Manifestaciones de trastornos musculoesqueléticos en moldeadores manuales metalúrgicos

Introducción: Los trastornos musculoesqueléticos en el contexto laboral metalúrgico repercuten negativamente desde la perspectiva personal, económica y social de los trabajadores. Objetivo: Identificar las manifestaciones de trastornos musculoesqueléticos en los moldeadores manuales metalúrgicos del área de fundición de la empresa Holmeca de la provincia Holguín, Cuba, en el período comprendido enero-marzo de 2021. Método: Se realizó un estudio observacional, no experimental de corte transversal en 19 moldeadores manuales metalúrgicos, en el que se incluyeron variables sociodemográficas, ubicación de zonas dolorosas, intensidad del dolor, tiempo de aparición y duración del trastorno. Se emplearon métodos teóricos, empíricos. Fue utilizado el Cuestionario Nórdico estandarizado de Kuorinka y la Escala Visual Analógica. El procesamiento de la información se llevó a cabo mediante la estadística descriptiva. Resultados: Se identificaron las zonas dolorosas y la prevalencia más alta de dolor musculoesqueléticos en: muñeca/mano (94,74 %), hombro (89,47 %), dorsal/lumbar (89,47 %) y codo/antebrazo (84,21 %). La intensidad del dolor fue determinada como intenso en el 36,84 % y moderado en el 42,11 % de los trabajadores; mientras que en el 21,05 % fue leve. El tiempo de padecimiento delos trastornos fue de 3-38 años,que aparecieron luego de 5 a 7 años de haber comenzado las labores en el área de estudio. Conclusiones: La prevalencia de manifestaciones de trastornos musculoesqueléticos en los moldeadores manuales metalúrgicos del área de fundición de la empresa Holmeca de Holguín es elevada. Se identifican en mano/muñeca, hombro, lumbar y codo/antebrazo, como las zonas anatómicas más afectadas en este grupo poblacional.

Introduction: Musculoskeletal disorders in the metallurgical work context have a negative impact from the personal, economic and social perspective of workers. Objective: To identify the manifestations of musculoskeletal disorders in metallurgical manual molders in the foundry area of the Holmeca company in the province of Holguín, Cuba, in the period from January to March 2021. Method: An observational, non-experimental study was carried out. cross-sectional study in 19 metallurgical manual shapers, which included sociodemographic variables, location of painful areas, pain intensity, time of onset and duration of the disorder. Theoretical and empirical methods were used. The standardized Kuorinka Nordic Questionnaire and the Visual Analog Scale were used. The information processing was carried out using descriptive statistics. Results: The painful areas and the highest prevalence of musculoskeletal pain were identified in: wrist/hand (94.74%), shoulder (89.47%), dorsal/lumbar (89.47%) and elbow/forearm (84.21%). The intensity of the pain was determined as intense in 36.84% and moderate in 42.11% of the workers; while in 21.05% it was mild. The duration of the disorders was 3-38 years, which appeared after 5 to 7 years after beginning work in the study area. Conclusions: The prevalence of manifestations of musculoskeletal disorders in metallurgical manual molders in the foundry area of the Holmeca company in Holguín is high. They are identified in the hand/wrist, shoulder, lumbar and elbow/forearm, as the anatomical areas most affected in this population group.

Introdução: As lesões osteomusculares no contexto do trabalho metalúrgico têm um impacto negativo na perspectiva pessoal, económica e social dos trabalhadores. Objetivo: Identificar as manifestações de distúrbios osteomusculares em moldadores manuais metalúrgicos da área de fundição da empresa Holmeca, na província de Holguín, Cuba, no período de janeiro a março de 2021. Método: Foi realizado um estudo observacional, não experimental. estudo transversal em 19 modeladores manuais metalúrgicos, que incluiu variáveis sociodemográficas, localização das áreas dolorosas, intensidade da dor, tempo de início e duração do distúrbio. Foram utilizados métodos teóricos e empíricos. Foram utilizados o Questionário Nórdico Kuorinka padronizado e a Escala Visual Analógica. O processamento das informações foi realizado por meio de estatística descritiva. Resultados: As áreas dolorosas e as maiores prevalências de dores musculoesqueléticas foram identificadas em: punho/mão (94,74%), ombro (89,47%), dorsal/lombar (89,47%) e cotovelo/antebraço (84,21%). A intensidade da dor foi determinada como intensa em 36,84% e moderada em 42,11% dos trabalhadores; enquanto em 21,05% foi leve. A duração dos distúrbios foi de 3 a 38 anos, surgindo após 5 a 7 anos após o início do trabalho na área de estudo. Conclusões: É elevada a prevalência de manifestações de distúrbios musculoesqueléticos em moldadores manuais metalúrgicos na área de fundição da empresa Holmeca em Holguín. São identificadas na mão/punho, ombro, lombar e cotovelo/antebraço, como as áreas anatômicas mais acometidas neste grupo populacional.

Hospital infection control and occupational medicine services in the face of the COVID-19 pandemic in occupational health / Serviços de controle de infecção hospitalar e de medicina do trabalho no enfrentamento à pandemia de COVID-19 na saúde ocupacional

In this article, the actions developed by the Hospital Infection Control Service (HICS) and Occupational Medicine (OM) to face the COVID-19 pandemic and track cases of infection among employees of a large hospital in Belo Horizonte, Minas Gerais, Brazil. Training actions, guidelines on how to collect a swab sample, Code 19 (COVID-19) simulation, dressing/undressing, hand hygiene, the definition of flows, and the quantification of cases infected by COVID-19 among employees in care areas were highlighted. The engagement of HICS and OM in the prevention and promotion of health were fundamental to facing the pandemic. It is estimated that SARS-CoV-2 infection rates among staff at the study hospital were similar to those at other hospitals. The experience report is important for expanding knowledge about action planning in the context of a large hospital (AU).

Neste artigo, são relatadas as ações desenvolvidas pelo Serviço de Controle de Infecção Hospitalar (SCIH) e Medicina do Trabalho (MT) para o enfrentamento da pandemia de COVID-19 e rastreamento dos casos de infecção entre funcionários de um hospital de grande porte de Belo Horizonte, Minas Gerais, Brasil. Destacaram-se as ações de treinamentos, orientações de como coletar amostra de swab, simulação Código 19 (COVID-19), paramentação/desparamentação, higiene das mãos, definição de fluxos e quantificação dos casos infectados por COVID-19 entre funcionários de áreas assistenciais. O engajamento do SCIH e da MT na prevenção e promoção da saúde foi fundamental no enfrentamento da pandemia. Estima-se que os índices de infecção pelo SARS-CoV-2 entre os funcionários do hospital em estudo foram similares aos de outros hospitais. O relato de experiência é importante para a ampliação do conhecimento sobre o planejamento de ações no contexto de um hospital de grande porte (AU).

Confidencialidade em medicina ocupacional: protegendo informações / Confidentiality in occupational medicine: protecting information / Confidencialidad en medicina del trabajo: protección de información

Resumo A confidencialidade é elemento central da relação médico-paciente e está associada à boa qualidade do atendimento. Contudo, pode ser rompida em conformidade com as normas éticas e legais estabelecidas no país. Este estudo objetiva mostrar os principais aspectos da confidencialidade em medicina ocupacional. Para isso, realizou-se revisão narrativa de literatura sobre o tema, utilizando bases de dados de livre acesso e embasando-se nos códigos de ética médica. A atuação do médico do trabalho envolve o trabalhador, outros profissionais não médicos e o empregador, situação capaz de desencadear conflitos, requerendo que o médico conheça suas obrigações e limites ético-legais. A proteção da confidencialidade respeita os direitos humanos, mas dilemas podem surgir, não bastando obedecer aos ditames éticos, mas sendo necessário essencialmente seguir as normas legais. Este estudo busca mostrar os principais aspectos éticos e legais atualizados referentes à saúde ocupacional.

Abstract Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.

Resumen La confidencialidad es clave en la relación médico-paciente y está asociada a buena calidad de la atención. Sin embargo, está sujeta a una quiebra de conformidad a lo establecido en las normas éticas y legales en el país. Este estudio pretende mostrar los principales aspectos de confidencialidad en la medicina del trabajo. Para ello, se realizó una revisión narrativa de la literatura en las bases de datos de acceso abierto basándose en códigos de ética médica. El actuar del médico del trabajo involucra al trabajador, a profesionales no médicos y al empleador, lo que puede desencadenar conflictos requiriendo que el médico conozca sus obligaciones y límites ético-legales. La protección de la confidencialidad respeta los derechos humanos, pero pueden surgir dilemas y no solo bastará atenerse a los dictámenes éticos, sino seguir fundamentalmente las normas legales. Los resultados mostraron los principales aspectos éticos y legales actualizados relacionados con la salud laboral.

COVID-19 in Turkish health care workers practicing chest medicine

SUMMARY OBJECTIVE: This study aimed to evaluate the data of Turkish health care workers practicing chest medicine on their coronavirus disease 2019 (COVID-19) status and related parameters. METHODS: This descriptive study included online survey data that the Turkish Thoracic Society conducted with its members in two phases starting in June and December 2020. The 33-item survey included demographic data, smoking status, the presence of any chronic diseases, occupation, working status, and non-work-related and work-related COVID-19 exposure characteristics. RESULTS: Of 742 responses, 299 (40.3%) reported that they had contracted COVID-19. The second survey detected a higher frequency of health care workers who had contracted COVID-19 (12.1% versus 57.4%, p<0.001) than the first survey. The analysis of the association between study parameters and COVID-19 in health care workers using logistic regression revealed statistical significance with working at the onset of the outbreak (OR 3.76, 95%CI 1.09-12.98, p=0.036), not working at the time of survey (OR 5.69, 95%CI 3.35-9.67, p<0.001), COVID-19 history in colleagues (OR 2.27, 95%CI 1.51-3.41, p<0.001), any non-work-related COVID-19 exposure (OR 4.72, 95%CI 2.74-8.14, p<0.001), COVID-19 exposure at home (OR 6.52, 95%CI 3.52-12.08, p<0.001), and COVID-19 history in family members (OR 8.16, 95%CI 5.52-12.08, p<0.001) after adjusting for age and sex. The study also observed an inverse relationship between the use of aprons and goggles and COVID-19 in health care workers. CONCLUSION: Occupational and nonoccupational characteristics are related to COVID-19 in health care workers practicing chest medicine. Therefore, active surveillance to detect health care workers contracting COVID-19 and to document and control occupational and nonoccupational risks should be provided.

Carcinógenos ocupacionales relevantes en Colombia, listado actualizado (2020) / Relevant occupational carcinogens in Colombia, 2020 updated list

RESUMEN Objetivo Actualizar la lista de carcinógenos ocupacionales relevantes para el contexto colombiano. Materiales y Métodos Se elaboró un listado único para el contexto colombiano a partir del Manual de Agentes Carcinógenos de los Grupos 1 y 2A de la IARC, de interés ocupacional para Colombia (2006) y del documento CAREX-2012 del Instituto Nacional de Cancerología. Estos documentos se compararon con los listados de carcinógenos ocupacionales relevantes a nivel internacional a partir de una revisión de literatura con las palabras "occupational carcinogens", "exposure" y"neoplasm". A su vez, estas publicaciones se cotejaron con la información disponible en el Programa de monografías en línea de la Agencia Internacional para la Investigación del Cáncer (IARC), hasta la monografía número 123. Resultados Se proponen 52 carcinógenos ocupacionales relevantes, 25 químicos, cuatro físicos, cuatro biológicos, ocho mezclas y once circunstancias de exposición. Conclusiones La actualización incluyó agentes físicos: radiación ultravioleta de la soldadura y Radón-222 y sus productos en descomposición (emisores de alfa partículas); mezclas: polvo de cuero, polvo de madera y aceite de esquisto; y circunstancias de exposición: humos de soldadura y contaminación del aire exterior y material particulado en aire contaminado exterior.

ABSTRACT Objective Update of relevant occupational carcinogens list in the Colombian context. Materials and Methods A unique list was prepared for the Colombian context from the Manual of Carcinogens of Groups 1 and 2A of the IARC, of occupational interest for Colombia, 2006 and the document CAREX-2012 of the National Cancer Institute. These documents were compared with lists of internationally relevant occupational carcinogens based on a literature review with words "occupational carcinogens", "exposure", and "neoplasm". Additionally, these publications were compared with the information available in the Online Monograph Program of the International Agency for Research on Cancer-IARC, up to monograph number 123. Results 52 relevant occupational carcinogens, 25 chemical, four physical, four biological, eight mixtures and eleven exposure circumstances are proposed. Conclusions the update included physical agents: ultraviolet radiation from welding and Radon-222 and their decomposition products (emitters of alpha particles); mixtures: leather dust, wood dust and shale oil; and exposure circumstances: fumes from welding and outside air pollution and particulate matter in outside polluted air.

Conocimientos sobre salud ocupacional en tenientes del ejército del Perú / Occupational health knowledge in lieutenants of the Peruvian army

Introducción: La salud ocupacional es una actividad multidisciplinaria que promueve y protege la salud de los trabajadores. El conocimiento de las condiciones de riesgo previene los accidentes y enfermedades ocupacionales. Objetivo: Determinar el nivel de conocimientos en salud ocupacional en tenientes del Ejército del Perú. Métodos: Estudio observacional y transversal. Participaron 86 tenientes de una promoción de la Escuela de Infantería. Se realizó el Cuestionario de conocimientos en salud ocupacional. Se aplicó estadística descriptiva para las características generales y para la asociación con los conocimientos, la prueba ji cuadrado. Resultados: La edad promedio fue 28,4 años (DE=1,26; Mín.26, Máx.32), 51,16 por ciento presentaron nivel bajo de conocimientos; trabajadores que no recordaban haber recibido capacitaciones en salud ocupacional y que sufrieron accidente de trabajo tuvieron nivel bajo de conocimientos, 80 por ciento (p = 0,049) y 73,68 por ciento (p = 0,026) respectivamente. La pregunta con mayores aciertos fue sobre el examen de salud ocupacional anual con un 75,58 por ciento, y la de menor conocimiento, sobre la cobertura del seguro complementario de riesgos con un 25,58 por ciento. Conclusiones: El nivel de conocimiento predominante sobre salud ocupacional en tenientes del ejército del Perú, fue bajo, con mayores porcentajes en los que no recuerdan capacitación en salud ocupacional y los que tuvieron algún accidente laboral(AU)

Introduction: Occupational health is a multidisciplinary activity that promotes and protects the health of workers. Knowledge of risk conditions prevents occupational accidents and diseases. Objective: To determine the level of occupational health knowledge in lieutenants of the Peruvian Army. Methods: Observational and cross-sectional study. 86 lieutenants of a promotion of the Infantry School participated. The Occupational Health Knowledge Questionnaire was applied. Descriptive statistics were applied for the general characteristics and the Chi-square test for the association with knowledge. Results: Mean age 28,4 years (SD = 1,26; Min. 26, Max. 32), 51,16 percent presented a poor level of knowledge; workers who did not remember having received training in Occupational Health and who suffered a work accident, 80 percent (p = 0,049) and 73,68 percent (p = 0,026) they had a bad level respectively. The question with the highest correct answers was about the annual occupational health examination with 75,58 percent, and the one with the least knowledge about the complementary risk insurance coverage with 25,58 percent. Conclusions: The predominant level of knowledge about occupational health in lieutenants in the Peruvian army was poor, with higher percentages in those who did not remember training in occupational health and those who had an occupational accident(AU)

Evaluación del riesgo ergonómico por posturas forzadas en fisioterapeutas / Evaluation of ergonomic risk due to forced postures in physiotherapists

INTRODUCCIÓN. Los trastornos músculo esqueléticos son problemas de salud en el trabajo y causa de ausentismo laboral a nivel mundial, por lo que la valoración de los factores de riesgo laboral es necesaria para lograr prevención. OBJETIVO. Evaluar el nivel de riesgo ergonómico por posturas forzadas en los fisioterapeutas. MATERIALES Y MÉTODOS. Estudio descriptivo transversal. Población de 35 y muestra de 31 fisioterapeutas del Área de Medicina Física y Rehabilitación del Hospital de Especialidades Carlos Andrade Marín, agosto de 2020. Se aplicó el cuestionario nór-dico para conocer la percepción de la sintomatología osteomuscular; una lista de verificación rápida de condiciones de riesgo (ISO TR 12295); y, para medir el nivel de riesgo de posturas forzadas se aplicó los métodos OWAS REBA. RESULTADOS. El 96,77% (30; 31) tuvo sintomatología osteomuscular en los últimos 12 meses. Las zonas corporales con mayor afectación fueron: cuello 77,42% (24; 31), espalda alta 64,52% (20; 31), y espalda baja 58,06% (18; 31). REBA mujer: puntaje de 11; nivel de acción 4, riesgo muy alto; y, hombre: nivel de acción 3, riesgo alto. OWAS mujer: nivel 3; y, hombre: nivel 2. CONCLUSIÓN. Se evaluó el nivel de riesgo ergonómico por posturas forzadas en los fisioterapeutas. Existieron factores predisponentes para el desarrollo de trastornos músculo esqueléticos que han repercutido en el normal desarrollo de sus actividades. Las metodologías REBA y OCRA, evidenciaron que las actividades laborales presentaron un nivel de riesgo alto a muy alto, por lo que es necesaria la actuación en el mejoramiento del puesto de trabajo.

INTRODUCTION. Musculoskeletal disorders are occupational health problems and a cause of absenteeism worldwide, so occupational risk assessment is necessary to achieve prevention. OBJECTIVE. To evaluate the level of ergonomic risk due to forced postures in physical therapists. MATERIALS AND METHODS. Cross-sectional descriptive study. Population of 35 and sample of 31 physical therapists of the Phy-sical Medicine and Rehabilitation Area of the Carlos Andrade Marín Specialties Hos-pital, august 2020. The nordic questionnaire was applied to know the perception of musculoskeletal symptomatology; a quick checklist of risk conditions (ISO TR 12295); and, to measure the level of risk of forced postures the OWAS REBA methods were applied. RESULTS. The 96,77% (30; 31) had musculoskeletal symptomatology in the last 12 months. The most affected body areas were: neck 77,42% (24; 31), upper back 64,52% (20; 31), and lower back 58,06% (18; 31). REBA female: score of 11; performance level 4, very high risk; and, male: performance level 3, high risk. OWAS woman: level 3; and, man: level 2. CONCLUSION. The level of ergonomic risk due to forced postures of physiotherapists was evaluated. There were predisposing factors for the development of musculoskeletal disorders that have impacted on the normal development of their activities. The REBA and OCRA methodologies showed that the work activities presented a high to very high level of risk, which is why it is necessary to revise the activities assigned to this job position.

Valoración del desempeño ocupacional: factor integrador en la calificación de la pérdida de capacidad laboral y ocupacional / Assessment of occupational performance: An integrating factor of the loss of work and occupational capacity

Resumen Introducción: El desempeño ocupacional (DO) como concepto integrador permite la valoración holística de la persona e identifica el potencial para el retorno a la actividad productiva a través del concepto ocupacional, como insumo para la valoración de la pérdida de la capacidad laboral y ocupacional (PCLO), esto permite una calificación objetiva de los aspectos que constituyen el Manual único para la calificación de la pérdida de la capacidad laboral y ocupacional (MUCPCLO). Métodos: Estudio transversal analítico con aplicación de una escala de evaluación del DO a una muestra de trabajadores seleccionados a conveniencia, con alteraciones en funciones o estructuras corporales, participación o restricción a nivel ocupacional. Se realizaron comparaciones analíticas con el estándar de calificación del MUCPCLO y se identificaron factores diferenciales e integradores. Resultados: La muestra estuvo integrada por seis sujetos, cuatro presentaron un accidente de trabajo y dos, enfermedades laborales. En cuanto a la evaluación del desempeño, se evidenció que el 66 % presentó dependencia leve en actividades específicas; producto de ello, se logró realizar un análisis diferencial con énfasis en la calificación del MUCPCLO. Se reconocen factores específicos en el proceso como la objetividad de la valoración del DO, los múltiples aportes del concepto de DO y las posibilidades de articulación con el manual MUCPCLO. Conclusiones: La valoración previa del DO y el concepto integral del terapeuta ocupacional se constituyen como un eje fundamental que aporta al proceso de la valoración PCLO.

Abstract Introduction: Occupational performance (OP) as an integrating concept allows the holistic assessment of the person and identifies the potential for the return to productive activity through the occupational concept as an input for the assessment of the loss of work and occupational capacity (LWOC), allowing an objective qualification of the aspects that constitute the Manual único para la calificación de la pérdida de la capacidad Laboral y Ocupacional (MUCPCLO, Spanish acronym for Manual for the qualification of the loss of labor and occupational capacity). Methods: A cross-sectional study was conducted with application of an OP evaluation scale to a sample of conveniently selected workers with alterations in body functions or structures, participation, or restriction at the occupational level. Analytical comparisons were made with the MUCPCLO scoring standard, and differential and integrating factors were identified. Results: Six subjects made up the sample, four had an occupational accident and two occupational diseases. In performance evaluation, 66% of the sample presented slight dependence on specific activities that lead to a differential analysis with emphasis on the MUCPCLO score. Specific factors were recognized, such as, objectivity of the assessment of occupational performance, multiple contributions of the concept of occupational performance, and possibilities of articulation with the manual. Conclusions: The prior assessment of occupational performance and the integral concept of the occupational therapist are constituted as a fundamental axis that contributes to the process of the assessment of the LWOC.

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19 / Criteria for returning to work and determination of the vulnerability value for Covid-19

Resumen: Objetivo: Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados: Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones: El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

Abstract: Objective: To establish medical criteria for return to work to people with increased risk of severe illness from Covid-19. Materials and methods. We performed a systematic review to identify the conditions and clinical characteristics that influence the risk of developing severe Covid-19. Results: Increased risk has been shown in obesity, age >60 years old, diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease and cancer. Only in diabetes it has been studied whether prior control influences. Specific medical conditions and epidemiological risk level for return to work are proposed. Conclusions: Return to work of vulnerable groups should be prioritized, seeking to promote disease control, identifying health conditions that increase risk, and protecting the right to work. We present recommendations to guide the return to work.

Cultivating public health youth talents with illustrious virtue and lofty aspirations to undertake glorious tasks of a new era: Minutes of the Sixteenth National Postgraduates Symposium on Environmental and Occupational Medicine / 环境与职业医学

　　From October 22 to 23, 2021, the 16th National Postgraduates Symposium on Environmental and Occupational Medicine was successfully held in Central South University, sponsored by the Editorial Board of Journal of Environmental and Occupational Medicine and Xiangya School of Public Health of Central South University, and co-organized by School of Public Health of South China University and Shanghai Preventive Medicine Association. Keeping in view the outbreak of COVID-19, the symposium was held in the form of "offline+online". More than 100 teachers and students from more than 30 universities and research institutions across China attended the conference. A total of 114 excellent papers were submitted to this conference. Focusing on the theme of "Research and practice: Healing the schism", young scholars' forum as well as postgraduates' academic exchanges at the main venue and four parallel sessions were launched. This conference not only provided an excellent platform for postgraduate students in the field of environmental and occupational medicine nationwide to share academic trends and exchange academic research, but also expanded the influence of the Journal of Environmental and Occupational Medicine.

Evaluation of the effects of single vision lenses with additional near-power on computer-induced asthenopia / Avaliação dos efeitos de lentes de visão simples com poder adicional de perto na astenopia induzida por computador

Abstract Objective: Compared to standard spectacle lenses, do +0.40 EyeZenTM lenses reduce symptoms of asthenopia induced by computer? Methods: A prospective clinical study was carried out with 39 volunteers who spent more than 4 hours a day using a computer (age, 27.31±4.24; male: female =13:26). Asthenopia and visual comfort were assessed using a questionnaires. All participants completed the asthenopia questionnaire with updated regular lenses (baseline). After 4 weeks of +0.40 Eyezen™ lenses wearing all subjects answered the asthenopia questionnaire and a second questionnaire to establish their level of satisfaction with these lenses. Statistical analysis was performed usind the Shapiro-Wilk test and Wilcoxon test, and p-values less than 0.05 were considered statistically significant. Results: Compared to standard spectacle lenses (baseline), +0.40 EyeZenTM lenses wearing reduced the total asthenopia score from17.44 ± 5.51 to 13.18 ± 10.22 (p < 0.001). Regarding the perception of the visual comfort levels with these lenses in the management of digital devices, more than 90% of subjects said they were entirely or delighted with their visual comfort.. Conclusions: Digital asthenopia induced by computer was significantly reduced by +0.40 EyeZen lenses wearing.

Resumo Objetivo: Comparadas com lentes oftálmicas regulares, as lentes de visão simples com +0,40D de poder adicicional de perto reduzem os sintomas de astenopia induzida por computador? Métodos: Foi realizado um estudo clínico prospectivo com 39 voluntários que passavam mais de 4h diárias utilizando computador (idade: 27,31±4,24 anos; masculino:feminino = 26:13). A astenopia e a percepção do conforto visual foram avaliadas com questionários. Todos os participantes respoderam ao questionário de astenopia com lentes regulares atualizadas (baseline). Após 4 semanas de uso das lentes +0.40 Eyezen™ os participantes responderam aos questionários de astenopia e de conforto visual. A análise estatística foi feita com os testes de Shapiro-Wilk e Wilcoxon. Valores de p<0,05 foram considerados estatísticamente significantes. Resultados: Comparadas com lentes oftálmicas regulares (baseline), o uso das lentes de visão simples com +0,40D de poder adicional de perto reduziu o escore total de astenopia de 17,44 ± 5,51 para 13,18± 10,22 (p< 0,001). Mais de 90% dos participantes se declaram completamente ou muito satisfeitos com o conforto visual percebido no uso de dispositivos digitais. Conclusão: A astenopia induzida por computadores foi significativamente reduzida pelo uso das lentes +0,40 Eyezen™ combinadas Crizal® Sapphire™.

Variaciones fisiológicas y antropométricas en trabajadores según su residencia en tres altitudes geográficas del Perú / Physiological and anthropometric variations in workers due to their residence in three geographic altitudes in Peru

Introducción: El organismo se adapta al lugar donde reside, pero este tema no ha sido estudiado en la población laboral peruana. Objetivo: Determinar las variaciones fisiológicas y antropométricas en trabajadores según su residencia en tres altitudes geográficas del Perú. Métodos: Se realizó una investigación transversal analítica, con los datos fisiológicos (6 parámetros de laboratorio) y antropométricos (peso y talla) de 7500 trabajadores en 3 altitudes diferentes: Lima (nivel del mar), Arequipa (2500 m sobre el nivel del mar) y Cerro de Pasco (4300 m sobre el nivel del mar). Estas mediciones fueron estándares, realizadas por clínicas ocupacionales con certificaciones de calidad. Se obtuvo los coeficientes y valores p para las diferencias según cada altitud y ajustados por el sexo y la edad de cada participante. Resultados: Todos los parámetros fisio-antropométricos variaron según la altitud de residencia (todos los valores p fueron menores a 0,005). Los que se incrementaron a mayor altitud fueron la hemoglobina, el colesterol total y el colesterol HDL; en cambio, disminuyeron a mayor altitud el peso y la glucosa en ayunas. En los hombres aumentaron todas las variables menos en el colesterol HDL (que disminuyó significativamente) y el colesterol LDL (que no tuvo variación estadística), en comparación con las mujeres. Conclusiones: Son evidentes las variaciones en las mediciones de los trabajadores según el lugar donde residían, lo que muestra que no se debe tomar parámetros fijos para su valoración laboral. Esto debe servir a los médicos del trabajo y las autoridades, para tener en cuenta al momento de la valoración de la aptitud médica y luego para la vigilancia ocupacional(AU)

Introduction: The human body adapts to its place of residence, but this topic has not been studied in the Peruvian working population. Objective: Determine physiological and anthropometric variations in workers due to their residence in three geographic altitudes in Peru. Methods: An analytical cross-sectional study was conducted of physiological data (6 laboratory parameters) and anthropometric data (weight and height) of 7 500 workers from three different altitudes: Lima (sea level), Arequipa (2 500 m above sea level) and Cerro de Pasco (4 300 m above sea level). The measures were standard and taken by occupational clinics with quality certifications. Coefficients and p values for differences between the altitudes were obtained and adjusted according to the sex and age of participants. Results: All the physio-anthropometric parameters varied with the altitude of the place of residence (all p values were under 0.005). The parameters which increased at a higher altitude were hemoglobin, total cholesterol and HDL cholesterol, whereas the ones which decreased at a higher altitude were weight and fasting glucose. Among men all variables increased except for HDL cholesterol (which decreased significantly) and LDL cholesterol (which did not show any statistical variation), in comparison with women. Conclusions: Variations in measurements taken from workers from different places of residence are obvious, which shows that fixed parameters should not be used for their labor assessment. This should be taken into account by occupational doctors and authorities for medical attitude assessment and occupational surveillance(AU)

Tendência na incidência de acidentes de trajeto em trabalhadores no Brasil entre 2009 e 2016 / Trend in the incidence of commuting accidents among workers in Brazil between 2009 and 2016

Introdução: Os acidentes de trajeto ocorrem no percurso do domicílio até o local de trabalho e vice-versa. Esse tipo de acidente de trabalho pode resultar em grave desordem à saúde do trabalhador e, em grande quantidade, impactar financeiramente o Sistema Único de Saúde e a Previdência Social Brasileira (PSB). Objetivos: Descrever o perfil epidemiológico e estimar a incidência dos acidentes de trajeto em trabalhadores no Brasil entre 2009 e 2016. Métodos: Estudo retrospectivo descritivo, com análises de séries temporais (2009­2016), baseado em dados secundários e oficiais extraídos dos Anuários Estatísticos da Previdência Social. As informações de População Economicamente Ativa foram retiradas da Pesquisa Nacional por Amostra de Domicílios. As incidências anuais foram calculadas para cada 100 mil pessoas economicamente ativas, independentemente de sexo, de idade e de contribuição para a PSB. Utilizou-se o Statistical Package for the Social Sciences (SPSS) para realizar testes de regressão linear simples temporal, considerando significância de p<0,05. Resultados: O perfil epidemiológico do trabalhador acometido foi de homem entre 20 e 29 anos com fratura de perna e/ou tornozelo, que representou 24,73% do total de trabalhadores acometidos. No período, a incidência dos acidentes de trajeto aumentou de 88,17 para 105,88, o que resultou em taxa de variação de 20,08% (R2 =0,715; p=0,008). Conclusão: O crescimento da incidência e do número de acidentes demonstra grande necessidade de elaboração de planos governamentais de prevenção, que devem ser direcionados aos principais grupos de risco.

Background: Commuting accidents might have serious consequences for the health of workers, in addition to considerable financial impacts on the national health system and the social security administration. Objective: To describe the epidemiological profile and calculate the incidence of commuting accidents in Brazil in the period from 2009 to 2016. Methods: Retrospective and descriptive study with time series analysis (2009­2016) based on official secondary data obtained from Social Security Statistical Yearbooks. Information on the economically active population was retrieved from the National Household Sample Survey. Annual incidence rates were calculated per 100,000 economically active population. Simple temporal linear regression analysis was performed with software Statistical Package for the Social Sciences. The significance level was set to p<0.05. Results: The epidemiological profile of workers involved in commuting accidents corresponded to men, aged 20 to 29 and with leg/ankle fractures, which represented 24.78% of the total population of involved workers. The incidence of commuting accidents increased from 88.17 to 105.88 in the analyzed period, which represents an variation rate of 20.08% (R2 =0.715; p=0.008). Conclusion: The detected rise in the incidence and number of commuting accidents point to the need for the government to formulate prevention plans targeting high-risk groups.

Asbestos in Colombia: Industry versus science and health / Asbesto en Colombia: industria versus ciencia y salud

Abstract The usefulness of an industrial product must be measured both in economic profitability and product safety terms, and the social benefit it represents. In the case of asbestos, due to its harmful effects on human health, its use, handling and production has been banned in high-income countries thanks to the efforts carried out by their oversight bodies. Worldwide, the industrial use of this mineral has been associated with high morbidity and mortality rates, hence the importance of denouncing the health effects of asbestos. Asbestos is a term used to refer to six naturally occurring silicate minerals that are used in the manufacture of building materials, such as asbestos-cement, and automotive components, including brake linings and brake pads; however, it has been proven that inhaling asbestos microscopic fibers can lead to the development of lung diseases (pneumoconiosis) and cancer. In many cases, these diseases are caused by a short occupational or environmental exposure to it, but their clinical manifestation occurs several years after the first time of exposure. The main objective of this paper is to reflect on the hazards related to the use of asbestos and to influence public health policies addressing this problem in Colombia, so that by means of the newly adopted law banning the use of this mineral in our country, significant progress is made in aspects such as the identification and the monitoring of people who were exposed to it, and the handling, removal and final disposal of materials containing asbestos.

Resumen La utilidad de un producto industrial se debe medir tanto por su rentabilidad económica, como por su seguridad y beneficio social. En el caso del asbesto, debido a sus efectos adversos sobre la salud, su uso, manipulación y producción se ha prohibido en países de altos ingresos gracias a esfuerzos realizados por sus respectivos entes de control. A nivel mundial, el uso industrial de este mineral se ha asociado con altas tasas de morbimortalidad, de ahí la importancia de denunciar sus efectos para la salud. El asbesto comprende un grupo de seis minerales fibrosos de origen natural que la industria utiliza en la fabricación de materiales de construcción en fibro-cemento y frenos de automóviles; sin embargo, se ha demostrado que la inhalación de sus fibras microscópicas puede producir enfermedades pulmonares (neumoconiosis) y cáncer. En muchos casos, estas enfermedades son causadas por una corta exposición laboral o ambiental al material y se manifiestan años después. El principal objetivo de este documento es reflexionar sobre los peligros del uso del asbesto e influir en las políticas de salud pública al respecto, esto para que con la recién aprobada ley que prohíbe el asbesto en Colombia se logren avances significativos en temas como la identificación y el seguimiento de las personas que estuvieron expuestas, y el manejo, remoción y eliminación de los productos que contienen el mineral.

Bernardino Ramazzini: un pionero de la medicina del trabajo / Bernardino Ramazzini: a pioneer of work medicine

Bernardino Ramazzini (1633-1714), médico italiano, es considerado el padre de la medicina del trabajo por su tratado sobre las enfermedades de los trabajadores, publicado en latín hace más de 300 años. Su fecha de nacimiento, 4 de octubre, se ha tomado como el Día de la Medicina del Trabajo. Fue un precursor de la salud pública y de la seguridad y salud laborales. Se recuerda en este artículo la vida y obra de este eminente clínico, que poseía una amplia formación humanística. (AU)

Bernardino Ramazzini (1633-1714), an Italian doctor considered the father of occupational medicine, for his treatise about workers' diseases, published in Latin more than 300 years ago. His date of birth, October 4, is the Day of Occupational Medicine. It was a precursor to public health and occupational health and safety. This article recalls the life and work of this eminent clinician, who had an extensive humanistic training. (AU)

Maltrato asociado al acoso laboral a internos de Medicina en hospitales peruanos / Mistreatment associated with workplace harassment against medical interns in peruvian hospitals

Introducción:El acoso a estudiantes de Medicina, en especial a internos, suele ser una constante dentro de los hospitales de Perú. Esto se vuelve un problema cuando proviene de los médicos del propio nosocomio.Objetivo:Determinar la relación entre el acoso y el maltrato de los médicos asistentes y residentes hacia los internos de Medicina en diferentes hospitales de Perú.Métodos:Estudio analítico transversal, basado en una encuesta a médicos que habían hecho recientemente su internado. Se usó el test de NAQ-R para evaluar el acoso, también se preguntó sobre su percepción del acoso y el maltrato que provino de los médicos residentes y asistentes. Se obtuvo estadísticos de asociación.Resultados: De los 617 internos encuestados, el mayor acoso que se alcanzó del test fue de los médicos residentes (RPa: 2,40; IC 95 por ciento: 1,75-3,30; valor p < 0,001) y asistentes (RPa: 2,08; IC 95 por ciento: 1,57-2,75; valor p < 0,001). En cambio, según la percepción de acoso, resultó mayor en los internos que habían realizado su internado en más de una sede hospitalaria (RPa: 1,96; IC 95 por ciento: 1,25-3,07; valor p = 0,003), pero también entre los que habían percibido maltrato por los médicos residentes (RPa: 2,41; IC 95 por ciento: 1,71-3,39; valor p < 0,001) y asistentes (RPa: 1,80; IC 95 por ciento: 1,32-2,44; valor p < 0,001).Conclusiones:Se encontró que hubo maltrato (mediante percepción y el test) por parte de los médicos asistentes y residentes, lo que se califica como grave ya que genera un ambiente laboral y formativo tóxico. De este modo, se recomienda propiciar análisis situacionales en cada realidad e intervenciones para romper el círculo vicioso del maltrato(AU)

Introduction:Harassment against medical students, especially interns, is usually a constant within hospitals in Peru. This becomes a problem when it comes from physicians belonging to the same hospital.Objective:To determine the values of harassment and mistreatment of medical assistants and residents towards medical interns in different hospitals in Peru.Methods:A cross-sectional and analytical study was carried out, based on a survey on doctors who had recently done their internship. The NAQ-R test was used to assess harassment. Also, the respondents were asked about their perception about harassment and mistreatment that came from medical residents and assistants. Association statistics were obtained.Results:Of the 617 interns surveyed, the highest value for harassment obtained in the test corresponded to medical residents (RPa: 2.40; CI95 percent: 1.75-3.30; p value<0.001) and assistants (RPa: 2.08; CI95 percent: 1.57-2.75; p value<0.001). On the other hand, according to perception about harassment, it was higher in the interns who had performed their internship in more than one hospital center (RPa: 1.96; CI95 percent: 1.25-3.07; p value=0.003), but also among those who had perceived mistreatments by medical residents (RPa: 2.41; CI95 percent: 1.71-3.39; p value<0.001) and assistants (RPa: 1.80; CI95 percent: 1, 32-2.44; p value<0.001).Conclusions:It was found that there was mistreatment (by perception and the test) by medical assistants and residents, which is described as serious since it generates a toxic work and training environment. Thus, it is recommended to promote situational analyzes in each reality and interventions to break the vicious circle of mistreatment(AU)

As varizes na saúde do trabalhador: sintomas, tratamento e prevenção / Varicose veins and occupational health: symptoms, treatment and prevention

Este estudo teve o objetivo de apresentar uma revisão de literatura sobre os sintomas, o tratamento e a prevenção das varizes na saúde do trabalhador. Para tanto, realizou-se uma revisão de artigos científicos, livros, dissertações e teses, por meio da síntese de resultados de estudos quantitativos e qualitativos, e de sites do governo federal relacionados à saúde do trabalhador e à medicina do trabalho, compreendendo o período de 2004 a 2018. Entendeu-se que as varizes são sinais caracterizados por veias com dilatação anormal, tortuosa e congestionada, ocasionadas pela hipertensão venosa prolongada e periférica e insuficiência venosa crônica (IVC). Comumente evidenciada nos membros inferiores, por causa da postura estática e da contração contínua que fadigam os músculos, principalmente em indivíduos que permanecem em pé por muito tempo, a ocorrência de varizes associa-se a fatores de risco como obesidade, sedentarismo, estilo de vida e de trabalho e hormônios. Como sintomas, apresentam-se cansaço, dor e inchaço, podendo, se não tratada a varize, provocar úlceras varicosas. Verificou-se que a medicina do trabalho deve promover mudança de hábito de vida dos trabalhadores, sobretudo atividades físicas (alongamento e caminhada), massagem local, descanso com os pés aproximadamente 15 cm acima do nível do coração, indicação de utilização de meias compressivas ou de bandagens funcionais e de medicamentos como a diosmina, o dobesilato de cálcio, os rutosídeos e o extrato de castanha-da-índia.

The aim of the present study was to perform a literature review about the symptoms, treatment and prevention of varicose veins (VV) within the occupational medicine setting. I reviewed scientific articles, books, master's and doctoral dissertations and synthesized the results of quantitative and qualitative studies. I further retrieved information from Brazilian federal government occupational health websites. The time frame considered was the period from 2004 through 2018. VV are abnormally dilated, twisted and congested veins caused by prolonged peripheral venous hypertension and chronic venous insufficiency. VV most commonly involve the lower limbs in association with static posture and continuous contraction which exhaust the muscles, especially among individuals who remain standing over long periods of time. VV are associated with risk factors such as obesity, sedentary lifestyle and hormones. Symptoms include feelings of tiredness, pain and swelling. When untreated VV might result in venous ulcers. Occupational physicians should promote changes in the workers' lifestyle, particularly as concerns physical activity (stretching and walking), local massage and elevating the lower limbs ­ feet about 15 cm above the heart level, and prescribe compression stockings or bandages, and medications such as diosmin, calcium dobesilate, rutosides and horse chestnut extract.

Epidemiología de lesiones ortopédicas de origen laboral en un hospital de Manizales / Epidemiology of occupational orthopedic injuries in a hospital of Manizales

Introducción En Colombia, tanto la accidentalidad como las enfermedades laborales van en aumento, siendo de mayor prevalencia la afección del sistema musculo-esquelético. Sin embargo, a la fecha no existen estudios epidemiológicos que permitan identificar las patologías y su prevalencia, lo que imposibilita la creación de programas de prevención e intervención encaminados a disminuir la incidencia de dichas patologías. Con este trabajo se pretende contribuir a lograr dicho objetivo. Materiales y métodos Se obtuvieron los registros de admisión de personas con patología laboral al servicio de ortopedia en un hospital de Manizales durante los últimos 5 años; se utilizaron los diagnósticos obtenidos clasificados por código CIE10 y se dividieron según género y grupo etario para estimar la prevalencia de estas patologías según dichas variables. Resultados Se obtuvo un total de 3724 diagnósticos, la edad mínima fue de 15 años y la máxima de 69 años, de estos diagnósticos un 79% correspondió a hombres, y un 21% a mujeres, Las patologías que se presentaron con mayor frecuencia fueron fracturas (28.09%), secuelas (20.09%) y esguinces y torceduras (16.19%). De cada una de ellas la lesión más frecuente fue fractura de epífisis inferior del radio (11,47%), secuelas de fracturas de miembro inferior (40,11%) y esguinces y torceduras de tobillo (22.46%) respectivamente. Discusión Hacen falta estudios epidemiológicos para enfocar las campañas de prevención e intervención oportuna de las patologías de mayor prevalencia, se espera que esta investigación además sirva de base para la realización de futuros estudios para comparación de resultados.

Background In Colombia, both accidents and occupational diseases are increasing, with a greater prevalence of the musculoskeletal system. However, to date there are no epidemiological studies that identify the pathologies and their prevalence, which makes it impossible to create prevention and intervention programs aimed at reducing the incidence of various pathologies. This work is intended to contribute to achieving this objective. Methods We obtained the records of people with occupational pathology who were admitted to the orthopedics service in a hospital in Manizales during the last 5 years; The selected diagnoses classified by ICD10 code will be used and divided according to gender and age group to estimate the prevalence of these pathologies according to the variables. Results They obtained a total of 3724 diagnoses, the minimum age was 15 years and the maximum age of 69 years, of these diagnoses 79% corresponded to men, and 21% to women, the pathologies that were considered most frequently were fractures (28.09%), sequelae (20.09%) and sprains and sprains (16.19%). Of each of them the most frequent lesion was the fracture of the lower epiphysis of the radius (11.47%), the sequelae of lower limb fractures (40.11%) and sprains and ankle sprains (22.46%) respectively. Discussion Epidemiological studies are needed to focus prevention campaigns and timely intervention of the most prevalent pathologies, this research is also expected to serve as a basis for future studies to compare results.

Application of team-based learning in the teaching of occupational health and occupational medicine for foreign students / 中华医学教育探索杂志

Objective To estimate the value of team-based learning ( TBL ) in the teaching of occupational health and occupational medicine for foreign students. Methods 42 foreign students from the majorofclinicalmedicineinHarbin Medical UniversitywereselectedtoformtheTBLdiscussiongroup. Before class, teachers assigned tasks, and the students were taught with the same teachers with TBL teaching method. The effect of learning was evaluated by questionnaire and classroom test. The t test was performed using SPSS 19.0 statistical software for comparison of the results of individual test and group test. Results The result of the questionnaire showed that students agreed that TBL teaching can improve students' interest, self-study ability and broaden their learning ideas. The classroom test results showed that after the TBL discussion, the test scores of occupational oncology and pneumoconiosis were significantly higher than those of individual test. The difference was statistically significant (P<0.05). Conclusion The TBL method can significantly improve the students' comprehension of knowledge and enhance their learning effect.

A restrição da jornada de trabalho do médico e seu impacto na segurança do paciente: uma revisão integrativa / Physicians' working time restriction and its impact on patient safety: an integrative review

Introdução: Apesar da jornada de trabalho em regime de plantão ser marco da rotina do profissional médico, há controvérsias em relação à duração dos turnos, bem como aos intervalos de repouso apropriados que tornam a atividade desse profissional segura. Se, por um lado, jornadas longas de trabalho podem gerar impacto negativo à assistência segura do paciente por alterar o funcionamento psicológico e físico do profissional, por outro, a redução do tempo de jornada de trabalho pode prejudicar a segurança do paciente por reduzir a continuidade do cuidado. Objetivo: Avaliar o impacto da restrição da jornada de trabalho médico na segurança do paciente. Método: Estudo do tipo revisão integrativa da literatura. Foi realizado um levantamento das publicações relacionadas a restrições na jornada de trabalho do médico e à segurança do paciente disponíveis nas bases de dados National Library of Medicine (PubMed) e Scientific Electronic Library Online (SciELO) até maio de 2018. Foram selecionados 35 artigos que atenderam aos critérios de inclusão. Resultados: Os desfechos relacionados à segurança do paciente avaliados pelos estudos foram mortalidade, eventos adversos, continuidade do cuidado, complicações intra-hospitalares, taxa de readmissões e duração da internação. A restrição à jornada de trabalho gerou impacto variável quanto aos indicadores de segurança do paciente entre os estudos. No entanto, frequentemente não modificaram sua performance. Conclusão: As restrições à jornada de trabalho frequentemente não resultam em melhora da performance dos indicadores de segurança do paciente. O foco em intervenções com propósito único de limitar a carga de trabalho médico é insuficiente para gerar melhoras consistentes ao cuidado do paciente.

Background: Although shift work is a part of the physicians' routine, there is controversy on the length of shifts and adequate rest for safe professional practice. If on the one hand long working hours might have negative impact on patient safety by interfering with the psychological and physical functioning of physicians, on the other shorter working hours might impair the safety of patients due to interference with the continuity of care. Objective: To analyze the impact of restrictions to physicians' working hours on patient safety. Method: Integrative literature review in which we surveyed studies on restriction to physicians' working time and patient safety included in databases National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) until May 2018. Thirty-five studies which met the inclusion criteria were included. Results: Patient safety outcomes analyzed in the included studies were mortality, adverse events, continuity of care, in-hospital complications, readmission rate and length of stay at hospital. Restriction to working time was associated with variable impact on patient safety indicators, but often did not modify their performance. Conclusion: Restrictions to physicians' working time did not always improved patient safety indicators. Focusing on interventions which only seek to limit the workload of physicians might be insufficient to bring consistent improvement to patient care