• An ecohydrological approach to the river contamination by PCDDs, PCDFs and dl-PCBs - concentrations, distribution and removal using phytoremediation techniques.

      Urbaniak, M; Kiedrzyńska, E; Wyrwicka, A; Zieliński, M; Mierzejewska, E; Kiedrzyński, M; Kannan, K; Zalewski, M; Nofer Institute of Occupational Medicine (2019-12-17)
      The levels of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in the Pilica River and Sulejów Reservoir were found to be 46% higher during the flood season than during stable flow periods. In addition, PCDD/PCDF and dl-PCB mass loads increased by 5- to 12-fold and by 23- to 60-fold for toxic equivalency (TEQ) during flooding. The Sulejów Reservoir was found to play a positive role in reducing PCDD, PCDF and dl-PCB transport within the study period, with reductions ranging from 17 to 83% for total concentrations, and 33 to 79% for TEQ. Wastewater Treatment Plants (WTPs) were not efficient at mass concentration removal, with small displaying the least efficiency. WTPs discharge pollutants into the aquatic environment, they also produce sludge that requires disposal, similar to reservoir sediments. Sludge- or sediment-born PCDDs, PCDFs and dl-PCBs may be removed using phytoremediation. The cultivation of cucumber and zucchini, two efficient phytoremediators of organic pollutants, on polluted substrate resulted in a mean decrease in PCDD + PCDF + dl-PCB TEQ concentrations: 64% for cucumber and 69% for zucchini in sludge-amended soil, and by 52% for cucumber and 51% for zucchini in sediment-amended soil.
    • [Using of the ROSA method to assess the musculoskeletal load on computer workstations].

      Jóźwiak, Zbigniew; Makowiec Dąbrowska, Teresa; Gadzicka, Elżbieta; Siedlecka, Jadwiga; Szyjkowska, Agata; Kosobudzki, Marcin; Viebig, Piotr; Bortkiewicz, Alicja; Nofer Institute of Occupational Medicine (2019-12-03)
      Wstęp: Celem pracy było porównanie obciążenia układu mięśniowo-szkieletowego ocenianego za pomocą metody szybkiej oceny obciążenia fizycznego na stanowiskach w pracy biurowej (rapid office strain assessment − ROSA) i metody szybkiej oceny obciążenia fizycznego ze szczególnym uwzględnieniem kończyn górnych (rapid upper limb assessment − RULA) u operatorów komputerowych oraz określenie korelacji wyników z występowaniem i nasileniem dolegliwości mięśniowo-szkieletowych (musculoskeletal complaints − MSCs) u tych osób. Materiał i metody: W grupie 72 osób (38 kobiet i 34 mężczyzn) pracujących przy komputerze > 4 godz./dobę do oceny obciążenia wykorzystano metody ROSA i RULA. Kwestionariusz wzorowany na Standardized Nordic Questionnary służył do oceny częstotliwości i nasilenia MSCs. Wyniki: Dolegliwości mięśniowo-szkieletowe wystąpiły u ok. 66% kobiet i 62% mężczyzn badanych w ciągu ostatniego roku. Wyniki uzyskane za pomocą obu metod nie były zbieżne. Końcowy wynik metody ROSA (skala 1−10 pkt) wynosił 26 pkt (M±SD = 3,51±1,09), a metody RULA (skala 1−7 pkt) – 2−4 pkt (M±SD = 3,00±0,17). Wartości ocen cząstkowych i oceny końcowej w metodzie ROSA były skorelowane z liczbą jednocześnie występujących dolegliwości oraz nasilenia dolegliwości w różnych okolicach układu mięśniowo-szkieletowego. Ocena pozycji poszczególnych części ciała podczas pracy u osób z dolegliwościami i bez nich, przeprowadzona za pomocą metody RULA, była prawie identyczna. Wnioski: Wykazano, że metoda ROSA jest użytecznym i łatwym w użyciu narzędziem do oceny komputerowych stacji roboczych, którego stosowanie może być rozpowszechniane.
    • [Assessment of consumer exposure to chemical agents on the example of the ConsExpo model].

      Niepsuj, Agnieszka; Czerczak, Sławomir; Nofer Institute of Occupational Medicine (2019-12-03)
      Not only employees in industrial plants but also consumers, by using finished products, are exposed to chemical substances. Therefore, consumer exposure assessment is also important. To assess the risk for the consumer, the exposure magnitude is needed but measuring these values in residential conditions of consumers is usually impossible. ConsExpo has been designed to facilitate the exposure assessment to substances in consumer products. It is available in English as a free web application at www. consexpoweb.nl. The ConsExpo Web tool, developed by the Netherlands National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu), contains a set of models that help in the assessment of exposure to the substances in consumer products. These are mathematical models with increasing complexity, describing exposure by inhalation, dermal and oral routes. Available models are described in this work. ConsExpo is also equipped with a products database with defined exposure scenarios and default values, which could be a starting point for the models. The aim of this work was to review the literature regarding ConsExpo and to present the application to Polish users through the description of the models contained therein and by providing assessments examples. The review was based on databases of scientific journals. ConsExpo is a commonly known tool, and one of its applications is exposure estimation in comparative studies and the development of new models. For lower-tier analyses ConsExpo can be used by less advanced users. The most favorable for Polish users would be the creation of the Polishlanguage version of the ConsExpo application or a detailed Polish-language instruction manual.
    • [The occurrence of asbestos-related diseases among former employees of asbestos processing plants in Poland].

      Świątkowska, Beata; Nofer Institute of Occupational Medicine (2019-12-03)
      Wstęp: Pomimo że w Polsce w produkcji nie stosuje się już azbestu, wciąż odnotowywane są nowe przypadki chorób azbestozależnych wśród pracowników narażonych w przeszłości na pył azbestu. Sytuacja ta jest związana ze specyfiką biologicznego działania tego minerału: następstwa zdrowotne ekspozycji na azbest mogą się ujawniać nie tylko podczas trwania narażenia, ale także wiele lat po nim. Celem analizy była ocena występowania chorób uznanych za zawodowe u osób narażonych na pył azbestu, które zgłosiły się na badania lekarskie w ramach ogólnopolskiego programu Amiantus. Materiał i metody: Materiał badawczy stanowiły karty badania programu wypełniane przez lekarzy przeprowadzających badania, jak również wyniki odczytu zdjęć radiologicznych płuc zapisane na formularzu Międzynarodowego Biura Pracy (International Labour Organization − ILO). Analizą objęto 8049 osób, w tym 37% kobiet przebadanych w latach 2000−2017. Wyniki: W badanej grupie byłych pracowników zakładów przetwórstwa azbestu chorobę zawodową stwierdzono u 1993 osób (25%), w tym u 584 kobiet (19%). Najczęstszą chorobą zawodową była pylica azbestowa (76% schorzeń zawodowych) oraz choroby opłucnej (17%). Nowotwory złośliwe stanowiły 7% przypadków w tej grupie. Analiza wykazała wzrost częstości występowania chorób układu oddechowego wraz z wiekiem badanych, ich stażem pracy w zakładach przetwórstwa azbestu, jak również ze zwiększaniem się skumulowanego wskaźnika narażenia. Ocena radiogramów klatki piersiowej wykazała zmiany radiologiczne wśród 75% badanych, przy czym zmiany upoważniające do rozpoznania azbestozy zgodnie z obowiązującymi w Polsce kryteriami wystąpiły u 23% badanych osób. Przyjęcie kryteriów międzynarodowych zwiększyłoby częstość występowania azbestozy jako choroby zawodowej o 19% w badanej grupie. Wnioski: Wzrost odsetka osób ze stwierdzoną chorobą zawodową świadczy o pogarszającej się kondycji zdrowotnej pracowników objętych badaniami, jak również o dobrej wykrywalności schorzeń azbestozależnych w ramach opieki nad pracownikami narażonymi w przeszłości na pył azbestu. Wyniki analizy wskazują na konieczność podjęcia w Polsce dyskusji nad wdrożeniem międzynarodowych kryteriów rozpoznawania pylicy azbestowej.
    • Pesticide poisonings in 2004-2014 in Łódź, Poland - an analysis of selected clinical and sociodemographic parameters.

      Krakowiak, Anna; Zajdel, Radosław; Kobza-Sindlewska, Katarzyna; Krakowiak, Michał; Piekarska-Wijatkowska, Anna; Nofer Institute of Occupational Medicine (2019-12-03)
      Background: Acute pesticide poisonings constitute an important toxicological problem in numerous countries. This report refers to patients treated for poisonings at the Toxicology Unit, Łódź, Poland, in the period 2004−2014. Material and Methods: Data to be analyzed were obtained from medical records of hospitalized people. A group of 24 301 patients aged ≥ 15 were selected. In the group of 149 people poisoned with pesticides (0.61% of all poisoning cases), there were 40 women and 109 men. Logistic regression analysis was used to evaluate the impact of age on suicide attempts using pesticides. Results: Suicide attempts significantly more frequently concerned younger people. In this type of behavior, coumarin derivatives were significantly more often used than organophosphorus compounds or pesticides classified as “others.” The patients with suicidal pesticide poisonings stayed in the ward significantly longer than those poisoned unintentionally. Conclusions: In the analyzed population inhabiting an area with a high degree of urbanization, in terms of the place of residence and employment, pesticide poisonings were more common in men than in women. Suicide attempts using pesticides more frequently concerned younger people. Information found in this study may prove useful for education purposes, and also in informing clinicians.
    • Airborne Staphylococcus aureus in different environments-a review.

      Kozajda, Anna; Jeżak, Karolina; Kapsa, Agnieszka; Nofer Institute of Occupational Medicine (2019-12-01)
      The aim of the literature review was to describe the environments where the presence of airborne Staphylococcus aureus was confirmed and to catalogue the most often used methods and conditions of bioaerosol sampling to identify the bacteria. The basis for searching of studies on S. aureus in the bioaerosol in different environments was PubMed database resources from the years 1990–2019 (May). The review included studies which were carried on in selected environments: hospitals and other health care facilities, large-scale animal breeding, wastewater treatment plants, residential areas, educational institutions, and other public places. The highest concentrations and genetic diversity of identified S. aureus strains, including MRSA (methicillin-resistant S. aureus), have been shown in large-scale animal breeding. The role of the airborne transmission in dissemination of infection caused by these pathogens is empirically confirmed in environmental studies. Commonly available, well-described, and relatively inexpensive methods of sampling, identification, and subtyping guarantee a high reliability of results and allow to obtain fast and verifiable outcomes in environmental studies on air transmission routes of S. aureus strains.
    • Dietary habits and myocardial infarction in occupationally active men.

      Bortkiewicz, Alicja; Gadzicka, Elżbieta; Siedlecka, Jadwiga; Szyjkowska, Agata; Viebig, Piotr; Wranicz, Jerzy Krzysztof; Kurpesa, Małgorzata; Trzos, Ewa; Makowiec-Dąbrowska, Teresa; Nofer Institute of Occupational Medicine (2019-11-15)
      Only a few studies have been undertaken to analyze the dietary habits of people with cardiovascular diseases. The aim of this study was to evaluate the dietary behaviors of working people who were hospitalized due to experiencing the first acute cardiovascular incident. Material and Methods: In the study, the Functional Activity Questionnaire was used. The study was conducted in 2 groups. The first group included all the men hospitalized during 1 year (January–December 2009) in 2 clinics of cardiology, who were professionally active until the first myocardial infarction (MI). It comprised 243 men aged 26–70 years. The reference group consisted of 403 men, blue- and white-collar workers, aged 35–65 years. Results: The body mass index of the MI patients was significantly higher (p = 0.006). The frequency of consumption of particular products in the MI group and in the reference group differed significantly for 11 of 21 products. The MI patients significantly less frequently reported the daily consumption of fruit, raw vegetables, cheese, vegetable oils and fish. In this group, the consumption of salty (p = 0.0226) or fatty (p < 0.0001) foods was significantly higher. It was shown that, after adjusting for age, education and the type of work, the daily consumption of fish, salads and cooked vegetables, as well as fruit and vegetable oils, significantly reduced the risk of myocardial infarction. An increased MI risk was, in turn, associated with obesity and preference for fatty foods. Conclusions: The authors found that diet significantly modified the MI risk in the examined workers. This indicates that an important aspect of prevention activities among working people should involve education about proper dietary habits
    • Hypercholesterolemia and prevention of cardiovascular diseases in the light of preventive medical examinations of employees in Poland.

      Śliż, Daniel; Marcinkiewicz, Andrzej; Olejniczak, Dominik; Jankowski, Piotr; Staniszewska, Anna; Mamcarz, Artur; Walusiak-Skorupa, Jolanta; Nofer Institute of Occupational Medicine (2019-11-15)
      Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In developed countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examinations and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient’s conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy.
    • Predictors of Counselling Related to a Healthy Lifestyle Carried Out by a General Practitioner.

      Znyk, Małgorzata; Polańska, Kinga; Wojtysiak, Piotr; Szulc, Michał; Bąk-Romaniszyn, Leokadia; Makowiec-Dąbrowska, Teresa; Zajdel-Całkowska, Justyna; Kaleta, Dorota; Nofer Institute of Occupational Medicine (2019-11-14)
      The aim of the study was to assess whether general practitioners (GPs) monitor and evaluate the health behavior of their patients in the field of a diet, physical activity, and weight control, and whether they provide appropriate counselling as part of this evaluation. Predictors of those activities among physicians were also determined. The cross-sectional study was conducted in the Piotrkowski district among 200 GPs. The questionnaire covered socio-demographic data and lifestyle characteristics of the physicians, their role as healthy lifestyle providers, and whether they assess lifestyle characteristics of their patients and perform healthy lifestyle counselling. More than 60% of the GPs did not evaluate lifestyle features during their patients' examination. In total, 56% of the GPs provided healthy lifestyle recommendations among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations, and 73% of GPs provided recommendations to patients with chronic diseases related to lifestyle. The study showed that the chance to assess lifestyle characteristics of the patients was significantly higher for the GPs who believed that they were obliged to do so (OR = 6.5; p = 0.002). The chance to recommend a healthy lifestyle among patients who have not been diagnosed with chronic lifestyle-related diseases but who do not follow healthy recommendations was 5.9 times higher among the GPs working in the public sector (p < 0.001) and 16.3 times higher for these who believed that they had sufficient knowledge to provide the advice (p = 0.02). The following predictors of providing a healthy lifestyle counselling among patients with diagnosed chronic lifestyle-related diseases were identified: conviction that a GPs is obligated to provide it (OR = 4.4; p = 0.02), sufficient knowledge (OR = 8.7; p = 0.01), and following health recommendations by themselves (OR = 3.9; p = 0.04). Conclusions: The identified predictors are crucial for the development of appropriate strategies aiming at increasing GPs' involvement in preventive measures and consequently at improving the population's health.
    • Circadian Gene Polymorphisms Associated with Breast Cancer Susceptibility.

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

      Aubert, Adrien M; Forhan, Anne; de Lauzon-Guillain, Blandine; Chen, Ling-Wei; Polanska, Kinga; Hanke, Wojciech; Jankowska, Agnieszka; Mensink-Bout, Sara M; Duijts, Liesbeth; Suderman, Matthew; et al. (2019-11-08)
      The ALPHABET consortium aims to examine the interplays between maternal diet quality, epigenetics and offspring health in seven pregnancy/birth cohorts from five European countries. We aimed to use the Dietary Approaches to Stop Hypertension (DASH) score to assess diet quality, but different versions have been published. To derive a single DASH score allowing cross-country, cross-cohort and cross-period comparison and limiting data heterogeneity within the ALPHABET consortium, we harmonised food frequency questionnaire (FFQ) data collected before and during pregnancy in ≥26,500 women. Although FFQs differed strongly in length and content, we derived a consortium DASH score composed of eight food components by combining the prescriptive original DASH and the DASH described by Fung et al. Statistical issues tied to the nature of the FFQs led us to re-classify two food groups (grains and dairy products). Most DASH food components exhibited pronounced between-cohort variability, including non-full-fat dairy products (median intake ranging from 0.1 to 2.2 servings/day), sugar-sweetened beverages/sweets/added sugars (0.3–1.7 servings/day), fruits (1.1–3.1 servings/day), and vegetables (1.5–3.6 servings/day). We successfully developed a harmonized DASH score adapted to all cohorts being part of the ALPHABET consortium. This methodological work may benefit other research teams in adapting the DASH to their study’s specificities.
    • Evaluation of agreement between static posturography methods employing tensometers and inertial sensors

      Kotas, R.; Janc, M.; Kamiński, M.; Marciniak, P.; Zamysłowska-Szmytke, Ewa; Tylman, W.; Nofer Institute of Occupational Medicine (2019-11-08)
      This study investigates the agreement between two methods used for the assessment of human balance system. Static posturography based on tensometers, using a commercially available platform, is used as the reference method. An alternative approach is a portable prototype MediPost system that utilises inertial sensors developed by the authors. Both approaches determine the movement of the subject’s centre of mass, quantifying this movement in terms of angular speed. Data for the evaluation of agreement were obtained from 205 subjects, with each subject simultaneously tested with both methods. During the tests, the subject performed a set of standard procedures involving quiet standing in an upright position. In order to verify the agreement between the evaluated methods, the Bland-Altman, concordance correlation and intraclass correlation coefficients were used. In addition, the trajectories of the centre of gravity were compared. The obtained results show good agreement between the verified methods, even though they are based on different physical phenomena.
    • Predictors of E-Cigarette Use Susceptibility-A Study of Young People from a Socio-Economically Disadvantaged Rural Area in Poland.

      Kaleta, Dorota; Niedzin, Mirosław; Jankowska, Agnieszka; Polańska, Kinga; Nofer Institute of Occupational Medicine (2019-10-16)
      Identification of the youth at risk of e-cigarette use is crucial for development of effective prevention strategies. The current study aims at evaluation of predictors of susceptibility to e-cigarette initiation and experimentation among adolescents. This cross-sectional study included 1693 students (non-current users of e-cigarettes) attending 21 schools in Piotrkowski district (a socially disadvantaged rural area in central Poland). The regression models were applied so as to study factors linked to susceptibility to e-cigarette use among never users (n = 1054) and ever users (n = 639) of e-cigarettes, with susceptibility defined as the absence of a firm decision not to use these products. A high proportion of the youth was susceptible to e-cigarette use (68% of never and 78% of ever e-cigarette users). The adjusted model confirmed the following risk factors: smoking parents and friends (never users: OR = 3.0; p < 0.001; OR = 2.0; p < 0.05; ever users: OR = 2.2; OR = 2.2; p < 0.01), alcohol consumption (never users: moderate drinking OR = 2.9; p < 0.001; binge drinking OR = 2.2; p < 0.01; ever users: moderate drinking OR = 4.2; p < 0.001), cigarette smoking (never users: OR = 14.1; ever users: OR = 11.3; p < 0.001), and perception that e-cigarettes are less harmful than traditional cigarettes (never users: OR = 1.8; p < 0.001). The youth whose mothers had a medium and high educational level (never users: OR = 2.7; p < 0.01; OR = 2.7; p < 0.05; ever users: OR = 5.4; OR = 4.4; p < 0.001), those who perceived girls who use e-cigarettes as more attractive (never users: OR = 4.1; p < 0.001; ever users: OR = 2.9; p < 0.01), and secondary school students (ever users: OR = 5.6; p < 0.001) had higher odds of susceptibility to e-cigarette use. The youth who had more money per month were less susceptible to e-cigarette experimentation (OR = 0.4; p < 0.001). A multi-level intervention approach, considering vulnerable populations, is required to prevent the youth from e-cigarette initiation and experimentation.
    • Occupational exposure to ionizing radiation and lens opacity in interventional cardiologists.

      Domienik-Andrzejewska, Joanna; Kałużny, Paweł; Piernik, Gabriela; Jurewicz, Joanna; Nofer Institute of Occupational Medicine (2019-10-16)
      Objectives: Interventional cardiologists (ICs) are occupationally exposed to low or moderate doses of ionizing radiation from repeated exposures. It is not clear whether these occupational conditions may affect their eye lens. Therefore, the risk of radiation-induced cataract in the cohort of Polish interventional cardiologists is analyzed in this paper. Material and Methods: The study group consisted of 69 interventional cardiologists and 78 control individuals occupationally unexposed to ionizing radiation. The eye lens opacities were examined using a slit camera and evaluated with Lens Opacities Grading System III. Cumulative eye lens doses were estimated retrospectively using a questionnaire including data on occupational history. Results: The average cumulative dose to the left and right eye lens of the ICs was 224 mSv and 85 mSv, respectively. Nuclear opalescence and nuclear color opacities in the most exposed left eye were found in 38% of the ICS for both types, and in 47% and 42% of the controls, respectively. Cortical opacities were found in 25% of the ICS and 29% of the controls. Posterior subcapsular opacities were rare: about 7% in the ICs group and 6% in the control group. Overall, there was some, but statistically insignificant, increase in the risk for opacity in the ICs group, relative to the control group, after adjusting for the subjects’ age, gender, smoking status and medical exposure (adjusted OR = 1.47, 95% CI: 0.62–3.59 for the pooled “any-eye any-type” opacity). There was also no evidence for an increased opacity risk with an increase in the dose. Conclusions: The study found no statistically significant evidence against the hypothesis that the risk of cataract in the group of the ICs occupationally exposed to low doses of ionizing radiation is the same as in the control group. Nevertheless, the adverse effect of ionizing radiation still cannot be excluded due to a relatively small study sample size
    • 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.
    • Cervico-ocular reflex upregulation in dizzy patients with asymmetric neck pathology.

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

      Santonen, Tiina; Alimonti, Alessandro; Bocca, Beatrice; Duca, Radu Corneliu; Galea, Karen S; Godderis, Lode; Göen, Thomas; Gomes, Bruno; Hanser, Ogier; Iavicoli, Ivo; et al. (2019-10-01)
      The EU human biomonitoring initiative, HBM4EU, aims to co-ordinate and advance human biomonitoring (HBM) across Europe. Within its remit, the project is gathering new, policy relevant, EU-wide data on occupational exposure to relevant priority chemicals and developing new approaches for occupational biomonitoring. In this manuscript, the hexavalent chromium [Cr(VI)] study design is presented as the first example of this HBM4EU approach. This study involves eight European countries and plans to recruit 400 workers performing Cr(VI) surface treatment e.g. electroplating or stainless steel welding activities. The aim is to collect new data on current occupational exposure to Cr(VI) in Europe and to test new methods for Cr biomonitoring, specifically the analysis of Cr(VI) in exhaled breath condensate (EBC) and Cr in red blood cells (RBC) in addition to traditional urinary total Cr analyses. Furthermore, exposure data will be complemented with early biological effects data, including genetic and epigenetic effects. Personal air samples and wipe samples are collected in parallel to help informing the biomonitoring results. We present standard operational procedures (SOPs) to support the harmonized methodologies for the collection of occupational hygiene and HBM samples in different countries.
    • 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.
    • [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