[The effect of stress on the semen quality]

BACKGROUND

Stress is one of the most important health and social problems. Psychological stress has long been suspected of having an important impact on infertility. Studies on the effects of psychological stress on male fertility, especially the semen quality, have so far yielded equivocal findings.

MATERIALS AND METHODS

The study population consisted of 179 men who had reported to the infertility clinic for diagnostic purposes, some of them with normal fertility (semen total concentration of 15-300 mln/ml) or with slight oligozoospermia (semen total concentration of 10-15 mln/ml). The semen samples were analyzed in one laboratory according to the WHO manual on basic semen analysis. The main semen parameters were assessed: volume, motility, percent of atypical and progressive spermatozoa. To assess the occupational stress the Subjective Work Characteristics Questionnaire was used. Assessing the level of stress we concentrated on the sum of points obtained by each man taking part in the study and the number of psychosocial factors present at work reported by the subjects.

RESULTS

Measuring the level of stress by the Subjective Work Characteristics Questionnaire, we revealed negative effects of a number of stressful situations at work, which affect semen volume and percent of progressive spermatozoa, taking account of confounding factors that can have impact on the semen quality and thus affect fertility, such as duration of the couple's infertility, past sexual abstinence and diseases.

CONCLUSION

The study confirm that the occupational stress can affect the male semen quality, however, due to the limited data on this issue, the obtained results must be confirmed by more extensive, longitudinal studies.

[Impact of prenatal environmental tobacco smoke exposure on birth parameters]

The aim of the study was to analyze the association between prenatal environmental tobacco smoke exposure (ETS) and child anthropometric parameters at birth such birth weight, length, head and chest circumference. The study population consisted of 107 pregnant women from Lodz district as the part of Polish Mother and Child Cohort study. The child prenatal ETS exposure was assessed based on questionnaire with mothers and cotinine level in saliva collected three times in pregnancy. The level of cotinine in biological samples was analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS ESI+). About 35% of the children were prenatally exposed to ETS. The birth weight of the children prenatally exposed to ETS was 335 g lower than the birth weight of non-exposed newborns p < 0.001 after adjustment for: maternal educational level, marital status, prepregnancy weight, child gender, and gestational age. The same refers to child length and chest circumference (coef. -1.1 cm; p = 0.03 and coef. -1.3 cm; p = 0.002 respectively). Taking into account the negative effect of prenatal exposure to ETS, more efforts need to be taken to eliminate child ETS exposure.

[Occupational diseases in Poland, 2009]

BACKGROUND

The aim of the paper was to present basic statistical data on occupational diseases diagnosed in 2009.

MATERIAL AND METHODS

The work was based on the data compiled from "Occupational Disease Reporting Forms" received by the Central Register of Occupational Diseases in 2009. The data comprised information on nosologic units, gender and age of patients, and duration of occupational exposure to harmful agents responsible for the development of specified pathologies. These data were further classified by sectors of the national economy and voivodeships. The incidence was specified in terms of the number of cases in relation to paid employees or to employed persons.

RESULTS

The number of occupational diseases diagnosed in 2009 accounted for 3146 cases. The incidence rate was 29.9 cases per 100 000 paid employees. The highest incidence rates were noted for infectious and parasitic diseases (8.4/100 000), pneumoconioses (6.0) and chronic voice disorders (5.9). As many as 78% of patients affected by occupational diseases had been exposed to harmful agents for longer than 20 years. In industrial sectors of the national economy, the highest incidence rate was noted in mining and quarrying (297.5/100 000). Taking into account the geographic distribution of occupational diseases, the highest incidence was recorded in the Silesian and the lowest in the Mazovian voivodeships (respectively 54 and 7.5 cases per 100 000 employed persons).

CONCLUSIONS

A decrease of 400 (11.3%) cases of occupational diseases and a decrease of 13.8% in their incidence rate over previous year were noted. The greatest drop in the number of cases was noted in infectious and parasitic diseases (of 168 cases, i.e. 23%).

Carcinogenic effect of arsenate in C57BL/6J/Han mice and its modulation by different dietary selenium status

In this study, carcinogenic effects of arsenate in female C57BL/6J/Han mice exposed in drinking water to 50, 200 or 500microgAs/L for 24 months were investigated. All animals were fed low-selenium diet, however half of them were supplemented with sodium selenite in drinking water (200microgSe/L) to ensure the normal dietary level of selenium. Glutathione peroxidase activity in erythrocytes and plasma as well as selenium concentration in plasma after 3, 6, 12 and 18 months in satellite groups showed considerable decrease in animals from non-selenium supplemented groups in comparison to supplemented groups. A clear arsenic concentration-dependent increase in the number of malignant lymphoma associated with increase in the risk of death was observed (hazard ratio=0.91, 1.46, and 2.24, for 50, 200 and 500microgAs/L, respectively). No significant influence of selenium dietary status on arsenic carcinogenicity was shown. A significant association between selenium supplementation status and increased risk of death of the animals from causes other than malignant tumors was found (HR=1.79, p=0.04).

Cancer mortality and occupational exposure to aromatic amines and inhalable aerosols in rubber tire manufacturing in Poland

AIM

Most data on carcinogenic risk in the rubber industry are based on data from Western countries. This study assessed cancer risks in a retrospective cohort in a Polish tire manufacturing plant, relying on quantified exposure to inhalable aerosols and aromatic amines instead of job titles or external comparisons.

METHODS

Cumulative exposure for all exposures was assigned to cohort members based on estimates from a company-specific JEM. Cancer risks associated with cumulative exposure adjusted for co-exposures, gender and year of birth were calculated.

RESULTS

Exposure levels were higher for women than for men. Aromatic amine exposure was significantly associated with increased urinary bladder cancer risk (RR=7.32-8.27), depending on exposure level, and prostate cancer at low levels only (RR=5.86). In women, increased risks were found for all cancers (RR=2.50) and of the digestive organs and peritoneum (RR=4.54) at low level only, while an exposure-response association with breast cancer risk was found. Inhalable aerosol exposure was associated with cancers of the liver and intrahepatic bile ducts in a dose-dependent manner, while dose-dependent reduced risks were found for respiratory cancers (most notably the larynx) and cancer of the colon.

CONCLUSIONS

Increased risks for specific cancer sites in this rubber plant were similar to Western Europe and the US. However, several cancer risks were gender-specific which could relate to higher exposure levels in women or to differences in exposures to chemicals not assessed in this study.

[Evaluation of susceptibility to antifungal agents of fungal strains isolated from pregnant women with diabetes and healthy pregnant women]

OBJECTIVES

An increase in the frequency of fungal infections is related with progress in mycology and decreased susceptibility of fungal strains to commonly used antifungal agents. Diabetes and pregnancy are two independent factors believed to be responsible for an increased risk of mycoses.

AIM

The aim of the study was to assess the susceptibility of fungal strains isolated from pregnant women with diabetes as well as healthy pregnant women to ten antifungal agents.

MATERIAL AND METHODS

In the study 106 diabetic pregnant women and 102 healthy pregnant women were included. Susceptibility of the fungal strains was assessed in vitro by disk diffusion test.

RESULTS

Fungal strains were detected in 190 (30.4%) out of 624 samples obtained from vagina, rectum and oral cavity of 208 women. Fungi were found in 42.1% of pregnant women with diabetes and in 41.5% of health pregnant patients. Strains isolated from the diabetic women showed the highest susceptibility to pimaricin (34.4%), nystatin (31.3%) and tioconazole (31.3%) while those from healthy pregnant women were mostly susceptible to itraconazole (59.6%) and miconazole (53.2%). The comparison of the susceptibility of fungi to antifungal agents revealed that the strains isolated form healthy women were significantly more susceptible to clotrimazole (p=0.003), itraconazole (p<0.001) and miconazole (p=0.001). No difference was found in susceptibility to pimaricin (p=0.54), nystatin (p=0.75), amphotericine B (p=0.84), ketoconazole (p=0.123) and fluconazole (p=0.61) between those two groups of fungal strains.

CONCLUSIONS

Significant differences in susceptibility of fungi isolated from pregnant diabetic women to clotrimazole, itraconazole and miconazole suggest that diabetes has influence on resistance of fungal strains to some antifungal agents.

Selenium supplementation to chronic kidney disease patients on hemodialysis does not induce the synthesis of plasma glutathione peroxidase

Numerous authors have shown that selenium (Se) concentration and glutathione peroxidase (GSH-Px) activity in plasma of chronic kidney disease (CKD) patients are lower than in healthy subjects, but there are only few publications on the level of GSH-Px protein in those patients and no reports on the effect of Se supplementation to HD patients on the level of this enzyme. Se concentration and GSH-Px protein level in plasma were measured in a group of 30 CKD patients on hemodialysis (HD) supplemented with 200 microg Se/day for 3 months, and 28 patients on HD administered with placebo. Se concentration was measured by graphite furnace atomic absorption spectrometry and plasma GSH-Px protein level by the sandwich ELISA method using polyclonal antibody specific for human plasma GSH-Px. Se concentration in patients on placebo did not change throughout the 3-month study period, but increased significantly in Se supplemented group. Se supplementation to CKD patients on HD had no effect on the level of GSH-Px protein. The lack of GSH-Px protein in CKD patients on HD is not linked to Se deficiency since the level of this element increased after Se supplementation while enzyme protein level did not change. The damaged kidney of HD patients is unable to synthesize GSH-Px, even after induction with selenium.

Selenium supplementation to chronic kidney disease patients on hemodialysis does not induce the synthesis of plasma glutathione peroxidase

BACKGROUND

Numerous authors have shown that selenium (Se) concentration and glutathione peroxidase (GSH-Px) activity in plasma of chronic kidney disease (CKD) patients are lower than in healthy subjects, but there are only few publications on the level of GSH-Px protein in those patients and no reports on the effect of Se supplementation to HD patients on the level of this enzyme.

SUBJECTS AND METHODS

Se concentration and GSH-Px protein level in plasma were measured in a group of 30 CKD patients on hemodialysis (HD) supplemented with 200 microg Se/day for 3 months, and 28 patients on HD administered with placebo. Se concentration was measured by graphite furnace atomic absorption spectrometry and plasma GSH-Px protein level by the sandwich ELISA method using polyclonal antibody specific for human plasma GSH-Px.

RESULTS

Se concentration in patients on placebo did not change throughout the 3-month study period, but increased significantly in Se supplemented group. Se supplementation to CKD patients on HD had no effect on the level of GSH-Px protein.

CONCLUSIONS

The lack of GSH-Px protein in CKD patients on HD is not linked to Se deficiency since the level of this element increased after Se supplementation while enzyme protein level did not change. The damaged kidney of HD patients is unable to synthesize GSH-Px, even after induction with selenium.

[Exposure to environmental tobacco smoke and psychomotor development of children]

BACKGROUND

In Poland, prenatal exposure to tobacco smoke is observed in about 30 percent of children and postnatal in over 50 percent of children. This exposure has serious health consequences, including the negative effect on child neurodevelopment. The aim of the study was to assess the effect of environmental tobacco smoke (ETS) exposure on child psychomotor development.

MATERIAL AND METHODS

The study population consisted of 63 children with well assessed prenatal ETS exposure (a threefold analysis of cotinine level in saliva of pregnant women). To assess ETS exposure in infants within one year after birth a questionnaire-based interview was conducted with mothers. The Bayley Scale for Infant and Toddler Development (BESID-III) was used for the evaluation of child neurodevelopment.

RESULTS

Multivariate analysis (including gender, birth order of the child and parental educational status) indicated the statistically significant association between prenatal exposure to ETS and cognitive child development (b = -4.0; p = 0.04). ETS exposure has also a negative impact on motor (b = -2.7; p = 0.2) and language (b = -3.4; p = 0.08) abilities of the child although the results were not statistically significant.

CONCLUSIONS

Maternal smoking was found to be related to a decrease in child neurodevelopment, however, it was impossible to separate the prenatal from postnatal exposure. A lot of effort should be made to eliminate ETS exposure of children.

[Exposure of smoking pregnant women to polycyclic aromatic hydrocarbons]

BACKGROUND

Polycyclic aromatic hydrocarbons (PAHs) are compounds that are formed as a result of incomplete combustion of organic matter. The most common sources of PAHs are cigarette smoke, coal-fired utilities, steel plants, coke-oven plants, graphite electrode manufacturing plant, Söderberg aluminum electrolysis plant, vehicle exhaust, wood-burning ovens and fireplaces, and charcoal-grilled and smoked food. The aim of the study was to assess the exposure of smoking pregnant women to PAHs.

MATERIAL AND METHODS

The study population consisted of 189 pregnant women from the Lódź voivodeship (province). Smoking status was assessed based on saliva cotinine level analyzed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The cutoff point 10 ng/ml was adopted for saliva cotinine level. 1-hydroxypyrene (1-HP) concentration in urine sample was chosen as the biomarker of exposure to PAHs.

RESULTS AND CONCLUSIONS

The mean concentration of 1-HP in urine of nonsmoking woman was 0.60 microg/g creatinine, whereas in smoking one 1.35 microg/g creatinine. Among the women with saliva cotinine level higher than 10 ng/ml, the mean concentration of 1-HP in urine was over twofold higher than that in women with cotinine level lower than 10 ng/ml after adjustment for the day of urine ample collection (ratio of geometric mean 2.3; 95% CI 1.7-3.0). The study confirmed a higher risk of exposure to PAHs in the group of women who smoke cigarettes during pregnancy as compared to nonsmoking women. It should be stressed that cigarette smoking is not the only source of exposure to PAHs.

[Prenatal and postnatal child exposure to environmental tobacco smoke]

The aim of the study was to evaluate the prenatal and postnatal child exposure to environmental tobacco smoke. The study population consisted of 83 women from Lodz, Poland among which detail questionnaire was conducted three times during pregnancy period. From all women included into the study the saliva sample was collected to verify smoking status in pregnancy. One year after delivery the second questionnaire was performed and urine sample from all children was collected. The cotinine level in saliva and urine was analyzed using Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS ESI+). About 22% of the children were expose to ETS during prenatal and 46% in postnatal period. Cotinine level in children's urine statistically differentiated children from smoking mothers (Geometric Mean (GM) 11.4 ng/ml; 95% CI 7.1-18.3) and exposed homes (GM 7.3 ng/ml; 95% CI 3.6-15.0) compared with non-exposed homes (GM 1.3 ng/ml; 95% CI 0.9-1.7) (p < 0.001). Children should be more protected from ETS exposure in prenatal and postnatal period.

[Occupational stress and the risk of sickness absence in customer service workers]

BACKGROUND

The aim of this study was to indicate psychosocial stressors at work that significantly affect sickness absence a workers.

MATERIALS AND METHODS

Study subjects included a group of 233 randomly selected women employed as post-office clerks. Sickness absence data covered the period of 2004-2006. The psychosocial factors were assessed by means of the Subjective Work Characteristics Questionnaire. The hazard ratio (HR) of sickness absence was analysed using the Cox regression model, separately for short- (1-9 days) medium- (10-29 days) and long-term (30 days and above) sickness absence.

RESULTS

The shortterm sickness absence risk was significantly related with the post-office size--in the offices employing 8-12 workers, the risk was by 50% lower compared to those employing a smaller number of workers (HR = 0.49; 95% CI: 0.27-0.90) and unpleasant working conditions (dirt), which contributed to the increased risk (HR = 1.30; 95% CI: 1.12-1.50). In the case of a 10-29-day absence, the risk was slightly elevated by the demand of long-term vigilance, financial responsibility, and strictly determined breaks at work In the model of long-term sickness absence, a significantly higher risk was noted when the number of employees was 16-25 compared to a smaller number of employees (HR = 2.92; 95% CI: 1.09-7.82), non-occupational, self-assessed workload was high (HR = 2.97; 95% CI: 1.34-6.62) or moderate (HR = 2.22; 95% CI: 1.11-4.44) compared to self-assessed low workload, and the work space was limited (HR = 1.21; 95% CI: 1.00-1.47).

CONCLUSIONS

Our analysis showed a significant effect of stressogenic work conditions on the patterns of sickness absence. Our findings may help in developing programs intended to reduce sickness absence through limiting the prevalence of unfavourable conditions at workplaces.

[Analysis of teenage pregnancy outcome and delivery between 2000 and 2006]

OBJECTIVES

The aim of our analysis was to retrospectively analyze the course of pregnancy and delivery in the group of Polish women, aged from 15 to 25.

MATERIAL AND METHODS

We analyzed 345 woman, aged 15-25, treated in the KMMPiG ICZMP in Lodz between the years 2000 and 2006. The investigated patients were divided into two groups: 15-18-year-olds constituted the research group and 19-25-year-olds, that is the control group. Factors which have been taken into consideration included: pregnancy history, ultrasound examinations, delivery mode, birth weight and the APGAR score.

RESULTS

62.7% (n = 69) delivered naturally, 30.9% (n = 34) by caesarean section and 6.36% (n = 7) by forceps in the group of adolescents and 67.6% (n = 159), 32.4% (n = 71) and 2% (n = 5) (p = 0.379; OR 1.27) in the control group. 25.5% (n = 26) of the adolescent women (< 37 week of gestation, WG) and 20.7% (n = 48) of the controls (p = 0.39; OR 1.31) had a pre-term delivery. There were 3.9% multiparas in the group of teenagers and 20.7% among adolescents (p = 0.001). Fetal malformations were diagnosed prenatally in 13.7% (n = 14) of newborns delivered by adolescents mothers and 11.6% (n = 27) in the control group (p = 0.591; OR 1.21).

CONCLUSIONS

Despite the dangers connected with the young age of the mother, the results of this study allow us to state that teenage pregnancy usually has a correct course and does not differ significantly from the pregnancy of an adult woman.

Elaboration of a quantitative job-exposure matrix for historical exposure to airborne exposures in the Polish rubber industry

BACKGROUND

A job-exposure matrix (JEM) for inhalable aerosols, aromatic amines, and cyclohexane soluble matter (CSM) was elaborated based on measurements collected routinely between 1981 and 1996.

METHODS

The data were grouped based on similarities in exposure levels and time trends in different departments, and were analyzed using smoothing splines and mixed effects models.

RESULTS

Although higher than in western European countries, inhalable aerosol exposure decreased after changes in production volume and implementation of exposure reduction measures in mid-1980s. Aromatic amines concentrations first increased following the factory's production volume, but subsequently decreased in more recent years. CSM concentrations were uniformly distributed between departments.

CONCLUSIONS

This JEM provides an overview of historical exposure levels in a large Polish rubber factory and will enable estimation of lifetime exposure for individual workers in a Polish rubber workers cohort and further investigation of the associations between specific exposures and cancer risk.

Sonographical integrated test for detection of chromosomal aberrations

PURPOSE

Different sonographical and biochemical methods for the detection of an elevated risk of chromosomal abnormality are used. The aim of our study was to establish a diagnostic scheme with the highest sensitivity by means of an algorithm incorporating all parameters.

MATERIALS AND METHODS

In a group of 1490 pregnant women, ultrasound examination including nuchal translucency and nasal bone measurement was performed in the first trimester. Then, in the early second trimester, a second ultrasound examination combined with measuring nuchal thickness and nasal bone was carried out.

RESULTS

The combination of the NT and NB measurement showed the highest sensitivity (94.7%), specificity (99.21%), PPV (85.7%) and NPV (99.73%).

CONCLUSION

The proposed integrated test is characterised by a high predictive value for the detection of chromosomal abnormalities, low cost of performance and absolute safety for the foetus and could be offered to all pregnant women. The combination of two ultrasound examinations and biochemistry greatly increased the value of the test.

[Cost-benefit analysis of the program on early detection of pulmonary diseases]

BACKGROUND

Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management.

MATERIAL AND METHODS

The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódź region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios.

RESULTS

The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios.

DISCUSSION AND CONCLUSIONS

The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity analysis allows for investigating how different assumptions of variables influence the study results. Variables useful for the scenarios of early lung diseases detection programs were identified for further studies.

[Definition, characteristics and methods of reducing the healthy worker effect]

A cohort study is the most important study design for analyzing industrial exposures. One of the sources of bias in industrial cohort studies is healthy worker effect (HWE). HWE consists of two selection processes: healthy worker hire and healthy worker survivor. In this article, methods of reducing HWE presented in the literature are compared and its limitations are discussed. The best method of reducing healthy worker hire effect is an internal reference group. But in the case of time related exposures (cumulative exposure) time from hire have to be controlled in the regression model. To minimize healthy worker survival effect internal reference group should be used and time from hire should be controlled.

[Occupational risk factors for lung cancer--a case-control study, Lódź industrial center]

BACKGROUND

The objective of this work was to investigate the association between occupational exposure and lung cancer risk based on a case-control study.

MATERIAL AND METHODS

The study of 414 primary lung cancer cases, recorded in the Lódź industrial center in the years 1998-2002, was carried out under the international multicentre case-control study, coordinated by the International Agency for Research on Cancer (IARC). The control group, composed of individuals who did not report any tobacco-related diseases or other cancers, were matched by gender and age. Data on lung cancer risk factors were derived from a questionnaire survey on life styles and occupational exposure. The detailed information on the occupational history of all the study subjects and exposure to lung carcinogens was collected and subsequently assessed by occupational hygienists. Logistic regression was used in the data analysis. Confounders, such as age, gender, education, diet and cigarette smoking were controlled in the analysis.

RESULTS

A total of 88 case patients and 79 controls had been employed in occupations and industries associated with the evidenced or suspected risk of lung cancer development. The corresponding odds ratio was 0.71 (95%CI: 0.48-1.06). The study population was mostly exposed to organic dust, lubricating oil mist, sand, mild steel dust, organic solvents and abrasives dust.

CONCLUSIONS

The present study provides evidence that occupational exposure in the investigated Lódź industrial center is responsible for a moderate increase in lung cancer risk among exposed persons. However, only a small fraction of the study population was exposed to well documented carcinogens.

[Predictors of smoking cessation in group-based behavioral intervention programme--research findings in 2001-2007]

The efficacy and cost-effectiveness of behavioral treatments compare favorably with the pharmacotherapies and community-based interventions. Group-based behavioral programmes have been scientifically proven as the effective smoking cessation intervention. Identifying predictors of the efficacy of smoking cessation within group-based programme using characteristics of participants (social and environmental approach). Program is a multicomponent group-based behavioral intervention with the elements recommended by the US Public Health Service as the most effective. 517 smokers were included into the program in the outpatient clinic setting in years 2001-2007. A point prevalence abstinence (PPA) was estimated by self-reported smoking cessation. 59.% of participants stopped smoking during four-week program. Using multivariate logistic regression, a model provided the optimal predictive ability. PPA decreased (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.24-0.93) for manual occupied and unemployed participant comparing to nonmanual occupied smoker, decreased (OR, 0.9; 95% CI, 0.20-1.19) for high-nicotine-dependent smoker, increased (OR, 1.49; 95% CI, 0.74-2.98) for high-motivated to quit smoking participant, increased (OR 2.31; 95% CI, 1.15-4.66) for subject smoked 1 pack or more of cigarettes per day, decreased (OR 1.41; 95% CI, 0.85-2.35) for participant with smoker in household, decreased (OR 1.74; 95% CI, 1.09-2.78) for smoker without any previous physician's advice to quit and did not distinguish for subject without any previous attempts. The future of behavioral group-based treatment will likely emphasize intensive intervention targeted to particular subgroups of smokers with the need and motivation for them (eg, the low nicotine-dependent but with high emotional and/or behavioral components of dependency, poor supported by family and non-medical patients). A blurring of the distinctions between behavioral interventions, pharmacotherapies, and community-oriented approaches is also likely as multidimensional cessation strategies are developed.

[Dermal exposure to pesticides among women working in Polish greenhouses using cotton patches]

BACKGROUND

The work in greenhouses might involve indirect exposure to pesticides, resulting from the contact with previously pesticide-treated flowers and vegetables. The objective of the study was to assess the exposure to selected pesticides of workers tending and harvesting greenhouse cultivations after the restricted-entry intervals expired using cotton patches.

MATERIAL AND METHODS

Pesticide exposure was assessed among women (n=19) tending and harvesting vegetables in one of the vegetable production greenhouse in Poland. The exposure assessment methods were used to estimate workers' exposure to selected pesticides (hexythiazoks, azoksystrobin, imazalil) after the restricted-entry intervals expired. Cotton gloves and patches on chest and arms were used during the whole workshift in the greenhouse.

RESULTS

All the three kinds of pesticides were found on cotton patches and gloves. The concentration of the examined active ingredients was higher on gloves than on patches. Their concentration on patches and gloves between sprayings was proportional to the concentration of active ingredients used during sprayings.

CONCLUSION

Dermal exposure of women to pesticides during work in a greenhouse takes place even when employees are not directly engaged in the process of spraying. Therefore, it is nececarry to ensure that this occupational group is provided with the efficient personal protective equipment.

The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection

OBJECTIVE

The aim of this study was to investigate the relationship between the concentration of selected proinflammatory cytokines (IL-1alpha, IL-1beta, IL-6 and IL-8) in cervicovaginal fluid, as measured in midgestation, and the risk of early-onset neonatal infection (EONI).

METHOD

Cervicovaginal fluids were obtained from a cohort of 114 pregnant women at 22 to 34 weeks' gestation. The samples were analyzed for the concentrations of selected proinflammatory cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture.

RESULTS

Mean gestational age at the time of sampling was 29.0 weeks. Mean time between sampling and delivery was 9.3 (SD 4.7) weeks. Bacterial vaginosis (BV) was diagnosed in 27.2% of subjects and M. hominis and U. urealyticum in 22.8% and 26.3%, respectively. Out of 114 women examined, 20 (17.5%) delivered newborns with EONI. Median cervicovaginal concentrations of IL-1alpha, IL-1beta, IL-6 and IL-8 did not differ between women who delivered newborns with EONI as compared to women who delivered newborns without EONI. Women with pathological lower genital tract microflora and low IL-8 concentration (below 25(th) percentile) during pregnancy presented a significant risk of delivering newborns with EONI (OR=4.9; 95% CI, 1.1-22.8). Subjects with pathological lower genital tract microflora and a low concentration of more than one cytokine had the highest risk of delivering a newborn with EONI, OR=16.2, 95% CI, 1.1-234.0.

CONCLUSIONS

Cytokine measurement in cervicovaginal fluid in early gestation could be useful for predicting subsequent EONI only among pregnant women with lower genital tract infection. Maternal genital tract immune hyporesponsiveness as represented by low concentrations of proinflammatory cytokines may create a permissive environment for ascending infection and may lead to subsequent EONI.

[Epidemiological risk assessment of asbestos-related benign pleural and parenchymal changes in workers after past exposure to chrysotile asbestos]

BACKGROUND

Health effects related with asbestos dust exposure are observed many years after its onset. The objective of the study was to evaluate the risk of pleural and parenchymal changes depending on the duration of exposure, lapse of time since first contact with asbestos dust, and cumulative dust exposure.

MATERIALS AND METHODS

The study population comprised 222 former workers of asbestos processing plants. Risk assessment was based on the results of chest radiograms and retrospective exposure measurements. The adjusted odds ratios (OR) were used as a relative risk measure and logistic regression models were employed in statistical analyses.

RESULTS

The risk of diffuse pleural thickening in the group of workers exposed to asbestos dust for more than 10 years (years x mg/m3) as well as the risk of parenchyma changes, density > or = 1/1, and diffuse pleural thickening in the group of workers employed under cumulative exposure to asbestos dust for similar period of time were significantly higher than in the reference group. No effect of the lapse of time since first contact with asbestos dust on the risk of analyzed radiological changes was observed in the study group.

CONCLUSIONS

The level of cumulative exposure to asbestos should be taken into account in the recommended frequency of preventive medical examinations of workers.

[Certain sickness absence factors among workers older than 45 years]

BACKGROUND

Along with many other factors, such as demographic features of a given population, working conditions, psychosocial, social and cultural factors, socioeconomic transformation and labor market situation exert their effects on health conditions of workers and also on sickness absence. The aim of the study was to highlight major determinants, including non-health determinants, which shape the sickness absence among persons older than 45 years.

MATERIAL AND METHODS

The study was carried out in a group of workers aged over 45 years, but before reaching the age of retirement who were employed in the production and production-related sectors in the years 1996-2000. Individual Sickness Absence Cards (ISAC) and the questionnaire "Health-related and socioeconomic determinants of early retirement among workers at the age of work capability" were used to collect the empirical material. The material was analyzed using Cox regression, separately for short-term (4-14 days) and long-term (longer than 14 days) sickness absence cases, to calculate hazard ratio (HR).

RESULTS

The analysis based on a multi-factor model of the short-term sickness absence risk showed the effect of the following variables on the aforementioned risk: too heavy physical work (HR = 1.65; 95% CI: 1.24-2.18), low self-assessment of one's own health (HR = 1.18; 95% CI: 0.96-1.45), and frequent (at least once a month) beer drinking (HR = 1.15; 95% CI: 0.96-1.38). The risk of long-term sickness absence was increased for health-related variables, such as occurrence of 2-3 chronic diseases (HR = 1.86; 95% CI: 1.05-3.30), occurrence of 4 or more diseases (HR = 2.65; 95% CI: 1.43-4.92), and smoking (HR = 1.48; 95% CI: 1.11-1.98).

CONCLUSIONS

The results of the study may become an important signal for undertaking preventive activities to improve working conditions for older physical workers, as well as for improving health and work ability in this group of workers.

[Occupation-related psychosocial factors in pregnancy and risk of preterm delivery]

BACKGROUND

Despite scientific developments and an increasing standard of medical care, preterm delivery does not cease to be the problem even in the developed countries. Among preterm delivery risk factors, attention is also paid to stress perceived by a pregnant woman, however, job-related stress is often disregarded as a problem. The purpose of this work was to define the extent to which psychosocial characteristics of the work environment are perceived to generate stress as well as to find out their relationship with preterm delivery.

MATERIAL AND METHODS

The study group comprised 1433 pregnant women working during pregnancy (terminated after the 22nd week with delivery of a living baby) in the period from January 1, 1999 to June 30, 2000. They delivered babies in obstetric wards of 23 hospitals of the Lódź region on randomly chosen days (94 days altogether). A standard questionnaire which sought information about the pregnancy as well as about time and kind of work performed was used after the delivery. Psychosocial factors were categorized by 19 characteristics, which were evaluated by women on the 1-5 point scale in view of the stress related with a given factor.

RESULTS

Although preterm delivery was not more frequent in women who evaluated particular work features as stressogenic, it did occur more frequently in the group of women whose overall evaluation score exceeded 50. After adjusting for age and health conditions during pregnancy the odds ratio of preterm delivery related to highly stressful work was 1.98 (95% CI: 1.12-3.48). It was also observed that the proportion of women who evaluated their work as highly stressogenic was smaller in the subpopulation that continued job performance after the 5th month of pregnancy than in the women working shorter. However, the relative risk of preterm delivery was significantly higher in the latter subpopulation and it accounted for 2.36 (95% CI: 1.05-5.30). It was found that fast work pace, high workload, insufficient equipment for the work performed, conflict situations in daily activities, lack of support in difficult situations, and negative influence of other people on work and conditions of work performance were the most common sources of stress.

CONCLUSIONS

The obtained data indicate the need to evaluate stress at work in groups of occupationally active pregnant women as well as to select more thoroughly work posts for this group of employees.

[Exposure to tobacco smoke of pregnant women--results of prospective study in Lodz region]

The aim of the study was to analyze the active smoking by pregnant women in different weeks of pregnancy. The study population consisted of 136 women before 22 weeks of pregnancy. The women were interviewed three times during pregnancy. From all women included into the study the saliva sample was collected three times to verified smoking status in pregnancy. Cotinine level in saliva was analyzes using Liquid Chromatography with Tandem Mass Spectrometry. Based on interview about 25-30% of pregnant women smoked cigarettes during pregnancy. This percentage was higher when the smoking status was verified using cotinine level in saliva (33-41%). In the group of pregnant women who smoked cigarettes there was no decreasing trend in cotinine level during pregnancy whereas in nonsmokers the decreasing trend was observed. Unmarried women, those with lover educational level, and unemployed had the highest risk of smoking during pregnancy.

Ascites in infants with severe sepsis - treatment with peritoneal drainage

BACKGROUND

Ascites in neonates and infants is usually caused by cardiac failure and urinary or biliary tract obstruction. The objective of this study was to characterize our experience with ascites as a complication of sepsis.

METHODS

We retrospectively collected and analyzed data of patients treated in the intensive care unit (ICU) of the university-based children's hospital, in whom ascites developed during nosocomial sepsis. Ten infants admitted to the ICU in the first 2 days of life developed sepsis on the mean 31.5 (+/-21.9) postnatal day. Gram-negative bacteria were the causative organism in nine cases, and Staphylococcus hemolyticus in one. Because of sepsis, reintubation and mechanical ventilation were necessary. All patients received broad spectrum antibiotics (including meropenem and ciprofloxacin), blood transfusions, catecholamines and intravenous immunoglobulin preparations. Ascites was observed on the median 13.5 day of sepsis (range 3-36), and severely compromised gas exchange. Continuous peritoneal drainage was applied by means of an intravascular catheter placed in the right lower abdominal quadrant.

RESULTS

The mean drained fluid volume was 44.7 (+/-20.4) ml.kg(-1).day(-1), drainage was continued for a median of 5.5 (range 1-56) day, and enabled significant reduction of ventilator settings 24 h after its implementation. No severe complications related to drainage occurred; six of 10 babies survived.

CONCLUSIONS

Ascites can develop in infants with sepsis and cause respiratory compromise. Continuous drainage of ascitic fluid by means of an intravenous catheter is relatively safe and can improve gas exchange.

Prevalence and estimated incidence of Toxoplasma infection among pregnant women in Poland: a decreasing trend in the younger population

This study investigated the prevalence of specific Toxoplasma gondii IgG in pregnancy, the incidence of congenital toxoplasmosis and the prevalence trend of T. gondii infection among pregnant Polish women between 1998 and 2003. The study population comprised 4916 women who were admitted to the Polish Mother's Memorial Hospital Research Institute in Łódź. Their sera were tested for specific IgG and IgM antibodies to T. gondii, and the incidence of T. gondii infection was calculated from the increase in prevalence rates of IgG antibodies in various age groups. Specific IgG antibody was found in 41.3% (95% CI 39.9-42.7) of pregnant women, and the prevalence of IgG increased with age. The linear trend was significant (p <0.001), with an annual seroconversion rate of 0.7% (95% CI 0.004-0.010). The risk of primary infection was estimated to be 0.5% for 9 months, i.e., an incidence of 5/1000 pregnancies. Assuming a 30% maternofetal transmission rate, 1.5/1000 neonates were infected in utero. Seroprevalence during the 6-year study period decreased from 45.4% in 1998 to 39.4% in 2003, with a yearly decline in prevalence of 1.0% (p 0.02). The most important contributory factor to this decline was the group of women aged 19-29 years, among whom seroprevalence decreased significantly (p 0.007). Specific IgM was found in 244 (4.9%) women.

[Prophylactic examinations of workers formerly employed in asbestos processing plants: outcome of the Amiantus project in 2000-2004]

BACKGROUND

Prophylactic examinations of workers formerly employed in asbestos processing plants were performed by virtue of the Act, dated 19 June 1997, putting a ban on the production of asbestos-containing products. To enforce the provisions of the Act, the Ministry of Health has initiated the Amiantus project implemented by 13 Occupational Medicine Centers throughout the country and coordinated by the Nofer Institute of Occupational Medicine (IMP) in Lódź.

MATERIAL AND METHODS

All the Centers perform diagnostic procedures according to the same criteria (clinical, radiological, spirometric and histological), based on the 1997 Helsinki criteria, to diagnose asbestos-related diseases. A specific "Examination Form", developed for the needs of the Amiantus project, is completed by an occupational physician during examinations and sent to the IMP, where health effects in the whole population covered by the project are monitored. Periodical medical examinations are performed at least every three years and they include: general examination, chest x-ray, resting spirometric examination and supplementary examinations (e.g., resting gasometric examination) or other diagnostic examinations if necessary (e.g., computed tomography).

RESULTS

Owing to the project implementation, it was possible to collect in the database information on 5466 persons who underwent 8763 prophylactic examinations in 2000-2004. Of the total population examined during a five-year period, occupational disease was certified in 728 (13%) persons. Asbestosis was diagnosed in 790 persons, lung cancer in 19 persons and pleural mesothelioma in 12 persons. Pleural changes in x-ray imaging were found in 1662 (30%) persons and opacities in pulmonary parenchyma in 2088 (38%) persons. Having compared these results with those from previous examinations, the total health condition deterioration was observed in 882 (16%) persons, including worsening of the lung x-ray imaging in 512 (9%) persons. An analysis showed the highest incidence of asbestos-related pathologies in workers of asbestos-cement plants. The collected data also confirmed an upward trend in the incidence of asbestosis and changes in the lung x-ray imaging related to age, duration of employment and latency.

CONCLUSION

The implementation of the Amiantus project has contributed to an increased detection of pathologies related with exposure to asbestos fibers. A growing proportion of radiograms, which indicate worsening of health condition provides evidence that morbid processes in the respiratory system are progressing in persons who in the past were occupationally exposed to asbestos dust.

[Environmental tobacco smoke exposure in pregnancy and postpartum period]

Among available methods to estimate the exposure to tobacco smoke, cotinine, a major metabolite of nicotine is considered the most accurate marker. The aim of this study was to evaluate environmental tobacco smoke exposure in pregnancy and postpartum period. The cohort study was conducted in 2004 and 2006 in public maternity units in Lodz, Poland. The study population consisted of women between 32-36 weeks of pregnancy who have quit smoking within 2 months before pregnancy or no later than three months prior to participation in the study. Women were interviewed twice: during pregnancy and three months after delivery. Self-reported non-smoking status was verified using saliva cotinine level. Cotinine level in saliva sample was analyzed using Liquid Chromatography with Tandem Mass Spectrometry. We included into the analysis 62 women who, based on self-reported smoking status and saliva cotinine level were classified as non-smokers. There were no statistically significant differences in mean saliva cotinine level measured in pregnancy and postpartum period. Pregnant women who smoked more cigarettes per day before quitting smoking had significantly higher cotinine level comparing to women who smoked < or = 10 cigarettes per day (p = 0.03). Saliva cotinine level was significantly higher among women exposed to environmental tobacco smoke at home compared to non-exposed (p = 0.02).

[Some job factors associated with departure from working life before retirement age]

BACKGROUND

Ongoing demographic changes observed in Poland indicate progressive aging of the population. The process of systemic transformation initiated in Poland in 1989 has contributed to a significant decline in occupational activity among people especially those at the pre-retirement age. The identification of determinants responsible for the decreased occupational activity in older age groups of the population may provide the basis for taking appropriate steps to extend their period of employment, which will become a must in the near future in view of current socio-demographic phenomena. Therefore, the aim of the this study was to identify factors, which mostly contribute to an earlier departure of older workers from working life. The presented analysis concerns occupational factors characteristic of working conditions.

MATERIAL AND METHODS

The study was carried out in a group of current and former workers aged over 45 years and below the retirement age, employed at production workposts and in production services in the years 1996-2000. Active workers of the same age (+/- 3 years) and gender, employed at adequate workposts were matched with selected persons who had left their job because of becoming entitled to disability pension, earlier retirement, benefit or pre-retirement allowance. A questionnaire-based interview was used to collect empiric material, and logistic regression to analyze the risk of earlier departure from working life.

RESULTS

The investigation carried out in the study group showed that the following factors mostly influenced departure from work before reaching the retirement age: piecework system (OR = 7.76; 95% CI: 2.53-23.79); heavy lifting at work (OR = 1.90; 95% CI: 1.11-3.25); physical workload (OR = 1.92; 95% CI: 0.74-5.00); exposure to low temperature (OR = 1.71; 95% CI: 0.94-3.09); exposure to whole-body vibration (OR = 1.47; 95% CI: 0.96-2.25); subjective assessment of fatigue after work (OR = 2.25; 95% CI: 1.45-3.48); and no leisure time after work (OR = 2.71; 95% CI: 1.52-4.83).

CONCLUSIONS

The results of the study can be regarded as an important indication that appropriate preventive measures should be taken to improve working conditions especially for older age groups, or to provide the possibility of their retraining if the occupational activity of older workers is to be increased.

[Usefulness assessment of selected proinflammatory cytokines' level in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery]

OBJECTIVES

Recent studies have suggested that proinflammatory cytokines might play a crucial role in the mechanism of preterm labour and delivery. The main aim of this prospective study was to evaluate the usefulness of selected proinflammatory cytokines' (IL-1 alpha, IL-1 beta, IL-6 and IL-8) levels in cervico-vaginal fluid of pregnant women as an early marker of preterm delivery.

MATERIAL AND METHODS

Cervico-vaginal fluids were obtained from 107 pregnant women at 22 to 34 weeks' gestation, including 61 women with threatened preterm labour (TPL) and 46 women with physiological course of pregnancy (reference group). Those samples were analyzed for the concentrations of selected cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture.

RESULTS

Mean gestational age at the time of sampling was 28.6 weeks. Mean time between sampling and delivery was 8,24 weeks in TPL group and 10.2 weeks in reference group. BV was diagnosed in 25.2% of subjects under study. M. hominis and U. urealyticum were diagnosed more frequently among women from TPL group (25.9% vs 14.9% and 36.2% vs 17.0%, respectively). Out of 107 women 15 (14.0%) delivered before 37th week of gestation. The rate of preterem delivery was significantly higher in threatened preterm labour group--21.3% is comparison to reference group--4.3%. Median cervico-vaginal concentration of IL-1 alpha, IL-1 beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Only women with lower genital tract infection and one cytokine's low concentration (below 25th percentile) presented a higher risk of preterm delivery--OR=2,91. If IL-1 alpha and IL-1 beta concentrations were below 25th percentile, the calculated risk of preterm delivery was OR = 4.65. The highest risk was noted for women with lower genital tract infection and low cervico-vaginal concentrations of IL-1 alpha and IL-8--OR = 8.0 (3.20-20.01).

CONCLUSIONS

The early gestation cytokines' levels in cervico-vaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract infection.

Decreased Proinflammatory Cytokines in Cervicovaginal Fluid, as Measured in Midgestation, are Associated with Preterm Delivery

PROBLEM

The main aim of this study was to investigate the relationship between selected proinflammatory cytokines [interleukin IL-1 alpha (IL-1alpha), IL-1 beta (IL-1beta), IL-6 and IL-8] concentrations in cervicovaginal fluid, as measured in midgestation, and the risk of subsequent preterm delivery.

METHOD OF STUDY

Cervicovaginal fluids were obtained from a cohort of 114 pregnant women at 22-34 weeks' gestation and analyzed for the concentrations of IL-1alpha, IL-1beta, IL-6 and IL-8 using enzyme-linked immunosorbent assay technique. Lower genital tract microbiology was diagnosed using Gram stain method and by culture.

RESULTS

Mean gestational age at the time of sampling was 29.0 weeks. Mean time between sampling and delivery was 9.3 weeks (S.D. 4.7). Median cervicovaginal concentrations of IL-1alpha, IL-1beta, IL-6 and IL-8 did not differ between preterm and term delivery group. Women with lower genital tract pathological flora and IL-1alpha concentration below 25th percentile presented significant risk of subsequent preterm delivery as compared with women with no low cytokines (OR = 10.7; 95% CI, 2.0-58.1). Women with more than one cytokine' low concentration (below 25th percentile) presented an increased risk of preterm delivery--OR = 11.8 (95% CI, 1.8-78.0).

CONCLUSIONS

The midgestation cytokines' measurement in cervicovaginal fluid of pregnant women could be useful for prediction of preterm delivery only among women with lower genital tract pathological flora.

Exposure to pesticides and heavy work in greenhouses during pregnancy: does it effect birth weight?

OBJECTIVES

Work in greenhouses is performed in warm microclimate during the most time of the year, involves usually moderately intense or heavy work. The working conditions in greenhouses might involve also indirect exposure to pesticides resulting from contact with pesticide-treated flowers and vegetables. The aim of the study was to investigate whether the work in greenhouse during pregnancy adversely influenced infant birth weight and, if so, which of the two main potential hazards typical for such environment (heavy physical work or exposure to pesticides) played the major role in this process.

METHODS

The list of 14 major greenhouses (each above 5 ha) growing vegetables (cucumbers and tomatoes) was obtained from the Polish Chamber of Horticulture. Between January 2001 and December 2003, 460 women at the age below 45 years, married or who lived with a partner and who had been working for a period of at least 2 years in greenhouses in Poland were asked to participate in the project. We classified pregnancies of women working in, and out of, greenhouses on the basis of energy expenditure during mother's work into three groups: A (200-700 kcal/shift); B (701-1000 kcal/shift); and C (1001-1200 kcal/shift). Information about application of pesticides in 1997-2001 was received from persons responsible for chemical protection in each examined greenhouse. Trade names of pesticides, names and amounts of the active ingredients, type of cultivation and its area were abstracted from pesticide application registers run by each greenhouse operator. Pesticides were classified as reproductive and developmental (RD) toxins according to Pan American Pesticide Database classification.

RESULTS

The mean birth weight of infants whose mothers worked in greenhouse during pregnancy (work expenditure >1000 kcal/shift) was 177 g lower than that of those whose mothers worked out of greenhouse (light work <700 kcal/shift) (p = 0.05). Mothers who during work in greenhouse were potentially exposed to RD pesticides, delivered infants with birth weight lower by about 70 g. than infants' mothers not working at places where pesticides RD were applied, but these findings were not statistically significant.

CONCLUSION

Our results indicate that infants of mothers performing heavy work inside greenhouse during pregnancy had lower mean birth weight than infants of mothers working out of greenhouse. No similar effects of current exposure to pesticides was observed.

Impact of prenatal tobacco smoke exposure, as measured by midgestation serum cotinine levels, on fetal biometry and umbilical flow velocity waveforms

The aim of this prospective cohort study was to evaluate the impact of tobacco smoke exposure, measured by maternal serum concentration of cotinine, on fetal midgestation biometric parameters and umbilical artery (UA) qualitative blood flow indices. The study population consisted of 114 healthy women in 20 to 24 weeks gestation who were recruited from the patients of two antenatal care units in Lodz, Poland. Significant negative correlation was found between fetal biparietal diameter (BPD) and serum cotinine concentration. Serum cotinine positively correlated with all blood flow indices under study (systolic/diastolic index [S/D], resistance index, and pulsatility index) after controlling for gestational age, gender, and femur length. The midgestation UA S/D ratio > 3 was found to be a significant risk factor for decreased birthweight. Tobacco smoke exposure is a significant factor inducing increased resistance of umbilical blood flow as measured in 20 to 24 weeks gestation. This could be one of the main mechanisms leading to decreased birthweight observed among infants with prenatal exposure to tobacco smoke.

[Health reasons for work disability among municipal transport drivers]

BACKGROUND

The health condition of public transport drivers is one of the factors playing a role in assuring safety of passengers taking use of this kind of transportation means. Therefore, the assessment of pathologies occurring in this occupational group is essential from the prevention point of view. Drivers employed in the municipal transport system are at particular risk. The aim of the study was to define health reasons of work disability among bus and tram drivers in general and to indicate pathologies responsible for disabilities in particular.

MATERIALS AND METHODS

The study covered 940 drivers (including 788 men and 152 women) employed in a municipal transportation enterprise during the years 1996-2000. Bus (30%) and tram (22%) drivers as well as transport service workers (48%), aged over 45 years, but under the retirement age, were eligible for the study. The analysis of temporary work disability during a five-year period was based on sickness absence, sickness absence rate and the average duration of sickness absence.

RESULTS

The analysis revealed that diseases of the circulatory system form the major group of pathologies responsible for total sickness absence among bus drivers (43%), tram drivers (27%) and transport service workers (27%). These disease are also a leading cause of earlier retirement. They mostly include ischemic heart disease in bus drivers and hypertension in tram drivers. Cancers (pleura, kidney and eye) were responsible for 9% of sickness absence in the group of male tram drivers, whereas endocrine, nutritional and metabolic diseases and immunity disorders (diabetes, disorders of thyroid gland) in 16% of female tram drivers. Diseases of the musculoskeletal system were major causes of sickness absence among female tram drivers (24%), whereas malignant and benign neoplasms of breast and uterine myoma in 24% of female transport service workers.

CONCLUSIONS

The results of the analysis are in agreement with the literature findings and provide explicit evidence that employment in the municipal transport system is the risk factor responsible for the development of serious diseases such as musculoskeletal disorders and neoplasms. Bearing this in mind, this occupational group (bus and tram drivers) should be covered by specially designed prevention programs to protect them against these pathologies, turning special attention to health promotion at and outside workplace.

[Characteristic of the smoking habit among pregnant women on the base of the test "Why am I smoker?"]

The aim of the study was to characterize the smoking habit among pregnant women and evaluate the effectiveness of antismoking intervention based on the results of the test "Why am I smoker?". A randomized trial was conducted between December 1, 2000, and December 31, 2001, in public maternity centers in Lódź, Poland. We included into the study all women below 36 weeks of pregnancy who smoke at least one cigarette per day (intervention group - 149 smokers, control group- 144 smokers). The intervention consisted of five visits of the midwife to the home of the smoking pregnant woman. The intervention was based on the results of the test "Why am I smoker?". The results of the test "Why am I smoker?" give the good characteristics of the smoking habit among pregnant women. The intervention based on the results of this test seems to be an effective tool to help them quit smoking.

Smoking relapse one year after delivery among women who quit smoking during pregnancy

OBJECTIVES

The aim of the randomized trial was to evaluate the risk of smoking relapse one year after delivery among the women who quit smoking during pregnancy.

MATERIALS AND METHODS

The study was carried out in 2002 and 2003 and included the collection of data on smoking relapse within one year after delivery among 175 women who participated in the randomized smoking cessation trial and quit smoking during pregnancy.

RESULTS

About 50% of women who quit smoking during pregnancy relapsed into that habit within 12 months postpartum. The analysis of women who quit smoking before 14 weeks of pregnancy revealed a significantly higher risk of smoking relapse after delivery for women with the higher level of smoking addiction indicated by the Fagerström test (OR = 5.0; 95% CI: 1.5-16.2). Compared to the control group, spontaneous quitters who participated in intervention activities during pregnancy showed lower risk of smoking relapse within one year after giving birth (OR = 0.3; 95% CI: 0.1-0.9). In the group of women who quit smoking after 14 weeks of gestation, the risk of smoking relapse postpartum was significantly higher for those with the higher Fagerström test score (OR = 4.8; 95% CI: 1.6-14.1). The risk of smoking relapse 12 months after delivery was lower for spontaneous quitters who participated in the intervention during pregnancy and for women who quit smoking after participation in the intervention activities than for controls (OR = 0.03; 95% CI: 0.01-0.2, OR = 0.1; 95% CI: 0.03-0.6).

CONCLUSIONS

Women who had higher score in the Fagerström test before quitting smoking had significantly higher risk of smoking relapse within 12 months after delivery. Anti-smoking intervention during pregnancy helps women to maintain smoking abstinence after delivery.

Current determinants of early retirement among blue collar workers in Poland

BACKGROUND

The current demographic trend in Poland indicates a progressive ageing process, which will result in a decreased number of persons at the age of work capability. Thus it is essential to find out the reasons for the diminished occupational activity of elderly workers. The aim of the project was to identify the factors that significantly contribute to early retirement during the period of socioeconomic transformation in Poland.

MATERIALS AND METHODS

The analysis concerned 637 workers, aged over 45 years, but before reaching the age of retirement (60 years for women and 65 years for men) who were employed in selected industrial enterprises at technological or production-related departments. The study group was recruited from the population of former workers who quit their employment between 1996 and 2000, before they reached the age of retirement. The reference population, matched for age (+/- 3 years) and gender, comprised workers at similar workposts.

RESULTS

The following groups of variables were found to be significant risk factors for early retirement: variables describing the conditions of work (piecework system, OR = 7.00, 95% CI: 2.01-24.37; heavy lifting at work OR = 2.24, 95% CI: 1.20-4.17) and variables related to the household characteristics (shortage of leisure time, OR = 1.87, 95% CI: 1.16-4.67), health condition (disability, OR = 1.87, 95%CI: 1.09-3.21; increased rate of sickness absence, OR = 2.20, 95% CI: 1.52-3.17), and alcohol abuse (OR = 3.19, 95% CI: 1.33-7.64).

CONCLUSIONS

The data analysis revealed a spectrum of factors that either contribute to or decrease the risk for early retirement. These may be used as a reference in taking on activities aimed at preventing this adverse trend and stimulating occupational activity of elderly workers.

Efficacy and effectiveness of the smoking cessation program for pregnant women

OBJECTIVES

The aim of randomized trial was to evaluate the effectiveness of anti-smoking counseling in the population of pregnant women from the maternity centers in Lódź, central Poland.

MATERIALS AND METHODS

One hundred and forty nine current smokers and 56 spontaneous quitters were randomized into the smoking cessation intervention and 144 current smokers and 37 spontaneous quitters were included in the control group. The intervention program covered four midwife visits during pregnancy and one after delivery. The control units received standard written information about the health risk from maternal smoking to the fetus.

RESULTS

The chance of quitting smoking by the women was significantly higher in the intervention group than in the control group (OR = 2.5; 95% CI 1.8-3.7). The difference in the mean infant birthweight between the quitters and non-quitters was 203.8 g (p = 0.01) in the intervention group and 198.2 g in the control group (p = 0.08). After controlling for socio-demographic characteristics that could affect the birthweight, the differences remained significant in the intervention group - 182.8 g (p = 0.02), whereas in the control group it was 92.4 g (p = 0.4).

CONCLUSIONS

The midwife-assisted smoking cessation intervention seems to be an effective tool to help pregnant smokers make a decision to quit smoking.

[Current use of pesticides in Poland and the risk of reproductive disorders]

Among numerous factors typical of occupations in agriculture, pesticides occupy a specific place. Their hazardous effects may be manifested among others by reproductive disorders. Therefore, it is very important to know what kind of pesticides is used in both agriculture and greenhouses. The aim of the study was to review the kinds and amounts of pesticides used in agriculture and greenhouses. The review was performed in the Kujawsko-pomorskie voivoship and on 14 horticulture farms. Their selection was based on the register of the Polish Horticulture Chamber. The pesticides were classified into two groups: those containing reproductive and/or developmental toxins (RD) and those acting as endocrine disrupters (ED). The majority of pesticides used in agriculture and horticulture belong to one of those groups. The results of the review suggest that the awareness of potential adverse effects of pesticides on fertility and pregnancy outcome should be increased among workers occupationally exposed to pesticides.

[Health reasons for work disability among persons before going into early retirement]

BACKGROUND

The demographic situation in Poland shows a progressive ageing of its population and a concomitant decrease in the number of people of the productive age. The identification of health problems in older groups of people of the productive age is essential for gaining better knowledge of measures to be taken in order to extend the period of occupational activity in this groups of workers. The aim of the study was to define the health status of persons going into early retirement on the basis of their sickness absence history covering the five preceding years.

MATERIALS AND METHODS

The study was conducted among workers, aged over 45 years and below the retirement age, employed at production posts or operating production processes. The analysis covered 303 workers who went into early retirement in the years 1996-2000 and 485 persons in the same age group, but still employed. Information on the health causes of their disability to work during a five-year period was collected for both groups of persons. The temporary work disability was analyzed using the following parameters: sickness absence rate, sickness absence cases and the average duration of sickness absence.

RESULTS

The study showed that the total sickness absence among persons going into early retirement during the preceding five years was 64% for men (sickness absence rate--18.56) and 14% for women (sickness absence rate--15.97), and it was higher compared to still employed persons. These differences were mostly observed in the group of diseases of the nervous system and sense organs (over twofold difference in men and about 58% in women), diseases of the circulatory and respiratory systems in men and diseases of the genitourinary system in women (about twofold difference). The main causes of sickness absence were: diseases of the circulatory (29% of male and 16% of female sickness absence), musculoskeletal (19 and 17%, respectively), and respiratory (15 and 19%, respectively) systems, as well as diseases of the nervous system and sense organs (15% of male sickness absence) and neoplasms (12% of female sickness absence).

CONCLUSIONS

The results of the study indicate that in the older group of workers, health problems are one of the major causes of going into retirement before reaching the retirement age.

Environmental tobacco smoke exposure among pregnant women: impact on fetal biometry at 20?24 weeks of gestation and newborn child?s birth weight

AIM

While there are sufficient data regarding the negative effect of exposure to the constituents of tobacco smoke on newborn infants' birth weights, it is still unclear whether this effect may originate in early pregnancy. The aim of the present study was to evaluate the impact of exposure to tobacco smoke components in early pregnancy (20-24 weeks) on fetal biometry.

METHODS

The study population comprised 183 women consecutively enrolled at 20-24 weeks of pregnancy at the two antenatal care units. Ultrasound biometric measurements of fetal bi-parietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were performed at the time of enrollment. Serum cotinine concentration was determined at 20-24 weeks of gestation by gas chromatography with mass spectrometry detector (GC/MS) to assess environmental tobacco smoke (ETS) exposure during the previous evening and the morning of the same day (blood collection at 1200-1300 h). ETS exposure (passive smoking) was assumed to occur when the level of serum cotinine ranged from 2-10 ng/ml.

RESULTS

In a multiple regression model for bi-parietal diameter (BPD), after adjustment for pregnancy duration at the time of ultrasound examination, fetal gender, and maternal pre-pregnancy weight, a statistically significant negative association was found between the BPD and serum cotinine concentration. A similar association was identified for subjects with serum cotinine concentrations below 10 ng/ml (corresponding to passive smoking) (P=0.06). After controlling for pregnancy duration, maternal pre-pregnancy weight and infant's gender, we found that serum cotinine levels at 20-24 weeks of gestation was inversely associated with infant birth weight (P=0.004). For the subjects with serum cotinine levels below 10 ng/ml, a borderline association (P=0.09) with infant birth weight was found.

CONCLUSIONS

Maternal exposure to tobacco smoke in early pregnancy, as measured by serum cotinine concentrations at 20-24 weeks of gestation, adversely affects fetal BPD. Preventive measures need to be undertaken to encourage pregnant women to stop smoking and avoid passive exposure to tobacco smoke from the very beginning of pregnancy.

The use of pesticides in a Polish rural population and its effect on birth weight

INTRODUCTION

The risk of adverse reproductive outcomes related to pesticide exposure has been investigated in few studies; however, the results have not been consistent. The goal of the present study was to evaluate the influence of maternal residual exposure to pesticides on birth weight among women in an agricultural district in Central Poland.

METHOD

Subjects included 104 women who delivered a single, live infant between 1 January 1994 and 31 December 2000. Based on maternal reports, the type of farming (crops, orchards, non-farming jobs), involvement in field work and the trade names of pesticides used within last pregnancy were established. Birth weight for the most recent pregnancy was abstracted from the medical data of the local maternity unit.

RESULTS

Mothers who reported involvement in field work had a similar pregnancy duration but delivered infants with a significantly higher birth weight than mothers not reporting such activities in the first or second trimester of pregnancy (P=0.04). However, after controlling for pregnancy duration and other factors affecting birth weight, we found that maternal exposure to synthetic pyrethroids in the first or second trimester was associated with a small but statistically significant decrease in birth weight (P=0.02).

CONCLUSIONS

We postulate that the observed effect of pyrethroids exposure was related to a slower pace of foetal development corresponding to the small-for-gestational-age (SGA) birth.

[Sick leave among workers employed in restructured enterprise]

Ownership and restructuring transformations that are taking now place in Poland, as well as the situation on the labor market have their impact on the indicators, which illustrate the workers' health situation, including temporary work disability preceding the issue of the certification granting the disability pension. The aim of this analysis was to identify the changes in the extent and causes of sickness absence among workers after restructuring. The study was carried out in one of the largest transport industry enterprises during the years of its restructuring (1984-1994), covering 8588 workers, and after its restructuring (1997-1999), covering 2702 workers. Following the restructuring, the enterprise's staff was rejuvenated so that the number of workers aged over 50 years decreased by almost fifty percent. The analysis was based on the sickness absence rate calculated as the ratio between the number of days of work disability in a given period of time and the number of person-days in the same period. In 1997-1999, a 33% decrease in sickness absence among women and a 25% decrease among men were observed in the study enterprise as compared with the period of 1989-1994. However, the enhanced absence was also found due to the following diseases: mental disorders (a threefold increase in men); diseases of the musculoskeletal system (by 54% in men and by 43% in women); endocrine, nutritional and metabolic diseases and immunity disorders (a threefold increase in women). Following the restructuring, considerable changes in the sickness absence structure, by causes of diseases, were revealed. A substantial decrease in the share of male and female absence due to diseases of the respiratory and circulatory systems and almost threefold decrease in complications of pregnancy, childbirth and the puerperium in women were noted. In addition, over twofold increase in male and female sickness absence due to diseases of the musculoskeletal system, and lower but significant increase due to mental pathologies (from 3 to 12% in males and from 4 to 7% in women) were recorded. The changes observed in sickness absence result mainly from the changes in the magnitude and structure of employment in the restructured enterprise and related organizational modifications, which arise stressogenic situations among workers, more intensified at risk of unemployment.

[Working condition of pregnant women. Departures from regulation on occupations especially noxious or hazardous to women]

To define the range and kind of discrepancies between regulations and actual state of working conditions and occupations performed by women during pregnancy, a survey was carried out in the population of 2649 women, a representative group of occupationally involved pregnant women in the region of Łódź. The questionnaire analysis provided information on the kind and arduousness of work performed, working hours and conditions in the work environment. Having verified the data obtained from 10% of women, a very high consistency between working conditions described by respondents and evaluated by experts was noted. Its was found that almost 60% of women under study indicated that their working conditions depart from those defined as admissible for women during pregnancy. Of the women who worked only during the first month of pregnancy, 75% of them were employed at workposts, which did not meet the requirements, and nearly half of women who worked during the whole period of pregnancy were employed in inappropriate conditions. The noxiousness most frequently reported by respondents applied to body posture: bending and position with rotated spine (about 40%). This was followed by lifting and carrying various objects (about 30%), prolonged working hours (about 20%), shift work, including night shifts (about 12%), work at conveyor belt and forced work pace (about 20%). Noise that makes it difficult to communicate, local vibration and work with computers over 4 hours daily was reported by 30% and 15% of respondents, respectively. The most common solution to limit the potential effect of hazardous and noxious working conditions on pregnant women was to remove them from work by issuing a sick leave certificates, while the modification of working conditions or shifting them to another post applied only to 14% of women. The results of the study showed that working conditions of pregnant women differed from those described by the State Labor Inspectorate. The discrepancy can be explained by different method of data collection.

Pesticide exposure and birthweight: an epidemiological study in Central Poland

The aim of this study was to evaluate the influence of maternal exposure to pesticides in the 1st and 2nd trimesters of pregnancy on infant birthweight in a population of Polish farmers. The subjects were women who delivered in 25 maternity hospitals in the region of Lódź (Central Poland), including 117 women who delivered infants with low birthweight (LBW) and 377 infants with birthweight > or = 2500 g delivered on randomly selected 70 days between 31 January 1998 and 30 June 2001. A questionnaire on maternal demographic and anthropometric characteristics as well as the occurrence of several occupational hazards, including pesticide use and involvement in heavy physical work on the farm in each of pregnancy trimesters, was administered by a physician 1-2 days after delivery. The pesticides used most frequently included: phenoxyacetic acid derivatives, organophosphates, ureas, triazines, synthetic pyrethroids and N-phenylamides (anilides). Infants born to women exposed to pesticides in 1st or 2nd trimester had birthweight lower by 189 g than that of infants of the non-exposed women. When adjusted for pregnancy duration, the women exposed to pesticides were found to deliver infants with birthweight lower by about 100 g (p = 0.067) than that of infants of the non-exposed women. After adjusting for the variables that may have impact on pregnancy duration, we noted that mothers exposed to pesticides, on average delivered half a week earlier than those non-exposed. Our results indicate that maternal exposure to pesticides may contribute to a slight reduction in the duration of pregnancy. A slower pace of fetal development, corresponding to the small-for-gestational-age effect, was observed, but the increment in the risk was of borderline significance.