Occupational diseases arising in the area of the Ministry of Defence in the Czech Republic and their relationship to work categorization.

OBJECTIVE: The article deals with occupational health protection and identification of health risks in the work environment of the Ministry of Defence (MoD) of the Czech Republic (CR). It focuses on the assessment of the incidence of occupational diseases (OD) in high-risk and risk-free occupational categories in the years 2010-2019 and compares them with data from the civilian sector. It identifies the differences between military staff and civilian employees of the MoD. METHODS: From the records of OD at the Department of Occupational Diseases of the Central Military Hospital in Prague, the data on acknowledged OD from the years 2010 to 2019 were obtained and then a retrospective analysis focusing on the classification of work at risk was performed. The obtained data were compared with the data from the Czech National Registry of Occupational Diseases (NROD), which are published annually by the National Institute of Public Health. RESULTS: In the years under review, 191 OD were confirmed at the area of MoD, 26% of all OD occurred in employees classified in the occupational risk category. Compared with the data in the NROD, where 50% of OD were found to have been caused by high-risk work, the incidence of OD caused by high-risk work in professional soldiers is lower. Only 1.6% of all OD occurred in professional soldiers whose work was classified as high-risk one. In civilian employees of MoD 24.6% of all OD were connected with high-risk work. On the contrary, the proportion of OD occurring in professional soldiers working in risk-free categories was 57.6%, in civilian employees of MoD was the ratio much lower - 16.2%. CONCLUSION: Work at the Ministry of Defence was not adequately categorized, therefore, in 2020 a new categorization of work was introduced, which together with preventive measures could contribute to reducing the incidence of OD at the Ministry of Defence.

[Diisocyanate exposure as a cause of occupational asthma]. / Expozice diizokyanátum jako prícina profesionálního astmatu.

The authors present a summary of current knowledge on asthma caused by diisocyanates in workers under occupational exposure and introduce basic characteristics of these chemicals widely used in industry. Although they represent one of the main causes of occupational bronchial asthma (AB) in developed industrial countries, the number of reported asthma caused by diisocyanates is still relatively low in the Czech Republic--it represents less than ten percent of all reported occupational asthma. One of the possible reasons is demanding diagnostics and assessment of occupational impact of chemical noxae with combined effect mechanism characteristic of low-molecular diisocyanates. Studies concerned with presented topics support the concept that AB caused by diisocyanates shows clinical features of both atopic and nonatopic asthma. AB caused by DI is presented by mixed type of the TH1/TH2 response, influx and regulatory role of CD4+ and CD8+ T lymphocytes. Mixed immunopathological mechanism and toxic effect are combined. For the present, evaluation of elimination and reexposure tests appear as the most valuable of available diagnostic methods, respectively simulated reexposure test in a health care facility and assesment of serum IgG or IgE antibodies against diisocyanates can be used. Data on occurrence of the disease in the Czech Republic and detailed information on the sample of patients with respiratory allergic disease caused by diisocyanates reported by the Clinic of Occupational Diseases of the Faculty Hospital in Hradec Králové in 1994-2003 are presented. The disease was caused by evaporation of diisocyanates released during the production of polyurethanes and evaporation of adhesives containing toluendiisocyanate (TDI). In most cases, there were milder forms of asthma with significant improvement or elimination of difficulties occuring after occupational exposure was interrupted. Knowledge of the pathogenesis of AB caused by diisocyanates should accelerate the development of diagnostic tests and consequent treatment intervention, as early determination of diagnosis and interruption of occupational exposure are essential for following prognosis of disease.

[Occupational asthma: current state of the problem]. / Profesionální bronchiální astma: soucasný stav problému.

Occupational asthma is a disease with serious medical, social and economical consequences. Most patients have to change their jobs and very often they lose their professional qualification. This article gives a current review of the problems of occupational bronchial asthma and allergic rhinitis in the region of Eastern Bohemia. The results obtained are compared with the situation in the whole Czech Republic and in the world. The number of new cases of occupational asthma and allergic rhinitis discovered in the contact area of the Department of Occupational Medicine at the University Hospital in Hradec Králové fluctuates around 15-20 cases per year, and 80-100 new cases are reported in the whole republic. The rate of occupational asthma and occupational allergic rhinitis of the total asthma and rhinitis incidence in the Czech population fluctuates between 5-15%. Regarding the number of affected employees, flour is considered the most important allergen. Other important noxas include agricultural allergens, textile dust, diisocyanates and disinfectious preparations. The importance of the alergogenius effect of natural rubber latex and diisocyanates has increased in occupational medicine mainly in the last 20 years. Regarding latex, its harmful effect has been especially demonstrated in health providers who wear protective latex gloves, which results not only in contact eczema-dermatitis, but also in bronchial asthma and allergic rhinitis. Diisocyanates, highly reactive and aggressive substances, originate during polyurethane production which has a wide industrial application (production of polyurethane foam and rubber, paints, adhesives, injected substances, glues, varnishes etc.). The incidence of occupational asthma diseases in workers exposed to diisocyanates is high. Typically, a development of the disease begins after a short time exposure. In this thesis, a diagnostic method in suspected occupational allergic disease of the airways is suggested and possibilities for the application of particular diagnostic methods are given with emphasis on their advantages and limitations and the necessity to determine a proper diagnostic method for the individual patient. In searching for a particular cause of the occupational disease a significant benefit is the determination of a wide range of specific Ig E class serum antigens, in case IgG and standardization of the method provoke tests for its practical application.