Saso Stoleski, Jovanka Karadzinska-Bislimovska and Dragan Mijakoski
Respiratory Symptoms, Immunological Changes, Ventilatory Capacity, and Bronchial Responsiveness in Welders
Objective: To evaluate the effect of workplace exposure and its duration on respiratory symptoms, atopic status, ventilatory capacity, and bronchial responsiveness in welders.
Material and Methods: We performed a cross-sectional study including 39 males working as stainless steel welders and an equal number of male office workers matched by age, duration of employment and smoking status. Respiratory symptoms and detailed smoking history were recorded by questionnaire. Evaluation of examined subjects included skin prick tests to common inhalant allergens, spirometry, and histamine challenge.
Results: We found non-significantly higher prevalence of respiratory symptoms in the last 12 months in welders with significant difference for cough (P = 0.043) and phlegm (P = 0.009). Prevalence of sensitization to common inhalant allergens was similar in both welders and controls. Mean values of spirometric parameters was lower in welders with significant difference for MEF50 (P = 0.008) and MEF75 (P = 0.000). Prevalence of bronchial hyperresponsiveness (BHR) was higher in welders with significant difference for borderline BHR (P = 0.038). Adverse respiratory effects were more expressed in welders with duration of workplace exposure more than 12 years compared to those exposed less than 12 years.
Conclusion: Our data suggest that workplace exposure in welders may lead to respiratory impairment which is close related to its duration.
Respiratory and Nasal Symptoms, Immunological Changes, and Lung Function in Industrial Bakers
Background: Several studies reported that occupational exposure in bakery may cause respiratory impairment in exposed workers.
Aim: To assess the respiratory effects and immunological changes of occupational exposure in industrial bakers.
Material and Methods: We performed a cross-sectional study including 43 industrial bakers (20 males and 23 females, aged 34-55 years) and an equal number of office workers, matched by sex, age and smoking status. Evaluation of examined subjects included completion of questionnaire, skin prick tests to common and work-related inhalant allergens, spirometry, and histamine challenge.
Results: We found higher prevalence of nasal symptoms in the last 12 months in bakers with significant difference for runny nose (P = 0.033). Prevalence of respiratory symptoms in the last 12 months was also higher in bakers and statistical significance was obtained for cough (P = 0.041) and phlegm (P = 0.023). We found similar prevalence of allergic sensitization to common inhalant allergens in both examined groups, while sensitization to wheat flour and meal flour was registered only among bakers. Measured spirometric parameters were lower in bakers with significant difference for MEF50 and MEF75 (P = 0.004, and P = 0.000, respectively). Prevalence of bronchial hyperresponsiveness (BHR) was non-significantly higher in bakers with significantly higher severity (P = 0.029).
Conclusion: Our findings confirm that occupational exposure in industrial bakers may lead to adverse respiratory effects and immunological changes in exposed workers.
OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics. METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing.
RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows.
CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact
Saso Stoleski, Elisaveta Stikova, Jovanka Karadzinska-Bislimovska and Dragan Mijakoski
Biological Monitoring Among Workers Exposed to Inorganic Lead and Its Compounds
Objective: To explore the association between lead biomarkers and their deviations in the circumstances of occupational exposure, and influence of life style factors.
Material and Methods: We performed cross-sectional study using 60 workers occupationally exposed to lead compared with 60 controls. All examinees were assessed by Questionnaire, and laboratory testing concerning blood lead level (BLL), activity of delta-aminolevulinic acid dehydratase (ALAD) in blood, concentration of delta-aminolevulinic acid (ALA) and coproporphyrin in urine, reticulocytes and erythrocytes with basophilic stippling (EBS).
Results: The mean values of BLL and ALA were significantly higher, and mean ALAD activity was significantly lower in lead workers than in controls. Lead workers also had a higher rate of abnormal BLL, ALAD, and ALA, significant for BLL and ALAD. The average BLL values among exposed workers and controls in men were significantly higher. There was strong inverse correlation between distribution of ALAD values in exposed workers due to their BLL values. Significant correlation with mean ALAD values was shown for alcohol consumption, form of compounds, and use of protecting equipment, whereas with mean BLL values was shown for age, gender, exposure duration, smoking, and alcohol consumption.
Conclusion: The data confirmed the association between occupational exposure and lead biomarkers abnormalities.
Dragan Mijakoski, Jovanka Karadzinska-Bislimovska, Elisaveta Stikova and Saso Stoleski
Occupational Sharp Injuries and Biological Markers of Hepatitis B and Hepatitis C Viral Infection in Nurses
Background: Nurses are at risk for occupational exposure to blood-borne pathogens (BBP), including hepatitis B (HBV), and hepatitis C virus (HCV). Occupational exposure to BBP among nurses includes percutaneous injuries with sharp objects or contacts of mucous membranes or nonintact skin with blood, tissues, or other potentially infectious body fluids.
Objective: To determine frequency of occupational sharp injuries, and to evaluate association between occupational sharp injuries and occurrence of biological markers of HBV and HCV infection in nurses.
Method: We performed cross-sectional study including 54 nurses (50 females, 4 males; aged 30-61 years) (Group I) engaged in workplace tasks characterized by possibility for occupational exposure to BBP including HBV and HCV. Additionally, 32 workers (25 females, 7 males; aged 21-64 years) (Group II) from health care system with workplace tasks which don't include possibility for occupational exposure to HBV and HCV were studied. Evaluation of examined subjects included completion of questionnaire, and laboratory tests for biological markers of viral infection (HBsAg, Anti-HBc-Ab, Anti-HCV-Ab).
Results: Data showed that needle-stick injuries (81.5%) were significantly more frequent than instrument injuries (61.1%) in examined nurses. Positive Anti-HBc-Ab were more frequently detected in nurses than in subjects from Group II with statistically significant difference (25.9% vs. 6.3%; P<0.05). Positive Anti-HBc-Ab status was registered only among nurses with percutaneous injuries at work.
Conclusion: Determination of frequency of percutaneous injuries at work with sharp objects should be one of the key elements in the process of identification of agents and dangers at the specific workplace - nurse.
Jordan Minov, Jovanka Karadzinska-Bislimovska, Tatjana Petrova, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski and Dragan Mijakoski
Efficacy and Tolerability of Various Antimicrobial Regimens in the Treatment of Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary Disease in Outpatients
Objective. To compare the efficacy and tolerability of different antibiotics empirically administered for exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD).
Methods. We performed an observational, non-randomized, open-label study including 226 outpatients with exacerbations of chronic bronchitis and mild or moderate COPD, 123 males and 103 females, aged 24 to 81. All patients were followed up for 30 days, with an intermediate visits at 5 and 10 days at which they were asked about the duration of symptoms (increased expectoration, increased dyspnea and/or presence of purulent sputum) and the side-effects of the drug. Five antibiotic regimens were evaluated: amoxicillin/clavulanic acid 875 mg/125 mg twice daily for 10 days, cefuroxime 250 mg twice daily for 10 days, cefixime 400 mg once daily for 10 days, clarithromycin 500 mg twice daily for 10 days, and ciprofloxacin 500 mg twice daily for 10 days.
Results. The clinical success rate, defined as a complete resolution or a return of the symptoms to the baseline severity, in the groups receiving amoxicillin/clavulanic acid, cefuroxime, cefixime, clarithromycin, and ciprofloxacin was 68.9%, 75.0%, 73.5%, 72.7%, and 77.1%, respectively. The mean time to relief of symptoms varied from 6.8 days with amoxicillin/clavulanic acid to 6.1 days with cefuroxime. Relapse within the first month was registered in the group receiving clarithromycin and ciprofloxacin (3.1% and 2.6%, respectively). The prevalence of the adverse events varied from 10.4% with ciprofloxacin, following by 8.9% for amoxicillin/clavulanic acid, 7.5% for cefixime, 6.8% with clarithromycin to 6.1% with cefuroxime.
Conclusion. Our findings suggest high efficacy and safety of all studied regimens in the treatment of exacerbations of chronic bronchitis and COPD.
Jovanka Karadzinska-Bislimovska, Jordan Minov, Dragan Mijakoski, Sasho Stoleski and Sasho Todorov
Brucellosis as an Occupational Disease in the Republic of Macedonia
Brucellosis, a bacterial disease caused by species of the genus Brucella, is an important zoonosis and recognized as an occupational disease. A high risk of infection with Brucella is associated with certain workplaces related to direct contact with infected animals or their products. Infection may occur by inhalation of infectious aerosols, conjunctival contamination, skin contamination, contact with laboratory cultures and tissue samples, and accidental injection of live vaccines.
Brucellosis is included as an occupational disease in the Macedonian List of Occupational Diseases, and diagnosis and verification of the occupational diseases, according to the national medical criteria, are realized at the Occupational Health Institute of R. Macedonia. According to the official health statistics, in the last two decades in Macedonia as an endemic region, a high incidence of human brucellosis has been registered, with more than 300 reported cases per year. In spite of a possible high occupational risk of infection with Brucella sp in the confirmed cases of disease, during 2008-09 just 12 cases of brucellosis (6 stockmen, 5 veterinarians and an agronomist) were confirmed as an occupational disease. These data suggest that human brucellosis is underdiagnosed and underreported as an occupational disease at national level.
An adequate management of brucellosis with a multidisciplinary approach should provide more accurate reported data in occupational epidemiology in the country.
There is a need to strengthen joint actions within the health care system, to promote an intersectoral collaboration and to support the successful realization of national control programme at the community level.
Marina Danilova, Saso Stoleski and Dragan Mijakoski
AIM: To assess the effect of occupational exposure on respiratory symptoms and ventilatory capacity in never-smoking male workers exposed to mineral or organic dusts.
MATERIALANDMETHODS: We performed a cross-sectional study including 138 never-smoking male workers exposed to mineral or organic dust (34 construction workers, 32 furniture manufacturers, 37 agricultural workers, and 35 bakers) and 35 unexposed controls (office workers). Evaluation of all study subjects included completion of a questionnaire and spirometric measurements.
RESULTS: The prevalence of the overall respiratory symptoms in the last 12 months was higher in dusty occupation workers than its prevalence in office workers. Statistically significant difference was found between the prevalence of cough in construction workers, agricultural workers and bakers, as well as between the prevalence of phlegm in construction workers, furniture manufacturers and agricultural workers as compared to its prevalence in office workers. The mean values of spirometric parameters were lower in all groups of exposed workers as compared to their mean values in office workers with statistical significance for all measured parameters in construction workers and furniture manufacturers, as well as for small airways indices in agricultural workers and bakers.
CONCLUSION: Our findings indicate significant effect of occupational exposure on respiratory symptoms and ventilatory capacity impairment in workers exposed to mineral or organic dusts.
Jordan Minov, Jovanka Bislimovska-Karadzhinska, Tatjana Petrova, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski and Dragan Mijakoski
Asthma Control Test™ in Assessment of Clinical Asthma Control
Background. The goal of asthma treatment is to achieve and maintain control of the disease.
Objective. To assess validity and reliability of Asthma Control Test™ (ACT) as a patient-based tool for quantifying the control of the disease in the subjects with persistent asthma.
Methods. A cross-sectional study including 396 subjects with persistent asthma drown from a population of treated patients was performed. Evaluation of the examined subjects included completion of the ACT, spirometry, and asthma specialist rating of control.
Results. The mean derived ACT score in all study subjects was 19.2±3.3. Prevalence of the study subjects with totally controlled (TC), well-controlled (WC) and not well-controlled (NWC) asthma by derived ACT score was 9.1%, 43.2% and 47.7%, respectively. Results from the spirometry showed that in 45% of the study subjects FEV1 value was less than 80%. Prevalence of the study subjects with TC, WC and NWC asthma by asthma specialist rating was 8.1%, 41.1% and 50.7%, respectively. A strong correlation between the derived ACT scores and asthma specialist rating of control was observed (r = 0.51, P = 0.000).
Conclusion. Our data confirm the usefulness of the ACT as a valid and reliable screening tool for asthma control.
Saso Stoleski, Jordan Minov, Jovanka Karadzinska-Bislimovska and Dragan Mijakoski
OBJECTIVE: To assess the effect of job exposure and its duration on chronic respiratory symptoms and ventilatory capacity among agricultural workers.
METHODS: We performed a cross-sectional study including 120 agricultural workers aged 36 to 53 years, compared to an equal number of office workers matched by age, duration of workplace exposure and smoking status. A questionnaire was used to record the chronic respiratory symptoms, detailed job history, specific job activities and tasks performed, and smoking history. Evaluation of examined subjects also included functional lung testing by spirometry.
RESULTS: We found non-significantly higher prevalence of respiratory symptoms in the last 12 months in agricultural workers with significant difference for cough (P = 0.044), and wheezing (P = 0.031). Mean values of all spirometric parameters were lower in agricultural workers, being significantly different for MEF50 (P = 0.001) and MEF75 (P = 0.000). Adverse respiratory effects and lung function deterioration were more expressed in agricultural workers with duration of job exposure more than 20 years than in those exposed less than 20 years.
CONCLUSION: Our data suggest that workplace exposure in agricultural workers may lead to respiratory impairment which is close related to its duration.