Andrzej Marcinkiewicz

Selected risk factors of diabetes mellitus among road transport drivers

OBJECTIVES Road transport drivers are one of the professional groups whose activities have a strong impact on public safety. In view of the nature of their professional activity, the drivers are at a higher risk of obesity and hypertension, and thus, indirectly, of carbohydrate metabolism disorders such as diabetes mellitus. MATERIALS AND METHODS Medical documentation was a source of data for the reported study. It derived from medical examinations of truck and bus drivers applying for the new category II driving licence or for prolongation of the one they already had. RESULTS Excessive body weight was recorded in 62.6% of the study population; 45.3% had overweight and 17.4% were diagnosed with obesity. Hypertension was noted in the medical records of 36.7% drivers. The prevalence of abnormal BP values was increasing with age. Overweight was found to be a risk factor for hypertension. Hyperglycaemia was found in 47.5% of the drivers and was also increasing with age. CONCLUSION In road transport drivers, the high prevalence of excessive body weight and elevated arterial blood pressure as the risk factors for diabetes indicates a need to undertake multidimensional actions targeted on this particular profession and involving various health care sectors. Prophylactic and detailed pre-placement examinations should be considered, depending on the rate and intensity of the disorders diagnosed. This should be coupled with an introduction of primary and secondary prophylactic activities and monitoring of relevant treatment. A close collaboration with the patients GP is necessary.

Night shift work and modifiable lifestyle factors

ObjectivesNight 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 MethodsThe 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.ResultsRecreational 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).ConclusionsThis 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.

Carbohydrate metabolism disturbances among public transport drivers--the need for regulations in Poland

INTRODUCTION The discussion on the relationship between diabetes and driving has continued in recent years all over the world. The issue of diabetes, its treatment models, the risk of hypoglycaemia and license to drive are receiving considerable attention. Driving ability is controlled by specific regulations. Polish legislation does not provide standard procedures for dealing with the question of diabetic drivers and driver candidates. The aim of study was to draw attention to some problems that may emerge when attempting to certify medical fitness of drivers or driver candidate to drive public service vehicles. MATERIALS AND METHODS Data were obtained from standardised prophylactic examination forms of public transport drivers employed in a small company between 2001 and 2007. Fasting capillary blood was collected to be analysed with a blood glucose meter. RESULTS Diabetes and its diagnosing during obligatory preemployment or periodic medical examinations constitutes a serious problem. Abnormal fasting glucose levels were noted in 23 drivers (21.7%). DISCUSSION Our study shows that the occupational physician must take into account the possibility of glucose metabolism disturbances. The results demonstrate that an unified approach to diagnosing of diabetes mellitus during such medical examinations is not available currently in Poland. CONCLUSIONS It is necessary to develop standard procedures to be used by occupational physicians for diagnosis diabetes mellitus and intermediate hyperglycaemia. Fasting capillary blood glucose measurement with a blood glucose meter may be used for screening, because it is easier, less expensive and less invasive than venous blood tests. Screening tests must be followed by oral glucose tolerance test using standard criteria in order to make the diagnosis. Frequency of periodic medical assessments in case of diagnosed diabetes mellitus or any intermediate hyperglycaemia must be determined. Specific situations must be identified when the consultation of diabetes specialist is mandatory with respect to therapy, risk of hypoglycaemia and hypoglycaemia awareness.

Analysis of tasks of occupational health services accomplished in Poland, 1997–2014. Do we exploit the full potential of prophylactic examinations of workers?

BACKGROUND Mandatory medical reports can be used to evaluate the scope of activity of occupational health services (OHS), including the number and kind of services. MATERIAL AND METHODS The analysis comprised data for the period 1997-2014, derived from mandatory reports MZ-35A submitted by OHS units. RESULTS During the analyzed period the number of occupational medicine physicians decreased from 8507 to 6741, while the number of OHS units - responsible for prophylactic care - increased from 4967 to 6261. In the years under report 3,961 million mandatory health check-ups were performed, of which 99.3% resulted in issuing fitness for work certificates. Pre-employment examinations made 38.8%, while periodical ones - 52.8% and control ones - 6.7% of all check-ups. Moreover, 336 700 examinations of apprentices, students, vocational courses attendants and Ph.D. students were performed to evaluate any contradictions for vocational training. In 2014, there were 1871 workers provided with preventive care per 1 occupational physician. It was estimated that despite legal obligation, only 22.2% of employers had signed agreements with OHS units. CONCLUSIONS The analysis of the number and kind of services provided by OHS units revealed high but not fully exploited potential for efficient prophylaxis of both directly occupational work-related and indirectly work-exacerbated diseases. Med Pr 2017;68(1):105-119.

Takotsubo cardiomyopathy in the case of 72-year-old teacher after work-related psychological stress. Evolution of left ventricular longitudinal strain – Delayed but complete recovery in automated function imaging (AFI)

Takotsubo cardiomyopathy (TC) is related to a transient systolic dysfunction of left ventricle (LV), accompanied by clinical and electrocardiographic symptoms of myocardial ischemia in the absence of hemodynamically significant coronary artery disease. Takotsubo cardiomyopathy is usually provoked by a psychologically or/and physically stressful event which may be related to occupational activities. Although visually assessed evolution of LV function is well documented, the data concerning strain changes is sparse and various patterns of deformation abnormalities are suggested. We have described a 72-year-old woman with chest pain related to a lecture given at the meeting of the Senior University, fulfilling all the Mayo Clinic criteria of the TC. The longitudinal strain analysis with automated function imaging (AFI) documented severe impairment and stepwise recovery of regional and global LV contractility. The case described confirms that accurate diagnosis, treatment and documenting of functional improvement in takotsubo cardiomyopathy may enable the return to occupational activities even for elderly persons. Int J Occup Med Environ Health 2017;30(4):681-683.

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

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 doctors 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.

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

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.

Can diabetes be treated as an indirectly work-related disease?

In this article the authors attempted to analyze the arguments for considering diabetes as a work-related disease. An overview of literature has been done out of articles published in the years 1980-2016, with the use of combination of key words referring to employment, workplace, and diabetes. The PubMed database was the source of data. The authors indicate that the following arguments are in favor of diabetes being recognized as a work-related disease: diabetes is not an occupational disease, it is not directly related to the work environment or the way the work is performed, but there are observed adverse effects of occupational work-related nuisances, such as night shift work, long work hours, job strain or workplace standing time, which influence its development and course. The number of publications on diabetes, including the problem of occupational work is comparable to the number of analogous publications concerning work-related diseases such as hypertension or ischemic heart disease. Moreover, some aspects of professional activity and diabetes were also included in clinical recommendations for the workplace, which is uncommon in the case of other diseases, even those generally recognized as work-related. Data from medical references, indicating the effectiveness of workplace interventions aimed at preventing diabetes development and/or worsening of its course should be considered as an argument for the inclusion of diabetes into the group of work-related diseases. This should also support the need for further research and practical actions aimed at preventing diabetes at the workplace. Med Pr 2017;68(5):667-675.

Usefulness of Biomarkers in Work-Related Airway Disease

Opinion statementDetermination 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.

Good practice in occupational health services – Certification of stroke as an accident at work. Need for secondary prevention in people returning to work after acute cerebrovascular events

The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances). During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI) scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employers post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors.