• Validation of the Polish version of the <i>Dizziness Handicap Inventory</i>.

      Szostek-Rogula, Sylwia; Zamysłowska-Szmytke, Ewa; Nofer Institute of Occupational Medicine (2019-09-18)
      Background: The Dizziness Handicap Inventory (DHI) was established to assess the impact of dizziness and balance problems on the quality of life. The aim of the study was to validate the Polish version of DHI for patients with vestibular disorders. Material and Methods: Two hundred and thirty patients diagnosed with vestibular impairment and/or positional vertigo were included in the study. The mean age of the study group was 56.2 years (SD = 13.6). The factor structure (the principal component analysis − PCA), internal consistency (Cronbach’s α), and discrimination ability (the receiver operating characteristic [ROC] curve) were examined. Results: A satisfactory internal consistency was found (Cronbach’s α coefficient = 0.92), while no floor or ceiling effect was revealed. The Dizziness Handicap Inventory demonstrated a good ability to discriminate between patients with and without the handicap (sensitivity and specificity about 80%, the cutoff point = 56). In PCA a 3-factor solution was obtained, with the factors related to restrictions in daily life, positional symptoms and visual-vestibular symptoms, which was not in agreement with the subscales provided in the original version. Conclusions: The Polish version of DHI demonstrates satisfactory measurement properties and can be used to assess the impact of dizziness on handicap and the quality of life. The functional, emotional, and physical subscales were not confirmed. In particular, the functional subscale revealed no satisfactory internal consistency which provides an indication for further studies.
    • Vertigo and severe balance instability as symptoms of Lyme disease - literature review and case report.

      Józefowicz-Korczyńska, Magdalena; Zamysłowska-Szmytke, Ewa; Piekarska, Anna; Rosiak, Oskar; Nofer Institute of Occupational Medicine (2019-11-12)
      Lyme disease is caused by a tick-borne bacterium Borrelia sp. This zoonotic infection is common in the Northern Hemisphere, e.g., Europe. Clinical presentation may involve multisystem symptoms and depends on the stage of the disease. The involvement of nervous system in Lyme disease is commonly referred to as neuroborreliosis. Neuroborreliosis may involve meningitis, mononeuritis multiplex, or cranial neuritis including the inflammation of vestibulocochlear nerve. In the late or chronic stage of Lyme disease, vestibular involvement may be the sole presentation, although such cases are rare. Our study was designed to present our own case and review the available literature reporting cases of neuroborreliosis with vertigo/dizziness and severe balance instability as a main disease symptom. The studies were obtained by searching the following databases: PubMed, Medline, and Embase. We included case reports of Lyme disease presenting with vertigo or gait disorders as the main symptom, written in the English language. Initially, 60 papers were identified. After analyzing the abstracts, seven manuscripts focusing on 13 clinical cases were included in this review. We conclude that the patients with neuroborreliosis sometimes present vertigo/dizziness, but rarely gait ataxia as a sole symptom. These complaints are usually accompanied by a hearing loss. Antibiotic treatment is usually effective. Balance instability in the patients with neuroborreliosis may persist but it responds well to vestibular rehabilitation.
    • Visible fungi growth and dampness assessed using a questionnaire versus airborne fungi, (1→3)-β-d-glucan and fungal spore concentrations in flats.

      Sowiak, Małgorzata; Jezak, Karolina; Kozajda, Anna; Sobala, Wojciech; Szadkowska-Stanczyk, Irena; Nofer Institute of Occupational Medicine, Łódź, Poland (2015-02-28)
      Objectives: The study aimed at determination of the usefulness of the subjective assessment of selected signs of fungi growth in flats and microclimate parameters to indicate the actual air contamination with culturable fungi, (1→3)-β-D-glucans and fungal spores. Material and Methods: This analysis covered 22 flats, the inhabitants of which declared in a questionnaire interview the presence of the developed mycelium on solid surfaces in the flat. Air samples for determination of the culturable fungi, (1→3)-β-D-glucans and (viable and non-viable) fungal spores concentrations indoor and outdoor the flats during the heating period were collected. During bioaerosol sampling microclimate parameters were measured. Predictive models for concentrations of the tested biological agents with regard to various ways to assess fungal contamination of air in a flat (on the basis of a questionnaire or a questionnaire and microclimate measurements) were built. Results: The arithmetic means of temperature, relative humidity, CO2 concentration and air flow velocity in the flats were respectively: 20.5°C, 53%, 1431.6 ppm and 0 m/s. The geometric mean concentrations of airborne fungi, (1→3)-β-D-glucans and fungal spores in these premises amounted to 2.9×102 cfu/m3, 1.6 ng/m3 and 5.7×103 spores/m3, respectively. The subjective assessment of fungi growth signs and microclimate characteristics were moderately useful for evaluation of the actual airborne fungi and (1→3)-β-D-glucan concentrations (maximum percent of explained variance (VE) = 61% and 67%, respectively), and less useful in evaluation of the actual fungal spore concentrations (VE < 29%). In the case of fungi, higher usefulness was indicated of the questionnaire evaluation supported by microclimate measurements (VE = 61.2%), as compared to the evaluation only by means of a questionnaire (VE = 46.9%). Conclusions: Subjective evaluation of fungi growth signs in flats, separately or combined with microclimate measurements, appeared to be moderately useful for quantitative evaluation of the actual air contamination with fungi and their derivatives, but more extensive studies are needed to strengthen those findings.
    • Vitamins A and E during Pregnancy and Allergy Symptoms in an Early Childhood-Lack of Association with Tobacco Smoke Exposure.

      Gromadzinska, Jolanta; Polanska, Kinga; Kozlowska, Lucyna; Mikolajewska, Karolina; Stelmach, Iwona; Jerzyńska, Joanna; Stelmach, Włodzimierz; Grzesiak, Mariusz; Hanke, Wojciech; Wasowicz, Wojciech; et al. (2018)
      Epidemiological studies have suggested an association between maternal antioxidant levels during pregnancy and development of allergic diseases in their offspring. The aim of the study was to determine plasma vitamins A and E concentration in the 1st trimester of pregnancy, at delivery and in cord blood and to search for a relationship with allergy in up to 2-year-old children who were prenatally exposed or not exposed to tobacco smoke. The study participants included 252 mother-child pairs from Polish Mother and Child Cohort. Vitamin concentrations were measured using the HPLC-UV method, smoking status—as saliva cotinine level using the HPLC-MS/MS technique. Children’s health status was assessed using a questionnaire and pediatricians/allergists examination. Cord plasma vitamin concentrations were significantly lower than their levels in maternal plasma in the 1sttrimester and at delivery (p < 0.001). Significantly higher concentrations of vitamin E have been shown to occur during the 1st trimester of pregnancy in plasma of the women who have actively/passively smoked cigarettes compared to the non-smokers (p < 0.02). Multivariate analysis with inclusion of a variety of confounding factors have not indicated any statistically significant associations between β-carotene, vitamins A and E and the risk of food allergy, atopic dermatitis and wheezing in their children up to 2 years of age. The interaction between smoking during pregnancy and vitamins levels on the risk of allergy was not statistically significant (p < 0.4). The relationship between plasma concentration of vitamins A and E, and the risk of allergy in their young children has not been demonstrated.
    • Wełna mineralna. Zagrożenia dla użytkowników, stan prawny i zasady bezpiecznego postępowania.

      Kupczewska-Dobecka, Małgorzata; Czerczak, Sławomir; Konieczko, Katarzyna; Nofer Institute of Occupational Medicine (Nofer Institute of Occupational Medicine, 2019)
    • WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Permanent Hearing Loss and Tinnitus.

      Sliwinska-Kowalska, Mariola; Zaborowski, Kamil; Nofer Institute of Occupational Medicine, Łódź, Poland (2017-09-27)
      Background: Hearing loss is defined as worsening of hearing acuity and is usually expressed as an increase in the hearing threshold. Tinnitus, defined as "ringing in the ear", is a common and often disturbing accompaniment of hearing loss. Hearing loss and environmental exposures to noise are increasingly recognized health problems. Objectives: The objective was to assess whether the exposure-response relationship can be established between exposures to non-occupational noise and permanent hearing outcomes such as permanent hearing loss and tinnitus. Methods: Information sources: Computer searches of all accessible medical and other databases (PubMed, Web of Science, Scopus) were performed and complemented with manual searches. The search was not limited to a particular time span, except for the effects of personal listening devices (PLDs). The latter was limited to the years 2008-June 2015, since previous knowledge was summarized by SCENIHR descriptive systematic review published in 2008. Study eligibility criteria: The inclusion criteria were as follows: the exposure to noise was measured in sound pressure levels (SPLs) and expressed in individual equivalent decibel values (LEX,8h), the studies included both exposed and reference groups, the outcome was a permanent health effect, i.e., permanent hearing loss assessed with pure-tone audiometry and/or permanent tinnitus assessed with a questionnaire. The eligibility criteria were evaluated by two independent reviewers. Study appraisal and synthesis methods: The risk of bias was assessed for all of the papers using a template for assessment of quality and the risk of bias. The GRADE (grading of recommendations assessment, development, and evaluation) approach was used to assess the overall quality of evidence. Meta-analysis was not possible due to methodological heterogeneity of included studies and the inadequacy of data. Results: Out of 220 references identified, five studies fulfilled the inclusion criteria. All of them were related to the use of PLDs and comprised in total of 1551 teenagers and young adults. Three studies used hearing loss as the outcome and three tinnitus. There was a positive correlation between noise level and hearing loss either at standard or extended high frequencies in all three of the studies on hearing loss. In one study, there was also a positive correlation between the duration of PLD use and hearing loss. There was no association between prolonged listening to loud music through PLDs and tinnitus or the results were contradictory. All of the evidence was of low quality. Limitations: The studies are cross-sectional. No study provides odds ratios of hearing loss by the level of exposure to noise. Conclusions: While using very strict inclusion criteria, there is low quality GRADE evidence that prolonged listening to loud music through PLDs increases the risk of hearing loss and results in worsening standard frequency audiometric thresholds. However, specific threshold analyses focused on stratifying risk according to clearly defined levels of exposure are missing. Future studies are needed to provide actionable guidance for PLDs users. No studies fulfilling the inclusion criteria related to other isolated or combined exposures to environmental noise were identified.
    • WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to occupational noise and of the effect of exposure to occupational noise on cardiovascular disease.

      Teixeira, Liliane R; Azevedo, Tatiana M; Bortkiewicz, Alicja; Corrêa da Silva, Denise T; de Abreu, Wagner; de Almeida, Márcia S; de Araujo, Marco A N; Gadzicka, Elzbieta; Ivanov, Ivan D; Leppink, Nancy; et al. (2019-04-01)
      The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from cardiovascular disease attributable to exposure to occupational noise, to inform the development of the WHO/ILO joint methodology. We aim to systematically review studies on exposure to occupational noise (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of occupational noise on cardiovascular diseases (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand search reference list of previous systematic reviews and included study records; and consult additional experts. We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (<15 years) and unpaid domestic workers. The eligible risk factor will be occupational noise. Eligible outcomes will be hypertensive heart disease, ischaemic heart disease, stroke, cardiomyopathy, myocarditis, endocarditis and other circulatory diseases. For Systematic Review 1, we will include quantitative prevalence studies of exposure to occupational noise (i.e., low: <85 dB(A) and high: ≥85 dB(A)) stratified by country, sex, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the relative effect of high exposure to occupational noise on the prevalence of, incidence of or mortality due to cardiovascular disease, compared with the theoretical minimum risk exposure level (i.e., low exposure).
    • Why do employees follow their superiors’ instructions? Identification of the reasons to comply with superiors’ will in a group of Polish employees

      Wojcik, Aleksandra; Merecz-Kot, Dorota; Andysz, Aleksandra; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Background: Managers influence the way organization works as well as the functioning of subordinates – in the context of their work life but non-professional functioning as well e.g., attitude towards work-life balance or taking care of health. We focused on the superior-subordinate relation, referring to social power bases theory by Raven. We identified the reasons why subordinates decide to follow their superiors’ orders and determined specific styles of compliance with superiors’ will. Understanding why employees listen to their superiors may be valuable in the context of supporting healthy organizational climate and atmosphere of co-operation or communicating values – for example, as regards taking care of own health. We discussed the results referring to the issue of influencing employees in the context of their health behavior. Material and Methods: The research involved 100 Polish employees, aged 28 years old on average, who filled in the Interpersonal Power Inventory by Raven et al. for subordinates in a Polish adaptation by Zaleski. The questionnaire includes 11 subscales referring to power bases. Results: Based on the cluster analysis results, we recognized people who complied because of: all kinds of power bases (typical for 46% of the respondents); the respect for superiors’ professionalism (34%); and formal/objective reasons (20%). Conclusions: Employees differ in terms of their styles of compliance. Their motives to comply with superiors’ instructions constitute compilations of power bases. The superiors’ awareness of the reasons why their employees decide to follow orders is necessary for successful management. It may motivate employees to work but also to take care of their own health.
    • Work Ability Index (WAI) values in a sample of the working population in Poland.

      Juszczyk, Grzegorz; Czerw, Aleksandra Izabela; Religioni, Urszula; Olejniczak, Dominik; Walusiak-Skorupa, Jolanta; Banas, Tomasz; Mikos, Marcin; Staniszewska, Anna; Nofer Institute of Occupational Medicine (2019-03-22)
      Introduction: Ability to work is most often defined as a relationship between a person’s resources and requirements specific to a particular type of work. It is the result of interaction between job requirements in terms of physical and mental strain, capabilities and skills of the employee, as well as his/her health condition and own evaluation of functioning in a given organizational and social situation. Objective: The primary objective of the study was to evaluate the current value of the Work Ability Index (WAI) in a sample of employees in Poland. Material and methods: The study sample was selected purposefully from 422,000 employees covered by the largest occupational health provider in Poland. The standard WAI questionnaire provided by CAWI (Computer-Assisted Web Interview) methodology was voluntary and completed anonymously by 688 employees within 12 months (0.16% response rate). The results were statistically analyzed using the Pearson’s chi-squared test and correlation coefficient, independent-sample T test and one-way analysis of variance (p<0.05). Results: It was found that the average value of WAI was 37.5 ± 7.7, and 37% of the participants represented low to moderate ability to work. The results showed no significant correlation between the WAI value and its 7 compounds and demographic variables. Nonetheless, a dependency between WAI level and industrial branch was observed.
    • Work fatigue in urban bus drivers

      Makowiec-Dabrowska, Teresa; Siedlecka, Jadwiga; Gadzicka, Elzbieta; Szyjkowska, Agata; Dania, Marta; Viebig, Piotr; Kosobudzki, Marcin; Bortkiewicz, Alicja; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Background: Bus drivers are a special group of professional drivers who are at a very high risk of fatigue. The aim of the study was to examine whether the driver’s subjective assessment of fatigue allows for the determination of its level and identification of its causes. Material and Methods: The study group comprised 45 randomly selected bus drivers (mean age – 43.7±7.9 years, period of employment as drivers – 14.7±8.6 years). Examinations were performed in all subjects four times – before and after work on the “easy” route (outside the city center, small traffic intensity) and before and after work on the “difficult” route (city center, heavy traffic). The fatigue test questionnaire, based on the list of symptoms of fatigue prepared by the Japan Research Committee of Fatigue, was used in the study. Results: The rating of fatigue after the work was significantly higher than that before the work. The profile of fatigue after work was not influenced by the type of route, but the assessment of most symptoms of fatigue reached a higher level after the “difficult” routes and the differences were statistically significant for 7 symptoms. Only the ratings of leg fatigue, feeling of heaviness, and the necessity to squint eyes and gaze with effort reached the higher levels after driving the “easy” routes. It has been found that the level of fatigue was significantly correlated with the job characteristics (driving time, the length of the route, number of stops, etc.) and with the abundance of food ingested and type of beverage (coffee vs. others) drunk prior to driving. Conclusions: The questionnaire used in our study to assess the subjective feeling of fatigue has proved to be a sensitive and useful tool for indicating the level and causes of fatigue. The relationship between the symptoms of fatigue and the wycharacteristics of job and lifestyle shows that actions must be taken by both the employers and employees to prevent fatigue in bus drivers.
    • Work-related rhinitis – is it always an occupational disease?

      Witold Salski; Marta Wiszniewska; Agata Salska; Diana Tymoszuk; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland; Medical University of Lodz, Łódź, Poland (2016-12)
      Rhinitis is a chronic inflammatory disease of the upper respiratory tract, characterized by a high prevalence and a complex pathogenesis. Work-related rhinitis (WRR) can be divided into occupational rhinitis (OR) and work-exacerbated rhinitis (WER). It is not only considered as a disease entity but also in the context of medical certification as the allergic disease associated with occupational exposure. Epidemiology of work-related rhinitis has been found to vary depending on the occupation and specific exposure, on the other hand the prevalence data may be underestimated due to the lack of uniform diagnostic criteria. This paper reviews the issues comprising the pathogenesis, epidemiology, diagnosis and treatment of patients with work-related rhinitis. It also discusses the significance of the disease in occupational medicine, particularly in terms of preventive worker care, general principles of good practice in primary and secondary WRR prevention and the necessary directions of changes in medical certification in the cases of occupational rhinitis.
    • Work-related symptoms among workers exposed to black tea dust.

      Lipinska-Ojrzanowska, Agnieszka; Wiszniewska, Marta; Tymoszuk, Diana; Palczynski, Cezary; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Tea may be classified as unfermented green, semi-ferinented oolong and fermented black. All of these types are derived from Camellia sinensis, the Tea Plant, which contains the low molecular weight (LMW) agent Epigallocatechin gallate (EGCg), probably responsible for allergic reactions. The aim of our study was to asses the work-related allergic symptoms and IgE-mediated sensitivity among black tea packers.
    • Worker exposure to ultrafine particles during carbon black treatment

      Mikolajczyk, Urszula; Bujak-Pietrek, Stella; Szadkowska-Stanczyk, Irena; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Wstęp: Celem badania była ocena uwalniania do powietrza stanowisk pracy cząstek ultradrobnych podczas przesypu i pakowania sadzy technicznej. Materiał i metody: Ocena obejmowała wyniki pomiarów przeprowadzonych w zakładzie przesypu sadzy technicznej przed rozpoczęciem procesu przesypu, w czasie wykonywania i po zakończeniu procesu. Określono stężenie liczbowe cząstek o wymiarach z zakresu 10–1000 nm i 10–100 nm z wykorzystaniem kondensacyjnego licznika cząstek (condensation particle counter – CPC). Do oceny stężenia masowego cząstek użyto monitora stężenia aerozolu w powietrzu DustTrak II DRX aerosol concentration monitor. Oszacowano także stężenie powierzchniowe cząstek potencjalnie odkładających się w rejonie pęcherzykowym (alveolar – A) i tchawiczo-oskrzelowym (tracheo-bronchial – TB) człowieka, korzystając z monitora nanocząstek AeroTrak 9000. Wyniki: Średnie stężenie masowe cząstek podczas procesu było 6-krotnie wyższe w porównaniu z wartością przed jego rozpoczęciem. Zaobserwowano 3-krotny wzrost średniego stężenia liczbowego cząstek 10–1000 nm i cząstek 10–100 nm podczas wykonywania ww. czynności. Stężenie powierzchniowe cząstek potencjalnie zdeponowanych w rejonie pęcherzykowym (A) i w rejonie tchawiczo-oskrzelowym (TB) wzrosło 4-krotnie. Wnioski: Podczas przesypywania i pakowania sadzy odnotowano istotnie wyższe wartości każdego z analizowanych parametrów charakteryzujących narażenie na cząstki ultradrobne. The aim of the project was to assess the exposure of workers to ultrafine particles released during handling and packing of carbon black. The assessment included the results of the measurements performed in a carbon black handling plant before, during, and after work shift. Material and Methods: The number concentration of particles within the dimension range 10–1000 nm and 10–100 nm was assayed by a condensation particle counter (CPC). The mass concentration of particles was determined by a DustTrak II DRX aerosol concentration monitor. The surface area concentration of the particles potentially deposited in the alveolar (A) and tracheo-bronchial (TB) regions was estimated by an AeroTrak 9000 nanoparticle monitor. Results: An average mass concentration of particles during the process was 6-fold higher than that before its start, while a 3-fold increase in the average number concentration of particles within the dimension range 10–1000 nm and 10–100 nm was observed during the process. At the same time a 4-fold increase was found in the surface area concentration of the particles potentially deposited in the A and TB regions. Conclusions: During the process of carbon black handling and packing a significantly higher values of each of the analysed parameters, characterizing the exposure to ultrafine particles, were noted.
    • [Workers' view on the preventive needs for civilization diseases' in prophylactic care taken on employees].

      Lipińska-Ojrzanowska, Agnieszka; Magnuska, Jadwiga; Świerczyńska-Machura, Dominika; Walusiak-Skorupa, Jolanta; Marcinkiewicz, Andrzej; Wiszniewska, Marta; Nofer Institute of Occupational Medicine (2019-07-16)
      Wstęp: Każdego roku w Polsce wykonuje się w celach przewidzianych w Kodeksie pracy prawie 5 mln badań profilaktycznych osób pracujących. Celem badania przeprowadzonego przez autorów artykułu było uzyskanie opinii pracowników na temat celowości poszerzenia zakresu tych badań o profilaktykę chorób cywilizacyjnych (m.in. działania edukacyjne dotyczące zdrowego stylu życia). Materiał i metody: Anonimową ankietę na temat rozszerzenia opieki o działania profilaktyczne dotyczące chorób cywilizacyjnych i nowotworowych wypełniło 325 pracowników. Zaproponowano uzupełnienie badań przeprowadzanych w celach przewidzianych w Kodeksie pracy o oznaczenie we krwi pobranej z opuszki palca glikemii przygodnej i cholesterolu całkowitego oraz wykonanie pomiaru obwodu brzucha i zapisu elektrokardiograficznego (EKG). Zapytano o najbardziej interesujące tematy, które powinien omówić lekarz służby medycyny pracy (SMP). Wyniki: Jako interesujące tematy najczęściej wskazywano badania przesiewowe w kierunku chorób nowotworowych (69,5%) oraz czynniki ryzyka chorób cywilizacyjnych (61,5%). Rozszerzenie zakresu badania profilaktycznego o EKG zaakceptowało 95,7% osób, pomiar stężenia cholesterolu całkowitego − 95,3%, oznaczenie glikemii przygodnej − 94,8%, pomiar obwodu brzucha − 80%. Aż 89,5% ankietowanych poparło organizację zajęć sportowych w miejscu pracy i/lub dofinansowanie przez pracodawcę dostępu do obiektów sportowych, a 77,8% badanych wyraziło chęć uczestniczenia w szkoleniach nt. zdrowego stylu życia w miejscu pracy. Wnioski: Ograniczenie badań lekarskich wskazanych w Kodeksie pracy do certyfikowania zdolności lub istnienia przeciwwskazań zdrowotnych do wykonywania określonej pracy skutkuje utratą szansy na wdrożenie profilaktyki schorzeń u osób aktywnych zawodowo, które mają poczucie pełnego zdrowia. Zaproponowane przez autorów publikacji rodzaje działań spotkały się z aprobatą pracowników.
    • [Workplace health promotion as a tool for reducing the consequences of ageing of the working population].

      Goszczyńska, Eliza; Nofer Institute of Occupational Medicine (2019-09-18)
      Prognozowana na najbliższe lata intensyfikacja procesu starzenia się polskiego społeczeństwa spowoduje poważne konsekwencje gospodarczo-społeczne. W skali makro będą obserwowane mniejsze wpływy do budżetu państwa (w związku ze zmniejszaniem liczebności siły roboczej) i wyższe wydatki publiczne (na emerytury, opiekę medyczną, opiekę długoterminową). Następstwa w skali mezo, tj. dotyczące zakładów pracy, polegają na kurczeniu i starzeniu się zasobów pracy, co spowoduje poważne trudności w rekrutacji. Prawdopodobny jest też spadek produktywności starzejącej się załogi powiązany z absencją chorobową i prezentyzmem. Państwo może sprostać tym wyzwaniom, wspierając jak najdłuższą, utrzymywaną na wysokim poziomie aktywność społeczną i zawodową społeczeństwa. Narzędziem takiej polityki uczyniono m.in. promocję zdrowia w miejscu pracy (PZwMP). W literaturze – choć w wielu pozycjach wskazuje się różnorodne zalety tej promocji – brakuje kompleksowego opracowania podsumowującego jej osiągnięcia w kontekście starzenia się ludności. Dlatego celem artykułu jest przedstawienie dowodów naukowych przemawiających za skutecznością promocji zdrowia w miejscu pracy w przeciwdziałaniu lub łagodzeniu skutków tego procesu demograficznego (kurczenia się zasobów pracy oraz spadku produktywności starzejącego się personelu powiązanego z zachowaniami absencyjnymi). Przeprowadzono narracyjny przegląd literatury (polsko- i angielskojęzycznej, zidentyfikowanej w bazach EBSCO, PubMed, za pomocą wyszukiwarki Google oraz metodą „śnieżnej kuli”). Potencjał PZwMP w omawianym zakresie polega na jej skuteczności we wzmacnianiu zdrowia i przeciwdziałaniu problemom zdrowotnym personelu. Dobra kondycja zdrowotna, poprzez wzmacnianie zdolności do pracy oraz podtrzymywanie aktywności zawodowej, ogranicza kurczenie się zasobów pracy. Zmniejsza skalę absencji i prezentyzmu. Szeroko rozumiane problemy zdrowotne mają z kolei działanie odwrotne. Chociaż analizy skuteczności PZwMP we wzmacnianiu zdolności do pracy, wydłużaniu aktywności zawodowej, redukcji absencji, prezentyzmu czy spowodowanych nimi strat produktywności należą do słabo rozwiniętych obszarów badawczych, to zgromadzone systematyczne przeglądy literatury wskazują na jej potencjał w tym zakresie. Med. Pr. 2019;70(5):617–631
    • Wplyw stresu i intensywnosci rozmow przez telefon komorkowy na stan zdrowia i dolegliwosci subiektywne pracownikow sieci GSM.

      Szyjkowska, Agata; Gadzicka, Elzbieta; Szymczak, Wiesław; Bortkiewicz, Alicja; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-07-26)
      There are no available data on the health consequences that may result from the synergistic effects of electromagnetic fields (EMF) and stress. Understanding the mechanisms of the simultaneous exposure will make it possible to develop procedures to minimize adverse health effects in professionals using mobile phones.
    • Wrist dosimeter in nuclear medicine - An alternative for the ring dosimeter?

      Wrzesień, Małgorzata; Olszewski, Jerzy; Nofer Institute of Occupational Medicine (2018-10-01)
      Individual dosimetry is undoubtedly one of the best methods of assessing the exposure of personnel to ionizing radiation, however in case of nuclear medicine, the method applied to measure the dose does not always present a picture of the worker's actual exposure. The highly non-homogeneous dose distribution on the hand means that the ring dosimeter, routinely used to measure the Hp(0.07), provides only approximate dose values received by fingertips, the body part most exposed to ionizing radiation. This paper is an attempt to answer the question whether the wrist dosimeter used as a replacement for the ring dosimeter is able to provide information on doses for the most exposed fragments of the hand of an employee during handling procedures with the use of radiopharmaceuticals. Throughout measurements performed in five nuclear medicine facilities, high-sensitivity thermoluminescent detectors were used. Correction coefficients have been determined, which constitute an amendment to be made to move from the dose recorded by the wrist dosimeter to the doses received by the most exposed hand fragments. The fingertips received on average 25 times higher doses, compared to the values recorded by the wrist dosimeter. A wrist dosimeter can be used to measure the Hp(0.07) in nuclear medicine, including as a gauge of the most exposed parts of the hand - the fingertips. However, the applicability of correction coefficients makes it necessary to ensure a stable position of the wrist dosimeter during routine procedures.
    • Wytyczne do opieki profilaktycznej nad uczniami szkol fryzjerskich.

      Golinska-Zach, Aleksandra; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland (2017-07-26)
      Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper). On the basis of information obtained from the authors' own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE) nor performance of skin prick tests (SPTs) and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5):677-687.
    • Wyzwania medycyny pracy wobec problemu chorób związanych z pracą oraz starzenia się populacji osób pracujących. Dalszy kierunek rozwoju i celowe zmiany w opiece profilaktycznej nad pracującymi w Polsce.

      Marcinkiewicz, Andrzej; Walusiak-Skorupa, Jolanta; Wiszniewska, Marta; Rybacki, Marcin; Hanke, Wojciech; Rydzyński, Konrad; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      The system of occupational health care in Poland, based on occupational medicine service, takes care of almost 12.5 million employees subjected to over 4.5 million obligatory periodic medical check ups. This form of providing prophylactic care comes down to examinations dictated by legal regulations, whose scope is not oriented towards a comprehensive workers’ health assessment, but to the examination of the systems and organs critical to work-related dangers. Simultaneously, epidemiological data indicate a large number of chronic diseases, which may influence the professional activity, like hypertension or diabetes and a high percentage of patients not aware of their illness. Since patients participating in obligatory examinations usually feel healthy and do not use health care services on a daily basis, an occupational medicine physician has a unique opportunity to detect health disorders at an early stage, which can prevent the development of health complications affecting the condition of the patient, limiting their professional activity, but also causing additional costs of the health care system. The authors have proven the need to involve occupational medicine services in the prevention of chronic diseases and the need to introduce additional sources of financing for procedures enabling early detection of diseases the patient may not be aware of or control of the effectiveness of already diagnosed illnesses. They addressed the need to change the current legal form of establishing and announcing the range of examinations and directives for certifying the lack or presence of health contraindications to work to the specified and updated standards prepared by scientific research institutes and occupational medicine societies. System ochrony zdrowia pracujących w Polsce, oparty na świadczeniach realizowanych przez służbę medycyny pracy, obejmuje opieką niemal 12,5 mln pracowników. Rocznie wykonuje się u nich ponad 4,5 mln obowiązkowych badań okresowych. Tak sprawowana opieka profilaktyczna sprowadza się jednak najczęściej tylko do wykonywania badań określonych przepisami Kodeksu pracy. Ich zakres nie jest ukierunkowany na kompleksową ocenę stanu zdrowia pracujących, lecz na ocenę tych układów i narządów człowieka, które są krytyczne dla zagrożeń występujących na stanowisku pracy. Tymczasem dane epidemiologiczne wskazują na wysoką chorobowość z powodu chorób przewlekłych, które wpływają na utrzymywanie aktywności zawodowej (takich jak nadciśnienie tętnicze czy cukrzyca), oraz na znaczny odsetek chorych nieświadomych swojej choroby lub nieuzyskujących odpowiednich efektów terapeutycznych. Na obligatoryjne badania lekarskie zgłaszają się osoby przekonane o swoim zdrowiu, niekorzystające na co dzień z opieki zdrowotnej, dlatego lekarz medycyny pracy ma unikalną możliwość wykrycia zaburzeń w stanie zdrowia pracownika na ich wczesnym etapie. Dzięki temu może zapobiegać rozwojowi powikłań z jednej strony obciążających zdrowie samego pracownika, a z drugiej powodujących dodatkowe obciążenie finansowe dla całego systemu ochrony zdrowia. Konkludując, w artykule wskazano potrzebę zaangażowania służby medycyny pracy w profilaktykę chorób przewlekłych i związaną z tym konieczność wprowadzenia dodatkowych (oprócz pracodawców) źródeł finansowania działań profilaktycznych, umożliwiających wczesne wykrywanie stanów chorobowych, których pacjent nie jest świadomy, lub kontrolę skuteczności leczenia chorób już zdiagnozowanych. Podniesiono także potrzebę zmiany ustanawiania i publikowania zakresu badań oraz wytycznych do orzekania o braku lub istnieniu przeciwwskazań zdrowotnych do pracy z dotychczasowej formy prawnej na rzecz standardów określanych i na bieżąco publikowanych przez instytuty badawcze i towarzystwa naukowe działające w obszarze medycyny pracy.
    • Zagrożenia zdrowotne wynikające z narażenia na cynk i jego związki nieorganiczne w przemyśle.

      Pakulska, Daria; Czerczak, Sławomi; Nofer Institute of Occupational Medicine, Łódź, Poland (2017-10-17)
      This article deals with health risks resulting from exposure to zinc and its inorganic compounds in industry. The main source of zinc exposure are fumes generated during thermal and chemical processes, mainly zinc oxide fume formed by immediate oxidation of metallic zinc vapor formed during high-temperature processes, as well as dust generated during the mechanical processing of zinc-containing materials. It is recognized that zinc ions are responsible for health effects of exposure to dust/fumes of the majority of zinc compounds, and the final effect of exposure depends on the degree of dispersion of dusts/fumes suspended in the air. Since the effects of exposure depends on the particle size, occupational exposure limits have began to be established separately for respirable and inhalable fractions. A critical effect of acute exposure to respirable fraction is a "fume fever" which in chronic exposure occurs as an effect associated with recurrent symptoms of acute poisoning. Impaired lung function and asthma symptoms are considered to be the main effects of exposure to inhalable fraction. Due to the limited number of the available data it is not possible to assess carcinogenicity, reproductive toxicity and teratogenicity of zinc and its compounds. The aim of the study was to analyze the major health hazards resulting from occupational exposure to zinc and its inorganic compounds in the context of their physico-chemical properties, a wide range of applications and occupational exposure data. Med Pr 2017;68(6):779-794.