• Cadmium and volumetric mammographic density: a cross-sectional study in Polish women

      Pepłońska, Beata; Janasik, Beata; McCormack, Valerie; Bukowska-Damska, Agnieszka; Kałużny, Paweł; Nofer Institute of Occupational Medicine (2019)
    • Can alveolar hypoventilation due to kyphoscoliosis be a contraindication to driving?

      Kania, Aleksander; Nastałek, Paweł; Celejewska-Wójcik, Natalia; Sładek, Krzysztof; Kosobudzki, Marcin; Bortkiewicz, Alicja; Siedlecka, Jadwiga; Nofer Institute of Occupational Medicine (2019-10-16)
      Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen.
    • Can Periodical Examinations of Employees Be Useful in Detection of Glycaemia Impairment and Improving Patients' Adherence to Medical Recommendations?

      Marcinkiewicz, Andrzej; Hanke, Wojciech; Kałużny, Paweł; Lipińska-Ojrzanowska, Agnieszka; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland (2018-03-30)
      Worldwide epidemiological data indicates insufficient diagnosis of diabetes as an increasing public health problem. In the search for solutions to this disadvantageous situation, occupational medicine health services seem to open up a unique opportunity to recognize some abnormalities in the early stages, especially among the asymptomatic working-age population. 316 workers underwent obligatory prophylactic examinations. In patients with twice assayed FGL ≥ 126 mg/dL (7.0 mmol/L) an additional intervention was implemented, including further diagnostic processes and therapy in General Practice (GP), followed by examination by an occupational health specialist within 3 months. The diagnosis of previously unknown diabetes was established among 2.5% of examined workers. All patients referred to the GP due to detected glycaemia impairment visited their doctor and finished the diagnostic process, took up therapy constrained by the occupational health physician to show the effects of intervention within 3 months. Prophylactic medical check-ups allow improved compliance and medical surveillance over glycaemia impairment in patients with prediabetes states, unknown diabetes or uncontrolled clinical course of diabetes. Considering fasting glucose level during mandatory prophylactic examination helps effective prevention of diabetes and its complications and thus provides public health system benefits.
    • The capability of fungi isolated from moldy dwellings to produce toxins

      Jezak, Karolina; Kozajda, Anna; Sowiak, Malgorzata; Brzeznicki, Slawomir; Bonczarowska, Marzena; Szadkowska-Stanczyk, Irena; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      Objectives: The main objective was analysis and assessment of toxinogenic capabilities of fungi isolated from moldy surfaces in residential rooms in an urban agglomeration situated far from flooded areas in moderate climate zone. Material and Methods: The assessment of environmental exposure to mycotoxins was carried out in samples collected from moldy surfaces in form of scrapings and airborne dust from 22 moldy dwellings in winter season. In each sample 2 mycotoxins were analyzed: sterigmatocystin and roquefortine C produced by Aspergillus versicolor and Penicillium chrysogenum, respectively. Mycotoxins were analyzed by high-performance liquid chromatography (HPLC) in: scrapings from moldy surfaces, mixture of all species of fungi cultured from scrapings on microbiological medium (malt extract agar), pure cultures of Aspergillus versicolor and Penicillium chrysogenum cultured from scrapings on microbiological medium; mycotoxins in the indoor air dust were also analyzed. Results: The production of sterigmatocystin by individual strains of Aspergillus versicolor cultured on medium was confirmed for 8 of 13 isolated strains ranging 2.1–235.9 μg/g and production of roquefortine C by Penicillium chrysogenum for 4 of 10 strains ranging 12.9–27.6 μg/g. In 11 of 13 samples of the mixture of fungi cultured from scrapings, in which Aspergillus versicolor was found, sterigmatocystin production was at the level of 3.1–1683.2 μg/g, whereas in 3 of 10 samples in which Penicillium chrysogenum occurred, the production of roquefortine C was 0.9–618.9 μg/g. The analysis did not show in any of the tested air dust and scrapings samples the presence of analyzed mycotoxins in the amount exceeding the determination limit. Conclusions: The capability of synthesis of sterigmatocystin by Aspergillus versicolor and roquefortine C by Penicillium chrysogenum growing in mixtures of fungi from scrapings and pure cultures in laboratory conditions was confirmed. The absence of mycotoxins in scrapings and air dust samples indicates an insignificant inhalatory exposure to mycotoxins among inhabitants in moldy flats of urban agglomeration situated far from flooded territories.
    • [Carcinogenic and mutagenic agents in the workplace, Poland, 2011-2012].

      Palaszewska-Tkacz, Anna; Czerczak, Slawomir; Konieczko, Katarzyna; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      The objective of the study was the analysis of structure of carcinogenic or mutagenic chemical substances and dusts occurring in Polish enterprises, 2011-2012, including the number of exposed employees reported to the "Central register of data on exposure to carcinogenic or mutagenic chemical substances, mixtures, agents or technological processes", Nofer Institute of Occupational Medicine, Łódź. In the paper the aims, range and methodology of data collecting by the Central Register are presented.
    • Cardiotoxic effect due to accidental ingestion of an organic solvent.

      Cieslik-Guerra, Urszula Izabela; Rechcinski, Tomasz; Trzos, Ewa; Wierzbowska-Drabik, Karina; Uznanska-Loch, Barbara; Winnicka, Renata; Krakowiak, Anna; Kasprzak, Jarosław Damian; Fröhlich, Colin; Kurpesa, Małgorzata; et al. (2015-02-28)
      Toxic myocardial injury can be misdiagnosed as a myocardial infarction, resulting in the patient undergoing standard treatment for cardiac rehabilitation. However, such inadequate therapeutic strategies can lead to cardiovascular complications including dilated cardiomyopathy. This study presents a case of a 65-year-old man after accidental ingestion of organic solvents (toluene and xylene), whose condition demonstrated all the criteria for diagnosis of myocardial infarction. The qualitative determinations of the above mentioned volatile organic compounds (VOCs) in whole blood were carried out using a headspace sampling by means of gas chromatography. Cardiac catheterization revealed no specific coronary lesions, only a muscular bridge causing a 30–50% stenosis in the middle of the circumflex branch of the left coronary artery.
    • Cervico-ocular reflex upregulation in dizzy patients with asymmetric neck pathology.

      Zamysłowska-Szmytke, Ewa; Adamczewski, Tomasz; Ziąber, Jacek; Majak, Joanna; Kujawa, Jolanta; Śliwińska-Kowalska, Mariola; Nofer Institute of Occupational Medicine (2019-10-16)
      Objectives: The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness. Material and Methods: Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R–) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded. Results: Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R– group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed. Conclusions: Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms.
    • Characteristics of interventional cardiologists and their work practices for the study on radiation-induced lens opacities based on the methodology developed by ELDO-preliminary results.

      Domienik, Joanna; Gryglak, Szymon; Jurewicz, Joanna; Nofer Institute of Occupational Medicine, Lodz, Poland (2016-03-16)
      Preliminary results of the Polish epidemiology study on eye lens opacities among interventional cardiologists (ICs), based on the methodology proposed by ELDO (epidemiological studies of radio-induced cataracts in interventional cardiologists and radiologists: methodology implementation), are presented. The aim of the study is to test the hypothesis concerning the excess risk of cataract in the group of ICs. The first results concern the study population characteristics, including the most important confounding factors for cataract, as well as a detailed description of the work practices in interventional cardiology needed in order to reconstruct the cumulative eye lens dose. The data from 69 ICs and 23 controls collected based on the general medical questionnaire and the occupational questionnaire (for ICs only) were analyzed. The mean age of ICs and of the control group was 41 and 44, respectively, while the mean duration of work for exposed physicians was 9 years. The analysis of the data from the occupational questionnaire concerning the procedures performed, the use of various access routes, as well as radiation protection tools (eye lens glasses, ceiling suspended transparent shield, etc.) are also presented. On the basis of this information and additional assumptions about the doses per procedure (as well as reduction factors for various types of radiation measures), the cumulative doses to the eye lens of ICs were evaluated. They ranged up to 1.55 Sv and 0.4 Sv for left and right eye, respectively; however, the dose to only 3% of ICs exceeded the new threshold for development of eye lens opacities (0.5 Gy) proposed by the ICRP.
    • [Chemical hazards arising from shale gas extraction].

      Pakulska, Daria; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      The development of the shale industry is gaining momentum and hence the analysis of chemical hazards to the environment and health of the local population is extreiely timely and important. Chemical hazards are created during the exploitation of all minerals, but in the case of shale gas production, there is much more uncertainty as regards to the effects of new technologies application. American experience suggests the increasing risk of environmental contamination, mainly groundwater. The greatest, concern is the incomplete knowledge of the composition of fluids used for fracturing shale rock and unpredictability of long-term effects of hydraulic fracturing for the environment and health of residents. High population density in the old continent causes the problem of chemical hazards which is much larger than in the USA. Despite the growing public discontent data on this subject are limited. First of all, there is no epidemiological studies to assess the relationship between risk factors, such as air and water pollution, and health effects in populations living in close proximity to gas wells. The aim of this article is to identify and discuss existing concepts on the sources of environmental contamination, an indication of the environment elements under pressure and potential health risks arising from shale gas extraction.
    • Chemical incidents resulted in hazardous substances releases in the context of human health hazards.

      Palaszewska-Tkacz, Anna; Czerczak, Sławomir; Konieczko, Katarzyna (2017-02-21)
      The research purpose was to analyze data concerning chemical incidents in Poland collected in 1999-2009 in terms of health hazards.
    • Chronic kidney disease - The relevant information for an occupational physician.

      Renke, Marcin; Parszuto, Jacek; Rybacki, Marcin; Wołyniec, Wojciech; Rutkowski, Przemyslaw; Rutkowski, Boleslaw; Walusiak-Skorupa, Jolanta; Dębska-Ślizień, Alicja; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-12-05)
      For a number of years chronic kidney disease (CKD) has been listed in the group of lifestyle diseases, such as obesity, diabetes, cardiovascular disease and hypertension. It is estimated that in Poland more than 4 million people may suffer from various stages of CKD. Chronic kidney disease may also be a consequence of all the other civilization diseases. At the same time it is worth noting that nephrological problems are increasingly being taken into account in modern medical certification. The aim of this work is, among other things, to improve safe access to the labor for patients with kidney diseases. In the legislation existing in our country since 2014 it is stated that chronic renal failure is a potential health contraindication to driving. Also in the annex to the Regulation of the Minister of Health dated 9 December 2015 on health conditions required for seafarers to work on a seagoing ship, it is said that ICD-10 codes (International Classification of Diseases) corresponding to acute and chronic renal failure (N17-N19) should be taken into account when qualifying employees to work at sea. Med Pr 2018;69(1):67-75.
    • Circadian gene methylation in rotating-shift nurses: a cross-sectional study.

      Reszka, Edyta; Wieczorek, Edyta; Przybek, Monika; Jabłońska, Ewa; Kałużny, Paweł; Bukowska-Damska, Agnieszka; Zienolddiny, Shanbeh; Pepłońska, Beata; Nofer Institute of Occupational Medicine (2018)
      Investigating the methylation status of the circadian genes may contribute to a better understanding of the shift work-related circadian disruption in individuals exposed to artificial light at night. In the present study, we determined the methylation status of the circadian genes associated with a shift work pattern among nurses and midwives participating in a cross-sectional study in Lodz, Poland. Quantitative methylation polymerase chain reaction assays were used to assess promoter CpG methylation in PER1, PER2, PER3, CRY1, CRY2, BMAL1, CLOCK, and NPAS2 in genomic DNA from whole blood of 347 women having a rotating-shift work schedule and 363 women working days only. The percentage of methylated reference (PMR) was assessed using fluorescent probes for PER1, PER2, PER3, CRY1, and NPAS2, and the percentage of gene methylation, as the methylation index (MI), using two sets of primers for BMAL1, CLOCK, and CRY2. We tested the possible association between current and lifetime rotating night-shift work characteristics and circadian gene methylation by using proportional odds regression model with blood DNA methylation, categorized into tertiles, and adjusted for age, current smoking status, folate intake and blood collection time. The findings indicated that CpG methylation in PER2 promoter was significantly decreased (P < 0.004) among nurses and midwives currently working rotating shifts, as compared with day-working nurses and midwives. The lower percentage of PER2 methylation was associated with a higher monthly frequency of current night duties (2-7 night shifts, and eight or more night shifts per month) (P = 0.012) and was associated at borderline significance (P = 0.092) with the lifetime duration of shift work (>10 ≤ 20 years and >20 ≤ 43 years of rotating-shift work) among nurses and midwives (N = 710). Moreover, women with a longer lifetime duration of shift work presented a lower status of PER1 methylation (P = 0.040) than did the women with up to 10 years of rotating-shift work. Long lifetime duration of shift work (> 10 years) among current rotating night-shift workers (N =  347) was associated with BMAL1 hypomethylation (P = 0.013). Among eight of the investigated circadian genes, only PER1, PER2, and BMAL1 showed differential methylation attributable to the rotating-shift work of nurses and midwives. The findings on blood-based DNA methylation in the circadian genes may provide a better insight into the mechanistic principles underlying the possible health effects of night-shift work but these should be verified in further studies recruiting larger populations of shift workers.
    • Circadian Gene Polymorphisms Associated with Breast Cancer Susceptibility.

      Lesicka, Monika; Jabłońska, Ewa; Wieczorek, Edyta; Pepłońska, Beata; Gromadzińska, Jolanta; Seroczyńska, Barbara; Kalinowski, Leszek; Skokowski, Jarosław; Reszka, Edyta; Nofer Institute of Occupational Medicine (2019-11-14)
      Breast cancer (BC) is a major problem for civilization, manifested by continuously increasing morbidity and mortality among women worldwide. Core circadian genes may play an important role in cancer development and progression. To evaluate the effects of single nucleotide polymorphism (SNP) in circadian genes in BC risk, 16 functional SNPs were genotyped in 321 BC patients and 364 healthy women using the TaqMan fluorescence-labelled probes or High-Resolution Melt Curve technique in the Real-Time PCR system. The selected SNPs were analyzed for the risk of BC, progression, and the influence on gene expression in BC tissue pairs to demonstrate the functionality of genetic variants. The study showed a relationship between an increased BC risk under the dominant genetic model of CRY2 rs10838524, PER2 rs934945, and recessive genetic model of PER1 rs2735611. A protective effect of BMAL1 rs2279287 was observed among carriers with at least one variant allele. Moreover, we found an increased risk of estrogen-/progesterone-positive tumors under the dominant genetic model of PER2 rs934945 and estrogen negative tumors under the variant genotype of CRY2 rs10838524, PER1 rs2735611. We demonstrated significantly altered gene expression of BMAL1, CRY2, PER1, PER2, PER3 according to particular genotypes in the BC tissue pairs. Our findings support the hypothesized role of circadian genes in breast carcinogenesis and indicate probable biomarkers for breast cancer susceptibility.
    • Clara cells protein, prolactin and transcription factors of protein NF-ĸB and c-Jun/AP-1 levels in rats inhaled to stainless steel welding dust and its soluble form.

      Hałatek, Tadeusz; Stanisławska, Magdalena; Świercz, Radosław; Domeradzka-Gajda, Katarzyna; Kuraś, Renata; Wąsowicz, Wojciech; Nofer Institute of Occupational Medicine (2018-10-23)
      Welding processes that generate fumes containing toxic metals, such as hexavalent chromium (Cr(VI)), manganese, and nickel (Ni), have been implicated in lung injury, inflammation, and lung tumor promotion in animal models. Bronchiolar epithelium Clara cells/club cells, coordinate these inflammatory responses. Clara cells secretory protein (CC16) with ant-inflammatory role. The pulmonary toxicity of welding dust (WD) was assessed for Wistar rats exposed to 60 mg/m<sup>3</sup> of respirable-size welding dust (mean diameter 1.17 μm for 1 and 2 weeks (6 h/day, 5 days/week)) or the aerosols of soluble form (SWD) in the nose-only exposure chambers. Additionally the effect of antiinflammatory betaine supplementation was assessed. Clara cells secretory protein, differential cell counts, total protein concentrations and cellular enzyme (lactate dehydrogenase - LDH) activities were determined in bronchoalveolar lavage fluid, and corticosterone and thiobarbituric acid reactive substances (TBARS) and prolactin concentrations were assessed in serum. Histopathology examination of lung, brain, liver, kidney, spleen was done. Additionally slices of brain and lung were exanimated in laser ablation inductively coupled plasma mass spectrometry. Both WD and SWD exposure evoked large bronchiolar infiltration shoved in histopathology examination. In this study, TBARS inversely correlated with a significant decrease of CC16 concentration that occurred after instillation of both WD and SWD indicating decreased anti- inflammatory potential in the lung. In WD exposed rats prolactin correlated with nuclear factor-kappa B (NF-κB), LDH, TBARS and serum levels Cr, Ni and inversely with c-Jun. In SWD exposed rats prolactin correlated with CC16 indicated effect of prolactin on the population of epithelial cells. In the current study, deleterious effects of repeated inhalation stainless steel welding dust form on club (Clara) cell secretory protein (CC16) were demonstrated. Clara cells secretory protein relation with prolactin in exposed rats to welding dust were shown and explored whether the NF-κB and c-Jun/activator protein 1 related pathway was involved. Int J Occup Med Environ Health 2018;31(5):613-632.
    • Climate conditions and work-related fatigue among professional drivers.

      Makowiec-Dąbrowska, Teresa; Gadzicka, Elżbieta; Siedlecka, Jadwiga; Szyjkowska, Agata; Viebig, Piotr; Kozak, Piotr; Bortkiewicz, Alicja; Nofer Institute of Occupational Medicine (2019-02-01)
      The possible associations between climate parameters and drivers' fatigue have not been subject to specific studies thus far. We have undertaken a study to investigate whether the particular climate parameters are related to fatigue perception by motor vehicle drivers. The study was performed from July to October. Each driver was surveyed four times: before and after workshift on a monotonous route outside the city center (MR), and on a heavy traffic route in the city center (HTR). The study was conducted among 45 city bus drivers aged 31-58 years (43.7 ± 7.9), seniority as driver 3-34 years (14.7 ± 8.6). Data on climate conditions (ambient temperature, air pressure, humidity, wind speed, precipitations) on particular study days was obtained from the Institute of Meteorology and Water Management, National Research Institute Warsaw, Poland. Fatigue was assessed using the Fatigue Assessment Questionnaire, developed at Nofer Institute of Occupational Medicine (Lodz, Poland). The total level of fatigue was significantly (p = 0.045) higher after driving on HTR than on MR. The number of symptoms was also significantly higher (p < 0.05) among drivers working on HTR. After MR, significant correlations were found between wind speed and heavy eyelid feeling, being prone to forgetting, eye strain, frequent blinking, and between ambient temperature and feeling thirsty. After HTR feeling thirsty, tiredness and difficulty in making decisions correlated with ambient temperature and feeling thirsty with wind speed. Climate conditions can modify the drivers fatigue; therefore, we should be aware of their impact on well-being.
    • CLOCKSHIFT_BRCA_lifestyle

      Peplonska Beata; Nofer Institute of Occupational Medicine (2017)
    • Co to jest promocja zdrowia w pracy?

      Instytut Medycyny Pracy. Krajowe Centrum Promocji Zdrowia w Miejscu Pracy; Nofer Institute of Occupational Medicine (2018)
    • [Comparison of chemical composition of selected essential oils used in respiratory diseases].

      Kucharska, Małgorzata; Szymańska, Jadwiga A; Wesolowski, Wiktor; Bruchajzer, Elżbieta; Frydrych, Barbara; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-12-19)
      Essential oils are fragrances extracted from plants. They have a smooth consistency and pleasant smell. Essential oils have been applied in aromatherapy, cosmetics, food and pharmaceutical products. The aim of the study was to analyze the composition of selected essential oils used in respiratory diseases.
    • Cooperation within physician–nurse team in occupational medicine service in Poland – knowledge about professional activities performed by the team-partner

      Sakowski, Piotr; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Background: The goal of the study has been to learn about physicians’ and nurses’ awareness of the professional activities that are being performed by their colleague in the physician–nurse team. Material and Methods: Postal questionnaires were sent out to occupational physicians and nurses in Poland. The analysis includes responses from 232 pairs of physician–nurse teams. Results: The knowledge among occupational professionals about tasks performed by their colleagues in the physician–nurse team seems to be poor. Respondents were asked about who performs tasks from each of 21 groups mentioned in the Occupational Medicine Service Act. In the case of only 3 out of 21 groups of tasks, the rate of non-consistence in answers was lower than 30%. A specified number of professionals performed their tasks on the individual basis. Although in many cases their team colleagues knew about those activities, there was a major proportion of those who had no awareness of such actions. Conclusions: Polish occupational physicians and nurses perform a variety of tasks. Occupational nurses, besides medical role, also play important organizational roles in their units. The cooperation between the two professional groups is, however, slightly disturbed by the deficits in communication. This issue needs to be improved for the betterment of operations within the whole system.
    • Cytostatics as hazardous chemicals in healthcare workers' environment.

      Pałaszewska-Tkacz, Anna; Czerczak, Sławomir; Konieczko, Katarzyna; Kupczewska-Dobecka, Małgorzata; Nofer Institute of Occupational Medicine (2019-04-03)
      Cytostatics not only induce significant side-effects in patients treated oncologically but also pose a threat to the health of occupationally exposed healthcare workers: pharmacists, physicians, nurses and other personnel. Since the 1970s numerous reports from various countries have documented the contamination of working areas with cytostatics and the presence of drugs/metabolites in the urine or blood of healthcare employees, which directly indicates the occurrence of occupational exposure to these drugs. In Poland the significant scale of occupational exposure to cytostatics is also confirmed by the data collected in the central register of occupational carcinogens/mutagens kept by the Nofer Institute of Occupational Medicine. The assessment of occupational exposure to cytostatics and health risks constitutes employers' obligation. Unfortunately, the assessment of occupational risk resulting from exposure to cytostatics raises a number of concerns. Provisions governing the problem of workers' health protection are not unequivocal because they derive from a variety of law areas, especially in a matter of hazard classification and safety data sheets for cytostatics. Moreover, no legally binding occupational exposure limits have been set for cytostatics or their active compounds, and analytical methods for these substances airborne and biological concentrations are lacking. Consequently, the correct assessment of occupational exposure to cytostatics, the evaluation of health hazards and the development of the proper preventive strategy appear difficult. The authors of this article described and discussed the amendments to the European provisions concerning chemicals in the light of employers' obligations in the field of employees' heath protection against the consequences of exposure to cytostatics. Some modifications aimed at a more effective health protection of workers occupationally exposed to cytostatics were also proposed. Int J Occup Med Environ Health. 2019;32(2):141-59.