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Occupational health in Poland.

Globalization and Poland's pending membership in the European Union have created a need for reappraisal of the country's occupational health and safety (OHS) programs. The current trend of industrial growth is likely to follow observed historical patterns in other parts of the world: the manufacturing sector will shrink, and the service sector will increasingly play a dominant role. Poland's OHS structure must be tailored accordingly. This article outlines the current state of OHS in Poland and indicates priorities for future research and special attention.

History, 20th Century↗
PubMed2002

[Occupational diseases--epidemiologic evaluation of the situation in Poland].

The incidence of occupational diseases is one of the basic indices of the effectiveness of prevention in the area of occupational health. It allows for the identification of jobs, plants and branches of the national economy with potentially increased risks for pathologies induced by working conditions. However, we should be aware of the fact that many of the recently diagnosed diseases result from long-term exposures experienced at work sites which are no longer under operation. The analysis was based on data included in occupational disease certificates. All sanitary and epidemiological stations throughout the country are committed to notify cases of occupational diseases to the National Register of Occupational Diseases at the Nofer Institute of Occupational Medicine in Łódź. After a significant increase in the number of occupational diseases (8305-12,017 cases per year) observed in 1980-1998, its decrease has been noted in Poland over the recent two years (9982 cases in 1999 and 7339 in 2000). In 1998-2000, a substantial decrease in the decreasing rate was also found (from 117.3 to 73.9 per 100,000 employed), which means that the decreasing trend does not result only from the increasing size of the working population in Poland. In 2000 like in previous years, among occupational diseases the following ones were most often diagnosed: diseases of vocal organ due to excessive voice effort most common in teachers, occupational hearing loss, pneumoconiosis, contagious and invasive diseases, dermatoses, chronic diseases of bronchi, vibration syndrome as well as acute and chronic poisonings. There were registered 6626 cases of the above listed diseases, that is 90.3% of all occupational diseases. In 1998-2000, a significant decrease in the incidence of this category of diseases was noted. The largest decrease applied to the vocal organ diseases, occupational hearing loss and contagious and invasive diseases (by 30%, 51% and 40%, respectively). Neither in the member states of the European Union, nor in the USA, vocal organ pathologies are listed among occupational diseases. The main reason for this is an inappropriate medical prevention in the group of teachers and somewhat limited opportunity to teach them how to use techniques of voice emission. A decreased incidence of occupational diseases observed in Poland in 1998-2000 results partly from improvements in working conditions and partly from more effective prevention.

Bronchial Diseases↗
PubMed2002

[Overweight and obesity in urban population in Poland in years 1983-1999].

There is a shortage of up-to-date data on the extent of the problem of overweight and obesity in Poland, although obesity is commonly considered as the 'epidemic of the end of the 20th century'. The aim of the study was to compare the percentages of overweight (BMI > or = 25) and obese (BMI > or = 30) adults from Wrocław population in particular categories of age, sex and social status. Material comprised the data of 15,641 men and 19,121 women aged 21-60, occupationally active inhabitants of Wrocław, examined in the DCDM 'DOLMED' in 1983-1999. BMI was used as a measure of general obesity (according to WHO categories). It was revealed that age, sex and social status significantly differentiated BMI of examined inhabitants of Wrocław. In the subsequent decades of life mean BMI values increased, hence an increase of percentages of overweight and obese persons was observed. More than the half of men exceeded their proper relative mass before 40 years of age, whereas the 2/3 of them had BMI over 25 before the age of 50 (independently on their social background). The process of increasing percentages of overweight women was socially differentiated; between the 3rd and the 6th decade of life the percentages of overweight women increased among intelligence from 16 to 60%, among clerks from 18 to 72% and among workers from 27 to 83%. A sexual dimorphism resulted in fact that in men an age-related increase of overweight subjects (25 > or = BMI < 30) was observed, whereas in women an age-related increase of obese persons (BMI ? 30) was found. In an urban population in Poland in the 1990s the percentage of overweight persons (BMI ł 25) exceeded 70% after the age of 50. Therefore--in the context of essential relationships between overweight and both mortality and morbidity--the health status of urban population in Poland is highly disturbing.

Adult↗
PubMed2002

Poland's syndrome with spontaneous pneumothorax: report of two cases.

Poland's syndrome is an uncommon congenital anomaly of the chest wall characterized by the absence of the pectoralis major muscle and other nearby musculoskeletal components. Many associated aberrations over the thoracic cage, intrathoracic organs, and upper limbs have been reported. However, spontaneous pneumothorax in these patients has not been reported. Here, we describe two patients with both Poland's anomaly and spontaneous pneumothorax. One patient was a 16-year-old boy with left chest wall hypoplasia and pneumothorax on the right side. The other was a 27-year-old man with right chest wall hypoplasia, hand brachydactyly, and pneumothorax. Pneumothorax in both patients was treated with bullectomy and mechanical pleurodesis with the aid of videothoracoscopy, and the postoperative courses were smooth. Blood supply disruption has been hypothesized as a pathogenic mechanism of both spontaneous pneumothorax and Poland's syndrome, suggesting an association between these two diseases.

Adolescent↗
PubMed2002

[Health care services for the elderly living in the rural area of Poland].

UNLABELLED: The aim of the paper was the indepth comparison of the health services use by the elderly living in rural and urban area of Poland. The representative survey of the 65-year old and older people was carried out in the year 2000, as a comparative study to the Piotrowski's survey from 1967. The sample (total N = 1821; consisted of 743 people living in rural and 1078 in urban area), was corresponding to the demographic structure of the general older population in Poland. RESULTS: As far as concerning socio-demographic features there were found slightly higher percentage of 'old old' people in rural community, their much worse living conditions and material situation in comparison to counterparts in urban community. The elderly living in the countryside have shown the worse subjective and objective health and functional indices. The positive selfrated health was found only in 12% of respondents living in rural and in 22% living in urban area. 71% people living in villages declared three or more complaints simultaneously while in the cities much less (57%). Moreover, the impairment of vision, hearing, chewing were found significantly more frequently among rural inhabitants, as well as almost twice higher percentages of dependence on P-ADL. The use of health services by the elderly during the last 12 months, in term of doctor's outpatient consultations, dentist visits rehabilitation, except of nurse visits, was significantly lower in countryside than in the cities. Use of an emergency (17%) and hospital stays (22%) was the same in the both sites. CONCLUSIONS: (1) Health status and functional ability of the older people living in rural area are dramatically worse than in cities. (2) Health care system for elderly people in Poland does not fulfill the geriatric standards in term of the commonness, availability and complexity. (3) The chance to improve health care on the elderly is an enhancement of knowledge and competence of practitioners in gerontology. The development of the geriatric base in the Medical Universities is a crucial for that.

Aged↗
PubMed2002

[Vaccination against rabies in Poland].

The data on anti-rabies vaccination in Poland in the last fifteen years are presented. In general, 89,019 people were vaccinated against rabies in Poland in the years 1986-2000, among them 580 after deep bite by rabid animal and 4814 after deep bite by an animal suspected of having rabies (III category of risk according to WHO). Among the patients with the III category exposition only a fraction were administered anti-rabies serum (12% of patients with deep bite by rabid animal), but this practice was becoming more frequent in recent years. 73% of patients were given vaccine after contact with domestic animals (dogs or cats), 9% after contact with wild foxes, which are the main reservoir of rabies in Poland. No cases of uneffective vaccination were observed. The preventive vaccination was sporadic and limited to persons with high professional risk of infection.

Animals↗
PubMed1975

[Mortality of children and adolescents in Poland caused by congenital cardiovascular system malformations, in 1961-1971 (author's transl)].

Congenital cardiovascular system malformations (including more than 90 per cent of heart malformations) constitute the largest group among patients with congenital malformations. The high mortality of children with these malformations in the first year of life (with the greatest threat in the first month of life) subsequently diminishes. The mortality rates of infants from congenital cardiovascular system malformations high in Poland and are exhibit no tendency to decrease. In opposition to countries with a generalized, efficient cardiological, particularly cardiosurgical treatment (Table I). The rate of occurrence of congenital circulatory system malformations amounts to 8 per 1000 live-born children. Consequently about 4300 children are born annually in Poland with cardiovascular malformations. With the present development of surgical and anesthesiological technique, and according to the kind of heart malformation, the indications for cardiosurgery include some 1,400 children annually with congenital heart and great arteries annually. In the last years annually some 200-250 cardiac operations and surgery of great arteries in children are performed in Poland; this amounts to 15 per cent of the present need.

Adolescent↗
PubMed2002

[Frequency of drug resistant tuberculosis in Poland in 2000 as compared to 1997].

Prevalence of drug resistance to one drug and multidrug resistance--MDR in different categories of tuberculosis patients is an important information about the susceptibility pattern of Mycobacterium tuberculosis isolates against antimycobacterial drugs. Poland joined WHO/IUATLD global project on TB drug resistance surveillance, and carried out in 1996/1997 the first prospective survey, simultaneously on primary and acquired drug resistance. This study is repeated in 2000 according to the WHO/IUATLD protocol. The programme covered the whole country. A total of 16 regional centers participated in the co-operative study. 3705 questionnaires and cultures were obtained from patients who excreted TB bacilli during the 12-months from 1 st. January to 31st December 2000. Drug resistance tests to INH, RMP, SM, EMB were performed on Lowenstein-Jensen medium according to the proportion method or/and Bactec 460 TB system. 3705 TB patients (3037 new and 668 treated cases) bacteriologically confirmed by culture were included in one-year study. Primary resistance to any drug was found in 6.12% (CI 5.27-6.56) of new cases. 35 patients (1.15%, CI 0.77-1.35) were infected with MDR strains. Acquired resistance to any drug was found in 16.6% (CI 5.27-6.56), 8.53% (CL 6.41-9.6) of the patients who excreted MDR strains. We have found increased resistance from 3.6% in 1997 to 6.12% (p < 0.001) in 2000 and MDR from 0.6% in 1997 to 1.15% (p < 0.001) in 2000 in untreated tuberculosis patients in Poland. The rate of resistance in the group of treated TB patients was very similar in 1997 (17.0%) and in 2000 (16.6%); except 20% increase of MDR cases--(7.0% in 1997, and 8.53% in 2000). We observed an increase in drug resistant tuberculosis first time during 40 years long period of its monitoring. Regular monitoring of drug resistance in TB patients in Poland is recommended.

Adolescent↗
PubMed2002

[Adverse events following immunization with BCG vaccine in Poland 1994-2000].

BACKGROUND: In Poland, since 1955 BCG mass vaccinations have been compulsory. During the last two decades the vaccination program has been developed and includes: 1) primary vaccination of the newborn, 2) vaccination of children aged 7 and 12, and 3) revaccination of 18 year old adolescents. More than 95% of newborns and about 80% of older children of this population have been vaccinated. BCG vaccine being in use in Poland bases on the Brazilian/Moreau sub strain and has been producing by the Polish Laboratory. Since 1994 the central register of adverse events of BCG has been introduced by National Tuberculosis and Lung Diseases Institute (NTLDRI). OBJECTIVES: The aim of this study was to evaluate the frequency, trends and clinical type of adverse events after BCG vaccination. In addition, correctness of case-finding and treatment of BCG complications was evaluated. METHODS: From January 1, 1994 to December 31, 2000 individual data on adverse events, on special card was reported to NTLDRI. Categories of BCG complications was based on classifications proposed by A. Lotte. RESULTS: Data of 7,354,780 BCG vaccinated persons was analyzed. Of them 1,559 cases reported AEFI. From the further analysis 98 cases with insufficient data were excluded. The frequency of these cases has been estimated to be 0.2@1000 (2 per 100,000 vaccinated) and was stabile. Among AEFI cases, 773 reported local complication (ulcer, abscess, K.F.) and 647 (44.3%) lymphadenitis including 353 cases with enlargement of lymph nodes and 287 cases of suppurative lymphadenitis (4 per 100,000 vaccinated). Majority of AEFI cases were infants (76%). Only 1 case (infant) with disseminated BCG disease, probably due to the partial interferon gamma receptor deficiency, was reported. Main errors in the diagnosis of complications and the management of adverse events after BCG vaccination were lack of data on the diameter of local changes and size of lymph nodes, as well as attempts to remove the lymph nodes. CONCLUSION: The results of the study indicate that BCG vaccinations in Poland rarely produce adverse reactions and therefore may be considered as safe method of tuberculosis prevention. Adverse reactions to BCG appears to be underreported. Surveillance of adverse reactions to vaccines should be included in the national immunization program.

Adolescent↗
PubMed2002

[Rabies in Poland in 2000].

In Poland in 2000, one case of human rabies was reported. It has been the first case of human rabies since 1986. The person with rabies was bitten by cat and has not received post-exposure treatment. Mass oral vaccination of wild animals against rabies which was introduced in 1993, showed a positive impact on the epizootic situation of rabies in Poland. However, we observed two-fold increase of animal rabies cases this year. Sources of wild and domestic animal rabies are present on the north-east, east, and south-east parts of the country, uncovered by oral vaccination. Out of 9,210 persons vaccinated in Poland against rabies, 2,587 (19%) were bitten by or were in contact with a rabid animals. Main reason for vaccination against rabies were contacts with animals category C (rabies not excluded, 5,741 cases; 62%) or category D (animals healthy during the exposition, 882 cases; 10%).

Adolescent↗
PubMed2002

Occupational diseases in Poland, 2001.

The Central Register of Occupational Diseases keeps the records of all reported and certified occupational diseases in Poland. In this paper the incidence of occupational diseases in Poland in 2001 is discussed on the basis of the data provided by the Register. The changes in the incidence pattern over the recent 30 years are also shown. In 2001, 6,007 cases of occupational diseases were registered, with the incidence rate of 63.2 per 100,000 employees. The highest incidence rates were noted for seven categories of diseases: the vocal organ diseases, noise-induced hearing loss, pneumoconioses, contagious and invasive diseases, dermatoses, chronic diseases of bronchi, and vibration syndrome. Altogether these diseases covered 5,239 cases (87.2% of all registered cases). Mining and quarrying, agriculture, hunting and forestry, education, health and social works were the economy activities with the highest incidence of occupational diseases. The majority of occupational diseases (93.9%) have developed after a long-term (over 10 years) exposure to particular harmful factors. As much as 58.5% of cases were recorded in males. The predominant occupational diseases in males were occupational hearing lesions, while in females chronic vocal organ diseases, most common in teachers, were most frequently recognized. In Poland, the diseases of the vocal organ poses a serious problem from the medical and socio-economic points of view. These pathologies show the highest dynamics of the incidence among all registered occupational diseases. Over the last five years the vocal organ diseases have moved upwards to the top in the ranking, both with respect to the number of cases and the incidence rate. Since 1998, the incidence of occupational diseases has been continuously showing a downward tendency. Four categories of occupational diseases have accounted mostly for this decline: noise-induced hearing loss, chronic diseases of vocal organ, contagious and invasive diseases, and dermatoses (a decrease by 64%, 54%, 40%, and 51%, respectively). The decreased incidence has been also noted for "classical pathologies": chronic poisonings, pneumoconioses and vibration syndrome. At least three most important explanatory factors have to be pointed out: a) the decrease in employment and liquidation of industrial plants with the highest health risk; b) the modernization of plants and improvement of working conditions: and c) effective prevention.

Female↗
PubMed2003

Prevalence of seroreagents to FMDV in the cattle population in Poland: results of 9-year monitoring studies.

The aim of this study was to evaluate the occurrence of antibodies to foot-and-mouth disease virus (FMDV) in sera of cattle in Poland. The examinations were performed using the virus neutralization (VN) test and ELISA methods: liquid-phase blocking ELISA (LPBE) and 3ABC-ELISA. During 1993-2001, about 681,000 samples of sera collected from animals held on the territory of Poland were tested. Of about 600,000 sera taken from animals exported to the European Union, 963 samples (0.16%) were found to be positive to FMDV types A, O and/or C. During 1996-2001 out of 85,000 sera tested as part of the national serological surveillance program for FMD, the FMDV antibodies were recorded in 51 (0.06%) samples. Persistence of FMD antibodies was observed in sera of cattle from the region around Zduńska Wola, which had been vaccinated annually during 1985-1985 with trivalent FMD vaccine. The results of the serological studies of 550 animals from this region indicates the presence of FMDV antibodies in sera of 240 (44%) cattle. A half-life of maternal antibodies in sera of calves born to seropositive dams was estimated; the highest level of FMDV antibodies was detected in sera taken from new-born calves aged 5-10 days. The level of FMDV antibodies in beestings of dams was highest during the first 10 hours after parturition; after 24 hours a significant decrease (3-5 times) was found and in two weeks post parturition FMDV antibodies were undetectable in the milk. It was established that all LPBE/VN positive sera of cattle exported from Poland, from the vaccination zone around Zduńska Wola as well as those tested as part of the national serological surveillance program for FMD, were taken exclusively from vaccinated animals or calves born to vaccinated dams.

Animals↗
PubMed2003

Neonatal hypothyroid screening in monitoring of iodine deficiency and iodine supplementation in Poland.

UNLABELLED: Neonatal hypothyroid screening in Poland is standardised and all newborns screening data are registered in central data base in the National Institute of Mother and Child. About 400,000 newborns are screened per year for hypothyroidism (TSH) and phenylketonuria (PKU). Unfortunately, obstetric clinics still use antiseptics that contain iodine. According to our data 71% of clinics used iodine in 1998 (58% iodine tincture and 13% povidone iodine) and 58.2% (35.4 iodine tincture and 13% povidone iodine) in the year 2000. Presence of iodine resulted in over 3 times increase of a percentage of TSH levels over cut off, increasing the number of false positives in the hypothyroid screening. Analysis of TSH distribution for iodine containing and iodine free hospitals gave totally different estimation of iodine deficiency according to WHO criteria. In the group of iodine free hospitals 24 regions were classified as not deficient, 9 regions were borderline with a fraction of TSH levels over 5 mlU/l of 3-5%. 10 regions could not be analysed because all hospitals declared use of iodine. In the second group all regions were iodine deficient. TSH distribution since 1994 shows significant decrease of percentage of TSH levels over cut off from 2.23% in 1994 to 0.16 in 1997 and to 0.12 in 2000. These changes are most probably connected with successive introduction of iodine supplementation which became obligatory in 1997 and suggest that iodine supplementation covers iodine requirements during pregnancy. CONCLUSIONS: Iodine deficiency and iodine supplementation in Poland can be studied using TSH blood spot newborn screening results in correlation with data on interfering factors and in reference to modified criteria for the analytical test and the population. To reduce false positive rate in neonatal hypothyroid screening iodine containing antiseptics, particularly iodine tincture, should be withdrawn from all obstetrics clinics in Poland.

Anti-Infective Agents, Local↗
PubMed2002

Primary and specialist diabetes care three years after introduction of health care system reform in Poland.

The authors discuss epidemics of diabetes in the world and in Poland. In the Lublin region (eastern Poland), for instance, they found type 2 diabetes (DM 2) in 15.6% of the examined aged over 35 (according to the WHO criteria of 1985). The health care system reform in Poland has made more difficult the access of the diabetic to a specialist that treats this disease. Therefore doctors and nurses of primary health care have become more responsible for diabcare than before. The authors believe that the systematic education of primary health care doctors by specialists so that they can treat patients according to the modern standards of practical diabetology as well as sharing of tasks and responsibilities between primary and specialist diabetologic care, are very important. Primary health care would be in charge of prevention and early diagnosis of DM 2 as well as prevention and early diagnosis of concomitant complications of the disease. Specialists would have consultation on the patients at the moment of diagnosis and then at least once a year. They would also take care of search for and diagnosis of remote diabetes complications. Primary health care doctors would still treat most of diabetics with DM 2; specialist centres doctors would treat most of diabetics with DM type 1, patients with complications and from special risk groups (e.g. women with gestational diabetes).

Adult↗
PubMed2003

[Occurrence of insect pests in hospitals in Poland].

The prevalent synantropic species present in hospitals in Poland was the German cockroach (Blattella germanica L.), found in about 70% hospitals. It was followed by Oriental cockroach (Blatta orientais L.) and Pharaoh's ant (Monomorium pharaonis L.) occurred in 40% and 17% of hospitals respectively. Kitchens, laundries and lavatories were the most often infested places. Preliminary investigation of German cockroaches caught in hospitals in Poland showed on their body surfaces presence of bacteria known as these causing nosocomial infection. Several strains were resistant to antibacterial drugs widely used for treatment and showed insensitivity to chemical disinfectants used for surface treatment. Additional risk elements in Poland could be high resistance levels to many insecticides used for insect control in hospitals.

Animals↗
PubMed2003

[Rabies in Poland in 2001].

In Poland in 2001, no case of human rabies was reported. Mass oral vaccination of wild animals against rabies, which was introduced in 1993, seems to show a positive impact on the epizootic situation of rabies in Poland. However, this year is the second one when we observed an increase in number of animal rabies cases. This year outbreak of animal rabies starts in Wielkopolskie voivodeship where we observed six-fold increase of animal rabies cases. Moreover sources of wild and domestic animal rabies are present on the north-east, east, and south-east of the country. Out of 9210 persons vaccinated in Poland against rabies, 3080 (33%) were bitten by or were in contact with a rabid animal. Main reason for vaccination against rabies was exposure to an animal category C--rabies not excluded (6747 cases, 73%) or category D--animals healthy at the moment of an exposition (1147 cases, 12%).

Adolescent↗
PubMed2003

[AIDS and HIV infections in Poland in 2001].

By the end of 2001 cumulative numbers of 1154 AIDS cases and 570 AIDS deaths were diagnosed and registered in Poland. After an initial increase of annually diagnosed AIDS cases (maximum 134 in 1999) and reported AIDS deaths (maximum 78 in 1995) the number of AIDS cases remained relatively stable and the number of AIDS deaths decreased. Aside from possible influence of highly active antiretroviral treatment these figures may be incomplete as it is evident from the comparison with data on deaths from Central Statistics Office in Poland. The biggest number of newly discovered HIV infections (809) was reported in 1990. Next years these numbers ranged from 384 in 1993 to 637 in 1998. Majority of AIDS cases and HIV-infected persons in Poland were drug users, respectively 49.7% and 62.7%. Persons infected heterosexually and without information about the way of HIV transmission account for an increasing proportion of new infections. Quality of collected epidemiological data will depend on easy access to HIV testing and quality of the information provided: data completeness, timely notification and consistency with obligatory definitions.

AIDS-Related Opportunistic Infections↗
PubMed1992

Problems of iodine and thiocyanate in domestic animals in goitrogenic areas of southern Poland.

High incidence of goitre in human together with low level of iodine in water and cow milk have been observed in Southern Poland (Table I). Therefore, iodine deficiency was considered as the only cause of goiter development. The correlation coefficient between iodine concentration in water and cow milk was r = 0.76 (Fig. 1) and indicate the possibility of iodine determination in milk instead of water. The iodine determination in milk reflects the level of iodine in water as well as in food, a negative correlation has been obtained between goitre incidence in human and iodine concentration in water (r = 0.43) (Fig. 2.). A low correlation coefficient suggest that iodine is not a solely factor responsible for goitre development. Studies on cows have indicated that thiocyanate may have effect on goitre development as well. There has been found higher concentration of thiocyanate (SCN) in blood plasma and in enlarged thyroids (Table II). Thiocyanate belongs to goitrogenic compounds and its main source are the plants of Brassica species widely cultivated in southern Poland. It has been found that cows fed with Brassica plants have high level of SCN both in blood and milk with no alteration of plasma iodine level. The transfer of iodine from plasma to milk is only slightly affected (Table III). The level of SCN in the thyroid depends on its plasma concentration; the calculated correlation coefficient is r = 0.88 (Fig. 3). Enhanced thyrotropin (TSH) secretion (during goitrogenesis) may be accompanied by increased accumulation of SCN in the thyroid (like iodide) and reduced oxidation to SO4 (unlike iodide) (Fig. 4). Therefore we postulated that TSH may be partly responsible for increased SCN level in goitrous thyroids. The question arise whether increased ingestion of SCN does really potentiate iodine deficiency and goitrogenic process in animals breeding in southern Poland. For explanation some additionally experiments were performed on laboratory animals. It have been observed that enhanced level of plasma SCN following feeding with Brassica plants increased proportionally the goitrogenic action as well as the accumulation of 131J by the thyroid and its conversion into organic form (Fig. 5). The latter data was confirmed by positive correlation between thyroxine and plasma SCN levels in sheep (r = 0.49), (Fig. 6) Thiocyanate like other monovalent anions suppress goitrogenic effect of propylthiouracil. However, anti-goitrogenic properties of SCN depends on normal iodine ingestion (Fig. 7).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗