<abstract><title style='display:none'>Abstract</title>This study aimed to provide a brief historical overview of occupational medicine in Sibiu County combined with epidemiological evidence and trends in occupational diseases useful to design an agenda for future research and development of other components. Methods: to depict a model of circumstances, correlations, and trends, we applied to the local employee population a semi-structured narrative review method combined with the analysis of occupational diseases. The search strategy relied on literature and document review to create a timeline. We used a statistic chart histogram to highlight the most significant factors. Results: since 1950, concerning the industrial profile and the significant health effects on workers, we identified six stages of developing an occupational health network. The coverage was both for medical and hazard surveillance through a centralized system in the communist regime and recovery in the unique Sanatorium for occupational diseases established in the area. Occupational medicine private health services and the Faculty of Medicine from Sibiu appeared in the 1990s. Sibiu’s occupational disease model was a particular one in the 20th century, given the burden of lead poisoning from local industries. Infectious diseases in medical staff related to sporadic epidemics and the ongoing COVID-19 pandemic as an emergent professional risk pose new current challenges for occupational medicine. Conclusion: unique challenges increase the need for occupational epidemiologic research and the need for advances in other components of occupational health, but lessons from the past and traditional methods are well documented and still valuable.</abstract>

Occupational medicine in Sibiu: the switch from historical diseases to the current and emergent ones

<abstract>
<title style='display:none'>Abstract</title>
<italic><bold>Objective</bold></italic>: Medical emergencies (ME) in the occupational medicine (OM) office represent an increasingly frequent challenge, because they may require treatment or an ambulance, involving monitoring the patient, halting scheduled activity. The objective of this retrospective observational study was to study ME in the on-site medical office of a local pharmaceutical company, with an emphasis on the differences between major and minor emergencies, and on the factors associated with a longer duration of consultations, in order to optimize management.
<italic><bold>Methods</bold></italic>: ME in the on-site office of a local company, January - June 2023 (109 working days), were recorded. The presentations were divided into 2 groups (G): G1 - ME that required ambulance/hospitalization/immediate treatment (etiological and/or symptomatic) and G2 - ME without immediate intervention.
<italic><bold>Results</bold></italic>: During the 109 working days analyzed, 173 consultations involved ME (12.5% of the total presentations), with a mean of 1.6 presentations/day, On the 62 days with ME, the average was 2.7 presentations/day. The presentations, with a mean age of 40.8 years and a female predominance (69.4%), were divided into 2 groups: G1 included 95 (54.9%) presentations with immediate intervention, G2 - 78 (45.1%). In G1, 8 (8.4%) presentations required ambulance to hospital, 39 (41.1%) received etiological treatment, and 76 (81.1%) symptomatic treatment. Presentations for infectious diseases in a pandemic context ranked first This emphasizes the role of the OM physician in assessing Covid-19 contacts/patients. An ME consultation lasted on average 16.2 minutes, with a maximum of 19.4 minutes (excluding Covid-19 rapid testing). The most frequent ME complaints/humors were of cardiovascular, neurological, digestive and musculoskeletal origin. The maximum duration was in cardiovascular disease, associated with each type of intervention (p&lt;0.0001 in the 3 cases: ambulatory/symptomatic/etiological treatment).
<italic><bold>Conclusion</bold></italic>: ME in the OM doctor’ activity are frequent, more so in middle-aged women, especially between 12:01-16:00. They add approximately 2-3 consultations daily, in addition to the scheduled ones (30-45 additional minutes). Most ME require medical intervention: treatment in the office/ambulance. Apart from the COVID-19 context, most ME were cardiovascular (most time-consuming), digestive, neurological, and musculoskeletal. The duration of emergency consultations, additional to appointments, could require dedicated intervals, in order not to overload the physician. A systematized analysis of ME, paralleled by a good feedback towards the employer, could favor an individualized approach and an optimized endowment of the office, allowing identification of undiagnosed chronic disease, which would enhance productivity.
</abstract>

Emergencies in occupational medicine: the experience of an on-site medical office

<abstract>
<title style='display:none'>Abstract</title>
This study aims to estimate the occupational etiology of COVID-19 in the healthcare sector and obtain a risk matrix for the burden of disease across occupations and specific activities. The study population included 4515 cases and 133077 controls. We have used an epidemiological model that included data collected over one year from employed persons with confirmed SARS-CoV-2 infection, age group 20-64, and residing in Sibiu County. We measured the incidence rate (IR), relative risk (RR), and risk of COVID-19 attributable to the occupational exposure (AR), respectively, statistical analysis based on frequency distribution and the portion of cases to compute the risk levels in social- and healthcare workers. According to this model, approximately 70.5% of COVID-19 risk could be attributable to occupational exposure. The workplace is a strong predictor of infection risk (RR 3.4), particularly in residential long-term care facilities, hospitals, and ambulance services. The highest-risk job functions are nurse, nursing assistant, ambulance worker, and dentist. In conclusion, we believe in having demonstrated that epidemiological modeling may be helpful for risk management and notification of COVID-19 as an occupational disease in frontline staff and essential healthcare personnel.
</abstract>

Epidemiological model of COVID-19 in healthcare workers: occupational vs. environmental disease

Professor Paraschiva-Marilena Oarga

<abstract>
<title style='display:none'>Abstract</title>
We report the case of a 63-year-old terracotta tiles manufacturer who presented with acute abdomen and normocytic anaemia. The patient presented with elevated levels of urinary delta-aminolaevulinic acid without any increase in the levels of urine porphobilinogen or urine coproporphyrin. Detection of elevated lead blood levels (1939 µg/dL one month before hospital admission in the occupational medicine clinic and 44.70 µg/dL at hospital admission, values come from two different laboratories) confirmed the diagnosis of chronic lead poisoning due to occupational exposure. Chelation therapy with D-penicillamine resulted in the improvement of clinical symptoms and lead blood levels. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in terracotta tiles manufacturing workers, lead poisoning being a neglected diagnosis in abdominal pain.
</abstract>

Occupational lead intoxication from terracotta tiles manufacturing: a case study

<abstract><title style='display:none'>Abstract</title>Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.</abstract>

Lung function testing assessment by impulse oscillometry in chronic lung disease

<abstract>
<title style='display:none'>Abstract</title>
<bold>Background</bold>: Historically, silicosis is a disease of miners, but the last decade witnessed outbreaks in occupational settings not traditionally associated with silica exposure. Evidence from other countries may ground awareness and control of re-emergent risks.
<bold>Methods</bold>: Incident cases of occupational diseases, ranking and trends were analysed within 2012-2016, respectively within 2007-2016 for silicosis using a cross-national comparative study. Labor force profile and occupation were additional data used to identify similarities and differences between Romania and Israel. The incidence rates for silicosis extracted from the Global Burden of Disease Study 2017 were compared to national, continental, and global level.
<bold>Results</bold>: Between the two countries, the ratio was 1:1.5 for musculoscheletal disorders, 1:3 for respiratory diseases, 1:4 for noise-induced hearing loss, and 1:10 for silicosis. Regarding silicosis, three major diffences were found, namely: the burden of disease, the trend of incidence (ascending in Israel; descending in Romania), and the occupational setting (coal miner in Romania; artificial stone worker in Israel). Globally, Romania was among countries with high incidence of silicosis in 2017.
<bold>Conclusion</bold>: Silicosis was a national issue of concern at the time, but vigilance should continue, given the severity of this disease and the occurrence of other silica-related diseases.
</abstract>

A cross-national perspective on silicosis: incidence, occupational settings, and trends

<abstract>
<title style='display:none'>Abstract</title>
Tuberculosis (TB) disease is treatable, but the postTB lung disease in previously treated patients is a reality which must not be ignored. A case report of a 52-year-old male patient, heavy smoker (50 pack-years), alcoholic, with occupational exposure to chemical hazards (such as gaz oil vapors, distillate fuels and industrial solvents), physical hazards (thermal extremes, noise, vibration, UV radiation), ergonomic hazards (manual handling activities); and psychosocial hazards (e.g. overload, isoloation from family and friends), was delayed diagnosed with severe extensive cavitary pulmonary TB disease in 1999, treated till 2001. The assessment of lung function was neglected before or after antiTB therapy ended, so COPD was ignored till 2009, when the patient was admitted in a Pneumology Hospital. Other long term postTB disorders, as left fibrothorax, bronchiectasis, cavitary open healling syndrome, were also identified. Chronic postTB lung disease (PTLD), centered on COPD, had unfavorable progressive evolution till September 2022, when premature death occured. In conclusion, the obstructive phenotype of PTLD was delayed diagnosed and had multiple risk factors as tobacco smoking, occupational exposure and severe TB disease itself. A protocol for monitoring obstructive lung disorders among workers in oil industry, especially those diagnosed with TB disease, should be properly adapted through a collaborative approach between the occupational and the chest physician.
</abstract>

The obstructive phenotype of chronic posttuberculosis disease - is there a role for the occupational exposure?

<abstract>
<title style='display:none'>Abstract</title>
<italic><bold>Background</bold></italic>: While the main occupational and non-occupational risk factors associated with carpal tunnel syndrome are known, we still need to understand which of these factors has a stronger correlation with carpal tunnel-related symptoms in office workers and to improve future work-space recommendations accordingly.
<italic><bold>Objective</bold></italic>: This study aimed to investigate the relationship between occupational and non-occupational risk factors and carpal tunnel syndrome-related symptoms among office workers who use a computer in their dayto-day activities.
<italic><bold>Methods</bold></italic>: The data used in this study were collected from May to September 2022 through an online questionnaire from one respondent to another through different forms of social media, using the snowball method. The recorded data were further analysed using an SPSS program. In this way, we analysed quantitative variables by calculating the means, the medians, the standard deviation and the normal distribution and qualitative variables by reporting them as absolute values and percentages of the total. We compared different subgroups of samples using the chi-square test and the binary regression method. A p-value of less than 0.05 was the threshold of statistical significance.
<italic><bold>Results</bold></italic>: This study evaluated 130 office workers and identified and analysed the complex relationships between occupational and non-occupational risk factors of CTS and CTS symptoms grouped as pain, sensory function impairment and motor function impairment. Through data analysis and further logistic regression analysis, we concluded that while sensory function impairment is mostly associated with occupational factors such as computer typing with one hand, pain and motor function impairment are associated with both non-occupational, well-known risk factors (female sex, high BMI) and number of hours on the computer outside of work, and occupational risk factors like using both a mouse and an external keyboard, having a chair with adequate arm support and typing with one hand.
<italic><bold>Conclusion</bold></italic>: Both occupational and non-occupational risk factors contribute to the development of CTS-related symptoms. Our dataset highlights the complex relationship between CTS occupational and non-occupational risk factors in office workers, thus providing insights for future workplace recommendations and preventive strategies.
</abstract>

Evaluation of occupational and non-occupational risk factors associated with carpal tunnel syndrome-related symptoms in office workers

<abstract>
<title style='display:none'>Abstract</title>
Allergic contact dermatitis is an inflammatory cutaneous reaction which occurs after immunological sensitization to the contact substance and clinically manifests with pruritic, erythematous, indurated, scaly plaques or cutaneous xerosis, thickening and scaling in case of chronic exposure. It is a T-cell mediated type IV reaction (delayed hypersensitivity response) and there have been discovered over 4000 contact allergens. As 30 percent of all occupational diseases involve cutaneous manifestations, irritant and contact dermatitis making up over 90 percent of instances of occupational skin diseases, the occupational doctor plays a key role in diagnosis and management of such patients. Prevention is the key in the treatment of this condition, thus recognizing the workplace risk factors, reducing antigen sources and providing appropriate protective equipment should be of utmost importance. Next, we present the case of a 48-year-old woman, who works as a technician in an aluminum manufacturing plant and who developed pruritic eczematous lesions located on the upper limbs, in order to review the risk factors and consequences of work-environmental exposure to allergens.
</abstract>

Occupational allergic contact dermatitis: a case report

<abstract>
<title style='display:none'>Abstract</title>
One of the most common causes of lung cancer is exposure to occupational carcinogens. Free silica, diesel exhaust fumes, dyes, radon and with asbestos at the top of the list, differ by percentage according to the predominant professional activities in each country. The occupational health doctor is directly involved in the surveillance of the exposed worker, during work or post exposure, in the diagnosis and reporting of occupational cancers. Efficient screening followed by reporting and monitoring cases of occupational lung cancer and, last but not least, reintegration into professional activity are important steps in the medical surveillance of the worker exposed to occupational lung carcinogens. Standardised information collected at the level of occupational exposure monitoring systems, separated by carcinogen category and profession, may form the basis of control and prevention plans. Harmonising medical surveillance at European and global level can lead to a decrease in the incidence and mortality of work-related lung cancer.
</abstract>

Patterns in medical surveillance of workers exposed to lung carcinogens

<abstract>
<title style='display:none'>Abstract</title>
The long journey of tuberculosis (TB) from exposure to latent or progressive TB infection, from primary stage to second stage of illness with or without infectious status, and then to chronic post-TB sequelae is very complex and still unclear, including a various spectrum of stages and manifestations. A case report of a 55 year-old woman with personal history of pleural effusion, in her youth, 2 previous episodes of COVID-19 infections, having no exposure to active smoking but occupational exposure to wood dust, hot steam, barbeque smoke, was admitted to Constanta Clinical Pneumology Hospital in October 2022 for hemoptysis and fatigue. Clinical and paraclinical investigations highlighted an acute evolutive episode of Pulmonary TB with metastatic bilateral nodular pattern, negative smears, positive cultures and positive QuantiFERON TB Gold in Tube (QFT-GIT). TB standard regimen of therapy was started, based on QFT-GIT positivity, and after it ended, chronic obstructive pulmonary disease was detected by spirometry and small airways dysfunction by impulse oscillometry. TB illness does not stop after directly observed therapy ends. So, systematical screening of pulmonary, bronchial or pleural sequelae should be performed and identified syndromes need to be treated, as well as reintegration in the job process by a careful monitoring.
</abstract>

Fitness for Work in the Long Journey of Tuberculosis Infection to Chronic Posttuberculosis Disease Case Report and Literature Review

<abstract><title style='display:none'>Abstract</title>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.</abstract>

Factors influencing the rationing of nursing care in Romania

<abstract><title style='display:none'>Abstract</title><bold>Context.</bold> Stress is a complex psychosocial phenomenon that significantly influences health. The individual differences in stress response depend on sensitivity to stressors, named “stress vulnerability”.<bold>Objectives.</bold> The aims of the study were to determine the level of perceived vulnerability to stress and compare stress vulnerability among students from 2 universities in Bucharest: University of Medicine “Carol Davila” and National University of Political Studies and Public Administration.<bold>Methods.</bold> An approximately equal number of students from the two selected universities completed the Romanian version of the Miller-Smith stress vulnerability questionnaire.<bold>Results.</bold> A number of 86 (60 women and 26 men) students agreed to participate. Average age was 23.56 years with a standard deviation of 4.86 years. The high vulnerability group included 18 (38%) medical students and 27 (60%) political science and public administration students. The difference was statistically significant (chi2 test, p=0.02) between the two groups. The average health score for medical students (MS) was 15.97, with a median of 15, while for the political science and administration students (PSPAS) the average health score was 24.91, with a median of 26. The average psychosocial score for MS group was 20.41 and the median was 20. In the PSAPS group, the psychosocial score was 26.14 and the median 24. The difference was statistically significant for both health score (p&lt;0.00001) and psychosocial score (p=0.0006).<bold>Conclusions:</bold> Stress is a common problem among undergraduated students. In this study the vulnerability to stress was higher for students PSAPS group compared to the students from MS group.</abstract>

Stress vulnerability assessment among medical and political science and public administration students

<abstract><title style='display:none'>Abstract</title>During periodic occupational medical checkup, in a sample including all employees from two high schools, a secondary school and a kindergarten, we administered through voluntary completion, questionnaires which assessed the employees’ occupational stress in terms of individual characteristics, anxiety, sense of self-efficacy, work ability, emotional exhaustion and health status (using ShortForm 36 questionnaire). A number of 233 questionnaires were returned. Only the occupational stressor represented by communication with superiors correlates significantly negatively with work ability in all four units. Work ability and communication with superiors also have average scores which differ significantly and are concordant in all four units. In the secondary school, work ability has the highest average value and the lowest average value of “communication with superiors” stressor. The same values are decreasing for WAI in order, from high school 2 to high school 1 and kindergarten while the stressor represented by communication with superiors has increasing values in order from high school no 2 to high school no. 1, and kindergarten. These results show that programmes to reduce occupational stress in school units should primarily address the school unit leadership in order to improve their communication with employees.</abstract>

Communication with superiors and colleagues and other occupational stressors. Correlations with work ability, self-efficacy and health in employees from primary and secondary education

<abstract><title style='display:none'>Abstract</title>Sick building syndrome (SBS) is a complex syndrome consisting of non-specific symptoms with an onset associated with subjects’ presence in some modern building and the disappearance of symptoms shortly after they leave it. The effects of SBS may be the result of a series of protective reactions of the human body triggered by various types of surrounding environment, further suggesting that the human response could be based on a three-phase biological model: sensory perception, low degree inflammatory reactions and environmental stress reactions. Besides stress created by the discomfort of people who develop symptoms, SBS is the cause of an extensive loss of productivity, sickness absenteeism, wasted time in complaints with all the legal punitive issues that arise from them. The subjects diagnosed with SBS are hard to follow-up over time due to workers often leaving their jobs and being lost from cohort databases. Achieving a reputation of a “sick building” may prove difficult to rehabilitate even after expensive repairs and upgrades. In extreme cases closure and even demolition can occur. SBS is an evolving concept and this review we will present part of this evolution and what are the major challenges for its definition.</abstract>

Sick building syndrome, a crossroad in modern occupational medicine assessment

<abstract><title style='display:none'>Abstract</title>The study was performed in seven medical units in Bucharest with the intention to offer a comprehensive analysis of the nurses’ current prevention practices for hospital-acquired pressure ulcers and also to determine: (1) the main risks that can negatively affect the prevention activities for this type of injury, and (2) if there is a correlation between the nurses’ knowledge and the clinical approach to the current hospital-acquired pressure ulcer prevention practices. The statistical analysis was based on data collected from 713 questionnaires from subjects who met the inclusion criteria of the study. The results showed that nurses considered protocols for hospital-acquired pressure ulcer prevention and its management to be important, but both were not always fully implemented into practice due to the lack of resources, time allocation and staff shortages. The regression analysis method we used was focused to assess the predictive capacity for the combined clinical knowledge and professional approaches to hospital-acquired pressure ulcer prevention and management. The conclusion was that a simultaneous improvement in the clinical approaches and professional knowledge on the topic of pressure-ulcer prevention and management may lead to an improvement of up to 6% of the practices in this field according to the results of the statistical analysis performed.</abstract>

The risks in nursing interventions offered by nurses with the purpose of preventing hospital-acquired pressure ulcers

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Romanian Journal of Occupational Medicine

 Romanian Journal of Occupational Medicine is a journal open to all those interested in understanding, conveying and promoting interest in this specialty area: defining...

 Romanian Journal of Occupational Medicine is a journal open to all those interested in understanding, conveying and promoting...