Attitudes regarding vaccination on the example of COVID-19 prevention.

BACKGROUND: COVID-19 vaccines for public use were approved at the turn of 2020 and 2021. The level of vaccination coverage against COVID-19 in Poland is one of the lowest in Europe. Despite scientific studies there are people who are afraid of vaccinations and spread false information about them. Vaccinations against COVID-19 allowed to learn about the attitudes of people who decided to be vaccinated, which can be used to improve the effectiveness of the infectious diseases prevention in the work and public environment. The aim of the study was to analyze the main reasons determining a decision to get vaccinated against COVID-19. MATERIAL AND METHODS: The study was carried on among all the people who decided to be vaccinated against COVID-19 in Nofer Institute of Occupational Medicine in Lódz. All vaccinated people completed an anonymous survey containing questions related to the most important factors, which encouraged them to undergo this vaccination. RESULTS: The study involved 945 people vaccinated against COVID-19. Statistical significance was revealed between 3 different reasons (one's own health, stress-free work, safe travelling and easier access to entertainment) for getting vaccinated and age, gender and a form of employment. The authors also found statistical significance of the correlation between the age, gender, education and form of employment of the respondents and the reason for choosing the specific vaccine product. CONCLUSIONS: Despite evidence presented by scientists about the effectiveness and safety of vaccinations, many people refused and still refuse to receive the vaccine. In order to increase the readiness of the population for vaccinations against COVID-19 and subsequent ones, if there is a need to limit new epidemics, the following should be done: introduce activities to raise health awareness, intensify strategies and campaigns aimed at increasing public trust in available vaccines against COVID-19, devolop individualized messages that contribute to vaccine hesitancy. Med Pr Work Health Saf. 2024;75(2):123-131.

[Active physician attitude vs. patient inertia: detection of chronic myeloid leukemia during periodic examinations]. / Aktywna postawa lekarza versus inercja pacjenta: wykrycie przewleklej bialaczki szpikowej podczas badan okresowych.

The case report concerns the prophylactic and medical certification procedure initiated during periodic examinations, which led to the early detection of chronic myeloid leukemia. Particular attention was paid to the shortening of the period of validity of the periodic examination, justified by an abnormal health condition that is not directly related to the working conditions, as well as the method of communication and influencing the employee to comply with medical recommendations. The conclusions stated that, although obligatory and periodic preventive examinations for the purposes of the Labor Code create the possibility of early detection of unawereness of disease, thus giving a chance to improve health, but at the same time they can be treated as an interference with the individual's right to self-determination about his life and health. It was noted that the key factor in assessing the situation would be the attitude of the occupational medicine physician and the manner of his communication with the employee, who would not be forced, but convinced - for his benefit, to undertake diagnostics or health interventions. Med Pr. 2022;73(6):485-90.

Nutritional Education and the State of Oral Health in Adolescents.

Background. Health promotion of adolescents is a high priority in Poland. Epidemiological data still indicates the low effectiveness of the health care system in this area. The relationship between the state of oral health and the vocational education of adolescents seems to be justified. The objective is to evaluate changes in the oral health status, eating habits, and the relationship between oral health and lifestyle related to vocational education among students from a secondary technical school of gastronomy and electro-engineering and information technology. Methods. The study consisted of two stages (at the beginning and end of education) and two parts: a questionnaire and a dental examination. The study group initially included 55 male students from the secondary technical school of gastronomy and 54 in electro-engineering and information technology school. In the second stage of the study, it was 42 and 51, respectively. Results. After three years, in the engineering and information technology group, compared to gastronomy one, a statistically significant increase in caries prevalence and the number of students eating between meals was observed. Conclusions. Professional education on proper nutrition conducted in the gastronomic school could have a decisive impact on the better oral health status of students.

[Is dental prophylaxis justified in activities of occupational medicine?] / Czy profilaktyka stomatologiczna ma uzasadnienie w dzialaniach z zakresu medycyny pracy?

BACKGROUND: The growing incidence of caries at all ages groups, justifies the need of constant search for effective methods of preventing, also in the context of the assessment of the impact of occupational agent. The research hypothesis assumed that due to the specificity of the profession, students of the gastronomic school have forced, additional contact with food. Thus it might be difficult for them students to maintain proper oral hygiene and, consequently, increase the incidence of tooth decay. MATERIAL AND METHODS: The study group comprised 109 men: 55 students of a gastronomic technical school (GA) and for comparison 54 students of an electrical and IT technical school (E-I), whose vocational education was completely unrelated to food processing. The study was performed at 2 stages (at the beginning and after 3 years of practical vocational training) and comprised of 2 parts: a dental examination and a questionnaire examination (assessment of individual oral hygiene, preferred food products and sources of knowledge about nutrition). RESULTS: After 3 years of observation, a higher, statistically significant, increase in the number of people with caries (P > 0) was observed in the group of students from the E-I school. The analysis of the sources of knowledge on healthy eating and oral hygiene showed that after 3 years of practical vocational training, the main source of knowledge for GA students was school and the Internet, for E-I students the internet and the family. CONCLUSIONS: The smaller increase in the incidence of tooth decay in the group of GA might probably be associated with the theoretical and practical teaching of food and nutrition in the school. Therefore, the methods of conducting pro-health education on oral hygiene in vocational schools should be improved and the standards of medical conduct during obligatory preventive examinations in every student starting their practical vocational training should be extended. Med Pr. 2022;73(3):219-27.

[The impact of the COVID-19 pandemic on the resources and activities of basic occupational health services in Poland]. / Wplyw pandemii COVID-19 na zasoby i dzialalnosc jednostek podstawowych sluzby medycyny pracy w Polsce.

BACKGROUND: In 2020, the first year of the COVID-19 pandemic, there were a number of factors affecting employees, employers, and consequently, both directly and indirectly, the occupational health service (OHS). The purpose of this publication is to analyze the activity of physicians and OHS units in this period in Poland. MATERIAL AND METHODS: The analysis of the number of physicians, OHS units and their activities was performed on the basis of the MZ-35 and MZ-35A statistical forms, which represent obligatory medical reporting. RESULTS: There were 6349 occupational medicine physicians in Poland, who are entitled to conduct prophylactic examinations of employees and provide preventive health care, necessary due to working conditions (less by 248 [3.8%] compared to 2019). At the same time, the number of OHS basic units decreased to 5784 (by 3.2%). In 2020, occupational health physicians reported 4 314 520 prophylactic examinations of employees and job applicants, what is over 1 million 231 thousand (22.2%) less than in the year preceding the pandemic. In addition, they reported the performance of 255 887 prophylactic examinations related to the practical vocational training of pupils, students, participants in qualification vocational training and Ph.D. candidates (less by 157 220 [38.1%]). In 2020, they performed 1 933 355 preliminary examinations (23.9% less), 1 924 929 periodic examinations (25.1% less) and 456 236 follow-up examinations (5.1% more). In 2020, there was also a significant decrease in the number of visits to entire workplaces (from 6437 to 3625) and individual positions (from 46 197 to 26 389) carried out by OHS units. Also in 2020, an almost threefold increase (to 2183) in the number of suspected occupational diseases was reported by OHS physicians. In 2019, the duty to submit an annual report regarding prophylactic activities on the MZ-35A form has been obeyed by only 3607 (56.8%) obliged physicians. CONCLUSIONS: The COVID-19 pandemic has significantly affected preventive activities carried out by occupational physicians. Med Pr. 2022;73(1):19-24.

[Occupational and work-related diseases in community law and in the legislature of selected EU member states - a comparative perspective]. / Choroby zawodowe oraz choroby niezawodowe zwiazane z praca w prawie wspólnotowym i wybranych krajach Unii Europejskiej ­ ujecie porównawcze.

Work-related diseases that are not included in the occupational diseases lists have become a significant social phenomenon, generating increasing costs for the EU member states and for European employers. The impact they have on workers' health and claims results in a need to implement changes in the legislation, which in Poland is currently limited to providing protection and prevention of already established occupational diseases. In the review, a formal-dogmatic approach was used, in a manner of analyzing the current state of Polish legislation and court rulings based upon it. The Polish legal framework was compared to that of the 3 EU member states selected on the basis of their regulations concerning occupational and work-related diseases (Germany, Finland and Ireland). The presented arguments indicate the purpose of the need for a change in the Polish legal framework of occupational and work-related diseases in the direction of either the Finnish or German model. The current Polish law forces people suffering from those work-related diseases which are not recognized as occupational diseases to seek legal remedies under general provisions of civil law, which demands proving not only an adequate causal link between the type of work and the disease but also the employer's culpability, which puts the affected employee in a worse legal situation than those suffering from an established occupational disease. The provisions of the statutory law implemented in the Federal Republic of Germany provides a solution for a fraction of the abovementioned problems deriving from the referred differences in occupational and work-related diseases regulation, while the Finnish model, based on causality, instead of the legal definition of occupational disease as such, practically allows for a complete elimination of the problem. Med Pr. 2021;72(5):549-60.

Dyslipidaemia, carbohydrate metabolism disorders and arterial hypertension detected in academic employees during examinations in occupational medicine.

INTRODUCTION: Many people have CVD risk factors without realising it and it is important to recognise the risk factors as soon as possible. Periodic examinations are a mandatory form of control for all employes in Poland. They provide an excellent opportunity to screen for the most common civilization diseases in the population. OBJECTIVE: The aim of this study is to evaluate the prevalence of dyslipidaemia, hyperglycaemia and hypertension among academics in a Polish university, and to compare the results between postdoctoral fellows and other academics. MATERIAL AND METHODS: The study group were postdoctoral fellows (HAB; N=135, 53 females) and other academics (NHAB; N=286, 179 females) over the age of 40 who reported for a periodic occupational medical check-up. Fasting blood samples were drawn, serum glucose, lipids and blood pressure (BP) were measured. RESULTS: The mean age was 56.7 (SD 9.8) in HAB and 49.8 (SD 8.1) in NHAB. Mean systolic BP and glycaemia were significantly higher in male HAB group than male NHAB (135.8 vs 130.9 mmHg and 6.0 vs 5.6 mmol/l, respectively). The relationship in females was non-significant. The age-adjusted odds ratios (OR [95% CI]) of having elevated low density lipoprotein cholesterol, total cholesterol, glucose and blood pressure in male HAB vs male NHAB were 0.61 [0.32. 1.16], 0.64 [0.33, 1.23], 1.52 [0.80, 2.88] and 2.11 [0.88, 5.23], and in female HAB vs female NHAB - 0.59 [0.31, 1.12], 0.64 [0.32, 1.26], 0.87 [0.40, 1.79] and 1.86 [0.70, 4.68], respectively. CONCLUSIONS: Adequately planned occupational medicine examinations provide an opportunity to diagnose dyslipidaemia, hyperglycaemia, or high BP in all groups of employees, including highly educated academics.

The role of occupational health services in cancer prevention - which factors determine the implementation of preventive measures?

OBJECTIVES: Epidemiological data on cancer diseases are alarming. The workplace has become an increasingly important site for disseminating health information and implementing health promotion activities. Occupational medicine physicians (OMPs) have the opportunity to carry out primary and secondary preventive activities focused on civilization diseases, especially cancer. The aim of this study was to evaluate the potential of OMPs in cancer prevention, including the analysis of factors determining the implementation of preventive measures, as part of standard healthcare for employees. MATERIAL AND METHODS: The study was conducted among 362 OMPs. The interviews were carried out by the computer assisted telephone interview (CATI) method. RESULTS: Over 60% of the surveyed OMPs are ready to implement cancer preventive activities among employees. The doctors with the longest seniority in occupational health services are more likely to declare unwillingness to implement cancer preventive activities. Patient's consent, informing women about the program and adjusting the time of the medical visit are the most important conditions for introducing cancer prevention programs by OMPs. Neither seniority nor the number of examinations performed by a physician influenced the currently implemented cancer preventive activities as part of occupational health services (including the evaluation of cancer risk factors occurrence among employees). CONCLUSIONS: In Poland, OMPs are willing to implement cancer preventive activities among employees, but their current activity in this area is limited and needs development. The most specific actions should be addressed to doctors with the longest seniority in occupational health services, who are frequently unwilling to implement cancer preventive activities. Strengthening the preventive potential of Polish occupational health services requires a systemic approach to the scope and way of action of healthcare professionals. Int J Occup Med Environ Health. 2021;34(6):723-36.

Patients with epilepsy as drivers in Poland.

BACKGROUND: Drivers suffering from epilepsy are commonly regarded as a threat to road safety. However, inability to use their own means of transport very often implies specific professional effects and lowers the quality of life. The aim of this study was to analyze the driving status of patients with epilepsy in Poland. MATERIAL AND METHODS: The prospective study was performed using an independent questionnaire developed by the authors, consisting of 4 parts: 1) socio-demographic information, 2) clinical information, 3) driving information, and 4) opinions about patients with epilepsy as drivers. The study was conducted in November 2018-September 2019. A total of 188 patients completed this study. RESULTS: More than one-quarter of the patients have a driving license. Among them, 35 individuals (accounting for 18.62% of the whole study group) said that they had received their driving license after the diagnosis of epilepsy. In 10 cases (5.32%), seizures occurred while the patients were driving and in 72 cases (38.30%) while they were traveling as passengers. Among all socio-clinical factors, having a driving license was conditioned by the marital status (p = 0.008) and education (p = 0.007). Other factors did not affect having a driving license or the time of obtaining the license (p > 0.05 for all cases). A relationship was observed between the occurrence of side effects of antiepileptic drugs and the occurrence of seizures while traveling as a car passenger (p = 0.001). Other factors did not affect the occurrence of epileptic seizures while traveling by car, either as a driver or a passenger (p > 0.05). CONCLUSIONS: A significant proportion of the respondents were of the opinion that patients with epilepsy should not be allowed to obtain a driving license, which is probably related to concerns about the occurrence of epileptic seizures while driving. It is necessary to conduct a nationwide educational and information campaign on epilepsy in various aspects. Med Pr. 2021;72(4):341-50.

The analysis of screening costs for hypercholesterolemia and hyperglycemia as part of obligatory examinations of employees.

OBJECTIVES: High prevalence of hyperlipidemia and hyperglycemia requires searching for efficient and cost-effective methods of an early detection of these disorders. In Poland, obligatory employee medical check-ups could be a solution. MATERIAL AND METHODS: The study included a group of university employees who underwent obligatory occupational examinations in 2018. Each employee had an additional lipid (unit cost: EUR 2.56) and blood glucose profile (EUR 0.93) done. The number of respondents involved in the study was 850 (340 males and 510 females), and their average age was 47 years (SD = 11 years). The education distribution was as follows: employees with secondary vocational and general education (physical, frontline and administrative workers): 176 (age: M±SD 50.3±10.3); employees with a university degree (academics with an M.Sc. or/and Ph.D. title and administrative staff): 535 (age: M±SD 43.6±9.8); and academics with a university title (Ass. Prof. and/or Prof.): 139 (age: M±SD 56.2±10.2). RESULTS: Dyslipidemia (elevated total cholesterol ≥190 mg/dl and/or low-density lipoprotein cholesterol ≥115 mg/dl) was reported in 560 workers (65.9%). Hyperglycemia (fasting glucose ≥100 mg/dl) was observed in 256 workers (31%). The total cost of detecting a single case of dyslipidemia and hyperglycemia was EUR 3.88 and EUR 3.09, respectively. Divided by age groups, the costs were as follows: EUR 4.34 and EUR 4.53 in the age group <45 years; EUR 3.56 and EUR 2.42 in the age group ≥45 years. The costs of detecting a single case of dyslipidemia and hyperglycemia in employees aged ≥45 with regard to education were as follows: EUR 3.20 and EUR 2.07 in persons with secondary vocational and general education; EUR 3.40 and EUR 2.80 in persons with a university degree; and EUR 4.38 and EUR 2.28 in persons with a university title. CONCLUSIONS: Due to the fact that the reporting rate for screening tests in the framework of occupational medicine is high, the cost of occupational screening tests for dyslipidemia and hyperglycemia can be lower than the cost of screening tests in the general population. Int J Occup Med Environ Health. 2021;34(5):581-9.

Evaluation of selected risk factors for cardiovascular diseases and diabetes as a background for the prevention program in occupational healthcare.

OBJECTIVES: Cardiovascular and metabolic disorders constitute major health problems in the working populations in Europe. The aim of this project was to evaluate the health condition of workers employed in a Polish research and medical institution, and then to establish the necessary preventive actions by creating a modern model of occupational healthcare integrated with civilization disease (CivD) prevention. MATERIAL AND METHODS: Overall, 100 workers voluntarily participated in a health program for CivD prevention during mandatory prophylactic examinations. Data from these examinations was collected in a system of electronic documentation to enable the analysis of the workers' health condition and risk factors of CivDs. RESULTS: Women accounted for 72% of the employees who voluntarily participated in the prevention program, and 80% of the subjects had university education. As regards the health condition, 27% of the patients had elevated systolic, and 23% diastolic, blood pressure, and 21% had an abnormal fasting glucose level. Stressful job was an important factor correlated with an excessive body mass index, diastolic blood pressure, as well as total and low-density lipoprotein cholesterol levels. Smoking, sedentary work and a lack of physical activity were significant factors for abdominal obesity. Generally, 94% of the program participants required some further interventions in lifestyle, diagnostics or treatment. CONCLUSIONS: Civilization disease prevention should focus on increasing physical activity both in leisure time and at the workplace as far as practicable. There is a need for implementing projects leading to occupational stress reduction and smoking cessation. Men as well as workers with vocational and elementary education need to be recruited for prevention programs dedicated to employees. Int J Occup Med Environ Health. 2021;34(3):403-13.

[Resources and activities of occupational health service units in Poland. An analysis of the mandatory medical reporting for 2014-2018]. / Zasoby i dzialalnosc jednostek sluzby medycyny pracy w Polsce: analiza obligatoryjnej sprawozdawczosci za lata 2014­2018.

BACKGROUND: The number and activities of occupational medicine physicians and occupational health service (OHS) units can be determined on the basis of obligatory medical reporting. MATERIAL AND METHODS: The paper covers an analysis of the MZ-35 and MZ-35A statistical forms dated 2014-2018. In order to assess the scope of medical reporting, an online questionnaire survey among occupational medicine experts was performed. RESULTS: the scope of medical reporting, an online questionnaire survey among occupational medicine experts was performed. Results: There were 6685 occupational medicine physicians, 6005 basic OHS units and 20 regional occupational health centers (ROHC) registered in Poland in 2018. Certain regional differences in access to OHS can be noticed. On average, there were 3481 persons of productive age per 1 occupational medicine physician. On average, in 2014-2018, 5 223 000 prophylactic examinations of workers were performed annually, along with 322 000 examinations (also annually) related to the practical vocational training of pupils, students, participants in qualification vocational training and Ph.D. candidates. For the first time in history, in 2018 more preliminary than periodic examinations were performed. Every year, approximately 0.03% of the medical certificates regarding the existence or lack of medical contraindications to perform work, which are issued by basic OHS units, are being questioned by either employees or employers. In 58% of such cases, the initial decision was changed as a result of an appeal procedure in ROHC. The duty to submit an annual report regarding prophylactic praactivities has been obeyed by <60% of the obliged physicians in the recent 2 years. Among the most important reasons for such a situation, the implementation of online reporting, a lack of real consequences for not submitting the report, and a poor knowledge of said reporting among physicians were mentioned. CONCLUSIONS: It is necessary to monitor, on the regional level, the availability of prophylactic care provided by OHS physicians, both for all employers obliged to provide such care and for all employees obliged to undergo medical examinations. The scope of obligatory public statistics reporting regarding OHS activities needs updates. Due to a relatively stable situation in relation to the types of issued certificates, it should be less detailed. Med Pr. 2020;71(4):429-40.

Prevention and health promotion at the workplace as a part of private medical care for employees in Poland - an overview.

This review includes information about the number of private health insurance and medical subscriptions in Poland, as well as the level of increases in premium rates, and the scale of health promotion and prevention conducted by Polish employers. The aim of this article is to present the current situation on the supplementary private medical market, which is involved in employees' healthcare, and the challenges that both employers and medical providers with health insurers are now facing, and also to present the reasons why prevention and health promotion are important factors of healthcare under private health insurance. For the purpose of this review, scientific publications devoted to health promotion at the workplace were used, along with statistical data presented in the studies released by the Polish Insurance Association, the Polish Social Security Institution, the World Health Organization and the Organization for Economic Co-operation and Development. The literature search was carried out using the electronic databases of PubMed. Search terms included medical subject headings and free text words. No year of publication restriction was imposed. The conducted analysis shows that the demand for private medical care is rising. Employers are willing to invest in private medical care for their employees, although the scale is much lower among small and medium-sized entrepreneurs due to fiscal burdens. Given the rising demand and an insufficient number of specialists, access to medical services is deteriorating, and the premium rates and costs are rising. More employers are investing in health promotion at the workplace in order to decrease absenteeism and presenteeism, lower the utilization of medical packages, and improve their attractiveness on the market. Although the interest in private medical care is rising, employers should focus on health promotion and prevention at the workplace, and adapt their actions to the employees' current needs and health issues. Med Pr. 2020;71(6):735-42.

Hypercholesterolemia and prevention of cardiovascular diseases in the light of preventive medical examinations of employees in Poland.

Long-term exposure to hypercholesterolemia is the cause of atherosclerosis, which in turn causes cardiovascular and cerebrovascular events. In developed countries, including Poland, vascular diseases are the main cause of death. They affect an ever younger part of the population, including the working population. The authors address the problem of epidemiology of cardiovascular diseases, unsatisfactory detection and treatment, economic consequences for the health care system, and the possibilities of using occupational medicine services in the prevention of this health problem. Due to the fact that the early detection of diseases caused by high blood cholesterol levels is relatively low in Poland, obligatory occupational medicine examinations seem to be a key element of the second-line prevention. Therefore, it seems natural to consider the idea of extending the scope of obligatory examinations and introducing tests that allow lipid disorders to be detected at an early stage. This can contribute to a general improvement of the health of the population, and to economic benefits, such as a decrease in the costs of treatment of the disorders that have been detected too late. Broadening the scope of occupational examinations is also important from the perspective of public health and epidemiology of cardiovascular diseases, thus being an element of prevention of civilization diseases. It means improving health and building health awareness, and it should translate into regular health examinations. The performance of these examinations should result not only from the obligation, but also from the patient's conviction about the importance of early detection of disorders, including lipid disorders, for an effective therapy. Int J Occup Med Environ Health. 2019;32(6):865-72.

[Workers' view on the preventive needs for civilization diseases' in prophylactic care taken on employees]. / Potrzeba dzialan prewencyjnych dotyczacych chorób cywilizacyjnych w opiece profilaktycznej sprawowanej przez sluzbe medycyny pracy ­ opinia pracujacych.

BACKGROUND: Every year in Poland almost 5 million prophylactic examinations (PEs) are carried out by occupational medicine specialists (OMPs) among workers, for the purposes envisaged in the Polish Labour Code. The aim of this study was to collect workers' opinions on the possible extension of these check-ups in the field of prophylaxis and prevention of civilization diseases (CivDs), focusing also on the "healthy lifestyle" recommendations. MATERIAL AND METHODS: The study group comprised 325 employees who filled out an anonymous questionnaire containing questions about the possible extension of the PE scope for CivD and cancer prophylaxis. During medical check-ups, evaluation of the incidental glucose (IG) and total cholesterol (TCh) levels, waist circumference measurement and electrocardiography (ECG) were proposed. The respondents were asked about the most interesting issues for discussing with OMPs. RESULTS: Screening tests for some cancers (69.5%) and risk factors for CivDs (61.5%) were indicated as the most interesting topics to discuss with OMPs. The possibility for evaluating the levels of IG and TCh during PEs was approved by approx. 94.8% and 95.3% of the respondents, respectively. Almost 96% accepted having ECG and 80% agreed to waist circumference measurement. As many as 89.5% of the respondents supported the idea of organizing physical activities at their workplaces, and 77.8% were eager to learn about "healthy lifestyles" during training sessions conducted at their workplaces. CONCLUSIONS: Restricting the aim of PEs just to certifying the ability to work, or identifying certain medical contraindications, means losing a chance for implementing the prophylaxis and prevention of diseases' development among active working subjects. The kinds of activities proposed by the authors of this publication have been approved by the employees. Med Pr. 2019;70(4):425-33.

[Health criteria and scope of workers' periodic health check-ups for selected types of work and exposure factors - Nofer Institute of Occupational Medicine guidelines]. / Kryteria zdrowotne i zakres badan profilaktycznych dla wybranych rodzajów prac i czynników narazenia ­ wytyczne Instytutu Medycyny Pracy w Lodzi.

Workers' medical prophylactic examinations referred to in the Labor Code are one of the tasks of the occupational medicine services. They are regulated by law which has been in force for more than 20 years in unchanged form. During this period, new harmful, burdensome or dangerous to health factors appeared in the workplaces, for which no preventive health check-up standard was defined. In the meantime, the health criteria for drivers and persons applying for driving licenses have also been significantly liberalized. The above changes, the authors' own experience, comments and problems reported by physicians who provide workers' prophylactic health care and employers as well as analysis of literature related to workers' health care in other countries have created the need to harmonize and update guidelines on health requirements for selected types of work. In addition the scope and frequency of prophylactic examinations for exposures, which are not included in applicable legal acts, has been developed. Med Pr. 2019;70(1):125-37.

Health promotion and prevention in occupational health systems in Europe.

OBJECTIVES: In the contemporary Western culture, working population health issues, stressed in various publications, have been perceived as a crucial part of public health. To deal with occupational health issues properly, occupational health services (OHS), aiming at the protection of the workers' health, are organized in many countries. The survey was to find the differences in occupational health systems that the European Economic Area countries use in order to execute prophylactic activities focused on diseases of affluence and how the OHS are used for health promotion actions. MATERIAL AND METHODS: The survey was conducted with the use of an on-line expert questionnaire. No deep statistical analysis was performed as for the designed aims of the study simple statistics were sufficient. RESULTS: All the reviewed countries have organized OHS. The funding mechanisms are based mainly on the financial involvement of employers. In the majority of countries, the main goal of the OHS is certification of the ability to work. Workplace surveillance aiming at the occupational risk assessment and health promotion activities that focus on work-related and/or occupational diseases are the most popular services provided within national systems. CONCLUSIONS: Occupational health professionals are well placed to perform actions directed at health promotion and prophylactics of a wide range of diseases - not only occupational/work-related, but also non-communicable, particularly life-style-related diseases of affluence. The engagement of the occupational medical services (OMS) in prevention of the non-work-related health issues would be valuable. However, it would be inevitable for employers to finance a wider range of services to a greater extent. Int J Occup Med Environ Health. 2019;32(3):353-61.

[Non-occupational but work-related diseases - Legislation, judicature and potential implications to employers and employees in Poland]. / Choroby niezawodowe zwiazane z praca ­ uregulowania prawne, orzecznictwo oraz potencjalne konsekwencje dla pracodawców i pracowników w Polsce.

BACKGROUND: Non-occupational work-related diseases refer to health problems of multifactorial etiology, the occurrence, development and prognosis of which may be affected by work environment or by the way the work is performed but are not treated as occupational diseases under the applicable law. When analyzing their impact on labor market, it is necessary to also consider the employees' right to put in a claim for compensation due to the consequences of the occurrence of such diseases. MATERIAL AND METHODS: Legal regulations as well as judicial decisions on the possibilities and methods of pursuing claims for compensation from an employer due to the occurrence of non-occupational work-related disease were analyzed. RESULTS: The analyzed legal regulations and judicial decisions referred to the regulations of the Labour Code, Civil Code and Resolution of the Supreme Court of 4 December 1987. The paper presents examples of non-occupational diseases considered to be work-related and conditions necessary to assert a claim by the employee at the court. CONCLUSIONS: Despite the lack of precise legal regulations in Poland, non-occupational work-related diseases may impact the legal situation of employees as well as employers. Employees are granted the right to claim for compensation from their employers in accordance with the Civil Code. Depending on the employer's legal responsibility, it is necessary to prove the meeting of the appropriate essential conditions to put in a claim for damage. Raising the employers' awareness of the legal and financial consequences shall support the occupational medicine services in intensifying their activity aimed at preventing all work-related diseases. Med Pr 2018;69(5):539-546.

Can Periodical Examinations of Employees Be Useful in Detection of Glycaemia Impairment and Improving Patients' Adherence to Medical Recommendations?

Worldwide epidemiological data indicates insufficient diagnosis of diabetes as an increasing public health problem. In the search for solutions to this disadvantageous situation, occupational medicine health services seem to open up a unique opportunity to recognize some abnormalities in the early stages, especially among the asymptomatic working-age population. 316 workers underwent obligatory prophylactic examinations. In patients with twice assayed FGL ≥ 126 mg/dL (7.0 mmol/L) an additional intervention was implemented, including further diagnostic processes and therapy in General Practice (GP), followed by examination by an occupational health specialist within 3 months. The diagnosis of previously unknown diabetes was established among 2.5% of examined workers. All patients referred to the GP due to detected glycaemia impairment visited their doctor and finished the diagnostic process, took up therapy constrained by the occupational health physician to show the effects of intervention within 3 months. Prophylactic medical check-ups allow improved compliance and medical surveillance over glycaemia impairment in patients with prediabetes states, unknown diabetes or uncontrolled clinical course of diabetes. Considering fasting glucose level during mandatory prophylactic examination helps effective prevention of diabetes and its complications and thus provides public health system benefits.

Is it possible to improve compliance in hypertension and reduce therapeutic inertia of physicians by mandatory periodic examinations of workers?

BACKGROUND: Due to high prevalence, insufficient recognition, and ineffective treatment, hypertension (HT) still remains a major medical and socio-economic problem. There is a real necessity to develop effective prophylaxis for cardiovascular disorders (CVD), based on strategies that support compliance during long-term therapy. The Polish scheme of occupational health services with mandatory periodical employee check-ups creates a unique opportunity for effective HT prophylaxis. As a result, visiting a doctor is required not only due to health ailments but also by law, which is especially important for those feeling well. It enables an improvement in tertiary prevention, including actions taken not only by the doctors of the occupa-tional health services, but also by the physicians in charge of treating the patients. AIM: Evaluation of the usefulness of mandatory health check-ups of employees concerning frequency of diagnosis and im-provement of treatment outcomes of HT. METHODS: The study group comprised 1010 Polish workers referred by their employers for mandatory medical examinations. All of the study participants filled in a questionnaire focused on self-assessment of their health, current blood pressure (BP) mea-surements, and in cases where HT had been previously detected - compliance with medical recommendations. Then in the doctor's office BP measurements were taken twice. Workers who fulfilled a criterion indicating a need for intervention were educated on optimal diet, physical activity, and risk factors for CVD. They also received medical instructions for three-step action. The first recommendation: measure BP three times a day for one week and record the results. The second: visit a gen-eral practitioner (GP) for a professional assessment of those results. The third: re-visit the occupational health physician within three months. The criterion for intervention was prior HT and a mean of two BP measurements ≥ 180/110 mmHg - in each case, or ≥ 140/90 mmHg - in the case of occupational exposure to risk factors for CVD. RESULTS: The mean age of the study participants was 41.7 years (similar in both genders). A previous diagnosis of HT was declared by 20.1% of patients. 11% of patients involved in the intervention did not comply with medical advice. The current HT therapy of all of the subjects with HT (100% of those with abnormal BP, who visited their GP) was modified. CONCLUSIONS: Prophylactic medical check-ups of workers gives improved compliance and medical surveillance of HT in patients with an uncontrolled clinical course of this disease. Obligations and periodic examinations encourage both patients and physicians to improve compliance and reduce the risk of therapeutic inertia.