[Good practice in occupational health services: recommendations for prophylactic examinations and medical certifications in persons with diabetes mellitus]. / Dobre praktyki w opiece profilaktycznej nad pracujacymi-zalecenia do badan profilaktycznych oraz postepowania orzeczniczego u osób z cukrzyca.

The prevalence of diabetes and a significant proportion of unawareness of its risk among the patients indicate the need to include into general prophylactic examinations the standards of medical certification, which would prevent discrimination and ensure public safety. In certifying medical predispositions to work in a person with diabetes mellitus the key issue is to distinguish 2 categories of medical requirements: the higher - related to qualifying workers for jobs demanding psychophysical abilities, which affect the safety of the workers and their environment and the lower - related to qualifying workers for jobs characterized by harmful factors and nuisances, which might have a negative effect on the course of diabetes. The very fact of having diabetes cannot be the reason for the patient being disqualified and the decision on certifying the capacity to perform a particular job should always be based on an individual health assessment of the patient, taking into account the risk of hypoglycemia, metabolic control, the progression and dynamics of chronic complications, as well as the level of health awareness in patients. The objective assessment of the health status of the patient with diabetes involves the judgment of an attending physician, additionally supported by the consultation of a diabetes specialist to ensure that the patient is able to perform properly the job, requiring psychomotor abilities.

[New medical standards for evaluation of driving predispositions of people suffering from diabetes mellitus]. / Nowe zasady orzecznictwa lekarskiego w zakresie oceny predyspozycji zdrowotnych do kierowania pojazdami u osoby chorej na cukrzyce.

As a result of the changed Ordinance of January 7, 2004, issued by the Ministry of Health, new medical standards for assessing people suffering from diabetes mellitus, in terms of their health contraindications for driving, came into force on June 29, 2011. Thus the medical standards for diabetes and driving have been harmonized with EU regulations. New standards for diabetes and driving define the key terms such as severe and recurrent hypoglycemia, and hypoglycemia awareness. In addition, health contraindications for Group 1 and Group 2 driving license, deadline for subsequent medical check-ups and indications for diabetologic consultation are defined. The regulations also introduce a new tool in the form ofa consultation file produced by the diabetologist. The structure of the consultation file imposes on the diabetologist an obligation to provide the physician, certifying the ability or disability to drive, the key diabetologic information. This guarantees an objective medical opinion based on an individual approach appropriate for each case.

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 patient's GP is necessary.

[Is healthcare personnel the only professional group exposed tothe risk of occupational HBV, HCV or HIV infections?]. / Czy ryzyko narazenia zawodowego na zakazenie wirusami HBV, HCV, HIV dotyczy tylko pracowników ochrony zdrowia.

BACKGROUND: Our paper presents the problem of exposure to potentially infectious material among health care workers, and also in police officers, prison guards, cleaning service personnel and ordinary citizens. MATERIALS AND METHOD: In the study period, 200 patients were admitted to the Infectious Diseases Clinic after exposure to potentially infectious materials in order to evaluate the risk of HBV, HCV and HIV infections and initiate post exposure prophylaxis. HBsAg, a-HCV and a-HIV were carried out on the day of admission, a-HBs was measured in patients who had been vaccinated against hepatitis B virus. Clinical evaluation of HBV, HCV, HIV infections was performed in the source patients' plasma. RESULTS: The study population consisted of 93 health-care workers (63 nurses, 25 physicians, and 5 medical students), 30 policemen, 23 prison guards, 42 cleaning service workers employed in health-care centers. The remaining 12 patients were inhabitants of the Lodz region who had not been occupationally exposed to potentially infectious material. CONCLUSIONS: Although "safe needles" are in use, exposure among health care personnel still occurs. The problem of occupational exposure among police officers and prison guards is highly underestimated. The lack of control over the vaccination against hepatitis B virus in groups not related with health care creates the risk of new infections.

[The medical certification for diabetic drivers in selected countries outside Europe]. / Postepowanie orzecznicze u kierowców chorych na cukrzyce w wybranych krajach pozaeuropejskich.

There are still many countries, which have not yet developed uniform recommendations on how to certify fitness to drive among people with diabetes mellitus. Studies on this problem from the European Union emphasize that recommendations issued in Canada, Australia and New Zealand are most unequivocal. There are a lot of factors affecting fitness to drive, therefore, assessing medical fitness to drive among driver candidates, as well as of persons who have a driving license but are obliged to extend its validity is absolutely essential. Health impairments may influence the ability to drive and lead to serious consequences. In all countries under study, the incidence and unawareness of hypoglycemia is the most important risk factor that influences fitness to drive. It is also important to take into consideration the current treatment modality. The presence and progress of chronic diabetic complications, which may influence driving must be assessed. Diabetes mellitus is a complex problem. Certifying fitness to drive among people with diabetes, the risk of road traffic accident for an individual and for other participants need to be well balanced.

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.

[Prevalence of impaired carbohydrate metabolism among public transport drivers]. / Wystepowanie zaburzen gospodarki weglowodanowej u kierowców transportu drogowego.

BACKGROUND: Considering the high incidence of impaired carbohydrate metabolism and the potential risk of diabetic complications posed to transport drivers, an attempt was made to assess the prevalence of diabetes among public transport drivers. MATERIAL AND METHODS: Medical records of 570 public transport drivers examined at an occupational health unit in one of the Polish towns with a population of 350.000 was the subject of analysis RESULTS AND CONCLUSIONS: The investigation revealed that 47.5% of the study population showed hyperglycemic conditions with the mean fasting glucose concentration of 99.9 mg/dl. A single case of abnormal glucose tolerance was diagnosed and 263 cases were recorded as hyperglycemia without final diagnosis. The diabetes-related morbidity amounted to 1.4%, which was over three times as high as in the general population of the same age. Every four case of diabetes was diagnosed during prophylactic examinations. Moreover, 2.45% of the subjects had glycemia levels classified as diabetic (fasting glucose > or = 126 mg/dl). The subject's age of more than 45 years and hyperglycemia revealed in previous laboratory findings were found to increase the risk of impaired carbohydrate metabolism by three times.

[Opinions on medical certification procedures for driving and diabetes presented by occupational medicine and diabetology experts]. / Opinie ekspertów w dziedzinie medycyny pracy i diabetologii dotyczace postepowania orzeczniczego u kierowców z zaburzeniami gospodarki weglowodanowej.

BACKGROUND: In Poland, there is an urgent need to set criteria and recommendations for medical certification of persons working or taking up the job involving driving vehicles when diabetes or other intermediate hyperglycemia could have particularly important and dangerous impact. Along with scientific research, literature reviews and knowledge of laws, rules and regulations, the opinion of experts on the subject plays an important role in establishing standards and recommendations for occupational physicians according to the latest medical knowledge and legislation requirements. MATERIALS AND METHODS: The questionnaire survey was conducted with the involvement of occupational medicine and diabetelogy consultants at the national and regional levels. RESULTS AND CONCLUSIONS: Experts unanimously opted for the need to establish recommendations for medical certification of drivers with diabetes. They indicated the required procedures concerning hyperglycemic patients, recommended an individual treatment of patients with diabetes and stressed that the reduction of hypoglycemia risk among drivers of motor vehicles should be given top priority.

[Medical certification for diabetic drivers in the selected European Union member states]. / Postepowanie orzecznicze u kierowców chorych na cukrzyce w wybranych krajach Unii Europejskiej.

There is in Poland an urgent need to set criteria and recommendations for medical certification of individuals working or taking up the job involving public safety, in which diabetes could have a particularly important and dangerous impact. In Europe, many countries have restrictions for diabetic drivers. Diabetes is identified as one of the medical conditions that may impair driving ability and thus drivers with diabetes must meet certain medical standards. The European Union legislation states that diabetic patients taking insulin are excluded from driving trucks, heavy goods vehicles, and buses, except for small trucks in "very exceptional cases". This directive is interpreted differently throughout the European Union. Several aspects should be taken into account when evaluating the current status of the medical certification: e.g., duration of diabetes, type of diabetes treatment, diabetes stability, hypoglycemias in the past, and diabetes complications.

[Diabetes mellitus: an issue for medical certification]. / Cukrzyca--nierozwiazany problem orzeczniczy.

Diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long- term. The number of people with diabetes and other glucose impairments is increasing due to population growth, aging, urbanization, and physical inactivity. In Poland, it has been estimated that there are about two million people with diabetes, half of them are not aware of their illness. Hypoglycemia is the most common and potentially most serious adverse effect of pharmacotherapy in diabetes, regardless of the model of treatment. The potential risk factors for severe hypoglycemia in subjects with treated diabetes are: physical activity, lifestyle circumstances, irregular eating habits, drug interaction or shift work. Therefore, there is an urgent need to set criteria and recommendations for medical certification of individuals working or taking up the job connected with public safety, where diabetes could have a particularly important and dangerous impact.

Modern technology in lifelong learning of occupational medicine.

The introduction of new learning technologies and an increasing usage of the Internet have the potential of changing the image of postgraduate education. A rapid progress in innovative communication systems has lead to essential changes in conditions of acquiring knowledge and professional skills. This has resulted in the development of different educational models and the incorporation of computer-assisted education into training programs. In 2002, the School of Public Health at the Nofer Institute of Occupational Medicine has launched first in Poland the introductory course in occupational medicine specialization in the form of distance education. The course was recognized to be equivalent to the traditional face-to-face education. The training process was based on the use of CD-ROM. E-mail was used as the main means of communication to facilitate the exchange between trainers and trainees. Particularly wide interest in distance education among physicians specializing in occupational medicine indicates the need to consider the possibility of introducing consecutive courses, which are required for specialization or for other professional developments in this form of teaching. The purpose of this paper was to discuss the development and implementation of a distance learning course taking into consideration the academic and educational requirements necessary for effective education and training at the post basic level.

[New forms of training in occupational medicine]. / Nowe formy ksztalcenia w medycynie pracy.

An extremely rapid progress in innovative communication systems has led to essential changes in conditions of acquiring knowledge and professional skills. This resulted in the development of different educational forms, focusing especially on distance learning, where trainers and trainees placed in different locations use different means of communication and information exchange, including most up-to-date information technology (IT). In 2002, the first distance learning specialization course for physicians was launched by the School of Public Health at the Nofer Institute of Occupational Medicine in Lódz. The e-based introductory course in occupational medicine was recognized as an equivalent to the traditional on-campus training. The training process is mainly based on CD-ROM containing lectures and necessary links to external sources of the internet information. E-mail is used as the major communication mean to facilitate the exchange between trainers and trainees. The quality control of the training involved two streams of effectiveness and utility measurement systems. The quality of distance learning, evaluated one year after its commence, is comparable with that of the on-campus training.

[Diabetes the challenge for public health]. / Cukrzyca wyzwaniem dla zdrowia publicznego.

Diabetes is one of the most costly and burdensome chronic diseases of our time and is reaching pandemic proportions throughout the world. Diabetes is frequently associated with long-term complications causing damage or failure of various organs such as the eyes, kidneys and nerves. Premature disability in this group of patients results in the loss of productivity, increased morbidity and mortality rates, and higher health care costs. Health care costs of diabetes rise because of increasing number of newly diagnosed cases of diabetes and its complications. Preventive measures in diabetes especially type 2 accounting for 90% of cases worldwide can be properly applied because most of the risk factors are well known. Prevention is less costly financial resources than the treatment, but the measurable economic and social profits will be seen in the future. The management of diabetes should be changed from traditional medical to the activity of public health. Public health messages, health care professionals and health care systems should all encourage behavior changes to achieve a healthy lifestyle that can prevent type 2 diabetes.

[Distance learning in postgraduate training of professionals. Example of occupational medicine specialization]. / Mozliwosci wykorzystania metod distance learning do podyplomowego ksztalcenia lekarzy na przykladzie specjalizacji z medycyny pracy.

The rapid development of science, technology, economy and the society has one along with the wide recognition of lifelong education and learning society concepts. Scientific centres worldwide conduct research how the access to the information and multimedia technology could bring about positive changes in our lives including improvement in education and the learning environment. Mankind development in conformity with social progress and sustainable development faces a new educational concept of learning society and open education in the information age, supported with multimedia and data processing technology. Constrains in resources availability for broadening the access to education had led to search for alternative, more time and cost-effective systems of education. One of them is distance learning, applied with success in many countries. The benefits of distance learning are well proven and can be extended to occupational medicine. Major advantages include: the integration of studies with work experience, flexibility, allowing studies to be matched to work requirements, perceived work and leisure timing, continuity of career progression. Likewise is in Poland this form of education becomes more and more popular. The distance education systems have been seen as an investment in human resource development. The vast variety of courses and educational stages makes possible the modern method of knowledge to be easily accessible. Experience of the School of Public Health in Lódz in distance learning had shown remarkable benefits of the method with comparable quality of intramural and distance learning in respect of the knowledge and experience gained by students.

Shift work and metabolic syndrome, diabetes mellitus and ischaemic heart disease.

Shift work is affecting 20% to 25% employees and is becoming increasingly prevalent in contemporary life all over Europe and USA. It is associated with several health problems, such as e.g. metabolic syndrome, diabetes mellitus and cardiovascular disease. These diseases are possibly due to an impairment of biological rhythm. The metabolic syndrome is a complex of interrelated risk factors for cardiovascular disease and diabetes. Higher prevalence of the metabolic syndrome has been demonstrated among shift workers. Rotating shift work has an impact on each component of metabolic syndrome. Shift work might also have an impact on metabolic variables, and be a risk factor for type 2 diabetes. Only a few studies reported prevalence of impaired glucose metabolism and diabetes mellitus in relation to shift work. There is rather strong evidence in favour of association between shift work and coronary heart disease and that has been repeatedly demonstrated during over 20 years of research. Recent data increasingly reveal relations between shift work and plasma resistin, ghrelin, leptin and adiponectin.