Respiratorne smetnje radnika izloženih nerđajućem čeliku

The study involved 106 workers exposed to stainless steel dust (47 stainless steel welders, 59 stainless steel handling workers) and 80 controls. Respiratory impairment was evaluated by means of a standardised questionnaire, clinical examination and lung function tests (spirometry, forced expiratory flow). Dyspnoea was encountered more frequently among exposed workers but there was no greater prevalence of chronic bronchitis compared to the control group. Lung function tests (FEV1, PEF, FEF75, FEF50, FEF25) were significantly lower in the exposed group. Smoking did not contribute essentially to these changes. The results confirm that stainless steel dust is an important cause of the development of respiratory obstructive disorders in the industrial working population.Pregledana je 106 radnika izloženih prašini nerđajućeg čelika, i to 47 zavarivača i 59 radnika zaposlenih na obradi nerđajućeg čelika, te 80 radnika kontrolne skupine koji nisu bili izloženi djelovanju bilo kojeg iritativnog ili alergogenog aerosola. Upotrebom upitnika o respiratornim smetnjama Komiteta za kronični bronhitis nije utvrđena veća učestalost kroničnog bronhitisa, ali je otežane disanje i gušenje bilo češće u radnika eksponirane skupine u odnosu na kontrolnu. Provjerom funkcionalnih testova ventilacije (FVK, FEV1, PEF, FEF75, FEF50, FEF25) ustanovljeno je kod eksponirane skupine značajno sniženje svih parametara osim FVK. Pušenje nije bitno utjecalo na nađene promjene. Ovi rezultati potvrđuju da je prašina nerđajućeg čelika jedan od činilaca razvoja opstruktivnih dišnih smetnji kod industrijske populacije

Whole-body vibration syndrome - a medical problem requiring more attention

Izloženost općim vibracijama u industriji, prometu i drugim gospodarstvenim granama sve je veća. Taj fizikalni stalni čimbenik ugrožava radnu efikasnost i zdravlje ljudi ne samo u profesionalnim aktivnostima već i u svakodnevnom životu, a javnim prometnim sredstvima, čak i u vlastitim stanovima. Međutim, u svakodnevnoj medicinskoj praksi ne posvećuje se dovoljno pažnje oštećenjima zdravlja nastalim djelovanjem općih vibracija. Zbog toga su u radu navedene osnovne fizikalne značajke vibracija, svjetski priznati standardi za dopušteno izlaganje općim vibracijama (ISO standard), posljedice njihovog štetnog djelovanja na različite organske sustave i procjena rizika oštećenja zdravlja.Exposure to whole-body vibration is a growing concern in industry, traffic and in other branches of the economy. This harmful physical factor endangers work efficiency and human health not only at work but also in everyday life, in public transportation and even at home. In spite of increasing exposure to vibrations, our medical practice does not pay adequate attention to the health effects of whole-body vibration. The paper deals with the basic characteristics of vibration (frequency, amplitude, velocity and acceleration), its adequate evaluation (effective or weighted average value, peak values, rating and weighting procedure of vibration measurement) and exposure (vibration direction, exposure time, transmission and dissipation). In industry and traffic, vibrations present complex oscillatory motions, characterized by a wide frequency spectrum, variable amplitude and acceleration, and different directions. To assess the harmful effects of vibration, the International Organization for Standardization (ISO) has proposed three standards for acceptable human exposure to whole-body vibration: fatigue-decreased proficiency boundary, exposure limit and reduced comfort boundary. Quantitative parameters of vibration for some vehicles, and for constructional, industrial and agricultural machinery are also given. The most pronounced long-term effect of whole-body vibration is damage to the spine. The spinal region most frequently affected is the lumbar part, where spinal deformation, lumbago and sciatica can develop. The possible cause of spinal damage could be mechanical overload and metabolic changes of the intervertebral disc. Other organ systems, such as peripheral and autonomic nervous, vestibular, vascular, digestive and female reproductive systems are also liable to become affected. Risk assessment of chronic health effects is based on the appropriate evaluation of whole-body vibration exposure and individual response. Health risk increases with the intensity and duration of vibration exposure. The concomitant factors are forced sitting posture and heavy physical work. Human response to whole-body vibration depends on factors promoting the development of degenerative changes such as constitution, previous spine disease and young age. The main problems in diagnosing whole-body vibration syndrome are differentiation of vibration induced disorders from age dependent changes of the spine and lack of a specific diagnostic method for assessing those changes. Therefore, only permanent medical surveillance can guarantee proper assessment of the damage induced by whole-body vibration. For vibration exposed workers preplacement and periodic examinations are recommended. Those should include a basic medical examination and an X-ray of the spine, or at least of its lumbar part

Early detection of the haematotoxic effect of benzene - the imperative of occupational medicine today

Za prikladan zdravstveni nadzor radnika izloženih benzenu potreban je složen pristup. Sastoji se od određivanja koncentracija benzena u zraku radne okoline, koja prema važećem standardu može maksimalno iznositi 15 ppm, dok su razvijene zemlje svijeta već prihvatile razinu od 1 ppm. Nužno je i praćenje metabolita benzena u organizmu izloženih radnika. Kod nas je općeprihvaćeno određivanje fenola u mokraći prije i poslije smjene sredinom radnog tjedna. Obavezni laboratorijski testovi uključuju određivanje kompletne krvne slike s eritrocitnim indeksima, a ostali navedeni hematološki testovi su potencijalno vrijedni, ali još nedovoljno ispitani. Promjena ni u jednom od navednih pokazatelja nije patognomonična, pa se svi nalazi moraju interpretirati istodobno i s puno opreza. Otkrivanje početnih oštećenja krvotvornog sustava osoba izloženih benzenu ostvaruje se kontinuiranim praćenjem zdravstvenog stanja i putem prethodnog i periodskih pregleda. Tako se jedino mogu zadovoljiti kriteriji suvremene medicine rada u otkrivanju početnih promjena i prevenciji nastanka ireverzibilnih toksičnih oštećenja krvotvornog sustava kao posljedice djelovanja benzena.Surveillance of workers exposed lo benzene calls for a complex approach. This includes the de-termination of benzene concentration in the working atmosphere, which, according to standards applied in Croatia, should not exceed 15 ppm. In the developed countries the allowable workplace level has been reduced to 1 ppm. The monitoring of benzene metabolites in the organism of exposed workers is also necessary. As an indicator of benzene exposure, the urinary phenol concentration determined before and after work in the middle of the week has been generally: accepted in Croatia. An essential laboratory test is a complete blood count including red cell indices. Other haematological tests that might be valuable early indicators of benzene haematotoxicity need to be more fully evaluated. Alterations in any of these indicators are not pathognomonic and all findings should therefore be interpreted at the same time and with caution. Early detection of benzene haematotoxicity can be accomplished by continuous health monitoring of exposed workers through preplacement and periodic health examinations. This is in accordance with the requires of modern occupational medicine which requires identification of early changes and prevention o irreversible benzene induced toxic changes in the haematopoietic system

Plućne funkcije i rendgenogram pluća i pleure u brodogradilišnih radnika izloženih azbestu

Lung functions and diffusing capacity for carbon monoxide were examined in 299 shipyard workers occupationally exposed to asbestos, among whom there was an equal number of smokers and non-smokers. The workers were classified into groups according to the lung fibrosis profusion and the length and width of the pleural plaques in accordance with the 1980 ILO International Classifications of Pneumoconioses. With regard to the profusion of the parenchyma, workers classified in category 2 (subcategories 2/1 and 2/2) had significantly lower FVC and FEV1 values than the workers in categories 0 (P<0.01) and 1 (P<0.05). With an increase in the category of profusion there was a trend towards a fall in mean MEF25, MEF50 and MEF75 values, but it was not significant. Diffusing capacity for carbon monoxide was identical for all categories. There were no significant differences between the workers without pleural plaques and those with visible plaques in respect to lung function values. With an increase in the length and width of the plaques FVC, FEV1, MEF25 and MEF75 values tended to become lower. The results demonstrate that the changes detected on the radiographs of the lungs and pleura are the early indicators of possible asbestos disease in shipyard workers.Plućne funkcije i difuzijski kapacitet za ugljik monoksid ispitivani su. u 299 brodogradilišnih radnika profesionalno izloženih azbestu. Među ispitanicima bio je podjednak broj pušača i nepušača. Dobiveni rezultati analizirani su u skupinama ispitanika svrstanih prema prožetosti plućnog parenhima fibrozom te duljini i širini pleuralnih plakova. U odnosu na prožetost parenhima ispitanici svrstani u kategoriju 2, supkategorije 2/1 i 2/2, imali su statistički značajno sniženu vrijednost FVK i FEV1 u odnosu na ispitanike svrstane u kategoriju 0 (P<0,01) i kategoriju 1 (P<0,05). Uočen je trend pada prosječnih vrijednosti MEP25, MEP50 i MEP75 s porastom kategorije prožetosti ali bez statističke značajnosti. Vrijednosti difuzijskog kapaciteta "za ugljik monoksid bile su podjednake u svim kategorijama. Nije bilo statistički značajne razlike u ispitanika bez pleuralnih plakova u odnosu prema ispitanicima s vidljivim plakovima. Uočen je trend pada FVK, FEV1, MEP25 i MEP75 s povećanjem i širine i duljine plaka. Rezultati pokazuju da je u odnosu na ispitivane plućne funkcije rendgenogram pluća i pleure raniji znak moguće azbestne bolesti u brodogradilišnih radnika

Digitalna fotopletizmografija u dijagnozi traumatske vazospastične bolesti

By means of the photoplethysmographic method including the cold test, skin blood flow was recorded m the fingers of 42 chain-saw operators and 36 control subjects. The essential difference between the groups pertained to the height of the pulse wave amplitude after the cold test and to the fall in amplitude expressed as a percentage of its initial value. A limit of a 90% fall in amplitude after the cold test is proposed as s criterion for differentiating a normal from a pathological vasospastic reaction. A fall in amplitude is correlated with the intensity of subjective disorders, Le. the attack of vibration-induced white fingers. The obstructive form and loss of amplitude of the pulse wave form are accepted as pathological.Mjerenje krvnog protoka u koži prstiju fotopletizmografskom metodom uz primjenu termalnog testa provedeno je kod 42 sjekača motornom pilom i 36 muškaraca kontrolne skupine. Bitna razlika između skupina nađena je u visini amplitude krivulje pulsnog vala poslije testa hladnoćom te u padu amplitude izražene kao postotak njezine početne vrijednosti. Predložena je granica od 90% rada amplitude nakon testa hladnoćom kao kriterij za razlikovanje normalne od patološke vazospastičke reakcije. Pad amplitude je povezan s intenzitetom subjektivnih smetnji, tj. pojavom »bijelih prstiju«. Kao patološki prihvaćeni su opstruktivni oblik i gubitak amplitude krivulje pulsnog val

Upotreba živinih mjernih uređaja u zdravstvenim ustanovama u Hrvatskoj

In 2009, we conducted a survey to assess the use of mercury-based thermometers and sphygmomanometers and their disposal in Croatian healthcare facilities. The questionnaire addressing the use of mercury-based medical devices, waste management, preferences between mercury-based and electronic devices, and the knowledge on mercury toxicity was filled by ward nurses affiliated with 40 (71.4 %) out of 56 contacted healthcare facilities. Only one of these facilities had given up the use of mercury-containing medical devices at the time. As many as 84.6 % of the nurses believed that broken devices did not increase the risk of mercury exposure, even though 90 % claimed they were aware of mercury toxicity. In fact, 69.4 % of the nurses preferred mercury-containing devices on account of their precision and reliability and because they received little training in the use of electronic devices. Breaking of thermometers and sphygmomanometers is common in healthcare facilities. The number of broken thermometers and sphygmomanometers was estimated to 278 and fi ve per month, respectively. Only 18 (46.2 %) of the surveyed healthcare facilities claimed to have had a proper disposal procedure for mercury from broken devices. Nurses, who most often handle these devices and collect mercury spills, are primarily exposed to mercury vapours via inhalation. Croatia has adopted the EU Directive 76/769/EEC intended to reduce mercury exposure in the living and working environment. Our survey suggests that all healthcare professionals need training in proper management of broken mercury-based medical devices, nurses in particular. To reduce the risk of exposure, all Croatian healthcare facilities should implement guidelines for staff protection and programmes to gradually replace mercury-based with electronic devices.Živa je štetni čimbenik izravno povezan s provođenjem zdravstvene zaštite. Tijekom 2009. provedeno je istraživanje u zdravstvenim ustanovama RH, s ciljem procjene uporabe živinih mjernih instrumenata, toplomjera i tlakomjera te načina odlaganja razbijenih uređaja. Upitnik o uporabi živinih uređaja, zbrinjavanju otpada, sklonostima uporabi živinih, odnosno elektroničkih mjernih uređaja te pitanja o poznavanju toksičnosti žive, ispunile su odjelne medicinske sestre iz 40 (71,4 %) od 56 zdravstvenih ustanova. Samo u jednoj ustanovi živini se mjerni uređaji uopće ne rabe. Čak 84,6 % ispitanica smatra da nisu dodatno izložene živi iz razbijenih uređaja, iako je 90 % svjesno toksičnosti Hg. Zbog njihove preciznosti, pouzdanosti i nedostatka edukacije o uporabi i održavanju elektroničkih uređaja prednost uporabi živinih uređaja daje 69,4 % medicinskih sestara. Razbijanje toplomjera i tlakomjera čest je incident u zdravstvenim ustanovama. Procijenjeni broj mjesečno razbijenih toplomjera bio je do 278, a razbijenih tlakomjera do 5. U samo 18 (46,2 %) ustanova pravilno se odlagala živa iz razbijenih uređaja. Medicinske sestre koje najčešće rukuju uređajima i prikupljaju živu najizloženije su živinim parama putem inhalacije. U Hrvatskoj su doneseni pravni akti s namjerom smanjenja prisutnosti žive u životnom i radnom okolišu. Time je stupila na snagu EU direktiva 76/769/EEZ-a o smanjenju proizvodnje i prometa uređaja koji ju sadržavaju. Rezultati upućuju na potrebu edukacije svih zdravstvenih radnika, posebno medicinskih sestara, o zbrinjavanju razbijenih živinih mjernih uređaja. Radi smanjenja potencijalne izloženosti i osiguranja boljih zdravstvenih uvjeta na radnome mjestu sve hrvatske zdravstvene ustanove trebaju provoditi smjernice za zaštitu radnika i programe za smanjenje uporabe žive uporabom zamjenskih toplomjera i tlakomjera dostupnih na tržištu

Vrijednost digitalne termometrije u dijagnostici vibracijske bolesti

Finger thermometry and cold provocation test were performed in 90 chain-saw workers and 38 healthy controls. The workers were grouped according to the Taylor-Pelmear scale of hand-arm vibration syndrome into subgroups 0, 1, 2, 3. The recovery rate reflected passive vasodilative ability. According to the results of the study, the test could differentiate the subjects with clinically manifest vibration-induced white fingers (stages 1, 2 and 3) from the controls. The discriminating threshold of recovery rate with regard to Raynaud\u27s phenomenon was 90%. With that diagnostic limit the above method was sensitive and specific enough to verify vibration-induced vasospastic disorders and therefore could be recommended for their surveillance.Mjerenje kožne temperature kontaktnom termometrijskom metodom uz primjenu termalnog testa provedeno je u 90 sjekača motornom pilom, grupiranih prema Taylor-Pelmearovoj skali, i 58 muškaraca kontrolne skupine. Indeks oporavka prikazuje sposobnost pasivne vazodilatacije. Prema rezultatima ovog rada, u sjekača motornom pilom utvrđene su niže vrijednosti svih vrijednosti kožnih temperatura tijekom testa, a indeks oporavka razlikuje sjekače s klinički prisutnim simptomima vazospastičke bolesti od kontrolne skupine. Predložena je vrijednost za indeks oporavka od 90% kao dijagnostička granica za razlikovanje normalne od vazospastičke reakcije, a metoda je preporučena za zdravstveni nadzor radnika izloženih djelovanju vibracija

Early detection of the haematotoxic effect of benzene - the imperative of occupational medicine today

Za prikladan zdravstveni nadzor radnika izloženih benzenu potreban je složen pristup. Sastoji se od određivanja koncentracija benzena u zraku radne okoline, koja prema važećem standardu može maksimalno iznositi 15 ppm, dok su razvijene zemlje svijeta već prihvatile razinu od 1 ppm. Nužno je i praćenje metabolita benzena u organizmu izloženih radnika. Kod nas je općeprihvaćeno određivanje fenola u mokraći prije i poslije smjene sredinom radnog tjedna. Obavezni laboratorijski testovi uključuju određivanje kompletne krvne slike s eritrocitnim indeksima, a ostali navedeni hematološki testovi su potencijalno vrijedni, ali još nedovoljno ispitani. Promjena ni u jednom od navednih pokazatelja nije patognomonična, pa se svi nalazi moraju interpretirati istodobno i s puno opreza. Otkrivanje početnih oštećenja krvotvornog sustava osoba izloženih benzenu ostvaruje se kontinuiranim praćenjem zdravstvenog stanja i putem prethodnog i periodskih pregleda. Tako se jedino mogu zadovoljiti kriteriji suvremene medicine rada u otkrivanju početnih promjena i prevenciji nastanka ireverzibilnih toksičnih oštećenja krvotvornog sustava kao posljedice djelovanja benzena.Surveillance of workers exposed lo benzene calls for a complex approach. This includes the de-termination of benzene concentration in the working atmosphere, which, according to standards applied in Croatia, should not exceed 15 ppm. In the developed countries the allowable workplace level has been reduced to 1 ppm. The monitoring of benzene metabolites in the organism of exposed workers is also necessary. As an indicator of benzene exposure, the urinary phenol concentration determined before and after work in the middle of the week has been generally: accepted in Croatia. An essential laboratory test is a complete blood count including red cell indices. Other haematological tests that might be valuable early indicators of benzene haematotoxicity need to be more fully evaluated. Alterations in any of these indicators are not pathognomonic and all findings should therefore be interpreted at the same time and with caution. Early detection of benzene haematotoxicity can be accomplished by continuous health monitoring of exposed workers through preplacement and periodic health examinations. This is in accordance with the requires of modern occupational medicine which requires identification of early changes and prevention o irreversible benzene induced toxic changes in the haematopoietic system

Vrijednost digitalne termometrije u dijagnostici vibracijske bolesti

Finger thermometry and cold provocation test were performed in 90 chain-saw workers and 38 healthy controls. The workers were grouped according to the Taylor-Pelmear scale of hand-arm vibration syndrome into subgroups 0, 1, 2, 3. The recovery rate reflected passive vasodilative ability. According to the results of the study, the test could differentiate the subjects with clinically manifest vibration-induced white fingers (stages 1, 2 and 3) from the controls. The discriminating threshold of recovery rate with regard to Raynaud\u27s phenomenon was 90%. With that diagnostic limit the above method was sensitive and specific enough to verify vibration-induced vasospastic disorders and therefore could be recommended for their surveillance.Mjerenje kožne temperature kontaktnom termometrijskom metodom uz primjenu termalnog testa provedeno je u 90 sjekača motornom pilom, grupiranih prema Taylor-Pelmearovoj skali, i 58 muškaraca kontrolne skupine. Indeks oporavka prikazuje sposobnost pasivne vazodilatacije. Prema rezultatima ovog rada, u sjekača motornom pilom utvrđene su niže vrijednosti svih vrijednosti kožnih temperatura tijekom testa, a indeks oporavka razlikuje sjekače s klinički prisutnim simptomima vazospastičke bolesti od kontrolne skupine. Predložena je vrijednost za indeks oporavka od 90% kao dijagnostička granica za razlikovanje normalne od vazospastičke reakcije, a metoda je preporučena za zdravstveni nadzor radnika izloženih djelovanju vibracija