THE IMPORTANCE OF SIGHT FOR DRIVERS

Sight is the basic sense for drivers. Condition of the eye determines correct, comfortable and safe performance of the work as drivers. This article presents various factors influencing the sight condition. There are two groups of factors, external (environment, the kind and time of work, stress caused by work) and internal (systemic and local disorders). All these factors can reduce significantly visual functions, such as visual acuity, field of vision, color vision, strereoscopic vision, twilight vision and glare sensitivity. There are also presented actual requirements for drivers and causes of the car accidents in various age groups. Impairments in vision functions can be dangerous for both the driver and other road users. Med Pr 2013;64(3):419–42

Can alveolar hypoventilation due to kyphoscoliosis be a contraindication to driving?

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen

Results of conservative, surgical treatment and rehabilitation of entrapment neuropathies in elderly patients in geriatric practice

Entrapment neuropahies of upper limbs can cause mainly nocturnal neuropathic pain and impaired manual dexterity. The most common entrapment neuropathy is carpal tunnel syndrome and ulnar groove syndrome - ulnar nerve entrapment at the elbow. Treatment of entrapment neuropathies is both analgetic therapy and physiotherapy. In the cases of conservative treatment inefficiencies surgical decompression of nerves is performed. Authors of this oublication present results of both conservative  and surgical of entrapment neuropathies in patients over 65 years old. Among the 17 patients with entraoment neuropathies 12 of them underwent surgical treatment. Achieved partial improvement in pain, mostly nocturnal and improving the quality of life and dexterity. In comparison, however, a group of younger patients who underwent surgery for the improvement was less spectacular, which may testify advancement and irreversibility of changes in older patients

Assessment of the prevalence of nootropic drugs by elderly patients in geriatric practice

So-called nootropics include a diverse group of drugs whose idea is to improve brain function. They are quite commonly accepted among the elderly. Although currently available data from the literature do not show unequivocally the efficacy of these drugs, in practice a large number of patients are in practice. These drugs are prescribed to patients fairly commonly and the range of indications for their use is wide and non-specific. This publication presents the mechanism of action of these nootropic drugs, historical outline of their use and epidemiological data on their use in elderly patients on the basis of patients treated in the Department of Geriatrics of Medical University in Bydgoszcz

Prevention of cardiovascular diseases – Prophylactic program in a selected enterprise

Background: In Poland cardiovascular diseases (CVD), classified as work-related diseases, are responsible for 25% of disability and cause 50% of all deaths, including 26.9% of deaths in people aged under 65 years. The aim of the study was to analyze employee expectations regarding CVD- oriented prophylactic activities in the selected enterprise. Material and Methods: A questionnaire, developed for this study, consists of: socio-demographic data, job characteristics, occupational factors, and questions about the respondents’ expectations concerning the prevention program. The study group comprised 407 multi-profile company employees aged (mean) 46.7 years (standard deviation (SD) = 9.1), including 330 men (81.1%), mean age = 46.9 (SD = 9.2) and 77 women (18.9%), mean age = 45.9 (SD = 8.2) The study was performed using the method of auditorium survey. Results: Employees declared the need for actions related to physical activity: use of gym, swimming pool, tennis (56.5%), smoking habits – education sessions on quitting smoking (24.6%). A few people were interested in activities related to healthy diet. According to the majority of the study group, the scope of preventive examinations should be expanded. Based on our own findings and literature data CVD- oriented preventive program, addressed to the analyzed enterprise was prepared. The program will be presented in another paper. Conclusions: The results showed significant quantitative and qualitative differences in the classic and occupational CVD risk factors between men and women, as well as in preferences for participation in prevention programs. Therefore, gender differences should be taken into account when planning prevention programs. Med Pr 2017;68(6):757–76

The management of obstructive sleep apnea syndrome in drivers - recommendations of the Polish Society Of Occupational Medicine, The Polish Respiratory Society, The Nofer Institute of Occupational Medicine in Lodz and The Polish Sleep Research Society

Na podstawie wyników wielu badań i analiz prowadzonych w różnych krajach potwierdzono, że obturacyjny bezdech senny (OBS) negatywnie wpływa na zdolności psychofizyczne kierowców. Dlatego w Dyrektywie Unii Europejskiej z dnia 1 lipca 2014 r. OBS został uznany za jeden z najważniejszych czynników ryzyka wypadków samochodowych. Realizacja postanowień tej dyrektywy w państwach członkowskich ma przyczynić się do jego ograniczenia. Wynikiem jej implementacji w Polsce jest rozporządzenie Ministra Zdrowia z dnia 23 grudnia 2015 r. zmieniające rozporządzenie w sprawie badań lekarskich osób ubiegających się o uprawnienia do kierowania pojazdami i kierowców. Mimo że w załączniku nr 2 tego rozporządzenia podano szczegółowe warunki badania lekarskiego w przypadku podejrzenia OBS, nie uregulowano ani nie wyjaśniono kwestii narzędzi i sposobu pozwalających na powzięcie w przypadku badanego pacjenta podejrzenia umiarkowanej lub ciężkiej postaci choroby. Dlatego konieczne było opracowanie dla lekarzy uprawnionych do badań lekarskich kierowców i osób ubiegających się o prawo jazdy standardów postępowania w przypadku podejrzenia występowania OBS. W artykule przedstawiono usprawniający proces orzeczniczy algorytm postępowania, który został opracowany przez Polskie Towarzystwo Medycyny Pracy, Polskie Towarzystwo Chorób Płuc, Instytut Medycyny Pracy w Łodzi i Polskie Towarzystwo Badań nad Snem. Med. Pr. 2020;71(2):233–243The findings of numerous studies and analyzes conducted in many countries have proven that obstructive sleep apnea (OSA) negatively affects the psychophysical abilities drivers. Therefore, in Commission Directive 2014/85/EU of July, 1 2014, OSA was recognized as one of the most important risk factors for car accidents. The implementation of said Directive by Member States is to contribute to reducing the risk of such accidents. The implementation of the Directive in Poland has resulted in enacting the Ordinance of the Minister of Health of December 23, 2015 amending the ordinance on medical examinations of applicants for a driving license and drivers. Although Annex 2 to that regulation sets out the detailed conditions for a medical examination for OSA, it does not regulate or clarify the issue of tools and methods for suspecting OSA in a moderate or hard form. Therefore, it was necessary to develop standards of management for doctors authorized to perform medical examinations of drivers and applicants for a driving license in the case of suspected OSA. The paper presents an algorithm of proceedings that streamlines the case-law process in the above-mentioned cases, which was developed by the Polish Society of Occupational Medicine in cooperation with the Polish Respiratory Society, the Nofer Institute of Occupational Medicine in Łódź and the Polish Sleep Research Society. Med Pr. 2020;71(2):233–4

Work fatigue in urban bus drivers

Background: Bus drivers are a special group of professional drivers who are at a very high risk of fatigue. The aim of the study was to examine whether the driver’s subjective assessment of fatigue allows for the determination of its level and identification of its causes. Material and Methods: The study group comprised 45 randomly selected bus drivers (mean age – 43.7±7.9 years, period of employment as drivers – 14.7±8.6 years). Examinations were performed in all subjects four times – before and after work on the “easy” route (outside the city center, small traffic intensity) and before and after work on the “difficult” route (city center, heavy traffic). The fatigue test questionnaire, based on the list of symptoms of fatigue prepared by the Japan Research Committee of Fatigue, was used in the study. Results: The rating of fatigue after the work was significantly higher than that before the work. The profile of fatigue after work was not influenced by the type of route, but the assessment of most symptoms of fatigue reached a higher level after the “difficult” routes and the differences were statistically significant for 7 symptoms. Only the ratings of leg fatigue, feeling of heaviness, and the necessity to squint eyes and gaze with effort reached the higher levels after driving the “easy” routes. It has been found that the level of fatigue was significantly correlated with the job characteristics (driving time, the length of the route, number of stops, etc.) and with the abundance of food ingested and type of beverage (coffee vs. others) drunk prior to driving. Conclusions: The questionnaire used in our study to assess the subjective feeling of fatigue has proved to be a sensitive and useful tool for indicating the level and causes of fatigue. The relationship between the symptoms of fatigue and the characteristics of job and lifestyle shows that actions must be taken by both the employers and employees to prevent fatigue in bus drivers. Med Pr 2015;66(5):661–67

Impedance cardiography – Old method, new opportunities. Part I. Clinical applications

Monitoring of cardiovascular hemodynamic changes requires a very expensive and highly specialized equipment and skilled medical personnel. Up to the present time, an inexpensive, non-invasive and easy-to-use method which, like Doppler echocardiography, magnetic resonance angiography or radionuclide imaging, would assess hemodynamics of the cardiovascular system was not available. A method known as impedance cardiography (ICG) or thoracic electrical bioimpedance cardiography (TEBC) meets those criteria. It is non-invasive, which is of a particular advantage over the conventional methods that require catheterization. As a result, the patient is not at risk of possible complications and the procedure is less expensive and easier. Impedance cardiography, despite its non-invasive character, has not been so far extensively used for monitoring of hemodynamic parameters in hospitalized patients. Various authors report that attempts have been continued to compare the results from ICG and those obtained by other diagnostic methods. This paper presents the use of impedance cardiography in diagnosis of hypertension, cardiac insufficiency, differentiating the causes of acute dyspnea, as well as in assessing the effects of cardiac rehabilitation in patients with heart failure

Impedance cardiography – Old method, new opportunities. Part II. Testing of cardiovascular response to various factors of work environment

Impedance cardiography seems to be a very good, although underappreciated diagnostic method. What may distinguish it from among the many research methods is the fact that it enables non-invasive monitoring of cardiac output, stroke volume and systemic vascular resistance. Holter recording of the hemodynamic parameters makes it possible to study them not only in stationary (hospital, outpatient clinic) conditions, but also during household or professional activities, e.g., during road vehicle driving. Assessment of the trends of changes in the circulatory system of the employee at work makes it possible to judge whether the type of work performed by the worker is well tolerated – whether it is not too hard or too stressful. This is important, therefore, impedance cardiography can be extensively used in occupational medicine. Provision of preventive care to workers according to current standards requires, on the one hand, the use of the latest diagnostic methods while, on the other hand, the methods must be inexpensive, because otherwise the employer would not be able or willing to pay the associated costs. Impedance cardiography meets those criteria; however, few data is available in literature worldwide on the use of this method in the research on the impact of occupational work on cardiovascular responses of the employees. This work reports the use of impedance cardiography in studies on the various aspects of work environment