[Occupational cancers - Epidemiology and certification]. / Choroby nowotworowe pochodzenia zawodowego ­ epidemiologia i aspekty orzecznicze.

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.

[Physicians' knowledge on the work-related chronic obstructive pulmonary disease]. / Ocena wiedzy lekarzy na temat przewleklej obturacyjnej choroby pluc pochodzenia zawodowego.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) may be induced by the work environment conditions. According to the estimates, 10-20% of all COPD cases are associated with occupational exposure to dusts and irritant gases. However, in 2014, only 11 cases of work-related COPD were recognized in Poland. The aim of the study was to analyze the reasons for the low incidence of work-related COPD in the context of pulmonologists' knowledge about occupational risk factors and procedures on reporting suspected occupational diseases. MATERIAL AND METHODS: A survey included 94 pulmonologists randomly selected out of 225 specialists registered at the Local Physicians Chamber in Lódz. The study was performed anonymously with the use of original questionnaire. RESULTS: More than a half of the surveyed pulmonologists identified environmental risk factors for COPD correctly, while only 23.4% properly identified the main occupational risk factors as the cause of COPD. Only 58.5% of the pulmonologists always asked their patients suffering from COPD about their job/profession and 60.6% of them did not have any knowledge about procedures on reporting suspected occupational diseases. CONCLUSIONS: The physicians rarely ask patients suffering from COPD about their job/profession and the relationship between their ailments and occupational exposure. What is more, they do not know legal regulations on proper referral of a patient with a suspected case of occupational disease. The results of the study clearly indicate that there is an urgent need for increasing pulmonologists' knowledge on work-related COPD. Med Pr 2016;67(3):375-384.

[Smoking at workplace - Legislation and health aspect of exposure to second-hand tobacco smoke]. / Palenie tytoniu w miejscu pracy - prawny i zdrowotny aspekt biernego narazenia na dym tytoniowy.

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.

[Can eosinophilic bronchitis be considered as an occupational disease? Medical certification aspects]. / Czy eozynofilowe zapalenie oskrzeli mozna zakwalifikowac do grupy chorób zawodowych? aspekty orzecznictwa lekarskiego.

Eosinophilic bronchitis (EB) is a condition which can be associated with occupational exposure to low, as well as to high molecular weight allergens. The prevalence of occupational eosinophilic bronchitis is unknown and the data concerning its work-related etiology are available only from the case reports. However, there is a need to establish the principles, especially in the context of medical certification among workers occupationally exposed to allergens. This paper reviews current knowledge on the etiology, clinical features, and diagnostic procedures in the eosinophilic bronchitis. The importance of EB, especially in view of the problems emerging in the prophylactic care taken by occupational health services and the principles of medical certification when occupational etiology is suspected are also presented.

[Good practice in prophylactic care: prophylactic care and professional activation of employees with multiple sclerosis]. / Dobre praktyki w opiece profilaktycznej: opieka profilaktyczna i problemy zwiazane z aktywizacja zawodowa osób niepelnosprawnych ze stwardnieniem rozsianym.

Multiple sclerosis (sclerosis multiplex-SM) is a chronic inflammatory disease, characterized by disseminated damage of the nervous system. It is most commonly diagnosed between the ages of 20 and 40, which puts it at the top of the lits of disabling neurological diseases in young and middle-aged adults. The third and fourth decade of life is the period of high activity, thus the progressive impairment of many functions of the nervous system is not only a medical problem, but also social and economic issues. Educational actions addressed to occupational health services physicians are needed because only adequate knowledge of the disease can prevent wrong decisions in certifying the ability to work.

[Barriers to professional activity among people with cardiovascular diseases]. / Bariery w aktywizacji zawodowej osób z chorobami ukladu krazenia.

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.

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

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.

Comparison of biomarkers in serum and induced sputum of patients with occupational asthma and chronic obstructive pulmonary disease.

OBJECTIVES: Occupational asthma and chronic obstructive pulmonary disease (COPD) are associated with the airway inflammatory process. The aim of this study was to compare the sputum and serum markers of inflammation in patients with occupational asthma and COPD. METHODS: The study group included 20 patients with stable COPD, 24 patients with asthma, and 22 healthy subjects. Interleukin (IL)-6, IL-1ß, tumor necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-9 levels in serum and induced sputum as well as fibrinogen and CRP in serum were determined in all the subjects. RESULTS: Higher concentrations of IL-1ß, IL-6, TNF-α, and MMP-9 in induced sputum and an increased concentration of acute-phase proteins in serum were observed in COPD patients compared with healthy subjects. Higher concentrations of IL-1ß and MMP-9 in induced sputum and a higher concentration of C-reactive protein (CRP) were detected in COPD patients than in asthmatic subjects. Never smokers with COPD had significantly higher levels of IL-1ß and MMP-9 in induced sputum than never smoker controls. There was no significant difference between the serum and sputum levels of cytokines and MMP-9 of never smokers and smokers with COPD. CONCLUSIONS: Higher concentrations of IL-1ß and MMP-9 in induced sputum and a higher concentration of CRP in serum allow distinguishing between biomarker profiles of COPD patients and asthmatic patients. Occupational exposure induces a systemic proinflammatory state with increased levels of acute-phase proteins in stable COPD patients. MMP-9 and IL-1ß concentrations are increased in induced sputum of never smokers with COPD, which is associated with occupational exposure.