Asbestos related diseases among workers of asbestos processing plants in relation to type of production and asbestos use.

BACKGROUND: Asbestos dust is one of the most dangerous pneumoconiotic and carcinogenic agents. The aim of this study was to assess the occurrence of asbestosis and pleural mesothelioma, depending on asbestos consumption and the type of manufactured products, among former asbestos workers in Poland. MATERIAL AND METHODS: The study subjects included employees of 18 large state-owned asbestos processing enterprises operating in the Polish market in 1945-1998. The study is based on data obtained from asbestos company records and the Central Register of Occupational Diseases data on the cases of asbestosis and mesothelioma for the period from 1970 till 2012 as well as data from Amiantus Programme. The analysis was performed for 5 sectors comprising plants classified according to the products manufactured and applied production technology. RESULTS: In the study period, 2160 cases of asbestosis and 138 cases of mesothelioma were reported. The plants processed a total of about 2 million tons of asbestos, including about 7.5% of crocidolite. Total asbestosis consumption was a strong predictor of the rate of asbestosis incidence (R2 = 0.68, p = 0.055). The highest risk occurrence of asbestosis was observed in the production of textiles and sealing products. Mesothelioma occurred only in plants where crocidolite had been ever processed. CONCLUSIONS: Total asbestos consumption was a strong predictor of the rate of asbestosis incidence. The observation confirms the relationship between exposure to crocidolite and the occurrence of mesothelioma, regardless of the manufactured products, and suggests the absence of such a link for the total volume of asbestos consumption.

[Sickness absence in Poland after socio-economic transformation]. / Absencja chorobowa w Polsce po transformacji spoleczno-gospodarczej.

BACKGROUND: The aim of the analysis was to determine the magnitude and causes of the sickness-related temporary incapacity for work in Poland, and to identify changes in sickness absence and its differences by the type of economic activity and region. MATERIAL AND METHODS: This analysis is based on the 2006-2012 data on sickness absence compiled from medical certificates of temporary incapacity for work and published by the Social Insurance Institution (Zaklad Ubezpieczen Spolecznych). The sickness absence is described in terms of the number of sick leave days relative to the number of the employed or insured people. RESULTS: In 2012, the number of days of disability per one employed was 14.5 (12.1 men, 17.4 women), representing 3,98% of the time lost due to illness. The main causes of absence were: complications of pregnancy and mother's diseases during pregnancy (33% of the sick leave days in women), injury and poisoning (men: 24%; women: 8%), diseases of the musculoskeletal system (men: 17%; woman: 11%). The highest level of sickness absence was noted in the lódzkie, slaskie and warminsko-mazurskie provinces (38-19% higher than nationwide) and in the administrative and support sectors (22.2 days per 1 employee), when analyzed by sectors of the national economy. CONCLUSIONS: The high increase in sickness absence over the recent 7 years due to cancer, mental and muscloskeletal disorders may be an important risk factor for early assessment of permanent incapacity for work. Another major problem is female sickness absence due to pregnancy complications and mother's diseases during pregnancy.

Fire Properties of Paper Sheets Made of Cellulose Fibers Treated with Various Retardants.

This article presents the results of flame-retardancy tests conducted on cellulose sheets produced using a Rapid Köthen apparatus treated with retardants. The agents used were potassium carbonate (PC) K2CO3 (concentrations of 20; 33.3; and 50% wt/wt), monoammonium phosphate (MAP) NH4H2PO4 (concentrations of 35% wt/wt), diammonium phosphate (DAP) (NH4)2HPO4 (concentrations of 42.9% wt/wt), and bisguanidal phosphate (FOS) C2H10N6 (concentrations of 22.5% wt/wt). The agents were used to improve Kraft cellulose-based sheets' flame-retardant properties and compare their performances. As part of the study, the flammability of the materials was determined by the following methods: an oxygen index (OI) test, a mass loss calorimeter (MLC) test, and a mini fire tube (MFT) test. All formulations showed an increase in flame retardancy compared to the control test. All protected samples were non-flammable for OI determinations, and DAP-protected samples showed the highest OI index. For the MLC test, DAP-protected and MAP-protected samples showed the best heat-release rate (HRR), total heat release (THR), and average heat-release rate (ARHE) (samples did not ignite for 600 s). In the MFT test, all treated samples had comparably reduced weight loss. The best parameter was achieved for MAP and DAP (15% weight loss).

[Evaluation of osteoporotic fractures in the group of woman over 50 years of age--comparison of tools FRAX BMD versus FRAX BMI]. / Ocena ryzyka zlaman osteoporotycznych w populacji kobiet w wieku powyzej 50 lat-- analiza wskazników FRAX BMI i FRAX BMD.

BACKGROUND: The aim of the project is to identify the risk of osteoporotic fractures in women aged over 50, the of FRAX BMD and FRAX BMI in women with and without osteoporotic fractures and the proposal of therapeutic starting points for treatment of osteoporosis. MATERIAL AND METHODS: A group of 1014 women aged 50-89, living in the Kujawsko-Pomorskie province, was investigated. The analysis was based on the WHO definition of osteoporosis. Calculations of 10-year absolute risk of major osteoporotic fractures (AR-10 MOF Fx) and femoral neck fractures (AR-10 FN Fx) were done using Polish 3.3 version of FRAX tool. The analysis of fracture risk employed the logistic regression method. RESULTS: A statistically significant relationship was found between the risk of osteoporotic fractures and age, femoral neck BMD, a history of previous osteoporotic fractures, estimated calcaneal BMD and vertebral column BMD. The differences between 10-year absolute risk of major osteoporotic fractures BMD and BMI was small, which means that FRAX BMI might be a useful tool for GPs and occupational medicine specialists. CONCLUSIONS: A high usefulness of the FRAX BMI tool for evaluating the risk of major osteoporotic fractures provide a new possibility of identifying women at risk of such events. The mean value of 10-year absolute risk of major osteoporotic fractures for FRAX BMD and BMI was identified as 10% and 12%, respectively and these values were proposed as therapeutic starting points for treatment of osteoporosis in women living in the Kujawsko-Pomorskie province.

[Certain issues concerning medical certification and driving fitness assessment after craniocerebral traumas]. / Wybrane zagadnienia orzekania o stanie zdrowia i zdolnosci do prowadzenia pojazdów: osób po przebytych urazach czaszkowo-mózgowych.

BACKGROUND: The incidence of craniocerebral traumas increases with a growing number of road accidents. It should be emphasized that it is rather difficult to determine precisely the craniocerebral traumas incidence rate, however, it is well known that road accidents are the major cause of these injuries. MATERIAL AND METHODS: The study embraced 43 men (mean age: 47.1; SD: 11.4) after craniocerebral traumas. Of the 43 men, 23 drivers had driving license of the following classes: A, Al, A2, AM, B, B1 and BE without professional driving permit, and 20 men worked as professional drivers licensed according to the following classes: C, CE, C1, C1E, D, DE, D1 and DIE. The duration of drivers' employment ranged from 4 to 33 years (mean: 19 years; SD: 7.7). The clinical diagnosis was based on the patient's medical history, medical records, neurological examination complemented with other specialist examinations. RESULTS: Posttraumatic encephalopathy diagnosed in 23 (53.5%) patients was characterized by varied clinical symptoms. Posttraumatic simple encephalopathy diagnosed in 13 patients was the most frequent contradiction to run motor vehicles. Posttraumatic epilepsy was a contradiction in 5 and posttraumatic subarachnoid haemorrhage in 2 patients (one with neurological deficiency hemiparesis, the other with frontal lobe syndrome. Following the treatment 46.5% of men under study did not show neurological deficits and were allowed to run motor vehicles. CONCLUSIONS: The certification procedure in cases of past craniocerebral traumas should not follow the routine and careful examination of each individual case is required prior to assessing a driver's ability to run motor vehicles.

[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.

[Occupational stress and the risk of sickness absence in customer service workers]. / Stres zawodowy a ryzyko absencji chorobowej na stanowiskach obslugi interesantów.

BACKGROUND: The aim of this study was to indicate psychosocial stressors at work that significantly affect sickness absence a workers. MATERIALS AND METHODS: Study subjects included a group of 233 randomly selected women employed as post-office clerks. Sickness absence data covered the period of 2004-2006. The psychosocial factors were assessed by means of the Subjective Work Characteristics Questionnaire. The hazard ratio (HR) of sickness absence was analysed using the Cox regression model, separately for short- (1-9 days) medium- (10-29 days) and long-term (30 days and above) sickness absence. RESULTS: The shortterm sickness absence risk was significantly related with the post-office size--in the offices employing 8-12 workers, the risk was by 50% lower compared to those employing a smaller number of workers (HR = 0.49; 95% CI: 0.27-0.90) and unpleasant working conditions (dirt), which contributed to the increased risk (HR = 1.30; 95% CI: 1.12-1.50). In the case of a 10-29-day absence, the risk was slightly elevated by the demand of long-term vigilance, financial responsibility, and strictly determined breaks at work In the model of long-term sickness absence, a significantly higher risk was noted when the number of employees was 16-25 compared to a smaller number of employees (HR = 2.92; 95% CI: 1.09-7.82), non-occupational, self-assessed workload was high (HR = 2.97; 95% CI: 1.34-6.62) or moderate (HR = 2.22; 95% CI: 1.11-4.44) compared to self-assessed low workload, and the work space was limited (HR = 1.21; 95% CI: 1.00-1.47). CONCLUSIONS: Our analysis showed a significant effect of stressogenic work conditions on the patterns of sickness absence. Our findings may help in developing programs intended to reduce sickness absence through limiting the prevalence of unfavourable conditions at workplaces.

[Certain sickness absence factors among workers older than 45 years]. / Niektóre uwarunkowania absencji chorobowej osób powyzej 45. roku zycia.

BACKGROUND: Along with many other factors, such as demographic features of a given population, working conditions, psychosocial, social and cultural factors, socioeconomic transformation and labor market situation exert their effects on health conditions of workers and also on sickness absence. The aim of the study was to highlight major determinants, including non-health determinants, which shape the sickness absence among persons older than 45 years. MATERIAL AND METHODS: The study was carried out in a group of workers aged over 45 years, but before reaching the age of retirement who were employed in the production and production-related sectors in the years 1996-2000. Individual Sickness Absence Cards (ISAC) and the questionnaire "Health-related and socioeconomic determinants of early retirement among workers at the age of work capability" were used to collect the empirical material. The material was analyzed using Cox regression, separately for short-term (4-14 days) and long-term (longer than 14 days) sickness absence cases, to calculate hazard ratio (HR). RESULTS: The analysis based on a multi-factor model of the short-term sickness absence risk showed the effect of the following variables on the aforementioned risk: too heavy physical work (HR = 1.65; 95% CI: 1.24-2.18), low self-assessment of one's own health (HR = 1.18; 95% CI: 0.96-1.45), and frequent (at least once a month) beer drinking (HR = 1.15; 95% CI: 0.96-1.38). The risk of long-term sickness absence was increased for health-related variables, such as occurrence of 2-3 chronic diseases (HR = 1.86; 95% CI: 1.05-3.30), occurrence of 4 or more diseases (HR = 2.65; 95% CI: 1.43-4.92), and smoking (HR = 1.48; 95% CI: 1.11-1.98). CONCLUSIONS: The results of the study may become an important signal for undertaking preventive activities to improve working conditions for older physical workers, as well as for improving health and work ability in this group of workers.

[Some job factors associated with departure from working life before retirement age]. / Wplyw czynników zawodowych na ryzyko odejscia z pracy przed osilgnieciem wieku emerytalnego.

BACKGROUND: Ongoing demographic changes observed in Poland indicate progressive aging of the population. The process of systemic transformation initiated in Poland in 1989 has contributed to a significant decline in occupational activity among people especially those at the pre-retirement age. The identification of determinants responsible for the decreased occupational activity in older age groups of the population may provide the basis for taking appropriate steps to extend their period of employment, which will become a must in the near future in view of current socio-demographic phenomena. Therefore, the aim of the this study was to identify factors, which mostly contribute to an earlier departure of older workers from working life. The presented analysis concerns occupational factors characteristic of working conditions. MATERIAL AND METHODS: The study was carried out in a group of current and former workers aged over 45 years and below the retirement age, employed at production workposts and in production services in the years 1996-2000. Active workers of the same age (+/- 3 years) and gender, employed at adequate workposts were matched with selected persons who had left their job because of becoming entitled to disability pension, earlier retirement, benefit or pre-retirement allowance. A questionnaire-based interview was used to collect empiric material, and logistic regression to analyze the risk of earlier departure from working life. RESULTS: The investigation carried out in the study group showed that the following factors mostly influenced departure from work before reaching the retirement age: piecework system (OR = 7.76; 95% CI: 2.53-23.79); heavy lifting at work (OR = 1.90; 95% CI: 1.11-3.25); physical workload (OR = 1.92; 95% CI: 0.74-5.00); exposure to low temperature (OR = 1.71; 95% CI: 0.94-3.09); exposure to whole-body vibration (OR = 1.47; 95% CI: 0.96-2.25); subjective assessment of fatigue after work (OR = 2.25; 95% CI: 1.45-3.48); and no leisure time after work (OR = 2.71; 95% CI: 1.52-4.83). CONCLUSIONS: The results of the study can be regarded as an important indication that appropriate preventive measures should be taken to improve working conditions especially for older age groups, or to provide the possibility of their retraining if the occupational activity of older workers is to be increased.

[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.

Predictors of short- and long-term sickness absence in female post office workers in Poland.

BACKGROUND: The aim of this study was to highlight major predictors of the frequency of sickness absence in a group of workers directly involved in customer service. MATERIAL AND METHODS: The study was carried out on a random sample of 229 women employed as assistants and clerks in post offices. The survey was based on the Subjective Work, Health Status and Life Style Characteristics Questionnaire, and sickness absence data for the years 2004-2006. RESULTS: The negative binominal regression model of sickness absence risk revealed the following significant predictors of short-term absence spells (1-29 days): 1) marital status, sickness absence risk for single women was (rate ratio (RR)) = 1.56 (95% confidence interval (CI): 1.01-2.39) vs. married women; 2) post offices employing 7 workers had a rate ratio of sickness absence of 1.6 (95% CI: 1.04-2.42); 13-25 workers - RR = 2.03 (95% CI: 1.41-2.93); > 25 workers - RR = 1.82 (95% CI: 1.15-2.88) compared with an average number of 8-12 workers; 3) shift work, RR = 1.57 (95% CI: 1.14-2.14); 4) breaks from work - the risk of absence in the case of any breaks amounted to RR = 1.5 (95% CI: 1.07-2.07) in comparison with the statutory breaks; 5) self-rated health reported as moderate relative to good health, RR = 1.71 (95% CI: 1.26-2.32); and 6) occurrence of respiratory diseases resulted in the risk of RR = 1.51 (95% CI: 1.08-2.08). The Poisson regression model of long-term sickness absence spells (≥ 30 days) revealed the following significant predictors: 1) number of clients per shift: 51-100 clients, RR = 3.62 (95% CI: 1.07-22.6) compared with a lower number of clients; 2) self-rated health, assessed as moderate, RR = 1.97 (95% CI: 1.06-3.78) and 3) household chores performed for at least 4 h a day, RR = 0.4 (95% CI: 0.18-0.79). CONCLUSIONS: Association between sickness absence and workload as well as work organization indicates directions of corrective actions, which could reduce the scale of the problem.

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.

[Health reasons for work disability among municipal transport drivers]. / Zdrowotne przyczyny niezdolnosci do pracy wsród kierujacych pojazdami komunikacji miejskiej.

BACKGROUND: The health condition of public transport drivers is one of the factors playing a role in assuring safety of passengers taking use of this kind of transportation means. Therefore, the assessment of pathologies occurring in this occupational group is essential from the prevention point of view. Drivers employed in the municipal transport system are at particular risk. The aim of the study was to define health reasons of work disability among bus and tram drivers in general and to indicate pathologies responsible for disabilities in particular. MATERIALS AND METHODS: The study covered 940 drivers (including 788 men and 152 women) employed in a municipal transportation enterprise during the years 1996-2000. Bus (30%) and tram (22%) drivers as well as transport service workers (48%), aged over 45 years, but under the retirement age, were eligible for the study. The analysis of temporary work disability during a five-year period was based on sickness absence, sickness absence rate and the average duration of sickness absence. RESULTS: The analysis revealed that diseases of the circulatory system form the major group of pathologies responsible for total sickness absence among bus drivers (43%), tram drivers (27%) and transport service workers (27%). These disease are also a leading cause of earlier retirement. They mostly include ischemic heart disease in bus drivers and hypertension in tram drivers. Cancers (pleura, kidney and eye) were responsible for 9% of sickness absence in the group of male tram drivers, whereas endocrine, nutritional and metabolic diseases and immunity disorders (diabetes, disorders of thyroid gland) in 16% of female tram drivers. Diseases of the musculoskeletal system were major causes of sickness absence among female tram drivers (24%), whereas malignant and benign neoplasms of breast and uterine myoma in 24% of female transport service workers. CONCLUSIONS: The results of the analysis are in agreement with the literature findings and provide explicit evidence that employment in the municipal transport system is the risk factor responsible for the development of serious diseases such as musculoskeletal disorders and neoplasms. Bearing this in mind, this occupational group (bus and tram drivers) should be covered by specially designed prevention programs to protect them against these pathologies, turning special attention to health promotion at and outside workplace.

Predictors of lung cancer among former asbestos-exposed workers.

OBJECTIVES: Despite extensive literature concerning the risk of lung cancer incidence among asbestos workers there is still lack of data specifying the association between the level of exposure and the frequency of cancer occurrence. The aim of the analysis was to assess the influence of smoking and selected factors related to occupational exposure on the risk of the incidence of lung cancer among the workers who were exposed to asbestos dust in the past. MATERIAL AND METHODS: The assessment was performed based on the case-control studies carried out within a cohort including 7,374 former workers of asbestos processing plants, examined over the years 2000-2013. Analysis of the material was based on the calculation of the odds ratio (OR) using conditional logistic regression modeling, adjusted for cigarette smoking, cumulative exposure, branch and time since last exposure. RESULTS: During the survey period there were 165 cases of lung cancer. Among the individuals who smoked, the relative risk of lung cancer incidence was twice as high in the persons smoking more than 20 pack-years (OR=2.23; 95% CI: 1.45-3.46) than it was in the case of the non-smokers. Analysis revealed that the risk of lung cancer in the group with the highest exposure was two times higher in comparison with the low cumulative asbestos exposure (OR=1.99; 95% CI: 1.22-3.25). The risk continued to increase until 30 years after cessation of asbestos exposure and started to decline many years after the last exposure. Influence of the mentioned above characteristics is particularly visible for tumors located in the lower parts of the lungs. CONCLUSION: Our findings confirm the strong evidence that the lung cancer risk is associated with asbestos exposure and it increases along with the increasing exposure. A strategy of smoking cessation among the individuals exposed to asbestos dust would potentially have health promoting effects.

Work-related injuries among firefighters: sites and circumstances of their occurrence.

The aim of the present study was to determine the injury ratio, causes and duration of temporal work disability from on-duty injuries among firefighters, taking into account the site and circumstances of their occurrence. The study was performed on a representative sample of 1503 firefighters from 29 fire stations who were employed between 1994 and 1997. Subject to investigation were data on the number of days and cases of work disability due to on-duty injury, personal data (age, work duration) and data on the circumstances of injury during emergency operations, taking part in compulsory physical training, performing maintenance and repair works, on duty at the fire station, and when commuting to or from work. The analysis of work-related causes and circumstances of injuries among firefighters revealed that the majority of injuries (40%) occurred during compulsory physical training, being responsible for 41% of post-injury absence at work. The workers employed for less than one year were at highest risk of injury. Injuries during emergency operations made 25% of all injuries and accounted for 24% of post-injury absence. The analysis of data showed that the frequency of injuries was not significantly aged-dependent, however, the duration of work disability was found to increase by 20% with increasing age of workers. The results indicated the need for undertaking preventive interventions to minimize occupational hazards to those involved in firefighting.

[Health reasons for work disability among persons before going into early retirement]. / Zdrowotne przyczyny niezdolnosci do pracy przed odejsciem na wczesniejsza emeryture.

BACKGROUND: The demographic situation in Poland shows a progressive ageing of its population and a concomitant decrease in the number of people of the productive age. The identification of health problems in older groups of people of the productive age is essential for gaining better knowledge of measures to be taken in order to extend the period of occupational activity in this groups of workers. The aim of the study was to define the health status of persons going into early retirement on the basis of their sickness absence history covering the five preceding years. MATERIALS AND METHODS: The study was conducted among workers, aged over 45 years and below the retirement age, employed at production posts or operating production processes. The analysis covered 303 workers who went into early retirement in the years 1996-2000 and 485 persons in the same age group, but still employed. Information on the health causes of their disability to work during a five-year period was collected for both groups of persons. The temporary work disability was analyzed using the following parameters: sickness absence rate, sickness absence cases and the average duration of sickness absence. RESULTS: The study showed that the total sickness absence among persons going into early retirement during the preceding five years was 64% for men (sickness absence rate--18.56) and 14% for women (sickness absence rate--15.97), and it was higher compared to still employed persons. These differences were mostly observed in the group of diseases of the nervous system and sense organs (over twofold difference in men and about 58% in women), diseases of the circulatory and respiratory systems in men and diseases of the genitourinary system in women (about twofold difference). The main causes of sickness absence were: diseases of the circulatory (29% of male and 16% of female sickness absence), musculoskeletal (19 and 17%, respectively), and respiratory (15 and 19%, respectively) systems, as well as diseases of the nervous system and sense organs (15% of male sickness absence) and neoplasms (12% of female sickness absence). CONCLUSIONS: The results of the study indicate that in the older group of workers, health problems are one of the major causes of going into retirement before reaching the retirement age.

[Sick leave among workers employed in restructured enterprise]. / Absencja chorobowa w przedsiebiorstwie po restrukturyzacji.

Ownership and restructuring transformations that are taking now place in Poland, as well as the situation on the labor market have their impact on the indicators, which illustrate the workers' health situation, including temporary work disability preceding the issue of the certification granting the disability pension. The aim of this analysis was to identify the changes in the extent and causes of sickness absence among workers after restructuring. The study was carried out in one of the largest transport industry enterprises during the years of its restructuring (1984-1994), covering 8588 workers, and after its restructuring (1997-1999), covering 2702 workers. Following the restructuring, the enterprise's staff was rejuvenated so that the number of workers aged over 50 years decreased by almost fifty percent. The analysis was based on the sickness absence rate calculated as the ratio between the number of days of work disability in a given period of time and the number of person-days in the same period. In 1997-1999, a 33% decrease in sickness absence among women and a 25% decrease among men were observed in the study enterprise as compared with the period of 1989-1994. However, the enhanced absence was also found due to the following diseases: mental disorders (a threefold increase in men); diseases of the musculoskeletal system (by 54% in men and by 43% in women); endocrine, nutritional and metabolic diseases and immunity disorders (a threefold increase in women). Following the restructuring, considerable changes in the sickness absence structure, by causes of diseases, were revealed. A substantial decrease in the share of male and female absence due to diseases of the respiratory and circulatory systems and almost threefold decrease in complications of pregnancy, childbirth and the puerperium in women were noted. In addition, over twofold increase in male and female sickness absence due to diseases of the musculoskeletal system, and lower but significant increase due to mental pathologies (from 3 to 12% in males and from 4 to 7% in women) were recorded. The changes observed in sickness absence result mainly from the changes in the magnitude and structure of employment in the restructured enterprise and related organizational modifications, which arise stressogenic situations among workers, more intensified at risk of unemployment.

[Health reason for firefighters to leave their job]. / Zdrowotne przyczyny odejscia ze sluzby strazaków jednostek ratowniczo-gasniczych.

The objective of this study was to identify major pathologies among firefighters, being the cause of leaving the job. The study was based on the analysis of temporary work disability and disability certificates, taking account of age and duration of employment in the capacity of a firefighter. The study was performed on a representative sample of 1503 firefighters, employed between 1994 and 1997 in 29 fire stations. During that period, 214 firefighters left their job (40% of them got retired and 38% of persons were given the right to receive disability pension). The analysis revealed the average annual frequency of leaving the job by firefighters that accounted for about 43/1000 persons (including 17 retired and 16 persons on disability pension per 1000 firefighters, respectively). Among firefighters, the frequency of leaving the job because of retirement or permanent disability was by 60% higher than among workers employed in different branches of the national economy. The analysis of the relationship between leaving the job and the duration of employment (adjusted for age) showed that the majority of those retired left job after 15 years and those on disability pension after 22 years. Sick absence among firefighters who left the job because of disability and retirement was respectively 13 and 4 times higher than that observed among firefighters in active service. Diseases of the musculoskeletal and circulatory systems and mental disorders were the most common causes of disability. Diseases of the circulatory system (26%), diseases of musculoskeletal system (25%) and mental disorders (16%) were the main causes of sick absence among those disabled, whereas diseases of the musculoskeletal system (26%), nervous system and sense organs (24%) and digestive system (13%) among those getting retired. The study indicated an interchangeable nature of two main reasons why firefighters leave their job (retirement and disability), which results from the right to get retired after 15 years of employment, regardless of the age. The aforesaid pathologies, being the major causes of disability certification and temporary disability for work should be the basis for developing an enlarged program of compulsory preplacement medical examinations addressed to candidates for employment in a fire-brigade.

[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.

[Prophylactic examinations of former workers of asbestos processing plants: the Amiantus project]. / Program badan profilaktycznych bylych pracowników zakladów przetwórstwa azbestu--Amiantus.

Prophylactic examinations of the former workers of asbestos plants are performed by virtue of the Law of 19 June 1997 on a prohibition against the use of asbestos-containing products. Periodical examinations allow to detect pathological changes in the pre-symptomatic or early-symptomatic period, which permits to apply an appropriate treatment and slows down considerably the progress of morbid processes. The main objectives of the surveillance and coordination are as follows: (1) to assure good quality of prophylactic examinations through the uniform methods of medical examinations and the detection of pathology resulting from the exposure to asbestos dust, based on international criteria for diagnosing asbestos-related diseases (the Helsinki criteria, 1997); (2) to monitor the respiratory health effects among persons occupationally exposed to asbestos dust; and (3) to keep the database on persons examined and subjected to periodical prophylactic examinations throughout the country. The program of prophylactic examinations of persons occupationally exposed to asbestos dust includes mass screening. For the purpose of this program, a unified strategy of mass screening, including documentation (questionnaires on clinical, radiological and spirometric examinations) and instructions for persons responsible for performing these examinations has been worked out. Each center involved in the implementation of the program has been provided with binding criteria elaborated on the basis of the world standards (the Helsinki criteria, 1977) of clinical, radiological, spirometric and histological examinations aimed at detecting asbestos-related diseases: asbestosis, fibrous mesothelioma and lung cancer. The data obtained will serve as a basis for assessing the morbidity and incidence of asbestos-related diseases among persons occupationally exposed to asbestos dust in asbestos processing plants.