• Assessment of occupational exposure to radio frequency electromagnetic fields

      Aniołczyk, Halina; Mariańska, Magda; Mamrot, Paweł; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Wstęp: Dyrektywa 2013/35/UE nałożyła obowiązek implementacji przepisów UE do prawa krajowego. Celem pracy jest ocena aktualnego stanu zagrożeń wynikających ze stosowania urządzeń wytwarzających PEM RF w zakresie od 100 kHz do 300 GHz oraz wskazanie urządzeń i miejsc pracy o najwyższym ryzyku narażenia zdrowia pracowników. Materiał i metody: Materiał stanowiły dane pochodzące z badań i pomiarów PEM RF realizowanych w Pracowni Zagrożeń Elektromagnetycznych Instytutu Medycyny Pracy im. prof. J. Nofera w Łodzi. Szczegółowej analizie poddano wyniki pomiarów natężenia pola elektrycznego (E) dla ponad 450 wybranych urządzeń, reprezentatywnych dla działów gospodarki, w których najczęściej są stosowane. Analizowano również zasięg występowania stref ochronnych i krotność przekroczenia najwyższego dopuszczalnego natężenia (NDN). Pomiary i badania PEM w środowisku pracy były zgodne z Polską Normą, a kryterium oceny ekspozycji stanowiły polskie przepisy o NDN. Wyniki: Najwyższe zmierzone wartości natężenia pola (E) na stanowiskach pracownika stwierdzono dla aparatów elektrochirurgicznych do 400 V/m, diatermii krótkofalowych (KF) do 220 V/m, zgrzewarek dielektrycznych do 240 V/m i wnętrza radiowych systemów antenowych UKF do 180 V/m. Największy zasięg stref ochronnych stwierdzono dla prototypowych urządzeń stosowanych w nauce, diatermii KF i zgrzewarek dielektrycznych. Najwyższą krotność przekroczenia NDN stwierdzono przy: zgrzewarkach dielektrycznych do 12, diatermiach KF do 11, diatermiach MF do 8. Wnioski: Potwierdzono wysokie wartości natężenia PEM RF w środowisku pracy dla takich grup zawodowych jak fizjoterapeuci, operatorzy zgrzewarek dielektrycznych i pracownicy technicznych grup masztowych w obiektach radiokomunikacji (w tym stacji radiowych i telewizyjnych).
    • [Assessment of temporary hearing changes related to work as a bartender].

      Wolniakowska, Anna; Zaborowski, Kamil; Dudarewicz, Adam; Pawlaczyk-Łuszczyńska, Malgorzata; Śliwińska-Kowalska, Mariola; Nofer Institute of Occupational Medicine (2019-02-28)
      Noise in entertainment industry often reaches high sound pressure levels. Nevertheless, the risk of hearing loss in this sector is insufficiently recognized. The aim of this study was the assessment of the relationship between noise exposure and temporary threshold shifts (TTS) for people working as bartenders at a variety of entertainment venues. The study comprised a total of 18 bartenders (mean age was 25±7 years old) employed at a music club (N = 8), pub (N = 5) and discotheque (N = 5). Personal dosimeters were used for determining noise levels and frequency characteristics. Hearing was evaluated by pre- (before work) and post-exposure (up to 15 min after the end of work) pure tone audiometry. Hearing tests were carried out for bartenders during 2 or 3 sessions while working on weekends. The mean personal noise exposure level normalized to a nominal 8-hour working day was 95 dBA, above 4 times higher than the accepted legal limit. The TTS values (10 dB HL or more) were significant at 4 kHz for both ears for 77% of bartenders. People working as bartenders represent a professional group with an increased risk of hearing loss. Raising awareness of this fact and implementing hearing protection programs in this group of workers is urgently needed, in line with the European Commission Directive (EU Directive 2003/10/EC). Med Pr. 2019;70(1):17-25.
    • The association between night shift work and nutrition patterns among nurses: a literature review.

      Pepłońska, Beata; Nowak, Paulina; Trafalska, Elżbieta; Nofer Institute of Occupational Medicine (2019-06-14)
      The shift work system may affect the temporal distribution of eating and diet quality. The paper aimed at reviewing a body of research examining the associations between night shift work and dietary habits among nurses. Data from the PubMed and Google Schoolar databases, as well as references lists in selected papers were searched. The authors used the following keywords: nurses, shift work, diet, nutrition. Papers published in English or Polish were selected for the review, and as many as 19 papers published in 2000−2017 were eventually identified. The studies varied greatly with respect to the study size, subjects’ age and the duration of night shift work. The major problem was the heterogeneity of the tools used for dietary assessment. Self-administered questionnaires were used and analyses were rarely adjusted for confounders. Alcohol consumption was the most frequently analyzed aspect (N = 8 studies), followed by the total energy (N = 7), protein, fat (N = 6), and carbohydrate intake, coffee and fruit consumption (N = 5). The results showed quite a consistent association of night work with higher coffee (caffeine) consumption, as well as lower alcohol, and fruit and vegetables consumption. Few studies also reported more frequent snacks consumption, later time of the last meal, eating at night, meals irregularity, and a poorer diet quality among night shift nurses when compared to the reference. The review showed some poor nutritional habits among nurses working night shifts. However, the topic warrants further attention, owing to the relatively small number of the studies performed so far, and their numerous methodological limitations.
    • Association of Rotating Night Shift Work with BMI and Abdominal Obesity among Nurses and Midwives.

      Peplonska, Beata; Bukowska, Agnieszka; Sobala, Wojciech; Nofer Institute of Occupational Medicine, Lodz, Poland (2015-07-21)
      Mounting epidemiological evidence suggests that night shift work may contribute to the etiology of increased body weight. The present study aimed to examine association between rotating night shift work and body mass index (BMI), and abdominal adiposity respectively among nurses and midwives.
    • Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies.

      Pastorino, S; Bishop, T; Crozier, S R; Granström, C; Kordas, K; Küpers, L K; O'Brien, E C; Polanska, K; Sauder, K A; Zafarmand, M H; et al. (2019-03-01)
      Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes. Individual level meta-analysis, which reduces heterogeneity across studies. A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants. Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses.
    • Auditory temporal processing tests – Normative data for Polish-speaking adults

      Majak, Joanna; Zamysłowska-Szmytke, Ewa; Rajkowska, Elżbieta; Śliwińska-Kowalska, Mariola; Nofer Institute of Occupational Medicine, Lodz, Poland (2015)
      Background: Several subjects exposed to neurotoxins in the workplace need to be assessed for central auditory deficit. Although central auditory processing tests are widely used in other countries, they have not been standardized for the Polish population. The aim of the study has been to evaluate the range of reference values for 3 temporal processing tests: the duration pattern test (DPT), the frequency pattern test (FPT) and the gaps in noise test (GIN). Material and Methods: The study included 76 normal hearing individuals (38 women, 38 men) at the age of 18 to 54 years old (mean ± standard deviation: 39.4±9.1). All study participants had no history of any chronic disease and underwent a standard ENT examination. Results: The reference range for the DPT was established at 55.3% or more of correct answers, while for the FPT it stood at 56.7% or more of correct answers. The mean threshold for both ears in the GIN test was defined as 6 ms. In this study there were no significant associations between the DPT, FPT and GIN results and age or gender. Symmetry between the ears in the case of the DPT, FPT and GIN was found. Conclusions: Reference ranges obtained in this study for the DPT and FPT in the Polish population are lower than reference ranges previously published for other nations while the GIN test results correspond to those published in the related literature. Further investigations are needed to explain the discrepancies between normative values in Poland and other countries and adapt tests for occupational medicine purposes. Med Pr 2015;66(2):145–152
    • Availability and the use of work-life balance benefits guaranteed by the Polish Labour Code among workers employed on the basis of employment contracts in small and medium enterprises

      Andysz, Aleksandra; Jacukowicz, Aleksandra; Stanczak, Aleksander; Drabek, Marcin; Nofer Institute of Occupational Medicine, Lodz, Poland (2016)
      Objectives: Polish Labour Code provides employees with a range of solutions (benefits) supporting them in achieving balance between work and private life. This paper was aimed at indicating availability and the use of legal benefits supporting work-life balance (WLB) among Polish workers of small and medium enterprises. Material and Methods: The study sample included 219 respondents, aged 22–64, working in small and medium enterprises and employed on the basis of employment contracts for at least a year. The respondents completed a questionnaire on availability and the use of benefits guaranteed by the Polish Labour Code, referring to their current workplaces. Results: Most frequently the studied employees took sick leave because of one’s own illness and leave on demand. In our sample, 45% of the women took maternity leave and 26% of the men took paternity leave. The respondents took educational and parental leave the least frequently. More than half of the respondents (58%) did not return to the same position after leave devoted to childcare, even though they had such a possibility. Conclusions: In fact, most of work-life balance benefits guaranteed by law were available to the employees of small and medium enterprises, regardless of their gender. Availability and the use of the majority of benefits were similar among the women and men. Availability of benefits depended on the specificity of industry and a profession, thus, future research on work-life balance policy should control for variables related to the character of work.
    • Badanie czynnościowe osób z zawrotami głowy i zaburzeniami równowagi dla potrzeb medycyny pracy.

      Zamysłowska-Szmytke, Ewa; Szostek-Rogula, Sylwia; Śliwińska-Kowalska, Mariola; Nofer Institute of Occupational Medicine, Lodz, Poland (2018-03-09)
      Balance assessment relies on symptoms, clinical examination and functional assessment and their verification in objective tests. Our study was aimed at calculating the assessment compatibility between questionnaires, functional scales and objective vestibular and balance examinations.
    • Bedside examination for vestibular screening in occupational medicine.

      Zamysłowska-Szmytke, Ewa; Szostek-Rogula, Sylwia; Sliwinska-Kowalska, Mariola; Nofer Institute of Occupational Medicine, Łódź, Poland; Rehabilitation Center “Repty”, Tarnowskie Góry, Poland (2015-03-17)
      Objectives: The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Material and Methods: Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Results: Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. Conclusions: The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.
    • Bezpomiarowa ocena narazenia na dzialanie substancji chemicznych przez kontakt ze skora w srodowisku pracy.

      Jankowska, Agnieszka; Czerczak, Slawomir; Kupczewska-Dobecka, Małgorzata; Nofer Institute of Occupational Medicine, Łódź, Poland (2017-06-27)
      Assessment of dermal exposure to chemicals in the work environment is problematic, mainly as a result of the lack of measurement data on occupational exposure to chemicals. Due to common prevalence of occupational skin exposure and its health consequences it is necessary to look for efficient solutions allowing for reliable exposure assessment. The aim of the study is to present predictive models used to assess non-measured dermal exposure, as well as to acquaint Polish users with the principles of the selected model functioning. This paper presents examples of models to assist the employer in the the assessment of occupational exposure associated with the skin contact with chemicals, developed in European Union (EU) countries, as well as in countries outside the EU. Based on the literature data dermal exposure models EASE (Estimation and Assessment of Substance Exposure), COSHH Essentials (Control of Substances Hazardous to Health Regulations), DREAM (Dermal Exposure Assessment Method), Stoffenmanager , ECETOC TRA (European Centre for Ecotoxicology and Toxicology of Chemicals Targeted Risk Assessment), MEASE (Metal's EASE), PHED (Pesticide Handlers Exposure Database), DERM (Dermal Exposure Ranking Method) and RISKOFDERM (Risk Assessment of Occupational Dermal Exposure to Chemicals) were briefly described. Moreover the characteristics of RISKOFDERM, guidelines for its use, information on input and output data were further detailed. Problem of full work shift dermal exposure assessment is described. An example of exposure assessment using RISKOFDERM and effectiveness evaluation to date were also presented. When no measurements are available, RISKOFDERM allows dermal exposure assessment and thus can improve the risk assessment quality and effectiveness of dermal risk management. Med Pr 2017;68(4):557-569.
    • Bilateral hypermobility of ulnar nerves at the elbow joint with unilateral left ulnar neuropathy in a computer user – A case study

      Lewanska, Magdalena; Grzegorzewski, Andrzej; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine, Lodz, Poland; Medical University of Lodz, Lodz, Poland (2015)
      Occupational ulnar neuropathy at the elbow joint develops in the course of long term direct pressure on the nerve and a persistently flexed elbow posture, but first of all, it is strongly associated with “holding a tool in a certain position” repetitively. Therefore, computer work only in exceptional cases can be considered as a risk factor for the neuropathy. Ulnar hypermobility at the elbow might be one of the risk factors in the development of occupational ulnar neuropathy; however, this issue still remains disputable. As this condition is mostly of congenital origin, an additional factor, such as a direct acute or chronic professional or non-professional trauma, is needed for clinical manifestations. We describe a patient – a computer user with a right ulnar nerve complete dislocation and left ulnar nerve hypermobility, unaware of her anomaly until symptoms of left ulnar neuropathy occurred in the course of job exposure. The patient was exposed to repetitive long lasting pressure of the left elbow and forearm on the hard support on the cupboard and desk because of a non-ergonomically designed workplace. The additional coexistent congenital abnormal displacement of the ulnar nerve from the postcondylar groove during flexion at the elbow increased the possibility of its mechanical injury. We recognized left ulnar neuropathy at the ulnar groove as an occupational disease. An early and accurate diagnosis of any form of hypermobility of ulnar nerve, informing patients about it, prevention of an ulnar nerve injury as well as compliance with ergonomic rules are essential to avoid development of occupational and non-occupational neuropathy.
    • [Biological agents intentionally used in Poland based on data from the National Register Of Biological Agents].

      Kozajda, Anna; Nofer Institute of Occupational Medicine (2018-08-20)
      Paper presents the intentional use of biological agents for industrial, diagnostic and research purposes in enterprises in Poland.
    • Biological monitoring and the influence of genetic polymorphism of As3MT and GSTs on distribution of urinary arsenic species in occupational exposure workers.

      Janasik, Beata; Reszka, Edyta; Stanislawska, Magdalena; Wieczorek, Edyta; Fendler, Wojciech; Wasowicz, Wojciech; Nofer Institute of Occupational Medicine, Łódź, Poland; Medical University of Lodz, Łódź, Poland; Medical University of Lodz, Lodz, Poland (2015)
      Purpose To examine the differences in urinary arsenic metabolism patterns in men affected by occupational exposure, we performed a study on 149 participants—workers of a copper mill and 52 healthy controls without occupational exposure. To elucidate the role of genetic factors in arsenic (As) metabolism, we studied the associations of six polymorphisms: As3MT Met287Thr (T>C) in exon 9; As3MT A>G in 5′UTR; As3MT C>G in intron 6; As3MT T>G in intron 1; GSTP1 Ile105Val and GSTO2 T>C. Methods Air samples were collected using individual samplers during work shift. Urine samples were analyzed for total arsenic and arsenic chemical forms (AsIII; AsV, MMA, DMA, AsB) using HPLC–ICP-MS. A specific polymerase chain reaction was done for the amplification of exons and flanking regions of As3MT and GSTs. Results The geometric mean arsenic concentrations in the air were 27.6 ± 4.9 μg/m3. A significant correlation (p < 0.05) was observed between arsenic in air and sum of iAs +MMA and iAs. As3MT (rs3740400) GG homozygotes showed significantly (p < 0.05) higher %iAs (21.8 ± 2.0) in urine than GC+CC heterozygotes (16.0 ± 2.1). A strong association between the gene variants and As species in urine was observed for GSTO2 (rs156697) polymorphism. Conclusions The findings of the study point out that the concentration of iAs or the sum of iAs + MMA in urine can be a reliable biological indicator of occupational exposure to arsenic. This study demonstrates that As3MT and/ or GSTs genotype may influence As metabolism. Nevertheless, further studies investigating genetic polymorphism in occupational conditions are required.
    • Biomarkers of exposure in environment-wide association studies - Opportunities to decode the exposome using human biomonitoring data.

      Steckling, Nadine; Gotti, Alberto; Bose-O'Reilly, Stephan; Chapizanis, Dimitris; Costopoulou, Danae; De Vocht, Frank; Garí, Mercè; Grimalt, Joan O; Heath, Ester; Hiscock, Rosemary; et al. (2018-04-04)
      The European Union's 7th Framework Programme (EU's FP7) project HEALS - Health and Environment-wide Associations based on Large Population Surveys - aims a refinement of the methodology to elucidate the human exposome. Human biomonitoring (HBM) provides a valuable tool for understanding the magnitude of human exposure from all pathways and sources. However, availability of specific biomarkers of exposure (BoE) is limited.
    • Biomarkers of selenium status and antioxidant effect in workers occupationally exposed to mercury.

      Kuras, Renata; Reszka, Edyta; Wieczorek, Edyta; Jablonska, Ewa; Gromadzinska, Jolanta; Malachowska, Beata; Kozlowska, Lucyna; Stanislawska, Magdalena; Janasik, Beata; Wasowicz, Wojciech; et al. (2018-09)
      The present observation based research was designed to evaluate the influence of occupational human exposure to metallic mercury (Hg°) vapor on the biomarkers of selenium status involved in the antioxidant defense system. For this purpose we determined Hg and selenium (Se) concentrations in body fluids, the markers of antioxidant effect measured as an activity of Se-dependent enzymes (red blood cell and plasma glutathione peroxidase: GPx1-RBC and GPx3-P), concentration of selenoprotein P in the plasma (SeP-P) and total antioxidant activity in the plasma (TAA-P) in 131 male workers from a chloralkali plant exposed to Hg° and 67 non-exposed males (control group). The mRNA expression levels of glutathione peroxidases (GPX1, GPX3), selenoprotein P (SEPP1), thioredoxin reductase 1 (TRXR1), thioredoxin 1 (TRX1), peroxiredoxins (PRDX1, PRDX2) were also examined in the leukocytes of peripheral blood. Hg concentration in the blood (Hg-B) and urine (Hg-U) samples was determined using the thermal decomposition amalgamation/atomic absorption spectrometry (TDA-AAS) method and Se concentrations in plasma (Se-P) and urine (Se-U) using the inductively coupled plasma mass spectrometry (ICP-MS) method. Activities of GPx1-RBC, GPx3-P and TAA-P were determined using the kinetic and spectrophotometric method, respectively. Gene expression analysis was performed using the quantitative Real-Time PCR. The results showed significant higher Hg levels among the Hg°-exposed workers in comparison to control group (12-times higher median for Hg-B and almost 74-times higher median for Hg-U concentration in chloralkali workers). Se-P was also significantly higher (Me (median): 82.85 μg/L (IQR (interquartile range) 72.03-90.28 μg/L) for chloralkali workers vs. Me: 72.74 μg/L (IQR 66.25-80.14 μg/L) for control group; p = 0.0001) but interestingly correlated inversely with Hg-U in chloralkali workers suggesting depletion of the Se protection among the workers with the highest Hg-U concentration. The mRNA level for GPX1, PRXD1 were markedly but significantly higher in the workers compared to the control group. Moreover, concentrations of Hg-B and Hg-U among the workers were significantly positively correlated with the levels of selenoprotein P at both the mRNA and selenoprotein levels. In the multivariate model, after adjusting to cofounders (dental amalgam fillings, age, BMI, job seniority time, smoking), we confirmed that Hg-U concentration was inversely correlated with genes expression of TRXR1. This is the first comprehensive assessment of the impact of occupational exposure of workers to Hg° at both the mRNA and selenoprotein levels, with investigation of fish intake obtained by means of a questionnaire. These findings suggest that exposure to Hg° alters gene expression of the antioxidant enzymes and the level of Se-containing selenoproteins.
    • Bisphenol A – Application, sources of exposure and potential risks in infants, children and pregnant women.

      Mikołajewska, Karolina; Stragierowicz, Joanna; Gromadzinska, Jolanta; Nofer Institute of Occupational Medicine, Łódź, Poland; Medical University, Łódź, Poland (2015-04-07)
      Bisphenol A (BPA) is used in the chemical industry as a monomer in the production of plastics. It belongs to a group of compounds that disturb some of the functions of human body, the endocrine system in particular. Extensive use of BPA in manufacturing products that come in contact with food increases the risk of exposure to this compound, mainly through the digestive tract. Literature data indicate that exposure to bisphenol A even at low doses may result in adverse health effects. The greatest exposure to BPA is estimated among infants, children and pregnant women. The aim of this review is to show potential sources of exposure to bisphenol A and the adverse health effects caused by exposure to this compound in the group of particular risk.
    • Broken heart as work-related accident: Occupational stress as a cause of takotsubo cardiomyopathy in 55-year-old female teacher – Role of automated function imaging in diagnostic workflow

      Mielczarek, Agnieszka; Kasprzak, Jarosław D.; Marcinkiewicz, Andrzej; Kurpesa, Małgorzata; Uznanska-Loch, Barbara; Wierzbowska-Drabik, Karina; Medical University of Lodz, Łódź, Poland; Nofer Institute of Occupational Medicine, Łódź, Poland; (2015)
      Takotsubo cardiomiopathy (TTC) (known also as “ampulla cardiomyopathy,” “apical ballooning” or “broken heart syndrome”) is connected with a temporary systolic left ventricular dysfunction without the culprit coronary lesion. Takotsubo cardiomyopathy was first described in 1990 in Japan after octopus trapping pot with a round bottom and narrow neck similar in shape to left ventriculogram in TTC patients. The occurrence of TTC is usually precipitated by a stressful event with a clinical presentation mimicking myocardial infarction: chest pain, ST-T segment elevation or T-wave inversion, a rise in cardiac troponin, and contractility abnormalities in echocardiography. A left ventricular dysfunction is transient and improves within a few weeks. Takotsubo cardiomyopathy typically occurs in postmenopausal women and the postulated mechanism is catecholamine overstimulation. Moreover, the distribution of contractility impairments usually does not correspond with typical region supplied by a single coronary artery. Therefore, the assessment of regional pattern of systolic dysfunction with speckle-tracking echocardiography and automated function imaging (AFI) technique may be important in diagnosis of TTC and may improve our insight into its patophysiology. We described a 55-year-old female teacher with TTC diagnosed after acute psychological stress in workplace. The provoking factor related with occupational stress and pattern of contraction abnormalities documented with AFI technique including basal segments of left ventricle make this case atypical.
    • 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.