Accidental discovery of asbestos-related occupational pleural disease in unemployed carpenter: a healthcare safety net that needs mending

Our plain-English summary of Accidental discovery of asbestos-related occupational pleural disease in unemployed carpenter: a healthcare safety net that needs mending, by I. Manfredo (Arhiv Za Higijenu Rada I Toksikologiju, 2015).

The study

• Author: I. Manfredo
• Journal: Arhiv Za Higijenu Rada I Toksikologiju
• Published: 2015;66(3):213-5
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Unemployed persons are often on the margins of the healthcare system and under the radar of safety and health organisations, as no systematic records are kept of occupational diseases caused by exposure at previous work place. Law in Slovenia requires that asbestos-related occupational diseases are verified by establishing the causal relationship between exposure at work and its effect on the worker. This report describes a case of verifying occupational pleural disease in an unemployed carpenter who was referred for consultation with occupational health specialist as part of the regular procedure for the unemployed registered at the Employment Service of Slovenia. At the consultation it turned out that the carpenter had been exposed to asbestos when he worked as a teenage apprentice. The diagnosis of the bilateral pleural disease and asbestosis was confirmed by X-ray and high-resolution computed tomography. Because he had no record of exposure in that period, we analysed his past working environment for minerals and found chrysotile in all asbestos board samples. The case was presented to an interdisciplinary committee, which verified his disease as occupational. This case points to the need of adopting guidelines for occupational health specialists providing counsel to the national employment service so that the number of unrecorded occupational diseases is minimised and their treatment is covered by the state.

In plain English

This Slovenian case report described a 60-year-old carpenter, unemployed for 10 years, whom the national employment service referred to an occupational health specialist in 2014 for a fitness-for-work assessment. As an apprentice from July 1971 to August 1974, he had cut, sawed and screwed asbestos insulating boards onto walls without masks, ventilation or other safety measures. A yearly chest X-ray showed extensive pleural plaques in 2012, 41 years after his first exposure. X-ray and high-resolution CT confirmed bilateral pleural disease in 2014. No contracts, measurements or workplace records existed. The only evidence was a signed statement from a collaborator of the master carpenter, and a first submission to an interdisciplinary committee that included it was rejected as insufficient. The author then sampled boards at an indoor swimming pool where the patient had worked, and laboratory analysis found chrysotile in all samples. On resubmission, the committee verified the asbestos exposure and extended the diagnosis to asbestosis. The author concluded that unemployed people are on the margins of the system and that the burden of proof should lie with the system, not the individual.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 60-year-old carpenter in Slovenia, unemployed for 10 years, referred by the Employment Service of Slovenia (ESS) to an occupational health specialist in 2014 for assessment of fitness for work
• Exposure: During the workshop practice part of his apprenticeship (July 1971 to August 1974), he installed asbestos insulating boards of Belgian make instead of working with wood. The boards were 1250x2050 mm and 6-15 mm thick, sold as Masal, Fasal or Glasal. They were cut, sawed and screwed on walls without masks, ventilation or other safety measures. He then worked as a carpenter in the same workshop until August 1975. The article does not say whether that later work involved the boards. It says he was not exposed to asbestos afterwards and continued to work with wood.
• Main results:
  • Smoking history: the patient had smoked about 15 pack-years of cigarettes over 35 years and quit in 2010.
  • Yearly follow-up chest X-rays from 2008 to 2011 showed no suspicious changes. In 2012 the X-ray showed extensive pleural plaques and atypical condensation.
  • Bilateral pleural disease was confirmed by X-ray in Zagorje and by high-resolution computed tomography at the University Clinic Golnik in 2014.
  • The interval from first exposure (1971) to the diagnosis of pleural plaques (2012) was 41 years.
  • There were no contracts, environmental measurements or risk assessments. The only evidence was a signed statement from a collaborator of the master carpenter saying the patient had worked with asbestos boards.
  • The first submission to the interdisciplinary committee, with the diagnosis and the collaborator's statement, was rejected as insufficient.
  • Board samples were taken from an indoor swimming pool in Zasavje where the patient had worked. They were analysed by scanning electron microscopy and dispersion spectroscopy, and white asbestos (chrysotile) was found in all of the samples.
  • On resubmission, the committee verified the asbestos exposure and extended the diagnosis from bilateral pleural disease to asbestosis.
• The authors' conclusion: The author concluded that unemployed people are on the margins of the system, with no established procedure to diagnose and record occupational diseases from earlier workplaces. The author proposed extending the role of occupational health counsellors working for the employment service. The author also said the burden of proof should lie with the system rather than the individual.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Chrysotile.

Medical terms in this study, explained in our Lexicon: Discovery, Occupational Disease, Bilateral, Chrysotile, Asbestos Millboard.

Related studies

• Asbestos-related diseases in construction carpenters — M. García-Closas, D.C. Christiani (1995)
• Asbestos-related chest disease in joiners — D.E. Fletcher (1971)
• Occupational exposure to wood dust and risk of lung cancer: the ICARE study — M. Matrat, L. Radoï, et al. (2019)
• WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of occupational exposure to dusts and/or fibres and of the effect of occupational exposure to dusts and/or fibres on pneumoconiosis — D. Mandrioli, V. Schlünssen, et al. (2018)
• Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II) — P.A. Demers, S.D. Stellman, et al. (1998)
• CT Characteristics of Pleural Plaques Related to Occupational or Environmental Asbestos Exposure from South Korean Asbestos Mines — Y. Kim, J.P. Myong, et al. (2015)

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