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Diabetic nephropathy in type 2 diabetes – from pathological mechanisms to clinical occupational medicine practice

Abstract

Employees with diabetes and nephropathy need special medical surveillance that involves occupational medicine specialists. However, diabetes is not a unique phenotype and each patient need to be carefully assessed. Age, gender, body mass index, renal function impairment (eGFR, creatinine, urea, uric acid), indicators of diabetes control (fasting glycaemia and HbA1C), the presence of co-morbidities, dyslipidaemia, level of serum albumin and total protein, cytokines and other inflammatory markers should be considered in a comprehensive evaluation of the severity of the chronic kidney disease and of the treatment plan. Chronic kidney disease in type 2 diabetes has many facets and various degrees of severity; therefore, permanent communication between the occupational medicine specialist and the treating physician should be maintained. For this purpose, this article reviews the current pathological mechanisms proposed for the explanation of the chronic kidney disease, the diagnostic and the general therapeutic recommendations and also the possible occupational interventions in patients with type 2 diabetic nephropathy.

Open access
The “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study protocol

Abstract

In many large cohort studies, the night shift constitutes a risk factor for developing cardiovascular disease and diabetes in workers. Current screening tests for people working in night shift include fasting glycaemia and electrocardiography. In fact, there are few studies focused on the description of the electrocardiographic changes after the night shift. This article describes the protocol of the “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study, which was initiated by the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”. Nurses represent the target population.

The protocol includes a full medical and occupational history, lifestyle habits (smoking, alcohol, nutrition), anthropometric and blood pressure measurements, blood tests (fasting glycemia, total cholesterol, triglycerides and high density lipoprotein cholesterol) and electrocardiogram recording. For nurses working in (night) shifts, we will record the electrocardiogram before and soon after the night shift. A cross sectional study will analyze the incidence of the metabolic syndrome criteria, the cardio-metabolic diseases and the electrocardiographic modifications and will compare the results between the group of nurses working and the group of nurse who do not. Based on these results, a longitudinal study will test the hypothesis that night shift increases the risk for cardio-metabolic diseases and that the electrocardiographic modifications precede the clinical symptoms. The results of the study will provide data on the association of night shifts and other non-occupational risk factors with the cardio-metabolic diseases in this specific population of healthcare workers that potentially will integrate into the occupational medicine policies.

Open access
Factors influencing the rationing of nursing care in Romania

Abstract

Understanding the factors influencing the rationing of nursing care is crucial for any quality control intervention in healthcare services. Occupational factors such as workload, night shifts, management style and organization of work have a potential influence. There are few studies specifically designed to evaluate these factors in relation with nurses’ work. In this study, we investigate several occupational factors influencing the quality of work in a sample of hospital nurses in order to identify the most important influencers of stress at work. The article describes the conceptual framework of the study, the population, the methods and the expected results. We also present a brief review of recent studies related to occupational risk factors and the perceived quality of care provided by Romanian nurse population.

Open access
Health particularities of the employees of clothing factories

Abstract

We present the particularities of the morbidity with temporary labor incapacity (TLI) of the employees of confection factories during the years 2011 - 2017. We placed emphasis on the risk factors affecting the health of the employees. It is an established fact that the main risk factors are unfavorable microclimate, vibration, dust, noise, and others. Morbidity with TLI according to frequency index (IFc) has practically a constant character. The highest level of IFc was registered in 2013, reaching 93.3 cases per 100 workers, while the severity index being oscillatory in nature constituted 1311.2 days in 100 workers in the same year. Both indices have shown a growth trend towards the end of 2017. The average duration of a case remained at the same level of 13-14 days. There were also particularities of morbidity based on gender, profession, etc. The data obtained can be the basis for the elaboration of the prophylaxis measures.

Open access
The need to improve screening and diagnostic methods in occupational irritant dermatitis

Abstract

Modern medicine has increasingly directed its interest towards discovering the etiology of occupational dermatitis, but unfortunately it is not completely elucidated. As with other occupational diseases, the presence of the exposure and the temporal relation between the exposure and the appearance of the characteristic signs is a defining element, but obtaining the information on the etiological factors is not always easy, therefore the attention must be directed to a systematic collection of these data. Clinical diagnosis is not sufficient, so additional paraclinical tests are needed for a complete diagnosis. Currently, more and more emphasis is being placed on experimental studies targeting the discovery of molecular or genetic markers that complement the idea of individual susceptibility in the appearance of contact dermatitis. As frequent as it is difficult to diagnose, occupational dermatitis is still a public health problem.

Open access
Professor Paraschiva-Marilena Oarga
MD PhD (1955-2019)
Open access
Prostate cancer: an occupational hazard in Romania?

Abstract

Several occupational carcinogens (arsenic, cadmium) and industries (rubber production) have been associated with prostate cancer risk but most of the data are from studies conducted on screened populations. Here we explored this association in Romanian men, a population with low PSA screening test coverage. We have analyzed 468 prostate cancer cases pathologically confirmed and 495 non-cancer hospital controls, recruited in the ROMCAN project. Personal information, including occupational activity, was collected through interview. Two experts classified jobs and activities into 15 economic sectors with similar patterns of exposure. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ever employed in each economic sector and prostate cancer risk. We observed a higher non adjusted risk for employment in electricity, gas, steam and air conditioning supply activities (OR=3.95, p=0.029), manufacturing–light industry (OR=1.88, p=0.039), financial, insurance and gambling (OR=1.44, p=0.046) and a lower risk for employment in construction industry (OR=0.62, p=0.010). After adjusting for potential confounders, only the low risk in construction workers was maintained (OR=0.55, p=0.004). Our study provides some evidence on the role of occupational factors on the prostate cancer risk but further assessments are needed. Healthy lifestyle promotion and prevention should be reinforced at workplaces.

Open access
Concentrations of selected metals (Na, K, Ca, Mg, Fe, Cu, Zn, Al, Ni, Pb, Cd) in coffee

Abstract

Introduction

The health benefits and detrimental effects of coffee consumption may be linked to chemical compounds contained in coffee beans. The aim of our study was to evaluate the concentration of sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), iron (Fe), copper (Cu), zinc (Zn), aluminum (Al), nickel (Ni), lead (Pb) and cadmium (Cd) in green and roasted samples of coffee beans purchased in Bosnia and Herzegovina, and to determine the potential health implications at current consumption level.

Methods

The concentrations were determined using a microwave high-pressure mineralization and atomic absorption spectrometer that measures total metal (ionic and non-ionic) content.

Results

The average metal concentrations (μg element/g coffee) in the green coffee beans were; Na: 18.6, K: 19898, Ca: 789, Mg: 1758, Fe: 60, Cu: 14, Zn: 3.6, Al: 4.2, Ni: 0.415, Pb: 0.076, and Cd: 0.015, while, in the roasted; Na: 23, K: 23817, Ca: 869, Mg: 1992, Fe: 41.1, Cu: 11.4, Zn: 5.41, Al: 4.19, Ni: 0.88, Pb: 0.0169, and Cd: 0.0140.

Conclusion

The level of investigated metals at the present level of consumption of coffee in Bosnia falls within the limits recommended as safe for health.

Open access
Hospital volunteering experiences suggest that new policies are needed to promote their integration in daily care: Findings from a qualitative study

Abstract

Objective

To explore Hospital Volunteers’ (HVs) motivations and experiences, as well as the strategies they adopt to overcome challenging situations during volunteering and the needs they perceive.

Methods

Eleven Italian HVs were purposively approached between January and July 2016, using face-to-face semi-structured interviews. The interviews were audio-recorded, transcribed verbatim and analysed using the descriptive phenomenological approach.

Results

Hospital volunteering emerged as a complex experience characterised by five themes: (a) becoming a volunteer; (b) developing skills; (c) experiencing conflicting emotions; (d) overcoming role difficulties by enacting different resources and strategies; and (e) addressing emerging needs.

Conclusions

According to the findings, hospital policies aimed at promoting volunteer integration in daily care are needed and should be based on (a) a shared vision between the hospital and the volunteer associations regarding the HVs’ role and skills; (b) the development of integrated models of care combining different workforces (i.e. professionals and volunteer staff); (c) appropriate training of HVs at baseline; (d) individualised continuous education pathways aimed at supporting HVs both emotionally and in the development of the required skills; and (e) tailored education that is directed to health-care staff aimed at helping them to value the service provided by HVs.

Open access
Perceived work ability index of public service employees in relation to ageing and gender: A comparison in three European countries

Abstract

Background

Increasing longevity raised the prospect of a workplace for ageing workers. Previous studies reveal that work ability decreases with age, even among the healthy, and decreased significantly with age among women. The aim of the study is to examine the perception of work ability of public sector employees aged 55 years and older and gender differences in three European countries.

Methods

A prospective longitudinal study design and standardized “Work Ability Index” (WAI) were used. This study analysed the relationship between ageing, gender, and perceived work ability among 1653 employees aged 45.06±10.90 years (562 men and 1091 women) from Spain, Bosnia and Herzegovina and Monte Negro. The research was conducted in 2018.

Results

Older employees had a better WAI than their younger colleagues (P<0.001). The lowest prevalence rate 20% of excellent WAI was between 35 and 44 years of age. The reduction of WAI in Bosnia and Herzegovina was huge 68%, compared with 30% in Monte Negro (more than 2 times) and 14% in Spain (almost 5 times more).

Conclusion

Gender and age was not protector and predictor of excellent or reduced work ability. Work ability did not decrease with age among women and men, public sector employees. Work ability depends of health and safety, promotion and preventive activities at the workplace.

Open access