Jordan Minov. COPD and the Workplace. New York: Nova Science Publishers, Inc.; 2016. 83 pages; ISBN 978-1-63484-249-5

PURPOSE: The aim of this monograph is to present a role of the workplace exposures on the development and progression of chronic obstructive pulmonary disease (COPD), the joint effect of the workplace exposures and tobacco smoke in its development and progression, the diagnostics of the COPD related to occupational exposures, as well as its management and prevention.CONTENTS: The publication consists of seven chapters supplemented by a list of abbreviations and index of terms. The cited literature at the end of the monograph obtains scientific support to the elaborated professional knowledge.CONCLUSION: The monograph COPD and the Workplace presents a comprehensive literature dedicated to this problem and a serious effort for improvement of detection and management of COPD related to workplace exposures by medical professionals and its prevention

Specific work activities and exposure to respiratory hazards - predictors of lung function impairment among crop farmers

OBJECTIVE: The objective of the study was to evaluate the specific work activities and occupational exposure to respiratory hazards as predictors of chronic respiratory symptoms development, lung function decline, and respiratory health impairment among crop farmers. METHODS: A cross-sectional survey was performed, including 87 crop farmers (mean age: 53.4 ± 7.8 years; and mean exposure duration: 22.9 ± 7.8 years) and 80 office workers as a control group (mean age: 52.7 ± 8.2 years) matched for age, smoking habits, and socioeconomic status. Subjects were evaluated by a questionnaire on respiratory symptoms in the past 12 months and spirometry testing. RESULTS: Crop farmers had a significantly higher prevalence of cough (41.4), phlegm (28.7%), and dyspnea (21.8%), than controls (p < 0.05). All mean baseline spirometric parameters were lower in crop farmers, but statistical significance was confirmed only for MEF25, MEF50, and MEF75 (p = 0.003, p = 0.000, and p = 0.001, respectively). Most of the respiratory symptoms were significantly associated with common work activities of crop farmers and all-day exposure to certain respiratory hazards. Age, exposure duration, and their combined effect with smoking habit had a significant effect on forced expiratory volume in one second FEV1 and FEV1/forced vital capacity. CONCLUSION: The results confirm that occupational exposure among crop farmers is associated with higher prevalence of respiratory symptoms and lung function decline and, together with specific workflow activities, may not only be a predictors of respiratory health impairment, but also a key tool in the creation of preventive strategies

Personal Protective Equipment in Health Workers during Coronavirus Disease-19 Outbreak

BACKGROUND: Coronavirus (CoV) disease (COVID)-19 pandemic has put immense pressure on the healthcare systems worldwide. AIM: The aim of the actual study was to assess the availability of personal protective equipment (PPE) in health workers (HWs) during an outbreak. METHODS: The study was conducted in April-May 2020 using an on-line questionnaire. Completed surveys were returned by 560 HWs (297 physicians, 79 nurses/technicians, 78 dentists, 9 pharmacists, and 97 other HWs). RESULTS: High proportion of HWs was using one surgery mask for two or more times or not using it at all when contacting patients who were self-isolated (35.3%) or severe acute respiratory syndrome CoV (SARS-CoV)-2 positive (19.3%). More than 90% of participants were using surgery masks and gloves every time or almost every time while working with patients who were self-isolated or SARS-CoV-2 positive. High frequency of participants reported: No isolation zones at the workplace (61.2%), no triage of patients at the entrance (33.4%), and not attended a training course about the correct usage of PPE (72%). CONCLUSION: The data obtained can be used in the creation of specific interventions in healthcare settings aimed at providing high-quality PPE through the development of a national healthcare strategy that can lead to the prevention of COVID-19 in HWs

Bronhokonstrikcija i respiratorni simptomi uzrokovani tjelesnim opterećenjem u radnika izloženih čajnoj prašini

Assuming that airborne particles and pollutants are important contributing factors in the development of exercise-induced bronchoconstriction (EIB), we performed a case-control study including 63 tea workers (36 men and 27 women, aged 36-55, duration of employment 3-30 years) and an equal number of office workers, matched by sex and age. Exercise-induced respiratory symptoms were recorded in a questionnaire. Skin prick tests, spirometry, as well as exercise and histamine challenge were carried out. Environmental measurements were performed on site during the work shifts. The prevalence of self-reported exercise-induced respiratory symptoms and EIB did not differ significantly between the exposed and control group (41.6 % vs 36.8 %, and 6.4 % vs 4.8 %, respectively). In both exposed and control workers, EIB was strongly linked to asthma (P<0.01). In the exposed workers it was significantly associated with positive family history of asthma (P<0.01) and positive family history of atopies (P<0.05), whereas in the exposed smokers it was significantly related to smoking duration (P<0.05). Bronchial reaction to exercise in the exposed smokers was significantly greater than in control smokers (P<0.05). Self-reported exercise-induced respiratory symptoms were weakly associated with EIB, with a large proportion of false positive and a low proportion of false negative results in both groups.Polazeći od pretpostavke da čestice nošene zrakom i onečišćivači bitno pridonose razvoju bronhokonstrikcije uzrokovane tjelesnim opterećenjem, ispitano je 63 radnika u tvornici čaja (36 muškaraca i 27 žena u dobi od 36 do 55 godina sa stažem od 3 do 30 godina) i 63 kontrolna ispitanika, administrativna službenika koji su izloženoj skupini odgovarali po spolu i dobi. Podaci o respiratornim simptomima uzrokovanim opterećenjem prikupljeni su s pomoću upitnika. Također su napravljeni skin-prick test, spirometrija te test tjelesnim opterećenjem i bronhoprovokativni test histaminom. Mjerenja u zraku radnoga okoliša napravljena su za trajanja smjene. Izloženi radnici nisu se statistički značajno razlikovali od kontrolne skupine u prevalenciji prijavljenih respiratornih simptoma odnosno bronhokonstrikcije uzrokovane opterećenjem (41,6 % naspram 36,8 %, odnosno 6,4 % naspram 4,8 %). U obje je skupine bronhokonstrikcija uzrokovana opterećenjem bila izrazito povezana s astmom (P<0,01). U izloženoj skupini, bronhokonstrikcija uzrokovana opterećenjem bila je statistički značajno povezana s pozitivnom obiteljskom anamnezom astme (P<0,01) i atopije (P<0,05). U izloženih pušača ona je značajno bila povezana s trajanjem pušenja (P<0,05). Bronhalne reakcije na opterećenje u izloženih pušača bile su značajno jače od onih u kontrolnih pušača (P<0,05). Zamijećena je slaba povezanost između prijavljenih respiratornih simptoma i bronhokonstrikcije uzrokovane opterećenjem, s velikim udjelom lažno pozitivnih i malim udjelom lažno negativnih nalaza u obje skupine

Health Promoting Workplaces

Workplace health promotion is a process of actively achieving health at workplace by changing working and living conditions. As a key concept it includes measures aimed both at individual and at environmental level from different areas. Good practice in workplace health promotion demands statutory requirements and strong motivation. Increasing consciousness and responsibility for health, identification and dissemination of models of good practice, development and incorporating adequate policies are priorities in workplace health promotion. The basic principles on which workplace health promotion has to be developed are: awareness raising, setting up infrastructure and service management. Beneficial effects can be achieved on individual, enterprise and society levels. The Institute of Occupational Health, WHO Collaborating Center, plays a major role in launching the first workplace health promotion activities in the Republic of Macedonia (education programs for stress managing at workplace, tobacco free workplaces), but the strongest impulse for workplace health promotion in the country is created by the implementation of the WHO’s Health, Environment and Safety Management in Enterprises (HESME) program

Case Study of Analysis and Targets Setting in Workplace Health Promotion: Pilot Implementation of Health Environment and Safety Management in Enterprises (HESME) Program in the Republic of Macedonia

HESME program concept is based on building and strengthening existing national structures and practices for health promotion at workplace, occupational health and safety, and environmental health. As part of the global HESME program, which includes different activities in the Republic of Macedonia, HESME pilot projects in two enterprises in 2003/2004 were aimed at analysis and setting targets of workplace health promotion. The analysis was made by the Institute of Occupational Health, WHO Collaborating Center and conclusions and recommendations to all stakeholders were presented. Workplace health promotion needs and priorities were defined: control of work environment hazards, smoking and alcohol consuming, encouragement of sport activities. Dealing with health problems (specific indications on stress, muscle pains, injuries at work, respiratory and allergy problems) and addiction problems (alcohol consuming, smoking), application of self-protection measures, education of managerial team on workplace hazards and ergonomics. HESME pilot implementation in both enterprises is centered on encouraging the integration of workplace health promotion issues at enterprise level as preparation for further steps

Occupational Exposure and Co-Occurrence of Work-Related Skin and Respiratory Disorder in Cleaner: A Case Report

BACKGROUND: Despite the connection between skin and respiratory system in occupational disease is growing area of research interest, there is still a limited evidence for the effects of both airborne and skin exposures together with skin and respiratory outcomes.CASE PRESENTATION: This report describes a 32-years old female with no previous history of atopy, asthma or skin disorders working as an office cleaner for three years. About two years after entering the actual workplace she developed episodic wheezing, shortening of breath and chest tightness. At the same time, she noticed eczematous lesions on the skin of both hands. She reported work-relatedness of both respiratory and skin symptoms, i.e. the symptoms improved during weekends and holidays and worsened when she returned to work. The patient was referred to Institute for Occupational Health of R. Macedonia for assessment of possible occupational asthma (OA) and occupational contact dermatitis (OCD). Diagnosis of asthma was confirmed by standard diagnostic procedure, while the diagnosis of sensitizer-induced OA was established by positive result of serial peak expiratory flow rate (PEFR) measurements at and away from work. Diagnosis of allergic OCD was confirmed by positive patch test to formaldehyde. The management of both diseases included complete removal from the harmful workplace exposure, as well as pharmacological treatment according to the actual recommendations.CONCLUSIONS: This case report represents a description of a co-occurrence of work-related skin and respiratory symptoms in a female working as an office cleaner. Formaldehyde is found to be a causative factor of allergic OCD, and it also may be a causative factor of sensitive-induced OA in the same patient, but other occupational sensitizers cannot be excluded

Violence and Injury Prevention – Challenges For Health Promotion in Macedonia

World Health Organization estimated 5.1 million deaths from injuries in 2002 in the world or 9% of all deaths, disproportionately affecting the young. These are a leading cause of premature death and DALYs at age of 5 to 45 years. In Europe injuries are third leading cause of death, after cardiovascular diseases and cancers with 800,000 or 8.3%. Injuries can be avoided and prevented. Many effective strategies can be used to target high risk groups and to reduce health consequences for victims of injuries. The health sector can play a key role in injury and violence prevention and control, by providing care and services to victims, prevention and advocacy, and engaging in partnerships with other sectors and across all levels of government and society. Decreasing the burden from injuries will require political commitment across all government levels and with this the allocation of adequate resources to take these activities forward. Future challenges for injury and violence prevention and health promotion, that the countries including Macedonia would face are: developing national action plans for unintentional injury and violence prevention, forming an intersectoral injury prevention committee, improving national surveillance system, strengthening national capacity to respond to the burden of injuries and violence through both primary prevention and care, promoting evidence-based practice by facilitating the exchange of knowledge and experience across the Region, recognize gaps in knowledge and prioritize research and development in both primary prevention and care, as well as studies on costs

Utjecaj pasivnog pušenja na radnome mjestu na dišne simptome, funkciju pluća i bronhijalnu reaktivnost u uredskih spremačica-nepušačica

This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1 %). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9 % vs. 8.8 %; P=0.036), wheezing without cold (25.9 % vs. 7.0 %; P=0.016), and breathlessness after effort (29.6 % vs. 8.8 %; P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6 % vs. 63.7 %; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2 % vs. 7.0 %; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.Provedeno je presječno istraživanje na skupini od 84 žene nepušačice u dobi od 24 do 56 godina s ciljem procjene učinaka pasivnog pušenja na radnome mjestu na dišne simptome, funkciju pluća i bronhijalnu reaktivnost. Podaci o dišnim simptomima, radnom stažu na poslovima spremačica ureda te o pasivnom pušenju na radnome mjestu prikupljeni su primjenom anketnog upitnika. Ispitanicama je zatim učinjen kožni pricktest (ubodni test) na najčešće inhalacijske alergene, mjerene su funkcije pluća te su provedena testiranja na histamin. Unatoč propisima o zabrani pušenja u zatvorenim prostorima, utvrdili smo veliku prevalenciju pasivnog pušenja na radnim mjestima (32,1 %). U tih smo ispitanica utvrdili i značajno veću prevalenciju piskanja u plućima i zadihanosti (25,9 % prema 8,8 %; P=0,036), piskanja u plućima bez prehlade (25,9 % prema 7,0 %; P=0,016) te gubitka daha nakon napora (29,6 % prema 8,8 %; P=0,014) u usporedbi s ispitanicama koje na radnim mjestima nisu bile izložene pasivnom pušenju. Mjerenja su pokazala i značajno nižu vrijednost maksimalnog ekspiracijskoga protoka pri 25 % forsiranoga vitalnog kapaciteta (MEF25) (53,6 % prema 63,7 %; P=0,001) te značajno višu pojavnost granične bronhijalne hiperreaktivnosti (22,2 % prema 7,0 %; P=0,044) u ispitanica koje su na radnim mjestima izložene pasivnom pušenju. Ovo je istraživanje dokazalo prisutnost štetnih učinaka na dišni sustav u ispitanica zaposlenih kao spremačice ureda koje su na svojim radnim mjestima bile izložene pasivnom pušenju. Dobiveni rezultati govore u prilog potrebi za oštrijom primjenom postojećih zakonskih propisa kako bi se zaštitilo zdravlje dišnog sustava u svih radnika

Profesionalna astma u autolakirera: opis dvaju slučajeva

This report describes two patients who had developed asthma after working as automobile painters with isocyanate-based aerosol paint for two years or over. In both patients asthma was confirmed using the standard diagnostic procedure. One of the subjects was atopic. One was ex-smoker and the other had never smoked. Neither had a family history of asthma. The symptoms occurred after workplace exposure lasting two years in one patient and three in the other. As both reported work-relatedness of the symptoms, they underwent serial peak expiratory flow rate (PEFR) measurement and bronchoprovocation testing. Significant work-related changes in PEFR diurnal variations and in non-specific bronchial hyperresponsiveness (NSBH) were observed in one patient, suggesting allergic occupational asthma (OA), while the other patient was diagnosed work-exacerbated asthma (WEA). Our data confirm that spray painting is an occupation with increased risk of respiratory impairment and asthma.U radu su opisana dva bolesnika koji su nakon rada s aerosolskom bojom na bazi izocijanata u autolakirerskoj radionici dobili astmu. U oba je slučaja dijagnoza potvr|ena standardnim postupkom. Jedan je bolesnik bio atopičan. Jedan je bivši pušač, a drugi nikad nije pušio. U obiteljskoj anamnezi nije bilo astme ni u jednog bolesnika. Simptomi su se javili nakon profesionalne izloženosti u trajanju od dvije odnosno tri godine. Budući da su oba bolesnika povezivala simptome s poslom, podvrgnuti su mjerenju vršnog ekspiratornog protoka (engl. peak expiratory flow rate, krat. PEFR) te nizu bronhoprovokacijskih testova. U jednoga su bolesnika zamijećene značajne profesionalne dnevne promjene u PEFR-u i nespecifične bronhalne hiperreaktivnosti, što upućuje na profesionalnu alergijsku astmu, dok je u drugoga ispitanika dijagnosticirano pogoršanje astme povezano s profesionalnom izloženosti. Naši podaci potvr|uju pretpostavku da posao autolakiranja sprejem nosi povećani rizik od respiratornih tegoba i astme