Search

The findings of numerous studies and analyzes conducted in many countries have proven that obstructive sleep apnea (OSA) negatively affects the psychophysical abilities drivers. Therefore, in Commission Directive 2014/85/EU of July, 1 2014, OSA was recognized as one of the most important risk factors for car accidents. The implementation of said Directive by Member States is to contribute to reducing the risk of such accidents. The implementation of the Directive in Poland has resulted in enacting the Ordinance of the Minister of Health of December 23, 2015 amending the ordinance on medical examinations of applicants for a driving license and drivers. Although Annex 2 to that regulation sets out the detailed conditions for a medical examination for OSA, it does not regulate or clarify the issue of tools and methods for suspecting OSA in a moderate or hard form. Therefore, it was necessary to develop standards of management for doctors authorized to perform medical examinations of drivers and applicants for a driving license in the case of suspected OSA. The paper presents an algorithm of proceedings that streamlines the case-law process in the above-mentioned cases, which was developed by the Polish Society of Occupational Medicine in cooperation with the Polish Respiratory Society, the Nofer Institute of Occupational Medicine in Łódź and the Polish Sleep Research Society. Med Pr. 2020;71(2):233-43.Na podstawie wyników wielu badań i analiz prowadzonych w różnych krajach potwierdzono, że obturacyjny bezdech senny (OBS) negatywnie wpływa na zdolności psychofizyczne kierowców. Dlatego w Dyrektywie Unii Europejskiej z dnia 1 lipca 2014 r. OBS został uznany za jeden z najważniejszych czynników ryzyka wypadków samochodowych. Realizacja postanowień tej dyrektywy w państwach członkowskich ma przyczynić się do jego ograniczenia. Wynikiem jej implementacji w Polsce jest rozporządzenie Ministra Zdrowia z dnia 23 grudnia 2015 r. zmieniające rozporządzenie w sprawie badań lekarskich osób ubiegających się o uprawnienia do kierowania pojazdami i kierowców. Mimo że w załączniku nr 2 tego rozporządzenia podano szczegółowe warunki badania lekarskiego w przypadku podejrzenia OBS, nie uregulowano ani nie wyjaśniono kwestii narzędzi i sposobu pozwalających na powzięcie w przypadku badanego pacjenta podejrzenia umiarkowanej lub ciężkiej postaci choroby. Dlatego konieczne było opracowanie dla lekarzy uprawnionych do badań lekarskich kierowców i osób ubiegających się o prawo jazdy standardów postępowania w przypadku podejrzenia występowania OBS. W artykule przedstawiono usprawniający proces orzeczniczy algorytm postępowania, który został opracowany przez Polskie Towarzystwo Medycyny Pracy, Polskie Towarzystwo Chorób Płuc, Instytut Medycyny Pracy w Łodzi i Polskie Towarzystwo Badań nad Snem. Med. Pr. 2020;71(2):233–243.

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 prevalence of diabetes and a significant proportion of unawareness of its risk among the patients indicate the need to include into general prophylactic examinations the standards of medical certification, which would prevent discrimination and ensure public safety. In certifying medical predispositions to work in a person with diabetes mellitus the key issue is to distinguish 2 categories of medical requirements: the higher - related to qualifying workers for jobs demanding psychophysical abilities, which affect the safety of the workers and their environment and the lower - related to qualifying workers for jobs characterized by harmful factors and nuisances, which might have a negative effect on the course of diabetes. The very fact of having diabetes cannot be the reason for the patient being disqualified and the decision on certifying the capacity to perform a particular job should always be based on an individual health assessment of the patient, taking into account the risk of hypoglycemia, metabolic control, the progression and dynamics of chronic complications, as well as the level of health awareness in patients. The objective assessment of the health status of the patient with diabetes involves the judgment of an attending physician, additionally supported by the consultation of a diabetes specialist to ensure that the patient is able to perform properly the job, requiring psychomotor abilities. Med Pr 2014;65(1):131–141

Objectives: Night shift work has been linked to some chronic diseases. Modification of lifestyle by night work may partially contribute to the development of these diseases, nevertheless, so far epidemiological evidence is limited. The aim of the study was to explore association between night shift work and lifestyle factors using data from a cross-sectional study among blue-collar workers employed in industrial plants in Łódź, Poland. Material and Methods: The anonymous questionnaire was self-administered among 605 employees (236 women and 369 men, aged 35 or more) - 434 individuals currently wor­king night shifts. Distribution of the selected lifestyle related factors such as smoking, alcohol drinking, physical activity, body mass index (BMI), number of main meals and the hour of the last meal was compared between current, former, and never night shift workers. Adjusted ORs or predicted means were calculated, as a measure of the associations between night shift work and lifestyle factors, with age, marital status and education included in the models as covariates. Results: Recreational inactivity (defined here as less than one hour per week of recreational physical activity) was associated with current night shift work when compared to never night shift workers (OR = 2.43, 95% CI: 1.13-5.22) among men. Alcohol abstinence and later time of the last meal was associated with night shift work among women. Statistically significant positive relationship between night shift work duration and BMI was observed among men (p = 0.029). Conclusions: This study confirms previous studies reporting lower exercising among night shift workers and tendency to increase body weight. This finding provides important public health implication for the prevention of chronic diseases among night shift workers. Initiatives promoting physical activity addressed in particular to the night shift workers are recommended.

Objectives: Viral hepatitis is the second most often identified infectious illness acquired at work and it is mostly registered among health care personnel. This group of workers is at greater risk of exposure to blood and bloodborne pathogens, including hepatitis B and C viruses. The aims of this study were to evaluate the efficacy of methods promoting work safety in healthcare settings, to assess the frequency of exposures in the last 12 months prior to the study and to determine a rate of reporting them to appropriate authorities. Methods: A total of 1138 Polish healthcare workers were interviewed during the study period (between 2009 and 2010). Results: Sustaining accidental occupational percutaneous exposure during last 12 months was declared by 242 workers (21% of the whole group). Only in 146 cases these incidents were reported to authorities. Exposure incidents were associated with self-perception of high risk of exposure (OR = 3.69, p = 0.0027), employment in out-patient (vs. hospital-based) healthcare setting (OR = 1.71, p = 0.0089), conviction that the level of information about bloodborne infections conveyed at work was insufficient, lack of both exposure reporting system and knowledge about the ways of reporting. Conclusions: Despite the different established proposals of the post-exposure procedures, it turns out that particularly in small, not providing 24 hours service healthcare settings these procedures are not known or are not respected. More attention should be given to education, especially in regard to the risk of infection, advantages of post-exposure prophylaxis and reporting exposure incidents. Med Pr 2013;64(1):1–10

Objectives: Hepatitis B (HBV) and C viruses (HCV) are among the most frequent blood borne pathogens. According to WHO, 5% of healthcare workers (in central Europe), are exposed to at least one sharps injury contaminated with HBV per year, 1,7% - contaminated with HCV. Aims: The aims of the study were to determine prevalence of HCV and HBV infections, vaccination efficacy against hepatitis B and usefulness of alanine aminotransferase (ALT) testing in prophylactic examinations in healthcare workers (HCWs). Material and Methods: In a group of 520 healthcare workers, a survey, laboratory and serologic tests such as ALT, HBsAg, anti-HBs, anti-HBcT and anti-HCV were carried out. Results: The study revealed a low rate of workers with presence of HBsAg and anti-HCV (1,2% and 0,8% respectively). Anti-HBcT was found in 99 subjects (19%) without a significant association with experiencing an occupational percutaneous injury. Being vaccinated against HBV was declared by 90% of the subjects. There was no relationship between ALT level rise and positive HBsAg, anti-HCV and anti-HBcT tests. Conclusion: A seroprevalence of HBV and HCV markers in HCWs found in the study is low and similar to the one found in general population. Current or past hepatitis B infections were independent of needle stick injuries. Vaccination against HBV coverage, although found to be high, should improve to 100%. Occupational prophylactic medical examinations found performing ALT test (obligatory in Poland for HCWs) not helpful. It seems that determination of anti-HBcT and anti-HCV status would be essential in pre-employment medical examinations.

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 definition of "inability to work" and principles of medical certification of disabilities, determining the entitlement to an ill-health pension provision are regulated by law. However, the term ,,"inability to work" is not precisely defined and the standards of its assessment are not accurately formulated. This refers not only to the term "loosing ability to work to considerable degree", but also to the criteria of occupational qualifications.The aim of this study was to identify the most common problems and mistakes in the medical certification that entitles to disability pension provision.The study, based on medical consultations provided for the president of the Social Insurance Company (ZUS) in the years 2005-2007, was carried out in the Out-Patient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Lódź. In total, 293 medical cases were analyzed, of which 61 concerned consequences of occupational diseases, 44--accidents at work and 188--idiopathic diseases.Men formed the majorityof the study group (66%) and the mean age of the examined individuals was 49. The predominant causes of medical certification of patient's inability to work, both in men and female, were musculoskeletal disorders, cardio-vascular diseases, diabetes and mental health problems. Significant discrepancies in the medical statements on inability to work were observed between ZUS and the Nofer Institute of Occupational Medicine. They concerned the evaluation of people's inability to work in general, as well as the degree (partial or complete) of lost capability for work. A consensus of medical statements was found in 153 cases, and differences in other 140 (47.8%) cases. Most differences were found in the evaluation of inability to work caused by consequences of occupational diseases.Lack of certification guidelines, excessive preference of medical criteria used for defining body fitness disturbances and insufficient consideration of occupational and economic aspects of certified inability to work in terms of assuming work in future) are the main reasons for difficulties in inability to work certification. The scheme of certification procedure was also suggested.

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.