforce. RESULTS: Altogether 2602 cases of OA were notified and the mean annual incidence rate was 17.4 cases/100,000 employed workers. The incidence rate was the highest in bakers, other painters and lacquerers, veterinary surgeons, chemical workers, farmers, animal husbandry workers, other food manufacturing workers, welders, plastic product workers, butchers and sausage makers, and floor layers. Cases caused by animal epithelia, hairs and secretions or flours, grains, and fodders accounted for 60% of the total. CONCLUSIONS: Estimation of occupation and industry-specific incidence rates forms the basis for successful prevention of OA, but necessitates collection of data over several years from well-established surveillance systems.     

Incidence and prevalence of ischaemic heart disease and cerebrovascular disease in Spain: a systematic review of the literature

Cardiovascular disease morbidity is not well documented in Spain, due to the fact that there is no comprehensive and reliable data source. This study sought to describe the population frequency of ischaemic heart disease and cerebrovascular disease in Spain. We used bibliographic search strategies in four different databases to identify scientific studies published in Spanish medical journals or by Spanish authors after 1990. We then selected studies drawn from population-based registers, prevalence surveys and cohort studies, from which age-adjusted incidence and/or prevalence rates could be extracted. We identified 19 papers published in the period 1993-2005, containing valid information on cardiovascular diseases population incidence or prevalence in Spain. Acute myocardial infarction incidence rates per 100,000 population ranged between 135-210 and 29-61 new cases annually for men and women aged 25-74 years, respectively. Acute myocardial infarction prevalence rates were not available, but a study of prevalence of angina showed rates of 7.3% in men and 7.5% in women. Cerebrovascular disease incidence rates per 100,000 population ranged between 364 for men and 169 women, in aged 69 years and over rising to 2.371 in men and 1.493 in women. Prevalence rates in population aged 65 years and over would be estimated in 7% in men and 6% in women. Although currently available information may serve as an initial reference, monitoring of the incidence and prevalence of these diseases will nevertheless call for an effort which exceeds the capacity of isolated research teams.     

Bladder cancer in Asturias, Spain: incidence and trends (1982-1993)

OBJECTIVES: To assess epidemiological aspects of bladder cancer in Asturias, as a preliminary step before undertaking epidemiological and genetic research of the etiology and survival of bladder neoplasm. METHODS: cases from the Asturias Regional Cancer Registry, Spain were used to calculated annual incidence rates between 1982 and 1993 for Asturias and all its health areas. It has been Standardized incidence ratios with the indirect method for the Asturian areas and other Spanish regions were obtained our results are also compared with other european countries. RESULTS: The trend in bladder cancer in Asturias has been increasing significantly in the last twelve years (11.03 to 15.10 age standardized rate per 100,000). For the different health areas no differences have been identified, while there were not significant differences between our region and other Spanish regions. Standardized rates for Asturian men are in the highest group among European countries, while women rates are at an intermediate level. CONCLUSIONS: Between 1982 and 1993, bladder cancer incidence has been increasing in Asturias. The different behaviour of incidence ratios between men and women and the similar epidemiological factors between Asturias and other parts of Spain point at the need for further epidemiological research to look at the different occupational factors existing in an industrial area like Asturias.     

Asthma incidence in wood-processing industries in Finland in a register-based population study

OBJECTIVES: This register-based population study determined incidence rates of clinically verified asthma among woodworkers, other blue-collar workers, and administrative personnel employed in wood-processing industries in Finland. Exposure to wood dust was under special scrutiny. METHODS: All Finns employed in wood-processing industries were followed for asthma incidence via record linkage in the years 1986-1998. Incident cases included people with asthma reimbursed for medication by the national health insurance or registered as having occupational asthma. Age-adjusted incidence rates and relative risks (RR) by gender were estimated for wood workers, other blue-collar workers, and administrative employees (referents) in wood industries. RESULTS: The relative risk of asthma was increased for all woodworkers among both genders [men: RR 1.5, 95% confidence interval (95% CI) 1.2-1.8; women: RR 1.5, 95% Cl 1.2-1.7]; a similarly elevated risk was also found for other blue-collar workers (men: RR 1.5, 95% Cl 1.2-1.8; women: RR 1.4, 95% Cl 1.2-1.6) in the same wood industries. Statistically increased relative risks were found for low and medium exposure to wood dust, but not for high exposure. Altogether 217 of the 4074 clinically verified asthma cases were reported as occupational asthma in the Finnish Register on Occupational Diseases. CONCLUSIONS: The incidence rates for asthma were significantly increased both among the woodworkers and the other blue-collar workers in wood industries but without a clear dose-response. Cases recognized as occupational asthma accounted for only a small part of the total asthma excess, indicating that much of the work-related asthma excess remains unrecognized in these industries.     

Incidence of urinary bladder cancer in an industrialized area of Spain

AIM: To identify all incident cases of bladder cancer in the county of Vallès Occidental (Spain), describe their histopathological characteristics, and make comparisons with other Spanish and European areas. METHOD: The study was carried out from the Corporació Parc Taulí (Sabadell). All new cases of bladder cancer in residents of the county Vallès Occidental, a highly industrialised area of Catalonia (Spain), were included between 1992 and 1994. Incidence rates of bladder cancer were adjusted and were compared with adjusted incidence rates reported by registries in other Spanish and European countries. RESULTS: 485 new cases were identified. Transitional cell carcinomas predominated (95.5%). The majority of tumours were diagnosed in their initial stages, 75.9% being superficial and 62.6% well to moderately differentiated. Bladder cancer was more common in men than in women, but women presented tumours of worse prognosis. The mean age at diagnosis was also higher in women than men (71 vs. 66 years, p = 0.03). The adjusted incidence rate in men (52.2 cases/100,000) was among the highest of the observed areas, whereas for women (5.4 cases/100,000) was relatively low. CONCLUSIONS: The incidence of bladder cancer among men in Vallès Occidental is among the highest in Europe, and intermediate for women. The high male/female ratio seen in all Spanish areas could be attributed to the fact that women in Spain have been less exposed than men to the risk factors, or their exposure occurred more recently.     

Detection methods of the drug-addiction and alcoholism treatment programme of the Spanish National Railway Company (RENFE)

BACKGROUND: Social problems in enterprises need to be approached by all groups involved in order to achieve a satisfactory result. With regard to Occupational Health and, specifically, drug-addiction, the groups concerned are Occupational Health Services, Trade Unionists and Managers. OBJECTIVES: To analyse the involvement of the social groups (Occupational Health Service, Management and Trade Unions) in relation to the detection of workers suffering from drug-addiction and/or alcoholism. METHODS: During the first eight years of implementation (1990-1997) of the Drug-Addiction and Alcoholism Treatment Programme of the Spanish National Railway Company (RENFE), a total of 477 workers consuming alcohol and drugs were detected and treated under the Programme (1.1% prevalence), 465 men (97.5%) and 12 women (2.5%), with an average age of 39.8 years. RESULTS: The subjects were detected by occupational physicians (55.4%), occupational psychologists (2.9%), managers (11.3%), trade unionists (19.5%), via self-referral (9.4%) and by other means (1.5%). CONCLUSIONS: The results demonstrate the efficiency and the profitability to the company of prevention and treatment interventions and the need for the coordination of managers, trade unions and occupational health services.     

Estimate of the mortality rate attributable to occupational diseases in Spain, 2004

BACKGROUND: Occupational diseases are not registered in Spain to a sufficient degree so as to be able to evaluate the impact thereof in our country. In this study, the occupational disease-related mortality and the costs thereof are estimated based on attributable risks calculated in international literature. METHODS: Attributable risk estimates are applied for the occupationally-caused deaths rate calculated by Nurminen and Karjalainen (Finland, 2001) are applied to the total number of deaths by the relevant diseases and age groups in Spain and in Autonomous Communities in 2004. The potential years of life and working life lost are calculated. Based upon the years of working life lost, the updated costs of the loss of productive life due to deaths caused by occupational diseases in Spain are estimated. RESULTS: According to our estimates, nearly 16,000 deaths would have occurred in Spain due to occupational exposure-related diseases, the majority in males (87%). These deaths could have caused nearly 152,000 potential years of life lost and somewhat over 47,000 potential years of working life lost, which would entail an updated cost in productivity losses of 580 million - 1 billion euros. CONCLUSIONS: In 2004, the occupational disease register in Spain included solely two deaths due to this cause. The results of this study however reveal the importance of working conditions as determining factors in preventable deaths among the population and the imminent need for adequate surveillance and prevention systems for dealing with this public health problem in its full magnitude.     

The epidemiology of lung cancer: Review of risk factors and Spanish data

Lung cancer is the main form of cancer among men both in Spain and in the rest of europe. However, Spanish incidence rates are among the lowest of the European registries, especially for women. In this country, lung cancer mortality increased much more rapidly for men than for women between the fifties and the eighties. This increase was larger for lung cancer than for any other site. The trend of incidence, in Spain as well as in the greatest part of the world, is entirely explained by tobacco consumption, which remains the major risk factor for lung cancer. Occupational radon and asbestos exposures are other important but less extended determinants of lung cancer. Genetic factors could also play a role in the occurrence of the disease. On the other side, a high consumption of fruit and vegetables is protective, but, so far, no single dietary component has been found to be preventive. In this article, we review the major risk factors of lung cancer with an emphasis on Spanish and European data.     

Surveillance for work-related hearing loss in the UK: OSSA and OPRA 1997-2000

Surveillance data on occupational audiological disorders have been collected by the Occupational Surveillance Scheme for Audiological Physicians (OSSA) since October 1997 and by the Occupational Physicians Reporting Activity (OPRA) from January 1996. During the 3 years ending in September 2000, a total of 1620 new cases were received from consultant audiological physicians; 988 new cases were estimated from reports by occupational physicians in the period from October 1997 to September 2000. The annual incidence of occupational noise-induced hearing loss (NIHL) was 1.94 and 1.23 per 100 000 workers for the OSSA and OPRA schemes, respectively. The median age at diagnosis with NIHL was 59 years in OSSA reports and 50 years in OPRA; nearly all cases were seen in men (95.6 and 92.5% male cases for OSSA and OPRA, respectively). High incidence rates based on OSSA reports were seen in foundry labourers (64.0 per 100 000 employed), coal gas and coke oven furnace workers (54.6), workers in transport and communication (43.1), metal workers (31.3), and members of the armed forces (28.3). Data from occupational physicians point to high rates in sawyers and woodworking machinists, metal furnace workers, coach and carriage builders, maintenance fitters, and engineering labourers. Among workers aged < or =45 years, those in manufacturing and the armed forces were prominent. The long latency of occupational hearing loss makes surveillance difficult, but consistent patterns in occupational risk suggest targets for preventive efforts.     

The risk of asthma among Finnish patients with farmer's lung

OBJECTIVES: To assess the incidence and risk of asthma in patients with farmer's lung in comparison with farm workers without farmer's lung. METHODS: The details of farmers and animal-husbandry workers notified in 1988-1999 for farmer's lung ( n=1,272) or other occupational disease ( n=5,045) to the Finnish Register of Occupational Diseases were followed until 31 December 2000 through two national registries of individuals eligible for reimbursement of the cost of asthma medication and the Population Register Center. Incidence rates of asthma were calculated, and a log-linear model adjusted for age, gender and occupation was used to estimate relative risks of asthma among those with farmer's lung compared to those with other occupational disease. RESULTS: Of the patients with farmer's lung, 109 (8.6%) were diagnosed with asthma during the follow-up compared with 202 (4.0%) incident cases of asthma among those in the reference population. The crude relative risk of asthma was 2.1 (95% CI 1.6-2.6) among those with farmer's lung compared with the reference population. The age- and occupation-adjusted relative risk of asthma among patients with farmer's lung was 2.5 (1.8-3.5) in men and 1.4 (1.0-1.9) in women. The rate of asthma was especially high during the first 2 years after notification of farmer's lung. CONCLUSIONS: Patients with farmer's lung have an increased risk of developing asthma in comparison to farm workers in general. Most of the cases of asthma occur relatively shortly after the diagnosis of farmer's lung, which should be taken into account in medical follow-up of patients with farmer's lung.     

Medico-legal aspects of malignant mesothelioma

The object of this investigation was to discuss medico-legal aspects of malignant mesothelioma in relation to social insurance legislation for occupational injuries and diseases in Norway. During the period 1960-79 the Cancer Registry of Norway recorded a total of 155 men and 35 women with malignant mesothelioma. However, only 21 men and no women were notified to the National Insurance Institution as occupational disease cases before 31 December 1979, in spite of the well established causal association between occupational asbestos exposure and the disease. The investigation is based on these 21 patients. The long latency period from first asbestos exposure until appearance of the disease and the short survival were evident in this study. Furthermore, the legislation and provisions for occupational injuries and diseases in Norway are obviously intended for occupational accidents, and consequently the legal assessment of patients with malignant mesothelioma was complicated. For those notified, the delay in notification was considerable, and only 50% were notified before death. Delay in the claim procedure was also substantial, and few patients survived the claim procedure period. The decisions were not consistent, particularly decisions regarding "the year of injury" and appeared to have been more restrictive during recent years. One of the 21 cases was not accepted as occupational disease, because domestic exposure was considered more probable than occupational exposure.     

Semicircular lipoatrophy: a new occupational disease

In February 2007, an outbreak of 200 cases of a rare condition called semicircular lipoatrophy was notified by a company of Barcelona with about 1,000 workers. In September of that year, more that 600 cases had been notified in other workplaces, most of them in Barcelona, but also in other Spanish cities. A case-control study identified the low indoor relative humidity and working tables with thin edges as risk factors. Four months after the onset of the outbreak, the guidelines for the management of similar work-related outbreaks were published. They were addressed to health care workers of occupational health services and insurance organisations of occupational injuries and professional diseases. The implementation of the recommended interventions has been followed by a dramatic reduction of the incidence of new cases as well as by the recovery of a significant proportion of cases.     

Occupational disparities in accidents and roles of lifestyle factors and disabilities: a population-based study in north-eastern France

OBJECTIVE: To assess occupational disparities with regard to the occurrence of occupational, traffic, domestic and sports accidents, and the role of factors such as smoking, excessive alcohol consumption, obesity, psychotropic drug intake and disability in mediating these disparities. METHODS: The sample included 3368 economically active subjects aged 18-64 years, selected at random in north-eastern France. Subjects completed a postal questionnaire about sociodemographic and lifestyle information, and recorded the occurrence of accidents by type during the previous 2 years. Data were analysed using a logistic regression model with different sets of independent variables and covariates in order to describe the disparities and investigate the role of personal factors. RESULTS: During the 2 years preceding the survey, 11.8% of men and 5.4% of women had an occupational accident, 3.7% of men and 4.5% of women had a traffic accident, 4.1% of men and 1.5% of women had a domestic accident, and 6.1% of men and 1.9% of women had a sports accident. Personal factors were strongly related to the occurrence of accidents, with different patterns in men compared with women, and according to the type of accident. Men in intermediary occupations, clerks, craftsmen and tradesmen and, to an even greater extent, manual workers and farmers had a much higher occurrence of occupational accidents than men in the upper occupations, while craftsmen and tradesmen had a much higher occurrence of traffic accidents. Manual workers had a lower occurrence of sports accidents. After adjustment for lifestyle factors and disability, estimated odds ratios were reduced slightly but remained significant. Occupational disparities in accidents were virtually non-existent among women. CONCLUSION: Occupational disparities in accidents mainly concern men and are predominantly observed in occupational and traffic accidents. Lifestyle factors do play a role in explaining these disparities, but are fairly limited. Improved work conditions, equipment, health behaviours, safe driving practices and accommodation of people with disabilities are needed to reduce the risk of accidents.     

Reported incidence of occupational asthma in the United Kingdom, 1989-97

OBJECTIVES—To examine trends in estimated population based incidence of occupational asthma by age, sex, occupation, geographical region, and causal agents based on 9 years of the Surveillance of Work Related and Occupational Respiratory Disease (SWORD) data.
METHODS—In January 1989 the SWORD scheme for the surveillance of occupational respiratory disease was established in the United Kingdom to make good the lack of epidemiological information on the incidence of these diseases in the United Kingdom. Between 80% and 90% of chest and occupational physicians report voluntarily all new cases they see, on a monthly or random sampling basis. During the 9 years 1989-97, an estimated 25 674 new cases of occupational respiratory disease, including 7387 of occupational asthma, were reported. Suspected causal agents were classified into 44 categories and estimated annual incidences of asthma were calculated with denominators from the labour force survey.
RESULTS—Overall, a third of the suspected causes of asthma were organic, a third chemical, 6% metallic, and the rest miscellaneous, or in 8%, unknown. There was evidence of an increase since 1989 in cases due to latex, and possibly glutaraldehyde, and an apparent drop since 1991 in the proportion of cases attributed to isocyanates. Incidences were higher in men than women and the disparity was especially marked in the population aged 45 years or more in which rates for men were at least twice those for women. Average annual rates per million workers for 1992-7 ranged from 7 (95% confidence interval (95% CI) 5 to 9) for the lowest risk group of professional, clerical, and service workers to 1464 (95% CI 968 to 2173) for coach and other spray painters. Except for laboratory technicians, all other occupations with rates over 100 were concerned with manufacturing and processing that used chemicals, metals, and organic materials. Incidences were two to three times higher in the north and midlands than in East Anglia and the south. The introduction of a sampling scheme in 1992 doubled estimates of reported incidence of occupational asthma, but there was little evidence of other temporal changes.
CONCLUSIONS—The SWORD scheme has produced consistent estimates of the causes and incidence of occupational asthma as seen by chest and occupational physicians. It has allowed the epidemiology of occupational asthma in the population to be studied and high risk occupations to be identified. There is certainly more occupational asthma in the population than that which reaches specialists in occupational and chest medicine; therefore the incidence rates presented here are underestimates, but by how much remains unknown.


     

Differences in Exposure to Occupational Health Risks in Spanish and Foreign-Born Workers in Spain (Itsal Project)

Migrant workers usually show higher rates of work-related health problems than natives. However, little information is available about their exposure to occupational risks. We describe self-reported working exposure in Spanish and foreign-born workers. A cross-sectional survey was conducted as part of the ITSAL Project. Data on sociodemographic and self-reported occupational exposure in 1,841 foreign-born and 509 Spanish workers were collected through face-to-face interviews. Prevalence and adjusted odds ratios-aOR- (by age, education, type of contract) were calculated. Foreign-born men in non-services sectors and those in manual occupations perceived exposure to occupational risks with lower prevalence than Spanish workers. Foreign-born women reported higher prevalence of exposure than Spanish female workers. By occupation, foreign-born female workers were more likely than Spanish workers to report working many hours/day (aOR2.68; 95 % CI 1.06–6.78) and exposure to extreme temperatures (aOR2.19; 95 % CI 1.10–4.38). Some groups of migrant workers may need increased protection regarding some occupational exposures.     

Occupational health in Brazil

Brazil is a recently industrialised country with marked contrasts in social and economic development. The availability of public/private services in its different regions also varies. Health indicators follow these trends. Occupational health is a vast new field, as in other developing countries. Occupational medicine is a required subject in graduation courses for physicians. Specialisation courses for university graduated professionals have more than 700 hours of lectures and train occupational health physicians, safety engineers and nursing staff. At the technical level, there are courses with up to 1300 hours for the training of safety inspectors. Until 1986 about 19 000 occupational health physicians, 18 000 safety engineers and 51 000 safety inspectors had been officially registered. Although in its infancy, postgraduation has attracted professionals at university level, through residence programmes as well as masters and doctors degrees, whereby at least a hundred good-quality research studies have been produced so far. Occupational health activities are controlled by law. Undertakings with higher risks and larger number of employees are required to hire specialised technical staff. In 1995 the Ministry of Labour demanded programmes of medical control of occupational health (PCMSO) for every worker as well as a programme of prevention of environmental hazards (PPRA). This was considered as a positive measure for the improvement of working conditions and health at work. Physicians specialising in occupational medicine are the professionals more often hired by the enterprises. Reference centres (CRSTs) for workers' health are connected to the State or City Health Secretariat primary health care units. They exist in more populated areas and are accepted by workers as the best way to accomplish the diagnosis of occupational diseases. There is important participation by the trade unions in the management of these reference centres. For 30 years now employers organisations have also kept specialised services for safety and occupational health. Although they are better equipped they are less well used by the workers than the CRSTs. At the federal level, activities concerned with occupational health are connected to three ministries: Labour, Health and Social Security. The Ministry of Labour enacts legislation on hygiene, safety and occupational medicine, performs inspections through its regional units and runs a number of research projects. The Ministry of Health provides medical care for workers injured or affected by occupational diseases and also has surveillance programmes for certain occupational diseases. The Ministry of Social Security provides rehabilitation and compensation for registered workers. In spite of a decrease in the number of accidents at work during the past 25 years, working conditions have not improved. Changes in the laws of social security in the 1970s discouraged registration and reporting of occupational injuries and diseases. In consequence death rates due to accidents increased. With the implementation of the CRSTs, the recorded incidence of occupational diseases has risen, not only because of improved diagnosis, but also because of stronger pressure from the unions and better organisation of public services and enterprises. Received: 24 February 1997 / Accepted: 14 March 1997     

Reported incidence of occupational asthma in the United Kingdom, 1989-90.

STUDY OBJECTIVE--To estimate the incidence of occupational asthma seen by respiratory and occupational physicians in the UK in 1989 and 1990. DESIGN--New cases of occupational asthma were taken from a national reporting scheme, the Surveillance of Work-related and Occupational Respiratory Disease Project (SWORD). Estimates of the working population from the Labour Force Survey were used to calculate reported incidence by age group, sex, occupation, and region. SETTING--The SWORD project is a scheme for the reporting of new cases of work-related respiratory disease by thoracic and occupational physicians from throughout the UK which began in 1989. PATIENTS--In 1989 and 1990, of 4229 cases reported, 1085 (26%) were in patients with occupational asthma. MAIN RESULTS--Only half the reported cases were attributed to agents prescribed under the Industrial Injuries Scheme. There was considerable diversity in risk by occupation, with highest annual rates in welders, solderers, and electronic assemblers (175/million), laboratory workers (188/million), metal treaters (267/million), bakers (334/million), plastics workers (337/million), chemical processors (364/million), and spray painters (658/million). Crude rates in men were higher than in women, but rates within occupations were similar in both sexes. Rates of disease rose with age; adjustment for occupation increased the gradient. Regional differences were only partly explained by diversity of industry and were probably mainly due to variation in levels of ascertainment and reporting. CONCLUSIONS--Asthma is the most commonly reported occupational lung disease in the UK. The incidence in the general population is unknown, but it was estimated that the incidence of new cases seen by respiratory and occupational physicians was about three times that reported. High relative risks were found in a number of occupations in which effective control of the work environment is urgently required.     

Occupational health in Australia

Australia is a developed country in the Asia-Pacific Region with a large land area but a small population. Its main economic activities are mining, agriculture and manufacturing, with its service and high-technology industries being the fastest growing sectors in recent years. The regulation and enforcement of Occupational Health and Safety policies are mainly administered by the Industrial Relations Departments of eight State and Territory jurisdictions in the country. A National Occupational Health and Safety Commission coordinates occupational health and safety at the Commonwealth level. In 1987 the six occupational health and safety priorities in Australia were listed as occupational back pain, management of chemicals used at work, occupational noise-induced hearing loss, occupational skin disorders, occupational cancer and mechanical equipment injury. Australia has probably the highest incidence of malignant mesothelioma in the world, although the use of asbestos has been largely phased out. There was an almost explosive “epidemic” of repetition strain injury in the 1980s. Approximately 500 work-related fatalities and 10,000 work-related injuries are notified for workers' compensation every year. In addition, it is estimated that there are several thousand cases of work-related diseases every year, many of which go unreported. Occupational physicians undergo 4 years of specialisation training. Occupational hygienists, nurses and ergonomists receive training supervised by their respective professional organisations. Received: 2 March 1998 / Accepted: 10 March 1998