Night shift work and modifiable lifestyle factors.

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 Lódz, 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.

Predictors of environmental lead exposure among pregnant women - a prospective cohort study in Poland.

Blood lead levels (BLL) in women of child-bearing age have been decreasing in recent decades, but still remains a concern for long-term effects of child psychomotor development. The aim of the study was to characterize lead exposure among Polish pregnant women and assess the relationship between BLL and selected socio-demographic, economic and lifestyle factors. The study population consisted of 594 pregnant women who had been the subjects of the prospective Polish Mother and Child Cohort Study (REPRO_PL). The women were interviewed three times during pregnancy (once in each trimester. Lead concentration in the blood collected during the second trimester of pregnancy was analyzed using graphite furnace atomic absorption spectrometry (GF-AAS), or inductively coupled plasma mass spectrometry (ICP-MS). Active and passive smoking was analyzed by the cotinine level in saliva using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The lead level in the blood ranged from 0.3 - 5.7 µg/dL, with a geometric mean (GM) of 1.1 µg/dL (GSD ±0.2 µg/dL). Statistically significant associations were found between BLL and factors such as maternal age (ß=0.01; p=0.02), education (ß=0.08; p=0.04) and prepregnancy BMI (ß=0.1; p=0.001). Additionally, BLL increased with increasing cotinine level in saliva (ß=0.02; p=0.06) and decreased with the increasing distance from the copper smelter (ß=-0.1; p=0.009). Public health interventions, especially in regions with a higher level of exposure to lead, among women with lower SES and among smokers, are still reasonable.

[The assessment of changes in radiological parameters of acetabulum of the hip joint according to position of the pelvis]. / Ocena zmian wartosci parametrów radiologicznych panewki stawu biodrowego w zaleznosci od ustawienia miednicy.

The aim of the study was to analyze the repeatability of selected radiological parameters in the assessment of mild forms of developmental dysplasia of the hip and to evaluate the changes of the parameters according the position of the pelvis. Retrospective review of radiographs of 98 hips (49 children) was done in antero-posterior and Lauenstein position. Among them 59 hips were treated for type II hip dysplasia according to Graf. At the latest follow-upthe mean age was 9.1 years (range from 4 to 15 years). On radiographs in antero-posterior position of the hips mean rotation index (Tönnis-Brunken index) was 1.0, and on radiographs in Lange position was 0.98 and had no influence on measured parameters. On radiographs in antero-posterior position pelvis was more in forward rotation than in Lange position. With the pelvis in more forward rotation (measured using Ball-Kommend index) the value of Lequesne and Ullmanna-Sharp angles were decreased and Wiberg angle was increased. The angles had good repeatability. The other parameters: acetabular index, decentration distance and Idelberg-Frank angle were not statistically related to Ball-Kommend index. Idelberg-Frank angle had satisfactory repeatability but acetabular index and decentration distance had poor repeatability. Considering above mentioned characteristics of Idelberg-Frank angle, this parameter may be a useful tool for assessment of the hip.

[Implementation of the Amiantus project involving prophylactic medical examinations of the former employees of asbestos processing plants]. / Realizacja programu badan profilaktycznych pracowników bylych zakladów przetwórstwa azbestu "Amiantus".

BACKGROUND: Based on a 11-year implementation of the Amiantus Project, this paper reports the results of prophylactic medical examinations of the former workers of asbestos processing plants. The Project involving employees of 28 former asbestos plants was started by the Ministry of Health in 2000 under the Act on the ban of all products containing asbestos. MATERIAL AND METHODS: Preventive examinations, continued in 13 centers of occupational medicine throughout the whole territory of Poland, have been coordinated by the Nofer Institute of Occupational Medicine in Lodz (NIOM). During the examinations, a specific Examination Form is filled-in by a physician. The Form is then sent to NIOM for monitoring health effects in the population covered by the Project. The results obtained by analyzing the lung radiological images are recorded in the Examination Form according to the ILO 1980 classification of pneumoconiosis. The diagnosis of the asbestos-related pathologies is based on the Helsinki criteria. RESULTS: During the years 2000-2010, altogether 6,853 people were involved in the Project, and they were subjected to a total of 18,955 preventive examinations. Asbestosis was diagnosed in 1475 people, representing 21% of all respondents, lung cancer in 68 and mesothelioma in 40 people. Pleural radiographic changes were observed in 3027 (44%) patients, pulmonary parenchymal opacities in 4086 (60%) patients. The analysis showed that the asbestos-related pathologies were most frequent in the group of former employees of asbestos-cement plants. This group was also characterized by an age-, tenure-, and latency-related increasing trend in the prevalence of silicosis and the frequency of radiographic lesions in the lungs of those subjects. CONCLUSIONS: The continuation of the examinations of former workers of asbestos processing industry has improved the detection of pathologies associated with exposure to asbestos and enabled undertaking an appropriate preventive action. The growing percentage of poorer radiography results reflects the progressive development of pathological processes in the respiratory system of people occupationally exposed to asbestos dust in the past.

Assessment of the dermal exposure to azoxystrobin among women tending cucumbers in selected Polish greenhouses after restricted entry intervals expired--the role of the protective gloves.

OBJECTIVES: The purpose of our study was to determine the level of skin contamination by azoxystrobin in a group of women tending cucumbers in a vegetable-growing greenhouse after restricted entry intervals expired. METHODS: Exposure samples were assessed on two days during the spring: first entry on the day after spraying of azoxystrobin and second entry six days later. Dermal exposure was measured by using patches on the outside of clothing and sampling gloves underneath regular working gloves. Pesticide deposited on clothing patches and gloves as a substitute for skin deposition was determined by liquid chromatography and mass spectrometry (LC-MS/MS). RESULTS: The study has shown that workers in a Polish greenhouse are exposed to pesticides at re-entry into the greenhouse after pesticides were sprayed several days earlier. Azoxystrobin has been detected on hands, shoulders and chest. Higher levels of azoxystrobin were found on the cotton gloves of women tending the vegetables than on the patches. The levels decreased (by about 60%) on the patches and increased (by about 250%) on the cotton gloves between the two days of measurement. CONCLUSIONS: Women working in a vegetable-growing greenhouse and not directly engaged in the process of spraying experience a measurable dermal exposure to azoxystrobin. The protective gloves constitute a source of secondary exposure rather than protecting employees' hands from contact with the pesticide. More efficient personal protective gloves for proper protection of women working in vegetable greenhouses are needed.

[Cost-benefit analysis of the program on early detection of pulmonary diseases]. / Ewaluacja kosztów i efektów programu wczesnego wykrywania chorób ukladu oddechowego.

BACKGROUND: Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management. MATERIAL AND METHODS: The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódz region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios. RESULTS: The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios. DISCUSSION AND CONCLUSIONS: The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity analysis allows for investigating how different assumptions of variables influence the study results. Variables useful for the scenarios of early lung diseases detection programs were identified for further studies.

[Predictors of smoking cessation in group-based behavioral intervention programme--research findings in 2001-2007]. / Predyktory skutecznego zaprzestania palenia w grupowym programie interwencji behawioralnej--wyniki badan w latach 2001-2007.

The efficacy and cost-effectiveness of behavioral treatments compare favorably with the pharmacotherapies and community-based interventions. Group-based behavioral programmes have been scientifically proven as the effective smoking cessation intervention. Identifying predictors of the efficacy of smoking cessation within group-based programme using characteristics of participants (social and environmental approach). Program is a multicomponent group-based behavioral intervention with the elements recommended by the US Public Health Service as the most effective. 517 smokers were included into the program in the outpatient clinic setting in years 2001-2007. A point prevalence abstinence (PPA) was estimated by self-reported smoking cessation. 59.% of participants stopped smoking during four-week program. Using multivariate logistic regression, a model provided the optimal predictive ability. PPA decreased (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.24-0.93) for manual occupied and unemployed participant comparing to nonmanual occupied smoker, decreased (OR, 0.9; 95% CI, 0.20-1.19) for high-nicotine-dependent smoker, increased (OR, 1.49; 95% CI, 0.74-2.98) for high-motivated to quit smoking participant, increased (OR 2.31; 95% CI, 1.15-4.66) for subject smoked 1 pack or more of cigarettes per day, decreased (OR 1.41; 95% CI, 0.85-2.35) for participant with smoker in household, decreased (OR 1.74; 95% CI, 1.09-2.78) for smoker without any previous physician's advice to quit and did not distinguish for subject without any previous attempts. The future of behavioral group-based treatment will likely emphasize intensive intervention targeted to particular subgroups of smokers with the need and motivation for them (eg, the low nicotine-dependent but with high emotional and/or behavioral components of dependency, poor supported by family and non-medical patients). A blurring of the distinctions between behavioral interventions, pharmacotherapies, and community-oriented approaches is also likely as multidimensional cessation strategies are developed.

[Epidemiological risk assessment of asbestos-related benign pleural and parenchymal changes in workers after past exposure to chrysotile asbestos]. / Epidemiologiczna ocena ryzyka zmian azbezstozaleznych w plucach i oplucnej wsród pracowników eksponowanych w przeszlosci na azbest chryzotylowy.

BACKGROUND: Health effects related with asbestos dust exposure are observed many years after its onset. The objective of the study was to evaluate the risk of pleural and parenchymal changes depending on the duration of exposure, lapse of time since first contact with asbestos dust, and cumulative dust exposure. MATERIALS AND METHODS: The study population comprised 222 former workers of asbestos processing plants. Risk assessment was based on the results of chest radiograms and retrospective exposure measurements. The adjusted odds ratios (OR) were used as a relative risk measure and logistic regression models were employed in statistical analyses. RESULTS: The risk of diffuse pleural thickening in the group of workers exposed to asbestos dust for more than 10 years (years x mg/m3) as well as the risk of parenchyma changes, density > or = 1/1, and diffuse pleural thickening in the group of workers employed under cumulative exposure to asbestos dust for similar period of time were significantly higher than in the reference group. No effect of the lapse of time since first contact with asbestos dust on the risk of analyzed radiological changes was observed in the study group. CONCLUSIONS: The level of cumulative exposure to asbestos should be taken into account in the recommended frequency of preventive medical examinations of workers.

[Prophylactic examinations of workers formerly employed in asbestos processing plants: outcome of the Amiantus project in 2000-2004]. / Badania profilaktyczne bylych pracowników zakladów przetwórstwa azbestu--wyniki realizacji programu Amiantus w latach 2000-2004.

BACKGROUND: Prophylactic examinations of workers formerly employed in asbestos processing plants were performed by virtue of the Act, dated 19 June 1997, putting a ban on the production of asbestos-containing products. To enforce the provisions of the Act, the Ministry of Health has initiated the Amiantus project implemented by 13 Occupational Medicine Centers throughout the country and coordinated by the Nofer Institute of Occupational Medicine (IMP) in Lódz. MATERIAL AND METHODS: All the Centers perform diagnostic procedures according to the same criteria (clinical, radiological, spirometric and histological), based on the 1997 Helsinki criteria, to diagnose asbestos-related diseases. A specific "Examination Form", developed for the needs of the Amiantus project, is completed by an occupational physician during examinations and sent to the IMP, where health effects in the whole population covered by the project are monitored. Periodical medical examinations are performed at least every three years and they include: general examination, chest x-ray, resting spirometric examination and supplementary examinations (e.g., resting gasometric examination) or other diagnostic examinations if necessary (e.g., computed tomography). RESULTS: Owing to the project implementation, it was possible to collect in the database information on 5466 persons who underwent 8763 prophylactic examinations in 2000-2004. Of the total population examined during a five-year period, occupational disease was certified in 728 (13%) persons. Asbestosis was diagnosed in 790 persons, lung cancer in 19 persons and pleural mesothelioma in 12 persons. Pleural changes in x-ray imaging were found in 1662 (30%) persons and opacities in pulmonary parenchyma in 2088 (38%) persons. Having compared these results with those from previous examinations, the total health condition deterioration was observed in 882 (16%) persons, including worsening of the lung x-ray imaging in 512 (9%) persons. An analysis showed the highest incidence of asbestos-related pathologies in workers of asbestos-cement plants. The collected data also confirmed an upward trend in the incidence of asbestosis and changes in the lung x-ray imaging related to age, duration of employment and latency. CONCLUSION: The implementation of the Amiantus project has contributed to an increased detection of pathologies related with exposure to asbestos fibers. A growing proportion of radiograms, which indicate worsening of health condition provides evidence that morbid processes in the respiratory system are progressing in persons who in the past were occupationally exposed to asbestos dust.

Current determinants of early retirement among blue collar workers in Poland.

BACKGROUND: The current demographic trend in Poland indicates a progressive ageing process, which will result in a decreased number of persons at the age of work capability. Thus it is essential to find out the reasons for the diminished occupational activity of elderly workers. The aim of the project was to identify the factors that significantly contribute to early retirement during the period of socioeconomic transformation in Poland. MATERIALS AND METHODS: The analysis concerned 637 workers, aged over 45 years, but before reaching the age of retirement (60 years for women and 65 years for men) who were employed in selected industrial enterprises at technological or production-related departments. The study group was recruited from the population of former workers who quit their employment between 1996 and 2000, before they reached the age of retirement. The reference population, matched for age (+/- 3 years) and gender, comprised workers at similar workposts. RESULTS: The following groups of variables were found to be significant risk factors for early retirement: variables describing the conditions of work (piecework system, OR = 7.00, 95% CI: 2.01-24.37; heavy lifting at work OR = 2.24, 95% CI: 1.20-4.17) and variables related to the household characteristics (shortage of leisure time, OR = 1.87, 95% CI: 1.16-4.67), health condition (disability, OR = 1.87, 95%CI: 1.09-3.21; increased rate of sickness absence, OR = 2.20, 95% CI: 1.52-3.17), and alcohol abuse (OR = 3.19, 95% CI: 1.33-7.64). CONCLUSIONS: The data analysis revealed a spectrum of factors that either contribute to or decrease the risk for early retirement. These may be used as a reference in taking on activities aimed at preventing this adverse trend and stimulating occupational activity of elderly workers.

[Usefulness assessment of selected proinflammatory cytokines' level in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery]. / Ocena przydatnosci pomiaru stezenia wybranych cytokin prozapalnych w wydzielinie szyjkowo-pochwowej kobiet ci ezarnych jako wczesnego markera wystapienia porodu przedwczesnego.

OBJECTIVES: Recent studies have suggested that proinflammatory cytokines might play a crucial role in the mechanism of preterm labour and delivery. The main aim of this prospective study was to evaluate the usefulness of selected proinflammatory cytokines' (IL-1 alpha, IL-1 beta, IL-6 and IL-8) levels in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery. MATERIAL AND METHODS: Cervico-vaginal fluids were obtained from 107 pregnant women at 22 to 34 weeks' gestation, including 61 women with threatened preterm labour (TPL) and 46 women with physiological course of pregnancy (reference group). Those samples were analyzed for the concentrations of selected cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture. RESULTS: Mean gestational age at the time of sampling was 28.6 weeks. Mean time between sampling and delivery was 8,24 weeks in TPL group and 10.2 weeks in reference group. BV was diagnosed in 25.2% of subjects under study. M. hominis and U. urealyticum were diagnosed more frequently among women from TPL group (25.9% vs 14.9% and 36.2% vs 17.0%, respectively). Out of 107 women 15 (14.0%) delivered before 37th week of gestation. The rate of preterem delivery was significantly higher in threatened preterm labour group--21.3% is comparison to reference group--4.3%. Median cervico-vaginal concentration of IL-1 alpha, IL-1 beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Only women with lower genital tract infection and one cytokine's low concentration (below 25th percentile) presented a higher risk of preterm delivery--OR=2,91. If IL-1 alpha and IL-1 beta concentrations were below 25th percentile, the calculated risk of preterm delivery was OR = 4.65. The highest risk was noted for women with lower genital tract infection and low cervico-vaginal concentrations of IL-1 alpha and IL-8--OR = 8.0 (3.20-20.01). CONCLUSIONS: The early gestation cytokines' levels in cervico-vaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract infection.

Efficacy and effectiveness of the smoking cessation program for pregnant women.

OBJECTIVES: The aim of randomized trial was to evaluate the effectiveness of anti-smoking counseling in the population of pregnant women from the maternity centers in Lódz, central Poland. MATERIALS AND METHODS: One hundred and forty nine current smokers and 56 spontaneous quitters were randomized into the smoking cessation intervention and 144 current smokers and 37 spontaneous quitters were included in the control group. The intervention program covered four midwife visits during pregnancy and one after delivery. The control units received standard written information about the health risk from maternal smoking to the fetus. RESULTS: The chance of quitting smoking by the women was significantly higher in the intervention group than in the control group (OR = 2.5; 95% CI 1.8-3.7). The difference in the mean infant birthweight between the quitters and non-quitters was 203.8 g (p = 0.01) in the intervention group and 198.2 g in the control group (p = 0.08). After controlling for socio-demographic characteristics that could affect the birthweight, the differences remained significant in the intervention group - 182.8 g (p = 0.02), whereas in the control group it was 92.4 g (p = 0.4). CONCLUSIONS: The midwife-assisted smoking cessation intervention seems to be an effective tool to help pregnant smokers make a decision to quit smoking.

[Assessment of risk of death due to malignant neoplasms induced by occupational exposure in a rubber footwear plant]. / Ocena ryzyka zgonu z powodu nowotworów zlosliwych wywolanych narazeniem w zakladzie obuwia gumowego.

The main goal of the study was to analyze thoroughly the results of a cohort study. Such an analysis renders it possible to eliminate certain neoplasms as those not related to the observed exposure. The cohort study was carried out in a group of workers, covering 11,342 persons (5472 men and 5870 women), employed for at least one year during the years 1945-1985 in a rubber footwear plant. The cohort study was continued until the end of December 1997. Of all the sites of malignant neoplasms observed in the cohort, significant, exposure-related excess mortality was found to be due to malignant neoplasms of larynx and lung in men, and malignant neoplasms of gallbladder and lung in women. For these neoplasms, the values of observed risk among those exposed were significantly higher than among non-exposed. Moreover, in a certain interval of employment duration, an increase in risk rates with increasing duration of employment under exposure was observed, which suggests the presence of dose-response relationship. For all these sites, a relevant trend was shown by the RR values calculated in relation to the group of persons non-exposed but employed in the same plant. The internal reference group used to calculate RR values allowed to eliminate the effect of confounding variables, which is not always possible when the general population is used as the reference group.

[Sickness absence in persons who leave their jobs due to various reasons]. / Absencja chorobowa osób odchodzacych z zatrudnienia z róznych przyczyn.

BACKGROUND: The present analysis is a continuation of studies carried out in the same plant during the economic transformation and after the restructure. It is aimed at indicating variations in sickness absence, its extent and morbid causes in persons who leave their jobs due to various reasons (disability pension, retirement pension, plant under economic constraint, agreed change of affiliation, or a worker's notice to terminate the employment contract). MATERIALS AND METHODS: The study was carried out in a large transport industrial plant during its economic transformation (1989-1994) in a group of 8588 workers, and after its restructure (1997-1999) in a group of 2702 workers. The analysis was based on such absence parameters as the age standardized sickness absence rate, sickness absence cases and the average duration of sickness absence. The linear regression and Poisson regression models were used in the analysis. RESULTS: The onset of the transformation was characterized by a growing number of workers who got retired or applied for disability pension prior to the period of redundancy procedures. After the restructure, affiliation changed to the private sector prevailed (44% of the staff), and the second place was occupied by the termination of employment contracts due to economic reasons (25%). The analysis revealed that sickness absence among workers who left the plant in 1989-1994 was twice as high as that among workers who continued their employment, whereas among workers who left their jobs in 1997-1999 it was 50% higher in men and 20% higher in women than that among workers who continued their employment. The highest rate of sickness absence was noted in 1989-1994, when workers applied for or left due to disability pension. This rate accounted for about 25, which means that those workers had failed to work one fourth of the required time. Diseases of the circulatory, respiratory and musculoskeletal systems formed the major group of causes of applying for disability pension. A high rate of sickness absence was noted in the group of workers discharged because of economic reasons. Interestingly, after the restructure of the plant sickness absence in this group of workers did not diminish, on the contrary it increased both in men (21%) and women (8%) mostly due to mental disorders and diseases of the musculoskeletal system. In 1989-1994, the sickness absence rate among men who continued their employment was 3.46 on average, and it remained low during the whole period covered by the study. In 1997-1999, this rate fell to 3.09. In the former period, the sickness absence rate among women was higher accounting for 5.87 and in the latter it decreased to 3.89% (a 34% decrease). The lowest rates were observed in workers who joined the private sector in 1997-1999 (2.29 for men and 3.48 for women). An analysis of dynamics showed that the decrease in the risk of sickness absence was significantly depended on the proportion of workers leaving the job because of the enterprise's economic constraints, and the increase in the average duration of sickness absence, especially in the onset of economic transformation, was also dependent on the percentage of workers discharged because of economic reasons. CONCLUSIONS: The plant restructure as a result of economic transformation in Poland contributes to the increase in sickness absence mostly through earlier retirement, disability pensions and discharge because of economic reasons. The increase in sickness absence is determined by still longer duration of sickness absence, as the number of identified cases decreases with the increasing lapse of time following the transformation.