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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.

For a number of years chronic kidney disease (CKD) has been listed in the group of lifestyle diseases, such as obesity, diabetes, cardiovascular disease and hypertension. It is estimated that in Poland more than 4 million people may suffer from various stages of CKD. Chronic kidney disease may also be a consequence of all the other civilization diseases. At the same time it is worth noting that nephrological problems are increasingly being taken into account in modern medical certification. The aim of this work is, among other things, to improve safe access to the labor for patients with kidney diseases. In the legislation existing in our country since 2014 it is stated that chronic renal failure is a potential health contraindication to driving. Also in the annex to the Regulation of the Minister of Health dated 9 December 2015 on health conditions required for seafarers to work on a seagoing ship, it is said that ICD-10 codes (International Classification of Diseases) corresponding to acute and chronic renal failure (N17-N19) should be taken into account when qualifying employees to work at sea. Med Pr 2018;69(1):67-75.Przewlekła choroba nerek (PChN) od kilku lat jest wymieniana wśród chorób cywilizacyjnych podobnie jak otyłość, cukrzyca, choroby sercowo-naczyniowe i nadciśnienie tętnicze. Szacuje się, że w Polsce na różne stadia tej choroby może cierpieć ponad 4 mln ludzi. Może ona być również następstwem wszystkich pozostałych chorób cywilizacyjnych. Jednocześnie warto dodać, że problemy nefrologiczne są coraz częściej uwzględniane w nowoczesnym orzecznictwie lekarskim. Celem pracy jest m.in. poprawa bezpiecznego dostępu do rynku pracy pacjentów z chorobami nerek. Przewlekła niewydolność nerek w stopniu zaawansowania, który może stanowić zagrożenie w sytuacji kierowania pojazdami, jest wymieniana jako przeciwwskazanie zdrowotne do kierowania pojazdami w przepisach prawnych obowiązujących w naszym kraju od 2014 r. Również w załączniku do Rozporządzenia Ministra Zdrowia z dnia 9 grudnia 2015 r. w sprawie warunków zdrowotnych wymaganych od marynarzy do wykonywania pracy na statku morskim wymieniono kody N17–N19 według klasyfikacji ICD-10 (International Classification of Diseases – Międzynarodowej Klasyfikacji Chorób), odpowiadające ostrej i przewlekłej oraz nieokreślonej niewydolności nerek, które należy wziąć pod uwagę przy kwalifikacji pracowników do pracy na morzu. Med. Pr. 2018;69(1):67–75.

Background: On 3 July 2009, new law pertaining to occupational diseases (ODs) became effective in Poland. The article presents opinions of the representatives of the 1st degree ODs certification entities and sanitary inspectorates on the changes in OD law and the problems that may cause difficulties and/or certification errors. Material and Methods: A questionnaire study was performed covering representatives of 20 voivodeship occupational medicine centers and 40 national district sanitary inspectorates. We received 57 completed questionnaires which were analyzed. Results: Positive opinions were expressed on changes in procedures on reporting suspected occupational diseases (50%), keeping time limits for diagnosing ODs (89.2%), and changes pertaining to entities responsible for certifying infectious ODs (92.9%). A large group of respondents (66.7%) was in favor of conducting jointly an occupational exposure risk analysis by occupational medicine physicians and occupational health and safety practitioners and/or sanitary inspectors. One-third of the respondents declared that changes in the list of ODs had no influence on the certification procedure. Conclusions: New law has improved the existing procedure of ODs certification. There is a need to elaborate detailed diagnostic guidelines on and criteria for ODs identification and recognition. A panel of experts should be established by the Ministry of Health to track the latest advancements in medicine and to update the list of ODs. Conducting jointly an occupational exposure risk analysis by occupational medicine physicians and occupational health and safety practitioners and/or sanitary inspectors should become a standard. Med Pr 2014;65(4):473–483

The system of occupational health care in Poland, based on occupational medicine service, takes care of almost 12.5 million employees subjected to over 4.5 million obligatory periodic medical check ups. This form of providing prophylactic care comes down to examinations dictated by legal regulations, whose scope is not oriented towards a comprehensive workers' health assessment, but to the examination of the systems and organs critical to work-related dangers. Simultaneously, epidemiological data indicate a large number of chronic diseases, which may influence the professional activity, like hypertension or diabetes and a high percentage of patients not aware of their illness. Since patients participating in obligatory examinations usually feel healthy and do not use health care services on a daily basis, an occupational medicine physician has a unique opportunity to detect health disorders at an early stage, which can prevent the development of health complications affecting the condition of the patient, limiting their professional activity, but also causing additional costs of the health care system. The authors have proven the need to involve occupational medicine services in the prevention of chronic diseases and the need to introduce additional sources of financing for procedures enabling early detection of diseases the patient may not be aware of or control of the effectiveness of already diagnosed illnesses. They addressed the need to change the current legal form of establishing and announcing the range of examinations and directives for certifying the lack or presence of health contraindications to work to the specified and updated standards prepared by scientific research institutes and occupational medicine societies. Med Pr 2016;67(5):691-700.System ochrony zdrowia pracujących w Polsce, oparty na świadczeniach realizowanych przez służbę medycyny pracy, obejmuje opieką niemal 12,5 mln pracowników. Rocznie wykonuje się u nich ponad 4,5 mln obowiązkowych badań okresowych. Tak sprawowana opieka profilaktyczna sprowadza się jednak najczęściej tylko do wykonywania badań określonych przepisami Kodeksu pracy. Ich zakres nie jest ukierunkowany na kompleksową ocenę stanu zdrowia pracujących, lecz na ocenę tych układów i narządów człowieka, które są krytyczne dla zagrożeń występujących na stanowisku pracy. Tymczasem dane epidemiologiczne wskazują na wysoką chorobowość z powodu chorób przewlekłych, które wpływają na utrzymywanie aktywności zawodowej (takich jak nadciśnienie tętnicze czy cukrzyca), oraz na znaczny odsetek chorych nieświadomych swojej choroby lub nieuzyskujących odpowiednich efektów terapeutycznych. Na obligatoryjne badania lekarskie zgłaszają się osoby przekonane o swoim zdrowiu, niekorzystające na co dzień z opieki zdrowotnej, dlatego lekarz medycyny pracy ma unikalną możliwość wykrycia zaburzeń w stanie zdrowia pracownika na ich wczesnym etapie. Dzięki temu może zapobiegać rozwojowi powikłań z jednej strony obciążających zdrowie samego pracownika, a z drugiej powodujących dodatkowe obciążenie finansowe dla całego systemu ochrony zdrowia. Konkludując, w artykule wskazano potrzebę zaangażowania służby medycyny pracy w profilaktykę chorób przewlekłych i związaną z tym konieczność wprowadzenia dodatkowych (oprócz pracodawców) źródeł finansowania działań profilaktycznych, umożliwiających wczesne wykrywanie stanów chorobowych, których pacjent nie jest świadomy, lub kontrolę skuteczności leczenia chorób już zdiagnozowanych. Podniesiono także potrzebę zmiany ustanawiania i publikowania zakresu badań oraz wytycznych do orzekania o braku lub istnieniu przeciwwskazań zdrowotnych do pracy z dotychczasowej formy prawnej na rzecz standardów określanych i na bieżąco publikowanych przez instytuty badawcze i towarzystwa naukowe działające w obszarze medycyny pracy. Med. Pr. 2016;67(5):691–700.

An increase in the frequency of allergic diseases, including bronchial asthma, in the children population has been observed over several last decades. This trend is reflected in the increasing number of young workers who suffer from allergy and asthma. The problem determines a new challenge to physicians responsible for medical prophylactic care of this group of patients. Active occupational counseling should be performed especially by general practitioners and occupational medicine specialists in in cooperation with allergologists. Apprenticeship is a period of increased risk of work-related respiratory allergic diseases, particularly in the case of occupational exposure to high molecular weight agents. An adequate prophylactic care of apprentices exposed to aeroallergens at workplace may help to reduce work-related allergic health problems, mainly by supporting adolescents in choosing their jobs.

Recently, infectious diseases have been found to be the most frequent among occupational diseases. Borreliosis, the most common among them, as well as tick-borne encephalitis is transmitted by ticks. Recognition of occupational etiology of such diseases is possible only when the relationship between the infection, occupational exposure and performed work is proved. A case report of a forest worker with borreliosis coexisting with tick-borne encephalitis is presented. Despite nonconcurrent recognition of both diseases it was highly possible that contagion took place at the same time or at a very short time interval. Despite high prevalence of tick-borne diseases, occupational etiology of these two infectious diseases in one patient is very rarely recognized.

Long-term exposure to hand-transmitted vibration can increase the occurrence of symptoms and signs of vascular neurological and musculoskeletal disorders of the upper extremities. The most common is the angioneurotic type of the vibration syndrome. Very little is known about possibility of withdrawal of symptoms after exposure cessation.The aim of the study was to evaluate the long-term effects of vibration exposure in people with diagnosed vibration syndrome. The particular aim of the study was to gain the information on possible withdrawal of symptoms in the peripheral vascular and nervous system after exposure cessation.The medical documentation of patients with vibration syndrome symptoms, examined in the years 1999-2004 in the Outpatient Clinic of the Nofer Institute of Occupational Medicine and in three Voivodeship Centers of Occupational Medicine has been analyzed.A group of 45 people who had been suffering from diagnosed angioneurotic vibration syndrome for at least 5 years was chosen. The mean age of the examined group at the time of occupational disease certification was 48.2 and the mean period of exposure to hand-transmitted vibration was nearly 20 years. The major group comprised persons with vibration syndrome diagnosed at an 'early symptoms' stage, an advanced stage of the disease was described in only 5 cases. From the time of occupational disease certification only 7 persons have been performing any job, and more than a half of the group has been granted disability pension.The results of the study show a bad prognosis of angioneurotic vibration syndrome despite cessation of the exposure to vibration. The total withdrawal of symptoms is possible only in people with vibration syndrome diagnosed at an 'early symptoms' stage, at young age and after short period of exposure.

The principles of performing prophylactic medical examinations of workers are regulated by the Labor Code and relevant executive regulations. There are also other regulations that concern particular groups of workers--like health care workers. The range and frequency of medical examinations are determined by the doctor who performs the examination on the basis of "Guidelines on prophylactic medical examinations of workers". Before determining the range of medical tests, the risk of occupational exposure to biological hazards in some of health care workers must be taken into account. This article presents legal regulations that determine the standards of prophylactic medical examinations of workers who are at risk of contracting pathogens such as HBV, HCV and HIV.

The performance of workers' prophylactic medical examinations is regulated by the Labor Code and relevant executive regulations. There are also other regulations that concern particular groups of workers, e.g., drivers. The range and frequency of medical examinations are determined by the physician responsible for their performance on the basis of the "Guidelines on prophylactic medical examinations of workers" The Guidelines do not focus on particular jobs, but on occupational exposure to physical, chemical, biological, and psychosocial hazards. Driving is a kind of job that requires total psychomotor efficiency. This article presents standards of prophylactic medical examinations of drivers who are engaged in the commercial "road transport", i.e., drivers who do not come under the provisions of the "Road Transportation Act", as well as of other persons who use their driving rights for occupational purposes.