• [The right of a doctor to inform an employer of contraindications to perform a certain type of work by an employee].

      Zajdel-Całkowska, Justyna; Winnicka, Renata; Krakowiak, Anna; Jabłońska, Marta Regina; Zajdel, Radosław; Nofer Institute of Occupational Medicine (2018-12-18)
      The aim of this study is to analyze the legal regulations that pertain to the duty of doctor-patient privilege and the possibility of its repeal on the plane to provide information about the patient's health status to his employer. The material constitutes the current Polish law regulations relating to the medical duty of doctor-patient privilege as well as provisions defining the scope of information on the patient's health status that may be transferred to a patient's employer. The doctor has no right to provide the employer with information on contraindications to perform a specific job, if the information was obtained in the mode of providing health services that are not eligible for the catalogue of preliminary/preventive/control examinations. The basis for the doctor providing information to the employer cannot be an exception to the obligation of medical confidentiality, which is governed by art. 40 § 2 pts 1-6 of the Act of Medical Profession, under which cases of admission of professional secrecy were listed, which makes it impossible to use the cited article in cases other than strictly specified in its content. Polish law specifies the circumstances in which it is possible to provide an employer with the medical information on the patient's health. However, there are regulations that provide for the information on contraindications to perform a certain type of work or job to be transmitted if the information has been obtained in a manner other than as provided in the ordinance on medical examinations of employees. Med Pr 2018;69(6):613-620.
    • [Psychological examinations in occupational health services: Legal regulations. Part II].

      Waszkowska, Małgorzata; Wężyk, Agata; Nofer Institute of Occupational Medicine (2018-12-18)
      This paper constitutes a continuation of the critical analysis of legal aspects of psychological examinations in some group of workers. In this part the appeal procedure, documentation, costs of examinations and supervision are discussed. The analysis has shown many deficiencies in regulations related to all aspects of psychological examinations. They arise from incoherence of legal regulations and the lack of regulations of some questions. This legal standing is restricted to occupational work and adversely affects the quality of supplied services. Therefore acts of law and regulations relevant to psychological examinations for the purpose of fitness-to-work certification need necessary adjustments. According to authors it is desirable to end the legal procedure amending the act of law on a profession of psychology and the self-government of psychologists, as well as to develop and implement executive regulations. Med Pr 2018;69(6):673-684. Artykuł kontynuuje krytyczną analizę prawnych aspektów badań psychologicznych różnych grup pracowników. W tej części omówiono kwestie dotyczące procedury odwoławczej, dokumentowania, kosztów oraz nadzoru nad badaniami. Obserwacje ukazały ich liczne niedoskonałości związane ze wszystkimi aspektami badań. Wynikają one z niespójności przepisów aktów prawnych oraz braku regulacji niektórych zagadnień. Taki stan prawny utrudnia psychologom prowadzenie czynności zawodowych i niekorzystnie wpływa na jakość wykonywanych świadczeń. Dlatego wprowadzenie zmian w ustawie i rozporządzeniach regulujących zagadnienia związane z wykonywaniem badań psychologicznych o zdolności do pracy jest konieczne. Pożądanym rozwiązaniem, zdaniem autorek, byłoby zakończenie prac nad ewentualnymi zmianami w ustawie o zawodzie psychologa i samorządzie psychologów oraz przygotowanie i wprowadzenie w życie odpowiednich aktów wykonawczych. Med. Pr. 2018;69(6):673–684.
    • The distribution and excretion of 1-Methylnaphthalene in rats exposed to 1-Methylnaphthalene by inhalation.

      Świercz, Radosław; Wąsowicz, Wojciech; Nofer Institute of Occupational Medicine (2018-12-20)
      1-Methylnaphthalene (1-MN) is a constituent of polycyclic aromatic hydrocarbons, the chemicals that have become ubiquitous in the environment as result of natural and industrial process. This paper reports a study on the distribution and excretion of 1-MN in rats after single and repeated inhalation exposure to 1-MN vapor. Male Wistar rats were exposed to 1-MN vapor at nominal concentrations of 50 mg/m3 or 200 mg/m3 in the dynamic inhalation chambers (TSE Systems Head Nose Only Exposure) for 6 h (single exposure) or 5 days (6 h/day, repeated exposure). Blood, urine and tissue samples were collected during and after the exposure. Blood, urine and tissue concentrations of 1-MN were estimated by gas chromatography using the headspace technique. The elimination of 1-MN from blood followed an open 2-compartment model. The concentration in rat tissues was dependent on the magnitude and time of exposure. After repeated exposure, the concentration 1-MN in tissue decreased in comparison to single exposure. The elimination of 1-MN with urine after single and repeated exposure to 1-MN occurred mainly in the samples collected during the first day of collection. 1-Methylnaphthalene was rapidly eliminated from the blood and tissues of animals exposed by inhalation to 1-MN. In repeated exposure, there was probably a significant increase of 1-MN metabolism in rats exposed to low and high 1-MN doses. Under conditions of repeated 1-MN exposure, no significant systemic 1-MN accumulation could be observed. Int J Occup Med Environ Health 2018;31(6):763-770.
    • [Occupational diseases in Poland in 2016].

      Świątkowska, Beata; Hanke, Wojciech; Nofer Institute of Occupational Medicine (2018-12-18)
      The aim of the work is to present the epidemiological situation in the field of occupational diseases in Poland in 2016. The cases of occupational diseases identified in accordance with the applicable case law system in Poland and reported to the Central Register of Occupational Diseases in 2016 were analyzed. The analysis includes nosologic units, their causative factors as well as gender and age of patients. Absolute numbers and incidence rates per 100 000 employees were presented. In 2016, 2119 cases of occupational diseases were recorded in Poland, i.e. 14.3 cases per 100 000 employed persons. The incidence rate was mainly caused by pneumoconioses (28.5%), infectious or parasitic diseases (27.2%), chronic voice disorders (9.7%), chronic diseases of the peripheral nervous system (8.6%) and hearing loss (6.3%). The highest incidence was recorded in the mining and quarrying (329.7 cases), agriculture and forestry (23.8 cases), manufacturing (20 cases) and education (17.9 cases) and healthcare and social work activities (17.7 cases). In comparison with 2015, there was an increase in the number of cases of occupational diseases by 1.2%, which was influenced mainly by a larger (by 181 cases) number of pneumoconiosis. The epidemiological situation resulting from occupational diseases in our country, although it covers all identified cases, should be assessed with caution because the suspicion arises underestimation of certain diseases, especially cancer. Med Pr 2018;69(6):643-650.
    • Health promotion for the aging workforce in Poland.

      Magnavita, Nicola; Sakowski, Piotr; Capitanelli, Ilaria; La Milia, Daniele Ignazio; Moscato, Umberto; Poscia, Andrea; Ricciardi, Walter; Nofer Institute of Occupational Medicine (2018-12-20)
      The aging of the workforce is an issue that calls for concrete measures to promote the health of older workers. This study reports on the results of the European "ProHealth65+" research project interventions conducted in Poland in relation to workplace health promotion for older workers (WHPOW) and the institutions involved in these programs. A three-stage search of peer-reviewed and grey literature on the WHPOW in Poland. A total of 59 WHPOW programs were retrieved in Poland in the observation period (2000-2015). Most of these aimed at improving the Qualification and Training or at the Work Climate and attitudes toward older workers. The promotion, organization, and funding of these activities were carried out mainly by supra-national and governmental bodies, enterprises and employers, and educational and trainee institutions. Although there is great commitment to the medical surveillance of workers on the part of the Polish occupational health service, our search detected a relatively low number of the WHPOW initiatives. Greater efforts should be made to introduce strategies for addressing aging of the workforce. Int J Occup Med Environ Health 2018;31(6):753-761.
    • Air pollution from natural and anthropic sources and male fertility.

      Jurewicz, Joanna; Dziewirska, Emila; Radwan, Michał; Hanke, Wojciech; Nofer Institute of Occupational Medicine (2018-12-23)
      Exposure to air pollution has been clearly associated with a range of adverse health effects, including reproductive toxicity. However, a limited amount of research has been conducted to examine the association between air pollution and male reproductive outcomes, specially semen quality. We performed a systematic review (up to March 2017) to assess the impact of environmental and occupational exposure to air pollution on semen quality. Epidemiological studies focusing on air pollution exposures and male reproduction were identified by a search of the PUBMED, MEDLINE, EBSCO and TOXNET literature bases. Twenty-two studies were included which assess the impact of air pollutants (PM
    • [Evaluation of on-the-job noise exposure in the case of bartenders].

      Dudarewicz, Adam; Zaborowski, Kamil; Wolniakowska, Anna; Pawlaczyk-Łuszczyńska, Małgorzata; Śliwińska-Kowalska, Mariola; Nofer Institute of Occupational Medicine (2018-12-18)
      In places associated with the entertainment industry in which music is performed or played, sounds with high sound pressure levels may occur. Such exposure is a threat to both people spending their free time at concerts, in discos or pubs, as well as employees in these places. The aim of the research conducted in 2017 was to assess on-the-job noise exposure in the case of bartenders at various premises of the entertainment industry. The measurements included 15 entertainment venues in Łódź, out of which 3 were selected: a music club, disco and pub. The exposure measurements were taken together for 4 work stations for bartenders using individual dosimetry in accordance with the PN-EN ISO 9612: 2011 standard. A total of 64 measurements were carried out, which showed that the equivalent sound levels A at the bartenders' workplaces vary considerably depending on the type of premises and the day of the week and the range of 67.6-108.7 dB. The highest sound levels occurred during the weekend (Fridays and Saturdays). The determined daily noise exposure levels exceeded the threshold of preventive action (80 dB) in 95% of the analyzed cases. Exceeding the maximum permissible noise level (NDN = 85 dB) was found in 66% of cases. It has been found that on-the-job noise levels in the case of bartenders significantly exceed the acceptable values of exposure levels and pose a risk of hearing damage. Med Pr 2018;69(6):633-641.

      Clairand, I; Behrens, R; Brodecki, M; Carinou, E; Domienik-Andrzejewska, J; Ginjaume, M; Hupe, O; Roig, M; Nofer Institute of Occupational Medicine (2018-12-01)
      In the context of a new annual eye lens dose limit for occupational exposure equal to 20 mSv, European Radiation Dosimetry Group (EURADOS) organized an intercomparison dedicated to eye lens dosemeters, including photon and beta radiations. The objective was to complete the first intercomparison recently organized by EURADOS for photons and to update the overview of eye lens dosemeters available in Europe. The dosemeters provided by the 22 participants coming from 12 countries were all composed of thermoluminescent detectors. The dosemeters were irradiated with photon and beta fields defined in relevant standards. The results, provided by participants in terms of Hp(3), were compared to the reference delivered doses. Results are globally satisfactory for photons since 90% of the data are in accordance to the ISO 14146 standard requirements. The respective values for betas stress the fact that dosemeters designed for Hp(0.07) are not suitable to monitor the eye lens dose in case of betas.
    • Endometriosis - The challenge for occupational life of diagnosed women: A review of quantitative studies.

      Andysz, Aleksandra; Jacukowicz, Aleksandra; Merecz-Kot, Dorota; Najder, Anna; Nofer Institute of Occupational Medicine (2018-12-18)
      The aim of the article was to summarize the results offered in the research on occupational functioning of women with endometriosis. We followed PRISMA guidelines. Database search was done in November 2017 using EBSCO. In the review were included the articles clearly referring to the relationships between endometriosis and work or any aspect of work (e.g., work productivity, work ability, absenteeism). Eight papers were included in the final review. Seven studies were cross-sectional, 1 retrospective. The majority of researchers used standardized research measures, such as <i>Work Ability Index</i>, <i>Work Productivity and Activity Impairment Questionnaire</i> or <i>Health Related Productivity Questionnaire</i>. Only in 2 studies the reference group was considered, one of them consisted of healthy women. The results clearly indicate that endometriosis is a disease that causes major disturbance in occupational functioning of the suffering women. In the future the researchers should search for individual and organizational correlates of the improvement of occupational functioning in this group of patients. The methodology of the existing studies has been evaluated and the methodological cues for future research has been given. Med Pr 2018;69(6):663-671. The aim of the article was to summarize the results offered in the research on occupational functioning of women with endometriosis. We followed PRISMA guidelines. Database search was done in November 2017 using EBSCO. In the review were included the articles clearly referring to the relationships between endometriosis and work or any aspect of work (e.g., work productivity, work ability, absenteeism). Eight papers were included in the final review. Seven studies were cross-sectional, 1 retrospective. The majority of researchers used standardized research measures, such as <i>Work Ability Index</i>, <i>Work Productivity and Activity Impairment Questionnaire</i> or <i>Health Related Productivity Questionnaire</i>. Only in 2 studies the reference group was considered, one of them consisted of healthy women. The results clearly indicate that endometriosis is a disease that causes major disturbance in occupational functioning of the suffering women. In the future the researchers should search for individual and organizational correlates of the improvement of occupational functioning in this group of patients. The methodology of the existing studies has been evaluated and the methodological cues for future research has been given. Med Pr 2018;69(6):663–671.
    • The Underground Tourist Route Kowary Drifts

      Olszewski, Jerzy; Nofer Institute of Occupational Medicine
      In recent decades, we have seen a rapid increase in the number of underground tourist routes. One of them, the underground tourist route “Kowary Drifts” placed in the tunnel No. 9 in the former uranium mine “Liczyrzepa”, was launched in 2002. Thanks to the high awareness of the owners, since the very beginning the route has been fully controlled, including control of exposure to radon. For the measurement of radon concentration trace detectors and scintillation chambers were used. Long-term studies have shown that the average concentration in this tourist route is 500 Bqm-3. Staff of the underground tourist route, and inhalation should be counted in the category of B radiation exposure
    • 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.
    • [Psychological examinations in occupational health services: Legal regulations. Part I].

      Waszkowska, Małgorzata; Wężyk, Agata; Nofer Institute of Occupational Medicine (2018-10-30)
      In Poland psychological assessment for the purpose of fitness-to-work certification is regulated by the law. In the majority of cases, only psychologists registered with the occupational health services are authorized to conduct the assessment procedures. In this study 32 legal documents (17 acts and 15 directives) have been analyzed to identify the most problematic issues pertaining to psychological examination and to suggest certain changes in the regulations, as well as to raise the psychologists' awareness of the legal aspects of their work. Due to the number of the topics explored, the results of the study will be published as two separate, yet related articles. The first one concentrates on the qualifications of psychologists, the examination reference process, the aim and scope of the psychological assessment, and the validity of the assessment results. In part II other issues, not directly related to the diagnostic process, will be discussed. Med Pr 2018;69(5):561-572. Zagadnienia związane z badaniami psychologicznymi w orzecznictwie o zdolności do pracy są regulowane przepisami prawa. W wielu przypadkach badania te mogą być wykonywane wyłącznie przez psychologów służby medycyny pracy. Dokonano analizy 32 aktów prawnych (17 ustaw i 15 rozporządzeń). Jej celem było m.in. wskazanie problematycznych kwestii związanych z badaniami i sformułowanie propozycji zmian przepisów oraz przybliżenie psychologom prawnych aspektów ich pracy. Ze względu na obszerność materiału (19 ustaw i 13 rozporządzeń) zostanie on opublikowany w dwóch częściach. Niniejsza część I dotyczy kwalifikacji psychologów, kierowania na badania, celu i zakresu badań oraz terminów ich przeprowadzania. W części II omówione zostaną zagadnienia niezwiązane bezpośrednio z diagnostyką. Med. Pr. 2018;69(5):561–572.
    • Poisonings in Poland reported to the Polish National Health Fund in the years 2009-2011.

      Świderska, Aleksandra; Wiśniewski, Marek; Wiergowski, Marek; Krakowiak, Anna; Sein Anand, Jacek; Nofer Institute of Occupational Medicine (2018-10-10)
      Poisonings constitute a significant medical, social and economic problem worldwide. In Poland there is no nationwide registry of poisonings, which results in a lack of accurate epidemiological data. Few publications dealing with the problem are based on data obtained from toxicology units and therefore do not include information about cases treated at emergency departments and other non-toxicology units. We analyzed all admissions due to poisonings reported to the Polish National Health Fund by all hospital units in Poland in the 2009-2011 period. Diagnoses were encoded according to the ICD-10 classification. A total of 254,425 admissions were reported, 85,398 in 2009, 85,230 in 2010 and 83,797 in 2011. The male to female ratios were 1.88, 1.75 and 1.80 respectively. The most frequent causes of admissions were poisonings with ethanol (n = 121,874; 47.9%), carbon monoxide (n = 17,179; 6.8%) and benzodiazepines (n = 10,340; 4.1%). Alcohols were the reason for 104,680 admissions in men (63.2%) and 22,612 admissions in women (25.5%; p < 0.01). Poisonings with pharmaceuticals and other drugs were reported in 34,616 men (20.9%) and 45,238 women (51%; p < 0.01). There were 1680 cases of fatal poisonings in the analyzed period. The hospital mortality due to poisonings increased from 1.1% in 2009 to 1.5% in 2011 (p < 0.01). The mortality in general Intensive Care Units increased from 14.4% in 2009 to 22.3% in 2011 (p < 0.01). The etiology of fatal poisonings was highly dependent on the type of hospital unit. The overall number of admissions due to poisonings decreased slightly during the study period, but they remained a significant cause of morbidity and mortality. Alcohols were the main cause of admissions in the analyzed period. Alcohol intoxications were more frequent in men while poisonings with pharmaceuticals were more frequent in women. Carbon monoxide exposures were a significant cause of morbidity and mortality in the studied period in Poland. A national poison information and toxicovigilance system should be created in Poland, ideally allowing for near real-time monitoring of cases of poisonings.
    • [Occupational diseases among healthcare and social workers in 2009-2016].

      Świątkowska, Beata; Hanke, Wojciech; Nofer Institute of Occupational Medicine (2018-10-30)
      The aim of the paper is to present statistical data on the occurrence of occupational diseases among healthcare and social workers in Poland in 2009-2016. All cards certifying that a case of occupational disease had been diagnosed in a patient belonging to this occupational group, received by the Central Register of Occupational Diseases, served as the basis of the study. Data is presented in absolute numbers and incidence rates. In the analysis, disease categories, voivodships and occupations were taken into account. In 2009-2016, as many as 1462 cases of occupational diseases were diagnosed for healthcare workers. In 2016, the number of cases was 42.6% lower than in 2009. Mean annual incidence rate in these years was 26.3 cases per 100 thousand workers. The most frequent were: infectious and parasitic diseases (64.8% of cases), peripheral nervous system diseases (9.6%), dermal diseases (8.9%), locomotor (8.3%), and chronic vocal organ disorders (3.2%). Among infectious or parasitic diseases, the most cases were viral hepatitis (56%) and tuberculosis (39%). Almost every second case of occupational disease in healthcare workers was detected in the nurses (47.8%). The incidence of occupational diseases in total and in the most frequent categories continued to decrease. One of the reasons for the decline is the improvement of working conditions resulting from the application of more modern instruments and apparatus as well as greater knowledge of the risks and the use of appropriate procedures. Med Pr 2018;69(5).
    • Establishing the European diagnostic reference levels for interventional cardiology.

      Siiskonen, T; Ciraj-Bjelac, O; Dabin, J; Diklic, A; Domienik-Andrzejewska, J; Farah, J; Fernandez, J M; Gallagher, A; Hourdakis, C J; Jurkovic, S; Järvinen, H; Järvinen, J; Knežević, Ž; Koukorava, C; Maccia, C; Majer, M; Malchair, F; Riccardi, L; Rizk, C; Sanchez, R; Sandborg, M; Merce, M Sans; Segota, D; Sierpowska, J; Simantirakis, G; Sukupova, L; Thrapsanioti, Z; Vano, E; Nofer Institute of Occupational Medicine (2018-10-01)
      Interventional cardiac procedures may be associated with high patient doses and therefore require special attention to protect the patients from radiation injuries such as skin erythema, cardiovascular tissue reactions or radiation-induced cancer. In this study, patient exposure data is collected from 13 countries (37 clinics and nearly 50 interventional rooms) and for 10 different procedures. Dose data was collected from a total of 14,922 interventional cardiology procedures. Based on these data European diagnostic reference levels (DRL) for air kerma-area product are suggested for coronary angiography (CA, DRL = 35 Gy cm
    • Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania.

      Santos, Susana; Eekhout, Iris; Voerman, Ellis; Gaillard, Romy; Barros, Henrique; Charles, Marie-Aline; Chatzi, Leda; Chevrier, Cécile; Chrousos, George P; Corpeleijn, Eva; Costet, Nathalie; Crozier, Sarah; Doyon, Myriam; Eggesbø, Merete; Fantini, Maria Pia; Farchi, Sara; Forastiere, Francesco; Gagliardi, Luigi; Georgiu, Vagelis; Godfrey, Keith M; Gori, Davide; Grote, Veit; Hanke, Wojciech; Hertz-Picciotto, Irva; Heude, Barbara; Hivert, Marie-France; Hryhorczuk, Daniel; Huang, Rae-Chi; Inskip, Hazel; Jusko, Todd A; Karvonen, Anne M; Koletzko, Berthold; Küpers, Leanne K; Lagström, Hanna; Lawlor, Debbie A; Lehmann, Irina; Lopez-Espinosa, Maria-Jose; Magnus, Per; Majewska, Renata; Mäkelä, Johanna; Manios, Yannis; McDonald, Sheila W; Mommers, Monique; Morgen, Camilla S; Moschonis, George; Murínová, Ľubica; Newnham, John; Nohr, Ellen A; Andersen, Anne-Marie Nybo; Oken, Emily; Oostvogels, Adriëtte J J M; Pac, Agnieszka; Papadopoulou, Eleni; Pekkanen, Juha; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Rifas-Shiman, Sheryl L; Roeleveld, Nel; Santa-Marina, Loreto; Santos, Ana C; Smit, Henriette A; Sørensen, Thorkild I A; Standl, Marie; Stanislawski, Maggie; Stoltenberg, Camilla; Thiering, Elisabeth; Thijs, Carel; Torrent, Maties; Tough, Suzanne C; Trnovec, Tomas; van Gelder, Marleen M H J; van Rossem, Lenie; von Berg, Andrea; Vrijheid, Martine; Vrijkotte, Tanja G M; Zvinchuk, Oleksandr; van Buuren, Stef; Jaddoe, Vincent W V; Nofer Institute of Occupational Medicine (2018-11-05)
      Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies. We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape. We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications. Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.
    • Sex-Dependent Impact of Low-Level Lead Exposure during Prenatal Period on Child Psychomotor Functions.

      Polanska, Kinga; Hanke, Wojciech; Pawlas, Natalia; Wesolowska, Ewelina; Jankowska, Agnieszka; Jagodic, Marta; Mazej, Darja; Dominowska, Jolanta; Grzesiak, Mariusz; Mirabella, Fiorino; Chiarotti, Flavia; Calamandrei, Gemma; Nofer Institute of Occupational Medicine (2018-10-16)
      The impact of exposure to lead on child neurodevelopment has been well established. However, sex differences in vulnerability are still not fully explained. We aimed at evaluating the effect of a low-level lead exposure, as measured between 20 to 24 weeks of pregnancy and in cord blood, on developmental scores up to 24 months of age in 402 children from the Polish Mother and Child Cohort (REPRO_PL). Additionally, sex-dependent susceptibility to lead at this very early stage of psychomotor development was assessed. The blood lead levels were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). In order to estimate the children's neurodevelopment, the Bayley Scales of Infant and Toddler Development was applied. The geometric mean (GM) for blood lead level during 20⁻24 weeks of pregnancy was 0.99 ± 0.15 µg/dL and, in the cord blood, it was 0.96 ± 0.16 µg/dL. There was no statistically significant impact of lead exposure during prenatal period on the girls' psychomotor abilities. Among the boys, we observed lower scores for cognitive functions, along with increasing cord blood lead levels (β = -2.07;
    • Noise exposure and hearing status among call center operators.

      Pawlaczyk-Luszczynska, Malgorzata; Dudarewicz, Adam; Zamojska-Daniszewska, Małgorzata; Zaborowski, Kamil; Rutkowska-Kaczmarek, Paulina; Nofer Institute of Occupational Medicine
      The overall objective of the study was to assess noise exposure and audiometric hearing threshold levels (HTLs) in call center operators. Standard pure-tone audiometry and extended high-frequency audiometry were performed in 78 participants, aged 19 to 44 years (mean ± standard deviation: 28.1 ± 6.3 years), employed up to 12 years (2.7 ± 2.9 years) at one call center. All participants were also inquired about their communication headset usage habits, hearing-related symptoms, and risk factors for noise-induced hearing loss (NIHL). Noise exposure under headsets was evaluated using the microphone in a real ear technique as specified by ISO 11904-1:2002. The background noise prevailing in offices was also measured according to ISO 9612:2009. A personal daily noise exposure level calculated by combining headset and nonheadset work activities ranged from 68 to 79 dBA (74.7 ± 2.5 dBA). Majority (92.3%) of study participants had normal hearing in both ears (mean HTL in the frequency range of 0.25-8 kHz ≤20 dB HL). However, their HTLs in the frequency range of 0.25 to 8 kHz were worse than the expected median values for equivalent highly screened otologically normal population, whereas above 8 kHz were comparable (9-11.2 kHz) or better (12.5 kHz). High-frequency hearing loss (mean HTLs at 3, 4, and 6 kHz >20 dB HL) and speech-frequency hearing loss (mean HTLs at 0.5, 1, 2, and 4 kHz >20 dB HL) were noted in 8.3% and 6.4% of ears, respectively. High-frequency notches were found in 15.4% of analyzed audiograms. Moreover, some of call center operators reported hearing-related symptoms. Further studies are needed before firm conclusions concerning the risk of NIHL in this professional group can be drawn.
    • [Non-occupational but work-related diseases - Legislation, judicature and potential implications to employers and employees in Poland].

      Marcinkiewicz, Andrzej; Tomczak, Paulina; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta; Dorre-Kolasa, Dominika; Nofer Institute of Occupational Medicine (2018-10-30)
      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.
    • 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.