Publications by authors named "Agnieszka Lipińska-Ojrzanowska"

28 Publications

  • Page 1 of 1

Evaluation of selected risk factors for cardiovascular diseases and diabetes as a background for the prevention program in occupational healthcare.

Int J Occup Med Environ Health 2021 Jan 18. Epub 2021 Jan 18.

Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Occupational Diseases and Environmental Health).

Objectives: Cardiovascular and metabolic disorders constitute major health problems in the working populations in Europe. The aim of this project was to evaluate the health condition of workers employed in a Polish research and medical institution, and then to establish the necessary preventive actions by creating a modern model of occupational healthcare integrated with civilization disease (CivD) prevention.

Material And Methods: Overall, 100 workers voluntarily participated in a health program for CivD prevention during mandatory prophylactic examinations. Data from these examinations was collected in a system of electronic documentation to enable the analysis of the workers' health condition and risk factors of CivDs.

Results: Women accounted for 72% of the employees who voluntarily participated in the prevention program, and 80% of the subjects had university education. As regards the health condition, 27% of the patients had elevated systolic, and 23% diastolic, blood pressure, and 21% had an abnormal fasting glucose level. Stressful job was an important factor correlated with an excessive body mass index, diastolic blood pressure, as well as total and low-density lipoprotein cholesterol levels. Smoking, sedentary work and a lack of physical activity were significant factors for abdominal obesity. Generally, 94% of the program participants required some further interventions in lifestyle, diagnostics or treatment.

Conclusions: Civilization disease prevention should focus on increasing physical activity both in leisure time and at the workplace as far as practicable. There is a need for implementing projects leading to occupational stress reduction and smoking cessation. Men as well as workers with vocational and elementary education need to be recruited for prevention programs dedicated to employees.
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http://dx.doi.org/10.13075/ijomeh.1896.01531DOI Listing
January 2021

[Health protection of employees against SARS-CoV-2 coronavirus infection causing the COVID-19 disease - the current state of knowledge and recommendations].

Med Pr 2021 Feb 2;72(1):69-87. Epub 2020 Dec 2.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Clinic of Occupational Diseases and Environmental Health).

The COVID-19 pandemic, despite the restrictions and preventive measures applied, has rapidly spread and reached Poland. The adaptation to the dynamically changing epidemiological situation requires a prompt implementation of effective preventive measures. The aim of the publication is to provide current knowledge to all persons involved in the preventive care system, i.e., employees, employers and professionals of occupational medicine, about the epidemiological situation related to SARS‑CoV- 2, as well as recommendations and possible solutions. In order to analyze these issues, a review of literature was conducted based on medical research databases: PubMed, SCOPUS, and the Web of Science Core Collection. The literature was supplemented with studies found on websites of the Ministry of Health and the World Health Organization. Data on the cases of and deaths due to COVID-19 come from reports provided by the Ministry of Health, data published on the websites of the European Center for Disease Prevention and Control, and ourworldindata.org. By the time of submitting the publication, 34 154 cases and 1444 deaths due to coronavirus had been recorded in Poland. Data from published studies suggest that the virus is mainly transmitted via droplets or through contact with contaminated objects and surfaces. Therefore, in the absence of an effective vaccine, preventive actions are based mainly on strategies that minimize the risk of pathogen transmission. In addition to discussing the current epidemiological situation, diagnostic procedures, risk groups and COVID-19 characteristics, the paper presents recommendations and proposed solutions for employers and employees regarding the prevention of SARS‑CoV- 2, along with currently applicable laws and recommendations on employee prophylactic examinations during the pandemic. Subsequently, COVID-19 was discussed in the aspect of an occupational disease and other health threats related to the pandemics. The epidemiological situation regarding coronavirus indicates the need to take immediate and effective actions to minimize infection transmission among employees, and to develop procedures for a quick and effective ability to locate the COVID-19 outbreaks in workplaces. Med Pr. 2021;72(1):69-87.
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http://dx.doi.org/10.13075/mp.5893.01042DOI Listing
February 2021

[Recommendations for performing specific inhalation challenge tests: Polish experience in relation to the European Respiratory Society guideliness].

Med Pr 2020 May 6;71(3):381-397. Epub 2020 May 6.

Instytut Medycyny Pracy / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Department of Occupational Diseases and Environmental Health).

A diagnosis of occupational diseases implicates some medical and legal consequences; therefore, the most specific and objective methods are needed in the diagnostic process. Specific inhalation challenge (SIC) tests currently play an irreplaceable role in diagnosing allergic airway diseases (e.g., allergic rhinitis, asthma) as well as allergic conjunctivitis and systemic reactions, also the occupational ones. In 2014, a team of the European Respiratory Society experts published a statement that provides practical recommendations for performing SIC tests in diagnosing occupational asthma. In the current publication, the authors discuss the European guidelines in the context of Polish experience of the reference center - the Department of Occupational Diseases and Environmental Health, the Nofer Institute of Occupational Medicine in Łódź. The article describes the procedures and diagnostic criteria employed during SIC tests in diagnosing occupational asthma. Med Pr. 2020;71(3):381-97.
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http://dx.doi.org/10.13075/mp.5893.00924DOI Listing
May 2020

Mannitol vs. methacholine in the evaluation of airway responsiveness in bakers' asthma.

Int J Occup Med Environ Health 2020 Mar 28;33(2):235-239. Epub 2020 Jan 28.

Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Occupational Diseases and Environmental Health).

Objectives: Various indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing occupational asthma (OA) is performed, e.g., to monitor the specific inhalation challenge test (SICT). The aim of this study was to preliminarily compare the results of methacholine and mannitol inhalation challenge tests in SICT monitoring in bakers with work-related airway symptoms.

Material And Methods: Four bakery workers with a suspicion of OA underwent single-blind placebo-controlled SICTs involving workplace allergens, accompanied by the evaluation of NSBHR with mannitol and methacholine, both before and after SICTs. Clinical examinations, spirometry tests, skin prick tests (SPTs) to common aeroallergens and occupational allergens, as well as tests to determine serum specific IgE antibodies to occupational aeroallergens were also performed.

Results: Positive SPTs results to occupational aeroallergens were found in all bakery workers, and specific IgE antibodies to flour were detected in 2 subjects. Three patients displayed positive SICT reactions. In all of these 3 patients, airway responsiveness to methacholine increased significantly. In 2 patients, airway reaction to mannitol was significant, whereas in 1 subject there was no increase in NSBHR after mannitol inhalation. The patient with a negative SICT result did not reveal any changes in NSBHR before and after the test, either to methacholine or mannitol.

Conclusions: The data obtained by the authors show that there is no clear correlation between the methacholine and mannitol inhalation challenge tests in SICT monitoring. Preliminary results indicate the need for further investigations to evaluate the usefulness of the mannitol challenge test in the diagnostics of OA. Int J Occup Med Environ Health. 2020;33(2):235-9.
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http://dx.doi.org/10.13075/ijomeh.1896.01459DOI Listing
March 2020

Bronchial Response to High and Low Molecular Weight Occupational Inhalant Allergens.

Allergy Asthma Immunol Res 2020 Jan;12(1):164-170

Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.

Purpose: Occupational asthma may be induced by high- or low-molecular weight allergens (HMWA or LMWA, respectively). The study was conducted to compare the pattern of bronchial response in 200 HMWA-induced asthmatics (n = 130) and LMWA-induced asthmatics (n = 70).

Methods: The study participants underwent a single-blind, placebo-controlled specific inhalation challenge (SIC) with workplace allergens, accompanied by evaluation of non-specific bronchial hyperresponsiveness (NSBHR) with methacholine before and after the SIC.

Results: A single early bronchial response more frequently occurred in HMWA-induced asthmatics than in LMWA-induced asthmatics (86.2% . 20%). An isolated late bronchial response or atypical patterns were more frequently observed in LMWA-induced asthmatics than in LMWA-induced asthmatics (45.7% . 3.8% or 34.3% . 10%, respectively). Baseline NSBHR before SIC was more often detected in LMWA-induced asthmatics than in HMWA-induced asthmatics (81.4% . 54.6%), and the median value of the provocation concentration of methacholine was relevantly lower in these patients before and after SIC. A significant 3-fold increase in NSBHR after SIC was observed more often in LMWA-induced asthmatics than in HMWA-induced asthmatics (82.8% . 66.1%). In addition, compared to LMWA-induced asthmatics, HMWA-induced asthmatics were older, were more frequently active smokers, showed lower level of NSBHR, and more frequently continued their work in harmful occupational exposure.

Conclusions: The results of this study suggest that HMWA-induced asthmatics may have milder clinical courses and that there is a possibility of job continuation despite asthma exacerbation requiring medical surveillance.
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http://dx.doi.org/10.4168/aair.2020.12.1.164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875485PMC
January 2020

[Workers' view on the preventive needs for civilization diseases' in prophylactic care taken on employees].

Med Pr 2019 Jul 26;70(4):425-433. Epub 2019 Jun 26.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Department of Occupational Diseases and Environmental Health).

Background: Every year in Poland almost 5 million prophylactic examinations (PEs) are carried out by occupational medicine specialists (OMPs) among workers, for the purposes envisaged in the Polish Labour Code. The aim of this study was to collect workers' opinions on the possible extension of these check-ups in the field of prophylaxis and prevention of civilization diseases (CivDs), focusing also on the "healthy lifestyle" recommendations.

Material And Methods: The study group comprised 325 employees who filled out an anonymous questionnaire containing questions about the possible extension of the PE scope for CivD and cancer prophylaxis. During medical check-ups, evaluation of the incidental glucose (IG) and total cholesterol (TCh) levels, waist circumference measurement and electrocardiography (ECG) were proposed. The respondents were asked about the most interesting issues for discussing with OMPs.

Results: Screening tests for some cancers (69.5%) and risk factors for CivDs (61.5%) were indicated as the most interesting topics to discuss with OMPs. The possibility for evaluating the levels of IG and TCh during PEs was approved by approx. 94.8% and 95.3% of the respondents, respectively. Almost 96% accepted having ECG and 80% agreed to waist circumference measurement. As many as 89.5% of the respondents supported the idea of organizing physical activities at their workplaces, and 77.8% were eager to learn about "healthy lifestyles" during training sessions conducted at their workplaces.

Conclusions: Restricting the aim of PEs just to certifying the ability to work, or identifying certain medical contraindications, means losing a chance for implementing the prophylaxis and prevention of diseases' development among active working subjects. The kinds of activities proposed by the authors of this publication have been approved by the employees. Med Pr. 2019;70(4):425-33.
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http://dx.doi.org/10.13075/mp.5893.00821DOI Listing
July 2019

Food processing and occupational respiratory allergy- An EAACI position paper.

Allergy 2019 10 23;74(10):1852-1871. Epub 2019 Jun 23.

Formerly professor of Occupational Medicine, University of Perugia, Perugia, Italy.

Occupational exposure to foods is responsible for up to 25% of cases of occupational asthma and rhinitis. Animal and vegetable high-molecular-weight proteins present in aerosolized foods during food processing, additives, preservatives, antioxidants, and food contaminants are the main inhalant allergen sources. Most agents typically cause IgE-mediated allergic reactions, causing a distinct form of food allergy (Class 3 food allergy). The allergenicity of a food protein, allergen exposure levels, and atopy are important risk factors. Diagnosis relies on a thorough medical and occupational history, functional assessment, assessment of sensitization, including component-resolved diagnostics where appropriate, and in selected cases specific inhalation tests. Exposure assessment, including allergen determination, is a cornerstone for establishing preventive measures. Management includes allergen exposure avoidance or reduction (second best option), pharmacological treatment, assessment of impairment, and worker's compensation. Further studies are needed to identify and characterize major food allergens and define occupational exposure limits, evaluate the relative contribution of respiratory versus cutaneous sensitization to food antigens, evaluate the role of raw versus cooked food in influencing risk, and define the absolute or relative contraindication of patients with ingestion-related food allergy, pollinosis, or oral allergy syndrome continuing to work with exposure to aerosolized food allergens.
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http://dx.doi.org/10.1111/all.13807DOI Listing
October 2019

[Authors' response (September 26, 2018) to the letter to the Editor concerning the paper The prophylactic operational model integrated with occupational healthcare - Prophylactic of some types of cancers among women].

Med Pr 2018 12 15;69(6):701-703. Epub 2018 Nov 15.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Department of Occupational Diseases and Environmental Health).

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http://dx.doi.org/10.13075/mp.5893.00824DOI Listing
December 2018

[The prophylactic operational model integrated with occupational healthcare - Prophylactic of some types of cancers among women].

Med Pr 2018 Aug 23;69(4):439-455. Epub 2018 Jul 23.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Department of Occupational Diseases and Environmental Health).

Periodical medical examinations are mandatory for employees in Poland. This rule makes a unique opportunity during occupational health services for implementation of prophylactic activities focused on early diagnosis of various diseases, including cancers. Epidemiological data about cancers is alarming and what is more, further increase in development of cancers is being predicted in population overall. The highest incidence of cancers in the case of Polish women belongs to breast cancer (21.7% of diagnosed cancers in general), while the morbidity rate for uterine cancer, ovarian cancer and cervical cancer amounts to 7.4%, 4.7% and 3.5%, respectively. The aim of this study was to elaborate an algorithm of prophylactic activities integrated with the occupational healthcare system, based on medical literature review and guidelines concerning prophylaxis of selected cancers. Polish cancers' prophylaxis programs related to risk factors were presented in this publication and practical indications for occupational healthcare physicians were worked out. Med Pr 2018;69(4):439-455.
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http://dx.doi.org/10.13075/mp.5893.00665DOI Listing
August 2018

Can Periodical Examinations of Employees Be Useful in Detection of Glycaemia Impairment and Improving Patients' Adherence to Medical Recommendations?

Int J Environ Res Public Health 2018 03 30;15(4). Epub 2018 Mar 30.

Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Łódź, Poland.

Worldwide epidemiological data indicates insufficient diagnosis of diabetes as an increasing public health problem. In the search for solutions to this disadvantageous situation, occupational medicine health services seem to open up a unique opportunity to recognize some abnormalities in the early stages, especially among the asymptomatic working-age population. 316 workers underwent obligatory prophylactic examinations. In patients with twice assayed FGL ≥ 126 mg/dL (7.0 mmol/L) an additional intervention was implemented, including further diagnostic processes and therapy in General Practice (GP), followed by examination by an occupational health specialist within 3 months. The diagnosis of previously unknown diabetes was established among 2.5% of examined workers. All patients referred to the GP due to detected glycaemia impairment visited their doctor and finished the diagnostic process, took up therapy constrained by the occupational health physician to show the effects of intervention within 3 months. Prophylactic medical check-ups allow improved compliance and medical surveillance over glycaemia impairment in patients with prediabetes states, unknown diabetes or uncontrolled clinical course of diabetes. Considering fasting glucose level during mandatory prophylactic examination helps effective prevention of diabetes and its complications and thus provides public health system benefits.
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http://dx.doi.org/10.3390/ijerph15040638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923680PMC
March 2018

Is it possible to improve compliance in hypertension and reduce therapeutic inertia of physicians by mandatory periodic examinations of workers?

Kardiol Pol 2018 19;76(3):554-559. Epub 2018 Jan 19.

Nofer Institute of Occupational Medicine, Św.Teresy od Dzieciątka Jezus 8, 91-348 Łódź, Poland; Instytut Medycyny Pracy im. prof. J.Nofera w Łodzi, Św.Teresy od Dzieciątka Jezus 8, 91-348 Łódź, Poland.

Background: Due to high prevalence, insufficient recognition, and ineffective treatment, hypertension (HT) still remains a major medical and socio-economic problem. There is a real necessity to develop effective prophylaxis for cardiovascular disorders (CVD), based on strategies that support compliance during long-term therapy. The Polish scheme of occupational health services with mandatory periodical employee check-ups creates a unique opportunity for effective HT prophylaxis. As a result, visiting a doctor is required not only due to health ailments but also by law, which is especially important for those feeling well. It enables an improvement in tertiary prevention, including actions taken not only by the doctors of the occupa-tional health services, but also by the physicians in charge of treating the patients.

Aim: Evaluation of the usefulness of mandatory health check-ups of employees concerning frequency of diagnosis and im-provement of treatment outcomes of HT.

Methods: The study group comprised 1010 Polish workers referred by their employers for mandatory medical examinations. All of the study participants filled in a questionnaire focused on self-assessment of their health, current blood pressure (BP) mea-surements, and in cases where HT had been previously detected - compliance with medical recommendations. Then in the doctor's office BP measurements were taken twice. Workers who fulfilled a criterion indicating a need for intervention were educated on optimal diet, physical activity, and risk factors for CVD. They also received medical instructions for three-step action. The first recommendation: measure BP three times a day for one week and record the results. The second: visit a gen-eral practitioner (GP) for a professional assessment of those results. The third: re-visit the occupational health physician within three months. The criterion for intervention was prior HT and a mean of two BP measurements ≥ 180/110 mmHg - in each case, or ≥ 140/90 mmHg - in the case of occupational exposure to risk factors for CVD.

Results: The mean age of the study participants was 41.7 years (similar in both genders). A previous diagnosis of HT was declared by 20.1% of patients. 11% of patients involved in the intervention did not comply with medical advice. The current HT therapy of all of the subjects with HT (100% of those with abnormal BP, who visited their GP) was modified.

Conclusions: Prophylactic medical check-ups of workers gives improved compliance and medical surveillance of HT in patients with an uncontrolled clinical course of this disease. Obligations and periodic examinations encourage both patients and physicians to improve compliance and reduce the risk of therapeutic inertia.
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http://dx.doi.org/10.5603/KP.a2017.0250DOI Listing
November 2018

[Occupational cancers - Epidemiology and certification].

Med Pr 2018 Jan 20;69(1):93-108. Epub 2017 Oct 20.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego, Oddział Chorób Zawodowych / Department of Occupational Diseases and Environmental Health, Department of Occupational Diseases).

The etiology of cancer is multifactorial. Malignant tumors caused by factors occurring in the work environment, classified as carcinogenic in humans, can be recognized as an occupational disease. Analysis of epidemiological data indicates a significant underestimation of occupational cancer, mainly due to long latency period of these diseases. This publication provides guidance to certify occupational etiology of malignant tumors, based on the reviews of existing legislation and medical literature, as well as on the experience of their authors. The publication presents the epidemiology of cancers, including occupational cancers, risk factors, occupational carcinogens and presents the principles of occupational cancer certification. Med Pr 2018;69(1):93-108.
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http://dx.doi.org/10.13075/mp.5893.00620DOI Listing
January 2018

Spirometric and hygienic criteria in recognition of occupational COPD in Poland - A retrospective analysis of medical records.

Int J Occup Med Environ Health 2018 01 2;31(2):139-150. Epub 2017 Oct 2.

Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Occupational Diseases and Environmental Health).

Objectives: Chronic obstructive pulmonary disease (COPD) may be work-related. It has been estimated that 15% of the population burden of COPD is attributable to occupational exposure. However, in Poland COPD is rarely recognized as an occupational disease. The aim of the study has been to analyze the causes of the low prevalence of work-related COPD in the context of the existing criteria as well as to analyze which part of the assessment - clinical or hygienic one - is responsible for such a low rate of occupational COPD recognitions.

Material And Methods: The study group included 150 patients hospitalized with a suspicion of occupational COPD. Each patient underwent a clinical examination, spirometry and reversibility test using bronchodilator. Moreover, hygienic evaluation of work conditions was performed in all the considered cases.

Results: In the case of the patients who fulfilled the criteria for COPD diagnosis in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) occupational origins of the disease, the disease was not recognized because 24.1% of the individuals did not meet spirometric criteria included in a definition of COPD in the Polish list of occupational diseases, while 27.8% of the individuals did not fulfill the criterion of a documented exposure to dusts and irritant gases. None of these criteria was fulfilled by 42.6% of the patients.

Conclusions: In our country, both clinical and hygienic criteria result in limitations in recognition of occupational COPD. There is the need to establish new guidelines for the recognition of COPD as a compensable disease in Poland. Int J Occup Med Environ Health 2018;31(2):139-150.
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http://dx.doi.org/10.13075/ijomeh.1896.00920DOI Listing
January 2018

Usefulness of Biomarkers in Work-Related Airway Disease.

Curr Treat Options Allergy 2017 11;4(2):181-190. Epub 2017 May 11.

Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 8 St. Teresy, 91-348 Lodz, Poland.

Determination of biomarkers may be useful in the surveillance of occupational exposure and workers' health. The possibility of predicting development/clinical course of specific disorders or current disease, diagnosing in early steps, and health condition monitoring is a real necessity. Various agents present in the workplace environment (or their metabolites) can be measured in samples possessed from human body (blood and urine, saliva, etc.). On the other hand, inhalant exposure may induce specific or non-specific, local or systemic, acute or chronic biological response expressed by synthesis or releasing specific or non-specific substances/mediators that also can be determined in blood, nasal and bronchial lavage or sputum, tear fluid, exhaled breath, etc. The least is known about genetic markers which may predict individual susceptibility to develop some work-related disorders under the influence of occupational exposure. Due to common exposure to inhalant agents at workplace, researches on biomarkers that allow to inspect the impact of exposure to humans' health are still needed. The authors of this article summarize the utility of biomarkers' determination in work-related airway diseases in a recent clinical approach.
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http://dx.doi.org/10.1007/s40521-017-0121-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488075PMC
May 2017

Work-related asthma among professional cleaning women.

Arch Environ Occup Health 2017 Jan 19;72(1):53-60. Epub 2016 Feb 19.

a Department of Occupational Diseases and Environmental Health , Nofer Institute of Occupational Medicine , Lodz , Poland.

The job of cleaning has developed dynamically as a working service, and women constitute the majority of all professional cleaning workers. Cleaners are at an increased risk of work-related asthma (WRA). This study characterizes work-related respiratory symptoms reported by female cleaners, evaluates any associated factors of WRA, and shows diagnostic management of medical certification. The study group comprised 50 professional cleaning women referred to our Occupational Diseases Department due to suspicion of occupational asthma (OA). A questionnaire, skin prick tests, serum specific IgE antibodies, and specific inhalant challenge were performed in all of the participants. Work-related asthma was recognized in 46% of symptomatic cleaners, of whom 15 were considered as having work-exacerbated asthma (WEA) and 8 as having OA. Sensitization to latex and disinfectants played an important role as a causative agent in OA of cleaners.
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http://dx.doi.org/10.1080/19338244.2016.1156046DOI Listing
January 2017

[Smoking at workplace - Legislation and health aspect of exposure to second-hand tobacco smoke].

Med Pr 2015 ;66(6):827-36

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Department of Occupational Diseases and Environmental Health).

Tobacco smoke contains thousands of xenobiotics harmful to human health. Their irritant, toxic and carcinogenic potential has been well documented. Passive smoking or exposure to second-hand smoke (SHS) in public places, including workplace, poses major medical problems. Owing to this fact there is a strong need to raise workers' awareness of smoking-related hazards through educational programs and to develop and implement legislation aimed at eliminating SHS exposure. This paper presents a review of reports on passive exposure to tobacco smoke and its impact on human health and also a review of binding legal regulations regarding smoking at workplace in Poland. It has been proved that exposure to tobacco smoke during pregnancy may lead to, e.g., preterm delivery and low birth weight, sudden infant death syndrome, lung function impairment, asthma and acute respiratory illnesses in the future. Exposure to tobacco smoke, only in the adult age, is also considered as an independent risk factor of cardiovascular diseases, acute and chronic respiratory diseases and cancer. Raising public awareness of tobacco smoke harmfulness should be a top priority in the field of workers' health prevention. Occupational medicine physicians have regular contacts with occupationally active people who smoke. Thus, occupational health services have a unique opportunity to increase employees and employers' awareness of adverse health effects of smoking and their prevention.
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http://dx.doi.org/10.13075/mp.5893.00357DOI Listing
February 2016

Work-related symptoms among workers exposed to black tea dust.

Med Pr 2015 ;66(1):11-5

Background: Tea may be classified as unfermented green, semi-ferinented oolong and fermented black. All of these types are derived from Camellia sinensis, the Tea Plant, which contains the low molecular weight (LMW) agent Epigallocatechin gallate (EGCg), probably responsible for allergic reactions. The aim of our study was to asses the work-related allergic symptoms and IgE-mediated sensitivity among black tea packers.

Material And Methods: Study groups comprised 26 black tea packers (group 1) and 20 office workers (group 2). A questionnaire, skin prick tests (SPTs) to common allergens and black tea, evaluation of specific IgE (asIgF) to Camellia sinensis and moulds, pre- and post-work-shift spirometry were performed.

Results: At least I symptom suggesting allergic disease was reported by 85% of the tea packers and 60% of the office workers. The most frequent positive results of SPTs were obtained with moulds (8%). A small decline in FE%1 (forced expiratory volume in I s) after the work shift was observed among tea packers sensitized to moulds.

Conclusions: Although specific sensitization to black tea was not observed in our study groups, cough and skin symptoms were significantly more frequently among the tea packers than in office workers. The irritant impact on the airways and the skin of tea dust and/or sensitization to moulds contaminating tea leaves are being suspected.
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June 2015

Work-related respiratory symptoms among health centres cleaners: a cross-sectional study.

Int J Occup Med Environ Health 2014 Jun 19;27(3):460-6. Epub 2014 May 19.

Department of Occupational Diseases and Toxicology, Nofer Institute of Occupational Medicine, Łódź, Poland,

Objectives: Several studies, mostly based on questionnaire-derived data, have shown an increased risk of allergic diseases, especially asthma, among cleaners. The risk factors and etiological mechanisms are still being investigated. Occupational exposure to various chemical and biological agents may induce specific sensitization and/or irritant effects. The aim of our study was to estimate the prevalence of work-related symptoms suggesting the presence of allergic disease reported by cleaners, and to relate them to the results of commercially available and standardized objective tests used for screening detection of occupational sensitization and chronic respiratory disorders.

Material And Methods: A cross-sectional study was performed among 142 Polish workers of cleaning service in their workplaces. A detailed questionnaire, skin prick tests to common allergens and chemicals used by these workers for cleaning purposes (chloramine T, chlorhexidine, formaldehyde, glutaraldehyde, benzalconium chloride), total and specific serum IgE antibodies to disinfectants and rest spirometry were performed in all the subjects.

Results: Fifty nine percent of all the subjects declared occurrence of at least 1 symptom suggesting allergic ailment during cleaning activities at work. Skin prick tests and specific serum IgE antibodies to disinfectants were negative in all the subjects. In 8 cases wheezing was detected during auscultation, but only in 5 of them obstructive pattern in rest spirometry was found.

Conclusions: Occupational allergic causation of symptoms among cleaners could be less likely than work-related symptoms associated with exacerbations of new-onset or pre-existing respiratory diseases. Therefore, in this group of workers, mainly the non-specific irritant impact of chemicals on airways should be taken into consideration.
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http://dx.doi.org/10.2478/s13382-014-0272-xDOI Listing
June 2014

[Quaternary ammonium compounds--new occupational hazards].

Med Pr 2014 ;65(5):675-82

Quaternary ammonium compounds (QACs, quats) belong to organic ionic chemical agents which display unique properties of both surfactants and disinfectants. Their wide distribution in the work environment and also in private households brings about new occupational hazards. This paper reviews reports about the health effects of QACs. QACs could play a role of sensitizers and irritants to the skin and mucous membranes. It is suspected that particular QACs can display an immunologic cross-reactivity between each other and with other chemical compounds containing ammonium ion, such as muscle relaxants widely used in anesthesia. They may promote the development of airway allergy, however, the background mechanisms are still unclear and need to be further investigated. Until now, a few cases of occupational asthma induced by QACs have been described and their involvement in contact dermatitis has been documented. The possibility of anaphylaxis due to QACs cannot be excluded as well.
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May 2015

[Good practice in occupational health services: prophylactic care and occupational activation of people with disabilities due to respiratory diseases].

Med Pr 2013 ;64(3):427-38

Instytut Medycyny Pracy im. prof. J. Nofera, Nofer Institute of Occupational Medicine, Lodz, Poland.

Respiratory diseases are a cause of long-term sickness absence, and even of partial or complete inability to work. This paper presents the first in Poland description of principles of good practice in occupational health service provided for people with respiratory diseases. The issues concerning the certification of the ability to work in this group of patients are discussed. The key-principles of preventive care of workers with obstructive and interstitial lung diseases with particular attention paid to the control of major risk factors are also presented. The importance of possible contraindications for job performance by workers affected by these diseases, as well as the responsibilities of occupational health physicians were highlighted. M
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January 2014

Occupational asthma in female factory worker resulting from exposure to savinase in dishwashing tablets-a case study.

J Occup Health 2013 2;55(4):318-21. Epub 2013 May 2.

Department of Occupational Diseases, Nofer Institute of Occupational Medicine.

Objectives: Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing.

Methods: A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets.

Results: Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient's serum blood we found significantly elevated asIgE to savinase. Decline of FEV1 and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24 hours after specific challenge in comparison to values noted before the SICT.

Conclusions: Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.
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http://dx.doi.org/10.1539/joh.12-0169-csDOI Listing
October 2014

[Chronic obstructive pulmonary disease--work-related disease].

Med Pr 2012 ;63(2):217-28

Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy im. prof. J. Nofera, Łódź.

Chronic obstructive pulmonary disease (COPD) can be induced by hazardous agents present in the work environment. It is estimated that employment in exposure to dust and irritant gases is responsible for 10 to 20% of COPD cases. The paper reviews the etiology (particularly the occupational risk factors) of the disease, its clinical symptoms, and diagnostic procedures. The significance of COPD in occupational medicine, especially in terms of prophylactic care of workers is also presented.
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August 2012

[Barriers to professional activity among people with cardiovascular diseases].

Med Pr 2012 ;63(1):105-15

Instytut Medycyny Pracy im. prof. J. Nofera, Łódź Klinika Chorób Zawodowych i Toksykologii, Oddział Chorób Zawodowych.

Cardiovascular diseases (CVD) are a very important issue for the health care system. They are usually chronic diseases widespread in the society that require costly treatment and cause long-term sick absenteeism and partial or total incapacity for work. CVD are one of the most common cause of disability in Poland, therefore they constitute a medical, social and economic problem. Low occupational activity of people with CVD at working age requires special effort to develop and implement methods of their professional activation. A key role in this process should be played by physicians of occupational health services (OHS). In the case of disabled workers with cardiovascular disease, the decision about avoiding professional activity is often medically unjustified. It arises from a lack of sufficient knowledge ofjurisprudence and the fear of both the physician and the employee ofpatient's health deteriorations. Therefore, educational actions addressed to OHS physicians and to the patients are needed to enable the patients with CVD to remain at or to return to work.
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August 2012

[The real value of diagnostic methods in case of long time of cessation of occupational exposure to diisocyanates among patients diagnosed in the nofer institute of occupational medicine in Łodź].

Med Pr 2011 ;62(6):567-77

Instytut Medycyny Pracy.

Background: The aim of the study was to analyze the data obtained during the diagnostic process and their real values in the final diagnosis of patients exposed to diisocyanates amd suspected of occupational allergic disease of the respiratory system The patients have been hospitalized in the Nofer Institute of Occupational Medicine over recent 11 years.

Material And Methods: In 1999-2009 we hospitalized 37 patients exposed to diisocyanates and suspected of occupational asthma.

Results: Test results of 37 patients were analyzed. The patients were divided into three groups of those with diagnosed occupational asthma, with diagnosed non-occupational asthma and those without any allergic airway disease. 40.0% of patients with occupational asthma, 64.3% of patients with non-occupational asthma and 15.4% of patients without any allergic disease were sensitized to at least one of common allergens. We did not find any specific IgE to diisocyanates. Specific challenge tests were performed in all the 37 subjects. We observed positive results of SIT with diisocyanates in 10 patients.

Conclusions: Only specific challenge test with diisocyanates showed the real diagnostic value in case of a 7.5-year cessation of exposure. Determination of serum specific IgE to diisocyanates does not seem to be of clinical value in the diagnosis of diisocyanate-induced asthma in case of a 7.5 year cessation of exposure. Atopy is not the risk factor in diisocyanate-induced asthma.
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February 2012

[Prophylactic care of apprentices occupationally exposed to allergens].

Med Pr 2011 ;62(4):403-13

Oddział Chorób Zawodowych, Instytut Medycyny Pracy im. prof. J. Nofera, Klinika Chorób Zawodowych i Toksykologii, Łódź.

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.
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November 2011

[Invasion by trichinae in the patient hospitalized with suspicion of occupational borreliosis: a case report].

Med Pr 2011 ;62(1):73-6

Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy im. prof. J. Nofera, Łódź.

Diagnosis of occupational infectious diseases gives rise to a number of problems in the practice of occupational medicine. Similar symptoms of many infections, including parasitic diseases, can limit the range of applied diagnostic and certification procedures only to diseases induced by pathogenic agents or exposures occurring in the occupational environment. In some cases this makes difficult or even impossible to explain a real cause of patients' complaints. We present a case report on the patient with suspected occupational borreliosis. Due to many diagnostic doubts during hospitalization, including long term presence of some clinical manifestations reported by the patient, which could occur in the course of borreliosis and also suggest earlier infection by trichinae, a wider span of specialist examinations was applied. Finally, the invasion of trichinae was diagnosed and later confirmed by serologic tests.
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September 2011

[Cleaners'asthma--etiology, diagnostics, prophylaxis and medical certification].

Med Pr 2011 ;62(2):163-73

Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy im. prof. J. Nofera, Łódź.

Asthma is the most common occupational allergic respiratory disease. The results of several current studies reveal also high risk of work-related asthma among cleaners. This kind of work may increase the risk of allergic as well as non-allergic asthma. However, the mechanism by which inflammation in respiratory airways is induced by cleaning chemicals is still unknown. This paper shows the results of numerous studies regarding exposure and respiratory symptoms among cleaning personnel. The increased risk of respiratory diseases among cleaners suggests the need to educate workers and to devise safety methods during multiuse cleaning both in occupational settings and in private households.
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July 2011