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  1. Article ; Online: Commentary: Silica-A Multisystem Hazard.

    Ehrlich, Rodney

    International journal of epidemiology

    2021  Volume 50, Issue 4, Page(s) 1226–1228

    MeSH term(s) Humans ; Silicon Dioxide
    Chemical Substances Silicon Dioxide (7631-86-9)
    Language English
    Publishing date 2021-02-11
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 187909-1
    ISSN 1464-3685 ; 0300-5771
    ISSN (online) 1464-3685
    ISSN 0300-5771
    DOI 10.1093/ije/dyab020
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  2. Article ; Online: Tuberculosis, mining and silica.

    Ehrlich, Rodney I

    Occupational and environmental medicine

    2018  Volume 75, Issue 11, Page(s) 763–764

    MeSH term(s) Humans ; Miners ; Mining ; Silicon Dioxide ; Tuberculosis ; Tuberculosis, Pulmonary
    Chemical Substances Silicon Dioxide (7631-86-9)
    Language English
    Publishing date 2018-10-08
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 1180733-7
    ISSN 1470-7926 ; 1351-0711
    ISSN (online) 1470-7926
    ISSN 1351-0711
    DOI 10.1136/oemed-2018-105318
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  3. Article ; Online: History and medicine--The case of silicosis.

    Ehrlich, Rodney

    American journal of industrial medicine

    2015  Volume 58 Suppl 1, Page(s) S1–2

    MeSH term(s) Congresses as Topic/history ; Epidemics ; History, 20th Century ; Humans ; Mining/history ; Silicosis/epidemiology ; Silicosis/history ; South Africa
    Language English
    Publishing date 2015-11
    Publishing country United States
    Document type Editorial ; Historical Article ; Introductory Journal Article
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.22528
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  4. Article ; Online: The editors respond to Dr Paustenbach.

    Ehrlich, Rodney / Markowitz, Steven

    American journal of industrial medicine

    2019  Volume 62, Issue 7, Page(s) 625–626

    Language English
    Publishing date 2019-06-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.22988
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  5. Article ; Online: The association between silica exposure, silicosis and tuberculosis: a systematic review and meta-analysis.

    Ehrlich, Rodney / Akugizibwe, Paula / Siegfried, Nandi / Rees, David

    BMC public health

    2021  Volume 21, Issue 1, Page(s) 953

    Abstract: Background: While the association between occupational inhalation of silica dust and pulmonary tuberculosis has been known for over a century, there has never been a published systematic review, particularly of experience in the current era of less ... ...

    Abstract Background: While the association between occupational inhalation of silica dust and pulmonary tuberculosis has been known for over a century, there has never been a published systematic review, particularly of experience in the current era of less severe silicosis and treatable tuberculosis. We undertook a systematic review of the evidence for the association between (1) silicosis and pulmonary tuberculosis, and (2) silica exposure and pulmonary tuberculosis controlling for silicosis, and their respective exposure-response gradients.
    Methods: We searched PUBMED and EMBASE, and selected studies according to a priori inclusion criteria. We extracted, summarised and pooled the results of published case-control and cohort studies of silica exposure and/or silicosis and incident active tuberculosis. Study quality was assessed on the Newcastle-Ottawa Scale. Where meta-analysis was possible, effect estimates were pooled using inverse-variance weighted random-effects models. Otherwise narrative and graphic synthesis was undertaken. Confidence regarding overall effect estimates was assessed using the GRADE schema.
    Results: Nine studies met the inclusion criteria. Meta-analysis of eight studies of silicosis and tuberculosis yielded a pooled relative risk of 4.01 (95% confidence interval (CI) 2.88, 5.58). Exposure-response gradients were strong with a low silicosis severity threshold for increased risk. Our GRADE assessment was high confidence in a strong association. Meta-analysis of five studies of silica exposure controlling for or excluding silicosis yielded a pooled relative risk of 1.92 (95% CI 1.36, 2.73). Exposure-response gradients were observable in individual studies but not finely stratified enough to infer an exposure threshold. Our GRADE assessment was low confidence in the estimated effect owing to inconsistency and use of proxies for silica exposure.
    Conclusions: The evidence is robust for a strongly elevated risk of tuberculosis with radiological silicosis, with a low disease severity threshold. The effect estimate is more uncertain for silica exposure without radiological silicosis. Research is needed, particularly cohort studies measuring silica exposure in different settings, to characterise the effect more accurately as well as the silica exposure threshold that could be used to prevent excess tuberculosis risk.
    MeSH term(s) Dust ; Humans ; Occupational Exposure/adverse effects ; Risk Factors ; Silicon Dioxide/toxicity ; Silicosis/epidemiology
    Chemical Substances Dust ; Silicon Dioxide (7631-86-9)
    Language English
    Publishing date 2021-05-20
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-021-10711-1
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  6. Article ; Online: Mining Migrant Worker Recruitment Policy and the Production of a Silicosis Epidemic in Late 20th-Century Southern Africa.

    Ehrlich, Rodney / Barker, Stephen / Montgomery, Alex / Lewis, Peter / Kistnasamy, Barry / Yassi, Annalee

    Annals of global health

    2023  Volume 89, Issue 1, Page(s) 25

    Abstract: Objectives: Between the 1980s and 2000s, an epidemic of silicosis was identified in migrant black gold miners, many from neighbouring countries, who had worked in the South African gold mines. This study uses the newly available employment database of a ...

    Abstract Objectives: Between the 1980s and 2000s, an epidemic of silicosis was identified in migrant black gold miners, many from neighbouring countries, who had worked in the South African gold mines. This study uses the newly available employment database of a large gold mining company to demonstrate how a sustained rise in employment duration in a new cohort of black migrant workers resulted from changes in recruitment policy, and it examines the implications for current surveillance and redress.
    Methods: Contract data of 300,774 workers from the employment database of a multi-mine gold mining company were analysed for 1973-2018. Piecewise linear regression was applied to determine trends in cumulative employment, including South African versus cross-border miners. The proportions with cumulative employment of at least 10, 15, or 20 years, typical thresholds for chronic silicosis, were also calculated.
    Results: Five calendar phases were identified between 1973 and 2018. During the second phase, 1985-2013, mean cumulative duration of employment rose fivefold, from 4 to 20 years. Cumulative employment continued to rise, although more slowly, before peaking in 2014 at 23.5 years and falling thereafter to 20.1 years in 2018. Over most of the 1973-2018 period, miners from neighbouring countries had greater cumulative employment than South African miners. Overall, the proportion of miners exiting with at least 15 years of cumulative employment rose from 5% in 1988 to 75% in 2018. This report identifies a number of fundamental changes in labour recruitment policy in the gold mining industry in the 1970s which provide an explanation for the subsequent rise in cumulative exposure and associated silicosis risk.
    Conclusions: These new data support the hypothesis of a silicosis epidemic driven by increasing cumulative silica dust exposure in a new cohort of circular migrant workers from the 1970s. They inform current programmes to improve surveillance of this neglected population for silicosis and related disease and to provide medical examinations and compensation to a large number of former gold mines. The analysis highlights the lack of information on cumulative employment and silicosis risk among migrant miners in previous decades. The findings have global relevance to the plight of such migrant workers in hazardous occupations.
    MeSH term(s) Humans ; Transients and Migrants ; Occupational Diseases/epidemiology ; Mining ; Silicosis/epidemiology ; Africa, Southern ; South Africa/epidemiology
    Language English
    Publishing date 2023-03-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2821756-1
    ISSN 2214-9996 ; 2214-9996
    ISSN (online) 2214-9996
    ISSN 2214-9996
    DOI 10.5334/aogh.4059
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  7. Article ; Online: Difficulties in distinguishing silicosis and pulmonary tuberculosis in silica-exposed gold miners: A report of four cases.

    Maboso, Botembetume / Te Water Naude, Jim / Rees, David / Goodman, Hillel / Ehrlich, Rodney

    American journal of industrial medicine

    2023  Volume 66, Issue 4, Page(s) 339–348

    Abstract: Silicosis and tuberculosis (TB) are both global health concerns, with high prevalence among miners from the South African gold mines. Although knowledge has accumulated about these two conditions as distinct diseases since the early 20th century, and ... ...

    Abstract Silicosis and tuberculosis (TB) are both global health concerns, with high prevalence among miners from the South African gold mines. Although knowledge has accumulated about these two conditions as distinct diseases since the early 20th century, and despite progress in technology with multiple diagnostic tools and treatment options available for TB, the challenge of distinguishing and therefore efficiently managing these two conditions in this population remains as current as it was 100 years ago. To illustrate the diagnostic and health service problems of distinguishing TB and silicosis clinically and radiologically in former gold miners from the South African mines living in resource-poor areas, we discuss four cases reviewed for this report by a panel of experts. For each case, occupational history, past and current medical history, physical examination, radiological and laboratory findings are described. Common themes are: (1) poor agreement between radiological and clinical presentation; (2) poor agreement between radiology findings and detection of active TB on sputum Xpert MTB/RIF testing; and (3) difficulty in distinguishing the clinical and radiological presentations of silicosis and tuberculosis. Possible consequences at the population level are undertreatment or overtreatment of TB, and underdiagnosis or overdiagnosis of silicosis. There is a need for training of practitioners who are screening or attending to former gold miners in the clinical and radiological features of combined disease, using a curated database of miners' chest X-ray images. Investment in protocols for management of both acute and chronic silicotuberculosis in ex-miners is needed, as is clinical, epidemiologic, and operations research.
    MeSH term(s) Humans ; Silicon Dioxide ; Gold ; Silicosis/epidemiology ; Tuberculosis, Pulmonary/epidemiology ; Miners ; Tuberculosis ; South Africa/epidemiology
    Chemical Substances Silicon Dioxide (7631-86-9) ; Gold (7440-57-5)
    Language English
    Publishing date 2023-01-30
    Publishing country United States
    Document type Case Reports ; Research Support, Non-U.S. Gov't
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.23460
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  8. Article ; Online: A century of miners' compensation in South Africa.

    Ehrlich, Rodney

    American journal of industrial medicine

    2012  Volume 55, Issue 6, Page(s) 560–569

    Abstract: The year 2011 marked the centenary of compensation legislation for miners' lung disease in South Africa. This commentary aims to demonstrate that the current compensation system does not serve its intended beneficiaries, particularly the large population ...

    Abstract The year 2011 marked the centenary of compensation legislation for miners' lung disease in South Africa. This commentary aims to demonstrate that the current compensation system does not serve its intended beneficiaries, particularly the large population of former gold miners affected by high rates of silicosis and tuberculosis. The system has a complex legislative history, reflecting contending political, and economic forces, and characterized by racial discrimination. The financial basis of the system is currently in crisis owing to historical underfunding and failure to take into account the mounting burden of disease among black former miners. The real value of compensation awards fell sharply between 1973 and 1993, only partly recovering in recent years. Barriers to claiming benefits, particularly by black former miners who know little about the process, have been extensively documented. Integration of miners' compensation into general workers' compensation has been mooted since the 1980s but has stalled, owing to the high cost of closing the gap between the mostly inferior financial benefits under the mining legislation and those available under workers' compensation legislation. A recent constitutional court decision has opened the way for unprecedented civil litigation against the gold mining industry for silicosis, adding to the pressure for reform. A number of changes are called for: harmonization of financial benefits with retention of certain of the special arrangements for miner claims, a regional cross-border system of medical examination points for former miners, education of miners about the system, and some degree of privatization of claims processing.
    MeSH term(s) Gold ; Humans ; Insurance Benefits/legislation & jurisprudence ; Mining ; Silicosis/economics ; Silicosis/etiology ; South Africa ; Tuberculosis, Pulmonary/economics ; Tuberculosis, Pulmonary/etiology ; Workers' Compensation/economics ; Workers' Compensation/legislation & jurisprudence
    Chemical Substances Gold (7440-57-5)
    Language English
    Publishing date 2012-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.22030
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  9. Article: Persistent failure of the COIDA system to compensate occupational disease in South Africa.

    Ehrlich, Rodney

    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

    2012  Volume 102, Issue 2, Page(s) 95–97

    Abstract: Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers' compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and ... ...

    Abstract Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers' compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and inadequate assessment of disability. These and other systemic deficiencies in administration of the Compensation for Occupational Injuries and Diseases Act of 1993 (COIDA) reduce access by workers with occupational disease to private medical care, and shift costs to workers and to public sector medical care. Another unintended effect is to promote underreporting of occupational disease by employers and medical practitioners. Reforms have been tried or proposed over the years, including decentralisation of medical assessment to specialised units, which showed promise but were closed. Improved annual performance reporting by the Compensation Commissioner on the processing of occupational disease claims would promote greater public accountability. Given the perennial failings of the system, a debate on outsourcing or partial privatisation of COIDA's functions is due.
    MeSH term(s) Adult ; Asthma, Occupational/diagnosis ; Asthma, Occupational/economics ; Delivery of Health Care/economics ; Female ; Humans ; Neurotoxicity Syndromes/diagnosis ; Neurotoxicity Syndromes/economics ; Occupational Diseases/diagnosis ; Occupational Diseases/economics ; Occupational Exposure/adverse effects ; Occupational Medicine/organization & administration ; Patient Rights ; Solvents/toxicity ; South Africa ; Work Capacity Evaluation ; Workers' Compensation/organization & administration
    Chemical Substances Solvents
    Language English
    Publishing date 2012-01-27
    Publishing country South Africa
    Document type Case Reports ; Journal Article
    ZDB-ID 390968-2
    ISSN 2078-5135 ; 0256-9574 ; 0038-2469
    ISSN (online) 2078-5135
    ISSN 0256-9574 ; 0038-2469
    DOI 10.7196/samj.5099
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  10. Article ; Online: The editors respond to Drs Mowat and Sheehan.

    Ehrlich, Rodney / Markowitz, Steven

    American journal of industrial medicine

    2018  Volume 61, Issue 3, Page(s) 272–273

    Language English
    Publishing date 2018-01-18
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.22808
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