Medycyna pracy最新文献

Bladder cancer (BCa) and prostate cancer (PCa) are genitourinary cancers which constitute significant health problems in men and in which environmental factors play an important role. Understanding the genetic susceptibility to BCa or PCa and occupational exposure is paramount to improving cancer prevention and early detection. The aim of this review article was to address the scientific evidence on the genetic risk factors and occupational exposure associated with the occurrence of BCa and PCa. The authors identified relevant original articles that have been published between 1994 and 2023. Variations of the following search terms: "gene" and "occupational" combined with one of the following terms: "bladder cancer" or "prostate cancer" were applied for the search purpose. The authors found 342 publications of which 50 population studies met their requirements for gene-occupation interactions. In total, 34 full-text manuscripts were about BCa and 16 about PCa. These research examines the genes involved in detoxification processes of xenobiotics (glutathione S-transferase, N-acetyltransferase, cytochrome P450, UDP-glucuronosyltransferase), oxidative stress (glutathione peroxidase 1, manganese superoxide dismutase, catalase), altering DNA repair capacity (X-ray repair cross-complementing 1, base excision repair, nucleotide excision repair), tumour suppression (TP53 gene), and vitamin D pathway (vitamin D receptor gene). The role of genetic factors in the occupational exposure has not been conclusively established, but it appears the possibility of genetic involvement. Determination of environmentally responsive genes provides important mechanistic implications for the etiology of occupational cancers, and valuable input in occupational exposure limits set by taking genetic susceptibility into account. More genetic research is needed to corroborate these findings and assess their significance in the workplace. Med Pr. 2023;74(2):127-44.

Background: This paper presents and discusses the results of the determination of elemental carbon emitted in diesel engine exhaust into the air of workplaces where machines and equipment with diesel engines are used. In order to assess occupational exposure to elemental carbon (EC) as a marker of exhaust gases emitted by diesel engines, 51 ground-based workplaces where people who operate or maintain equipment with this type of engine work were measured. Measurements were also carried out at 9 workplaces in non-coal mines.

Material and methods: For air sampling at workplaces of diesel exhaust emitting machines and equipment located on the surface, a cartridge sampler without an impactor with a quartz filter was used for elemental carbon determination, while for measurements in non-coal mines the Higgins-Dewell Cyclone FH022 respirable fraction sampler was used. The thermo-optical carbon analysis method using a flame ionisation detector was used to determine elemental carbon.

Results: Analysis of the results of the determined elemental carbon concentrations at workplaces located on the ground, i.e., in car repair shops, and in the steelworks where combustion forklifts are operated, showed that the highest concentrations of elemental carbon were determined at the old forklift workplaces in the steelworks. The determined EC concentrations at these workstations were 353 μg/m³ and 78 μg/m³, respectively. In the non-coal mines, elemental carbon concentrations were in the range of 7.5-50 μg/m³.

Conclusions: Exposure assessment at the surveyed workplace in the steelworks showed the highest 7-fold exceedance of the maximum admissible concentration (MAC) at the position of the combustion forklift operator. At the other surveyed workplaces in the car repair shop the marked concentrations were in the range of 0.1-0.5 MAC or <0.1 MAC. In non-coal mines, the determined concentrations ranged 0.12-1 times the MAC. Med Pr. 2023;74(2):93-102.

Background: Medication administration errors (MAE) are a worldwide issue affecting the safety of hospitalized patients. Through the early identification of potential causes, it is possible to increase the safety of medication administration (MA) in clinical nursing. The study aimed to identify potential risk factors affecting drug administration in inpatient wards in the Czech Republic.

Material and methods: A descriptive correlation study through a non-standardized questionnaire was used. Data were collected from September 29 to October 15, 2021, from nurses in the Czech Republic. For statistical analysis, the authors used SPSS vers. 28 (IBM Corp., Armonk, NY, USA).

Results: The research sample consisted of 1205 nurses. The authors found that there was a statistically significant relationship between nurse education (p = 0.05), interruptions, preparation of medicines outside the patient rooms (p < 0.001), inadequate patient identification (p < 0.01), large numbers of patients assigned per nurse (p < 0.001), use of team nursing care and administration of generic substitution and an MAE.

Conclusions: The results of the study point to the weaknesses of medication administration in selected clinical departments in hospitals. The authors found that several factors, such as high patient ratio per nurse, lack of patient identification, and interruption during medication preparation of nurses, can increase the prevalence of MAE. Nurses who have completed MSc and PhD education have a lower incidence of MAE. More research is needed to identify other causes of medication administration errors. Improving the safety culture is the most critical challenge for today's healthcare industry. Education for nurses can be an effective way to reduce MAEs by enhancing their knowledge and skills, mainly focusing on increasing adherence to safe medication preparation and administration and a better understanding of medication pharmacodynamics. Med Pr. 2023;74(2):85-92.

Mass casualty incident (MCI) is one of the most difficult situation in emergency medicine. Due to the specific conditions, MCIs occurring at sea are usually far more demanding than those happening on land. In this paper the authors would like to describe the MCIs, which have happened during almost 10 years of functioning of the Polish Telemedical Maritime Assistance Service (TMAS). First incident concerned a group of migrants floating on a raft on the Gulf of Mexico. The cause of the second incident was acute organophosphate intoxication among the crew of the merchant ship. The third incident was triggered by the coronavirus disease 2019 (COVID-19). It is important to emphasize, that triage system may help in proper management of MCIs. Cooperation of the medical services, such as TMAS, local emergency medical staff, Search and Rescue (SAR) service and military force seems to be crucial in MCI managements occuring at sea. In case of any doubts, change of a course and heading to the nearest port or immediate evacuation should be taken into consideration. The authors believe that analysis of these incidents may help TMAS personnel all over the world to handle MCIs in the future. Med Pr. 2023;74(2):145-50.

Background: A paramedic is a person providing health services in a state of sudden threat to life or health. This profession is one of the most difficult and responsible, and the appearance of SARS-CoV-2 has made working in the healthcare system an incredible challenge. The aim of the study was to analyze the impact of the SARS-CoV-2 pandemic on the psychological condition of paramedics.

Material and methods: The research material was a database developed from a questionnaire administered to 300 active paramedics. Respondents answered questions about their subjective feelings and questions related to their experiences as paramedics during the COVID-19 pandemic.

Results: More than half of the respondents were infected with the SARS-CoV-2 and the majority contracted it at work. The survey showed that 11% of the respondents felt very high stress, 38.4% high and 32% moderate. Research has shown that very high, high and moderate levels of stress were experienced more often by paramedics in the 31-40 age group, and little or no stress in the 20-30 age group and paramedics with the longest professional experience less frequently declared experiencing stress at a very high or high level and less frequently experienced burnout in relation to paramedics working in the profession of 1-5 or 6-10 years.

Conclusions: The results of a study showed that performing professional duties during the SARS-CoV-2 pandemic may have influenced paramedics' perceptions of their psychological condition, including subjective feelings of stress levels, social exclusion, or burnout. Med Pr. 2023;74(1):9-17.

Background: Chemical substances from the halogenated aliphatic hydrocarbons group are used in industry, e.g., as intermediates in syntheses, auxiliaries, solvents in degreasing processes, and laboratory tests. Due to their harmful effects on human health and the environment, their use is often banned or limited to certain industrial uses only.

Material and methods: A sorbent tube containing 2 layers (100/50 mg) of coconut shell charcoal was used as a sampler for air sampling. Gas chromatography-mass spectrometry technique and the use of HP-5MS column (30 m × 0.25 mm × 0.25 μm), an oven temperature ramp program from 40°C to 250°C and selected ion monitoring mode were chosen for the determination.

Results: The established chromatographic conditions enable the simultaneous determination of tetrachloromethane, trichlorethane, 1,1,2-trichloroethane and tetrachloroethene in the concentration range 2-100 μg/ml. The average desorption coefficients obtained were: 0.97 for tetrachloromethane, 0.96 for trichloroethene, 0.96 for 1,1,2-trichloroethane and 0.96 for tetrachloroethene.

Conclusions: The calculation of the substance concentration in the analyzed air requires the determination of the amount of substances trapped by the sorbent tube, the desorption coefficient and the air sample volume. Adequate dilution of the extract makes it possible to determine tetrachloromethane, trichloroethene, 1,1,2-trichloroethane and tetrachloroethene in ranges corresponding to 0.1-2 times the maximum admissible concentrations in the workplace air. This article discusses the issues occupational safety and health, which are the subject matter of health sciences and environmental engineering research. Med Pr. 2023;74(1):53-62.

Background: The COVID-19 pandemic has led to a fundamental change in the lifestyle and the ways of learning and working patterns which in turn might lead to health consequences including musculoskeletal disorders. The aim of this study was to evaluate the conditions of e-learning and remote working and the impact of the learning/working modality on the occurrence of musculoskeletal symptoms among university students and workers in Poland.

Material and methods: This study covered 914 students and 451 employees who filled in an anonymous online questionnaire. The questions covered 2 periods: before the COVID-19 pandemic and during the period from October 2020 to June 2021 and were aimed at obtaining information about lifestyle (including physical activity, perceived stress and sleep pattern), ergonomic of computer workstations, the incidence and severity of musculoskeletal symptoms and headaches.

Results: During the outbreak, the severity of musculoskeletal complaints increased significantly in the teaching staff group (3.2±2.5 vs. 4.1±3.0 VAS pts), in the administrative staff group (3.1±2.5 vs. 4.0±3.1 VAS pts), and in the student group (2.8±2.4 vs. 3.5±2.8 VAS pts). The average level of burden and risk of musculoskeletal complaints was revealed by the assessment using the ROSA method, in all 3 study groups.

Conclusions: In light of current results, it is very important to educate people on the rational use of new technology devices, including the appropriate design of computer workstations, planning breaks and time for recovery and physical activity. Med Pr. 2023;74(1):63-78.

Background: Along with socio-economic pression increase in developed countries, the progressive shortening of night sleep has been observed. Sleep plays a vital role in human organism regeneration, and its deprivation leads to a series of adverse psychosomatic effects, including intellectual performance limitation or reducing body immunity, which increases susceptibility to diseases. Chronic sleep deprivation, quite often affecting medical students, significantly contributes to hypersomnia and leads to chronic fatigue.

Material and methods: The results of 60 students were analysed; students were divided into 2 subgroups, depending on the average sleep duration during previous 2-3 nights: IA (2.3±0.8 h on average) and IB (4.9±0.5 h on average). The control group consisted of 50 students, whose night sleep duration in that period was 7.5±0.62 h. In all subjects under analysis visual and auditory evoked potentials were registered, which is a non-invasive method of cognitive performance tests.

Results: The obtained results showed that people with average night sleep duration 2.3±0.8 h (subgroup IA) had worse rate and precision of stimulus response, and thereby significantly worse (p < 0.001) sensorimotor performance, then those from subgroup IB. The study of evoked potentials showed significant (from p < 0.04 to p < 0.001) elongation of all latency p-waves connected with the stimulus perception (N₇₅) and attention span (P₁₀₀, N₁₃₅). Moreover, significant elongation of visual latency wave P₁₀₀ and auditory wave V was related to psychophysical fatigue occurring in sleep deprivation.

Conclusions: The analysis of this study results, obtained in medical students showed that sleep deprivation occurring during exam session is closely related to cognitive abilities, which in turn adversely affects the academic achievement. These results indicate that night sleep duration is a differentiating factor for cognitive abilities quality. Also, psychosomatic fatigue adversely affects cognitive processes. Med Pr. 2023;74(1):27-40.

Background: Lean healthcare management is an innovative approach to process management in healthcare organizations. Despite that the Lean principles have been increasingly recognized worldwide as a tool to boost organizational performance, improve the quality of care and curb waste, the Lean methodology can be difficult to implement in some countries. This study seeks to identify the facilitators of and barriers to the implementation of Lean in the healthcare system in Poland.

Material and methods: A public consultation was held among 318 representatives of stakeholder groups in the healthcare system in Poland. Data was collected using validated self-administered questionnaires. Statistical analysis was performed using the IBM SPSS Statistics 25 software.

Results: The study revealed that a large share of respondents believed that the awareness of the existing organizational deficiencies in work practices among stakeholders can greatly facilitate the implementation of Lean in the healthcare system in Poland (50.9%, p < 0.05). The main barriers to the deployment of Lean include lack of awareness of the Lean methodology and its benefits (76.1%, p < 0.001); insufficient institutional support (43.7%), and lack of funding for Lean solutions (32.4%).

Conclusions: Gaps in the medical curricula and education programs for healthcare professionals concerning the latest process management solutions in healthcare should be addressed in order to raise awareness of the benefits of cooperation with and the active involvement of Lean experts in applying "lean" ideas to improve the organizational performance in healthcare. It is also necessary for policy makers to be aware of the benefits of contemporary process management in healthcare and to support its implementation. Med Pr. 2023;74(1):1-8.

Background: The problem of the intensification of mental disorders, including depressive disorders, is well documented in the world, but in Poland data on this subject are still insufficient. It can be assumed that the worldwide increase in mental health problems resulting from the outbreak of the COVID-19 pandemic in the winter of 2019 could also change the current statistics with regard to depressive disorders occurring in Poland.

Material and methods: Longitudinal studies diagnosing depressive disorders were carried out on a representative group of 1112 Poles working in various occupations, employed on the basis of various types of employment contracts in the period January-February 2021, and a year later. During the first measurement of depressive disorders, the respondents were also asked to retrospectively assess the severity of these disorders in the early autumn of 2019, i.e., 6 months before the outbreak of the COVID-19 pandemic. Depression was diagnosed using the Patient Health Questionnaire PHQ-9 (PHQ-9).

Results: The results of the research presented in the article indicate a significant increase in the level of depression among working Poles in the period 2019-2022, as well as an exacerbation of the severity of its symptoms, probably resulting from the outbreak of the pandemic. However, in the years 2021-2022, a growing level of depression was observed only among working women, less educated people, people engaged in physical and mental work, as well as people with less stable employment (temporary work contracts, specific-task contracts and fixed-term contracts).

Conclusions: Due to the high individual, organizational and social costs that generate depressive disorders, there is an urgent need to develop a comprehensive depression prevention strategy, including programs to prevent these disorders in the workplace. This need applies in particular to working women, people with lower social capital and those with less stable type of employment. Med Pr. 2023;74(1):41-51.