Medycyna Pracy (Occupational Medicine) 2020/03

  • Occupational exposure to Staphylococcus aureus in the wastewater treatment plants environment
    The aim of the study was to assess the occupational exposure to Staphylococcus aureus bacteria, including methicillin- resistant S. aureus (MRSA) and other antibiotic-resistant strains in the municipal wastewater treatment plants (WWTPs) environment. In general, WWTPs workers are occupationally exposed to S. aureus, including MRSA, and other antibiotic- and multi-antibiotic-resistant strains. The highest risk of infection concerns the activities carried out in direct contact with wastewater or devices through which wastewater flows, particularly at the stage of mechanical treatment. A significant source of S. aureus seems to be intensive livestock farming located in the area of the WWTPs under analysis. The study confirms the necessity to disinfect the wastewater discharging into WWTP.
  • Oral cavity status of long-term hemodialized patients vs. their socio-economic status
    The chronic kidney disease, blood hypertension and diabetes are recognized as civilization diseases that affect more and more people. The probability of encountering a patient suffering from these diseases is increasing. As such, it appears crucial to better understand the specific dental needs of such groups of patients. The aim of the work was to assess the oral hygiene status and the needs of patients suffering from the end-stage chronic kidney disease, arterial hypertension or/and diabetes. The socio-economic status of hemodialized patients was low, which in most cases was a result of the difficulties in starting a job. Due to the lower standards of life, the neglect of oral hygiene maintenance and its consequences could be observed.
  • Health promotion in workplaces counteracting the effects of aging personnel. How is it different from other companies and what obstacles are there?
    The purpose of the article is to answer the question whether companies that implement staff health promotion to counteract the effects of their aging are different from workplaces that do not follow this motive in their health-promoting activities. The differences analyzed relate to the frequency of implementation and evaluation of separate health-related projects, conducting assessments of the health needs and expectations of staff, managers' interest in the topic of aging population and developing motivation to promote health. In addition, obstacles encountered by employers in the promotion of staff health in the context of the aging problem were analyzed. The conclusions indicate the postulated directions of support for companies to reduce the adverse effects of demographic change by promoting health.
  • Assessment of the role of the Social Insurance Institution (ZUS) in the professional activation of people with health problems, implemented by issuing decisions on the desirability of retraining
    The introduction of the training pension into the social insurance system was aimed at bringing back to the labor market persons who due to illness became unable to practice their current profession. These persons - after specialist training - can obtain new qualifications allowing for professional activity on the general labor market. The aim of the study was to assess the role of the Social Insurance Institution (ZUS) in the professional activation of people with health problems, implemented by issuing decisions on the desirability of retraining. The analysis included 460 files of cases in which a ruling was issued in 2009 on the desirability of retraining because of the inability to work in the profession. The effectiveness of the training pension as a tool for professional activation of people with health problems, expressed in the number of retrained people who returned to the labor market, is low. Over 80% of people do not change their profession, some of them again submit an application for a disability pension. The large number of incorrect judgments and the lack of cooperation between institutions implementing vocational retraining, i.e. ZUS, and labor offices, is the reason for the low effectiveness of the training pension. In order to increase it, it is necessary to carry out organizational and legislative changes, with particular emphasis on expanding the knowledge of ZUS adjudicating doctors and occupational medicine doctors, as well as improving cooperation between all institutions involved in the professional activation of people with health problems.
  • Over-mortality trends in working-age men in the voivodship with the highest death rates in Poland
    In 2014, the rate of premature deaths in the Łódź Voivodeship was 40 per 10,000 and was the highest in the country (Poland average: 32). Hyper mortality for men before age 65 remains a serious medical and social problem. The aim of the study was to analyze time trends in the excessive mortality of men of working age in the Lodzkie Voivodship in total and by major causes of deaths. The purpose of the work is to analyze time trends in the excessive mortality of men of working age in the Lodzkie Voivodship in total and by the most important causes of deaths. Despite the reduction in deaths in both sexes, men's mortality due to external causes of death and cardiovascular disease increased.
  • Intersecting competences (skill mix) in medical and medical-related professions
    The problem of many health care systems is the shortage of medical staff, primarily doctors and nurses. Their number, competences and authorizations determine the availability of medical services and their quality. The demand for medical services is increasing along with the progressing aging of the population, the increase in the incidence of chronic diseases and continuous reforms of health systems. Labor costs in healthcare are the costs that burden the system the most, so you need to create effective teams of sectoral employees, using the available resources. These factors result in rationalization of employment or giving new medical and medical related rights to new groups of professionals, which results in the phenomenon of skill mix. Well prepared and implemented intersecting competences allow to improve the quality of patient care, increase patient satisfaction and achieve better clinical results. In the process of intersection of competences, the roles performed so far are changed. When some professionals develop existing roles, others are required to take on some aspects of the previous role. When the competences are crossed, new roles and new professions often appear, the scope of which is being developed so that they match the current practice. The most common intersecting competences relate to nursing and obstetric staff as well as doctors and paramedics. To counteract the shortage of doctors in Poland, changes were introduced to increase access to medical services: nurses and midwives obtained the right to write prescriptions and medical regulations, paramedics - the right to perform medical emergency services and health services, and physiotherapists - the right to conduct an independent physiotherapy visit. A new profession was also created - a medical coordinator.
  • Mesoamerican nephropathy - a new challenge for occupational medicine doctors
    Mesoamerican nephropathy (MeN) is an endemic form of chronic kidney disease (CKD) that is unrelated to the risk factors for CKD development, such as diabetes and hypertension. It occurs primarily in men employed in agriculture, performing heavy physical work in a hot and dry climate. Since the late 1990s, there has been a significant increase in the incidence of CKD in Central America and southern Mexico, and its incidence in this region is almost 9 times higher than in the United States. The world's highest mortality from CKD is in El Salvador: it increased 10-fold in 1984–2005. MeN pathophysiology remains unclear. Histopathological interstitial changes are present in the histopathological material, which may be accompanied by changes in the glomeruli. The development of the disease is significantly affected by cyclical heat stress, excessive sweating and dehydration associated with it. The disease is an important social and economic problem and a challenge in the field of diagnostics, therapy and prevention for doctors of many specialties, especially for occupational medicine doctors.
  • Fluorouracil and doxorubicin - cardiotoxic workplace cytostatics
    The aim of the study is to analyze potential occupational hazards associated with fluorouracil (FU) and doxorubicin (DOX). The literature review was conducted using factual and bibliographic scientific bases including peer-reviewed journals and the so-called gray literature. In Poland, the process of determining occupational exposure limits for selected anticancer drugs has been underway since 2014, and the basis for determining the highest allowable concentrations is usually the equivalent concentration of 0.1% of the lowest therapeutic dose found in the literature. Uncertainty coefficients are also used, which take into account: mechanism of cytostatic activity, metabolism dynamics, assessment of classification and labeling for carcinogenic, mutagenic and genotoxic properties, reproductive toxicity, organ toxicity, ability to accumulate cytostatics, assessment of combined effects with other cytostatics, physicochemical form and data completeness. If possible, the risk of additional cancer is estimated. In the European Union, the CMD (carcinogens and mutagens directive) is a key legal solution regarding public health, focused on the issue of occupational cancer. These cytostatics show genetic toxicity and are included in the group of dangerous drugs. Their serious side effect is life-threatening heart damage. The analysis showed that the inclusion of dangerous drugs in the list of substances subject to the requirements of the CMD Directive is completely justified. The cytostatics classification and labeling procedure should be harmonized throughout the European Union: this would ensure reliable and credible risk management.
  • Acute lead poisoning in an indoor firing range
    The presented case demonstrates that acute lead poisoning may occur due to just short-term exposure to a mixture of lead-containing dust and ammunition. Such exposure may result in high blood lead levels persisting for years in the absence of any symptoms. A middle-aged male with a history of an approximately 7-day cleanup of an old recreational firing range with large ammunition and dust deposits presented to an emergency department with abdominal pain, dyspnea, fatigue and impaired cognitive function. Given his occupational history, specific tests were performed that showed high lead concentrations in both blood and urine. The patient was diagnosed with acute lead poisoning. He was started on chelation therapy that improved both clinical and laboratory parameters. Over a subsequent nearly 3-year follow-up, the patient’s blood lead levels fluctuated and continued to be increased. Given the absence of other sources of lead exposure, these were likely due to the formation of bone deposits.
  • Guidelines for conducting specific inhalation provocation tests: the position of the European Association of Respiratory Diseases (ERS) in the context of Polish experiences
    It is very important to use objective methods with the highest specificity in the diagnostic and jurisprudence process, because the diagnosis of an occupational disease implies medical and legal consequences. Specific inhalation challenge (SIC) is an irreplaceable diagnostic tool in diagnosing allergic respiratory diseases (such as rhinitis, asthma) as well as allergic conjunctivitis and acute generalized allergic reactions, also of occupational etiology. In 2014, a team of experts from the European Respiratory Society published guidelines for carrying out SICs used in the diagnosis of occupational respiratory diseases. The authors of this publication discuss European guidelines in the context of Polish experience from the reference center, i.e. from the Clinic of Occupational Diseases and Environmental Health at the Institute of Occupational Medicine in Łódź. The article describes in detail the course of SIC and the criteria for assessing the results obtained in the diagnosis of occupational asthma.
  • Erratum to Wrzesień “Calibration of thermoluminescent detectors in Hp(0.07) units by using an X-ray tube and a 137Cs source” (Med Pr. 2019;70(6):669–73)
    The original version of the article can be found at,109931,0,2.html.

Medycyna Pracy (Occupational Medicine) - full list