Bronchial hyperresponsiveness (BHR) is the individual ability to respond with bronchoconstriction to a variety of specific and nonspecific stimuli which do not cause these symptoms among healthy subjects. Bronchial hyperresponsiveness is one of the hallmark features of asthma. The degree of bronchial hyperresponsiveness is variable among individuals with asthma and may correlate to its severity (the more severe asthma the higher bronchial hyperreactivity). Bronchial hyperresponsiveness is evaluated by performing bronchial provocation test (BPT). Provocation tests are classified - according to their mechanisms - into direct and indirect tests. Direct challenge tests are highly sensitive and they are used primarily to rule out asthma. In contrast, provocation tests with indirect stimuli are less sensitive but more specific to the direct tests; they are used generally to confirm the diagnosis of asthma and they allow for more accurate conclusions about inflammatory lesions in the case of a patient. Bronchial provocation tests play a significant role in occupational medicine. They are particularly relevant to be performed prior to employment, during periodic examinations, and to diagnose and monitor both occupational asthma and work-related asthma. This article presents selected bronchial provocation tests and their usefulness in the diagnosis of occupational asthma. Med Pr 2018;69(4):457-471.
Non-occupational work-related diseases refer to health problems of multifactorial etiology, the occurrence, development and prognosis of which may be affected by work environment or by the way the work is performed but are not treated as occupational diseases under the applicable law. When analyzing their impact on labor market, it is necessary to also consider the employees' right to put in a claim for compensation due to the consequences of the occurrence of such diseases. Legal regulations as well as judicial decisions on the possibilities and methods of pursuing claims for compensation from an employer due to the occurrence of non-occupational work-related disease were analyzed. The analyzed legal regulations and judicial decisions referred to the regulations of the Labour Code, Civil Code and Resolution of the Supreme Court of 4 December 1987. The paper presents examples of non-occupational diseases considered to be work-related and conditions necessary to assert a claim by the employee at the court. Despite the lack of precise legal regulations in Poland, non-occupational work-related diseases may impact the legal situation of employees as well as employers. Employees are granted the right to claim for compensation from their employers in accordance with the Civil Code. Depending on the employer's legal responsibility, it is necessary to prove the meeting of the appropriate essential conditions to put in a claim for damage. Raising the employers' awareness of the legal and financial consequences shall support the occupational medicine services in intensifying their activity aimed at preventing all work-related diseases. Med Pr 2018;69(5):539-546.
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.
Periodical medical examinations are mandatory for employees in Poland. This rule makes a unique opportunity during occupational health services for implementation of prophylactic activities focused on early diagnosis of various diseases, including cancers. Epidemiological data about cancers is alarming and what is more, further increase in development of cancers is being predicted in population overall. The highest incidence of cancers in the case of Polish women belongs to breast cancer (21.7% of diagnosed cancers in general), while the morbidity rate for uterine cancer, ovarian cancer and cervical cancer amounts to 7.4%, 4.7% and 3.5%, respectively. The aim of this study was to elaborate an algorithm of prophylactic activities integrated with the occupational healthcare system, based on medical literature review and guidelines concerning prophylaxis of selected cancers. Polish cancers' prophylaxis programs related to risk factors were presented in this publication and practical indications for occupational healthcare physicians were worked out. Med Pr 2018;69(4):439-455.
Objectives: The role of cross-reactive carbohydrate determinants (CCDs) in diagnostics of occupational allergy remains unclarified and its clinical relevance is still questioned. The aim of the study was to assess the frequency of positive response to CCDs in the subjects with suspected occupational allergy and the relationship between other diagnostic test results and final diagnosis. Material and Methods: The study group included 201 patients. They underwent clinical examination, skin prick test (SPT) to common and occupational allergens, specific serum immunoglobulin (sIgE) determinations, spirometry and specific inhalation challenge test. Moreover, sIgE to CCDs from bromelain was assessed in all subjects. Results: Occupational respiratory allergy was recognized in 64.3% of CCD-positive and 52.4% of CCD-negative patients. Positive SPT results to common and occupational allergens were found in 64.3% and 35.7% of CCD-positive subjects, respectively. In all subjects with CCDs, the sIgE to grass pollens as well as to occupational allergens were detected. The total IgE level > 100 kU/l was significantly associated with the presence of sIgE to CCDs. Conclusions: sIgE to CCDs were found in 7% of subjects suspected to suffer from occupational respiratory allergy. The presence of CCDs is not significantly associated with occupational respiratory allergy. It is also not more frequent in subjects reporting work-related respiratory symptoms in whom occupational allergy was not confirmed. The elevated total IgE level was related with CCD positivity. In patients with suspected occupational allergy, the presence of sIgE to CCDs in serum did not indicate the irrelevance of positive sIgE to occupational allergens.
Over many years, allergy to natural rubber latex has been a major problem among health care workers (HCW). The diagnosis of occupational allergy requires methods of high diagnostic accuracy in view of certification implications (e.g., a sick worker quits a job). With the development of molecular methods, the frequency of application of recombinant allergens it the diagnostics of allergic diseases continues to increase. This paper reviews the applicability of laboratory tests which use recombinant allergens in the diagnostics of occupational allergy. The diagnosis of latex allergy is based on the presence of clinical symptoms linked with exposure to latex allergens, positive skin prick tests and detection of specific IgE antibodies to latex in serun. Moreover, in some cases specific challenge tests are conducted. The analysis of literature indicates that applying the panel of recombinant latex allergens in diagnostic tests, cross-reactivity can very likely be excluded and/or sensitization can be confirmed without the need for specific challenge tests, which in case of latex allergens carries a potential risk of aeneralized reactions.
Workers' medical prophylactic examinations referred to in the Labor Code are one of the tasks of the occupational medicine services. They are regulated by law which has been in force for more than 20 years in unchanged form. During this period, new harmful, burdensome or dangerous to health factors appeared in the workplaces, for which no preventive health check-up standard was defined. In the meantime, the health criteria for drivers and persons applying for driving licenses have also been significantly liberalized. The above changes, the authors' own experience, comments and problems reported by physicians who provide workers' prophylactic health care and employers as well as analysis of literature related to workers' health care in other countries have created the need to harmonize and update guidelines on health requirements for selected types of work. In addition the scope and frequency of prophylactic examinations for exposures, which are not included in applicable legal acts, has been developed. Med Pr. 2019;70(1):125-37. Badania profilaktyczne pracowników, o których mowa w Kodeksie pracy, to jedno z zadań służby medycyny pracy. Są one regulowane przepisami prawa obowiązującymi w niezmienionej formie już od ponad 20 lat. W tym okresie na wielu stanowiskach pracy pojawiły się nowe czynniki szkodliwe, uciążliwe lub niebezpieczne dla zdrowia, dla których nie określono standardu badania profilaktycznego. Znacznie zliberalizowano także kryteria zdrowotne dla kierowców i osób ubiegających się o uprawnienia do prowadzenia pojazdów silnikowych. Powyższe zmiany, doświadczenia własne autorów, uwagi i problemy zgłaszane przez lekarzy sprawujących opiekę profilaktyczną i pracodawców oraz analiza piśmiennictwa związanego z ochroną zdrowia pracujących w innych krajach stworzyły konieczność ujednolicenia i uaktualnienia wytycznych dotyczących wymagań zdrowotnych dla wybranych rodzajów prac. Ponadto opracowano zakres i częstotliwość badań profilaktycznych dla narażeń, które nie są ujęte w obowiązujących aktach prawnych. Med. Pr. 2019;70(1):125–137.
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.
Methemoglobinemia is a relatively rare, but potentially life-threating medical condition, which may be induced by application of topical anaesthetic agents commonly used during endoscopic procedure. The aim of our study was to assess the influence of lidocaine used prior to transesophageal echocardiography (TEE) on the blood level of methemoglobin in vivo. Additionally we attempted to establish the occurrence rate of clinically evident lidocaineinduced methemoglobinemia on the basis of data collected in our institution. We retrospectively analyzed patient records from 3,354 TEEs performed in our echocardiographic laboratory over the course of 13 years in search for clinically evident methemoglobinemia cases. Additionally, 18 consecutive patients referred for TEE were included in the prospective part of our analysis. Blood samples were tested before and 60 min after pre-TEE lidocaine anesthesia application. Information concerning concomitant conditions and pharmacotherapy were also obtained. In 3,354 patients who underwent TEE in our institution no cases of clinically evident methemoglobinemia occurred. In the prospective part of the study, none of 18 patients [16 (89 %) men, mean age 63 ± 13] was diagnosed with either clinical symptoms of methemoglobinemia or exceeded normal blood concentration of methemoglobin. Initial mean methemoglobin level was 0.5 ± 0.1 % with mild, statistically (but not clinically) significant rise to 0.6 ± 0.1 % after 60 min (p = 0.02). Among the analyzed factors only the relation between the proton pump inhibitors intake and methemoglobin blood level rise was identified as statistically relevant (p = 0.03). In adults, pre-TEE lidocaine anesthesia with recommended dosage results in significant increase in methemoglobin blood level, which however does not exceed normal values and does not result in clinically evident methemoglobinemia.
In Poland patients with psychiatric problems form a large group; in 2010 there were almost 1.5 million people for whom outpatient psychiatric care was provided, whereas approximately 200 thousand ill individuals were treated in 24-h psychiatric wards. Only 17% of the mentally disabled are professionally active. The results of many researches show that despite the detrimental influence of mental disorders on the employment (e.g., lower productivity, absenteeism, presenteism, increased risk of accidents at the workplace), professional activity can play a key role in the7stabilization of the mental state, it can also help in disease recovery. People with mental disorders are a social group that is at the higher risk of exclusion from the job market. The opinion prevailing among employers is that mentally ill individuals have decreased ability to conduct professional activity, and social attitudes towards them tend to be based on marking and stigmatizing. This review tackles the advantages of working during the illness, barriers which people with mental disorders face on the job market when they want to either start or continue work, and professional functioning of people with diagnosed depression (e.g., affective disorders) and schizophrenia (representing psychotic disorders). The analysis of existing data show that to improve the situation of mentally ill people present on the job market close cooperation between the representatives of various medical specializations is necessary, as well as their active participation in the process of social and professional rehabilitation of people affected by mental disorders.
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