Nexo causal entre trabalho e saúde/doença e o problema das perícias / Causal nexus between work and health/illness and the issue of expert testimonies

Resumo A esfera das perícias comumente reduz a questão do estabelecimento do nexo de causalidade entre trabalho e saúde/doença apenas ao binômio trabalho/vida pessoal. Partindo dos pressupostos dos campos Saúde do Trabalhador (ST) e Saúde Mental Relacionada ao Trabalho (SMRT), este ensaio visa problematizar o resultado da questão, que reside na existência de dificuldades enfrentadas por trabalhadores na obtenção do nexo causal entre seus agravos/adoecimentos, cuja causalidade mais complexa se explica a partir de várias mediações pouco consideradas nos atos periciais circunscritos apenas às anamneses clínicas de cunho biomédicas pautadas nos pressupostos da Medicina do Trabalho, Higiene e Saúde Ocupacional. As formas de superação à ideia de causa-efeito passam pelo entendimento de que o processo de adoecimento é social e histórico e de que é preciso buscar mediações entre trabalho e adoecimento para elucidar sintomatologias singulares a partir da experiência do desgaste coletivo. Tal averiguação deve, ao mesmo tempo, problematizar os próprios processos de trabalho dos atores sociais envolvidos nas investigações periciais e partir das prioridades definidas pelos próprios trabalhadores que atuam como sujeitos da análise da nocividade do trabalho para a saúde.

Abstract Expert testimonies commonly reduce the establishment of causal links between work and health/illness solely to the dichotomy of work/personal life. Based on the assumptions from the fields of Workers Health and Work-Related Mental Health, this essay problematizes the results of this issue, namely the difficulties faced by workers in establishing the causal link between their ailments/illnesses, whose more complex causality is explained through several mediations that are often overlooked by the limited expert acts restricted only to clinical anamneses based on Occupational Medicine, Hygiene, and Occupational Health. Overcoming the idea of cause and effect involves understanding that the process of falling ill is social and historical, and requires exploring the mediations between work and illness to elucidate singular symptomatology based on the collective wear and tear experience. Such an investigation should simultaneously problematize the very work processes of the social actors involved in the expert investigations, starting from the priorities defined by the workers themselves who act as subjects in the analysis of work-related harm to health.

Epidemiological characteristics of new pneumoconiosis in Zigong City in 2018 - 2022 / 公共卫生与预防医学

Objective To understand the epidemiological characteristics of new occupational pneumoconiosis in Zigong City from 2018 to 2022, and to provide the basis for further prevention and treatment of local pneumoconiosis. Methods The information of newly diagnosed and reported cases of pneumoconiosis in Zigong City from 2018 to 2022 was collected through the occupational disease and occupational health information monitoring system, and the characteristics of the distribution of pneumoconiosis in three regions, the composition of diseases and the length of service of exposure to dust were analyzed. Results From 2018 to 2022, the top 3 newly diagnosed pneumoconiosis diseases in Zigong City were silicosis, coal workers' pneumoconiosis and asbestosis. Silicosis cases were mainly distributed in small and medium-sized employers, accounting for 81.41%. Coal workers' pneumoconiosis was mainly distributed in large and medium-sized employers, accounting for 97.24%. Asbestosis mainly distributed in large scale employers, accounting for 96.36%. There was significant difference in dust handling age of different scale employers (H=11.453, P<0.05). The median ages of silicosis, coal workers' pneumoconiosis and other pneumoconiosis were 47.0 years, 52.0 years and 48.2 years, respectively. The median age of dust handling was 3.3 years, 22.0 years and 23.2 years, respectively. The age of onset of coal workers' pneumoconiosis was higher than that of silicosis and other pneumoconiosis (H=72.547, P<0.05), and the age of dust exposure of silicosis was shorter than that of coal workers' pneumoconiosis and other pneumoconiosis (H=10.453, P<0.05). Conclusion The current situation of pneumoconiosis in Zigong City is still severe, with obvious clustering in disease types and industries. Prevention and treatment of pneumoconiosis in key industries should be further strengthened to protect the health rights and interests of workers.

Câncer nasal e dos seios paranasais relacionados à saúde ocupacional / Nasal and paranasal sinus cancer related to occupational health

Resumo: Esta pesquisa, apresentada no formato de artigo, está inserida na linha de pesquisa Processo de Cuidar em Saúde e Enfermagem, do Programa de Pós-Graduação em Enfermagem, e integra o Grupo de Pesquisa Multiprofissional em Saúde do Adulto da Universidade Federal do Paraná. Introdução: o câncer nasal e dos seios paranasais corresponde a menos de 1% dos demais tipos de câncer, com fatores etiológicos decorrentes do meio ambiente, das atividades ocupacionais e dos hábitos de vida, com período de latência que pode variar até 20 anos para o aparecimento dos sintomas neoplásicos. Objetivos: caracterizar o perfil sociodemográfico, clínico e ocupacional dos brasileiros com câncer nasossinusal; traduzir, adaptar culturalmente e validar o Questionario Sulla Storia di Lavoro e Sulle Abitudini di Vita utilizado pelo Registro Tumori Seni Nasali e Paranasali da Lombardia, Itália, para o contexto cultural brasileiro; examinar o perfil sociodemográfico, clínico e ocupacional dos pacientes com câncer nasossinusal e relacionar a ocupação com a exposição ao pó de couro, lenha, cromo e níquel. Artigo 1: é um estudo observacional, descritivo e retrospectivo, utilizando os dados secundários do Integrador de Registro Hospitalar de Câncer no período de 2007 a 2019, com os CIDs: C30.0 e C31.0 a C31.9. Foram analisados 1.803 registros e destacou-se que 1.161 (64%) eram do sexo masculino, com faixa etária predominante entre 50 e 59 anos (26%; n=298), da raça/cor branca (46%; n=535), solteiros (55%; n=640) e com ensino fundamental incompleto (40%; n=461), que tinham incidência da neoplasia no seio maxilar (52%; n=943), com estadiamento clínico grau IV (32%; n=575). A ocupação foi registrada nos brasileiros com câncer nasossinusal no Grupo 6 (64,7%; n=701) - trabalhadores agropecuários, florestais e da pesca, e no Grupo 8 (26,7%; n=289) - trabalhadores da produção de bens e serviços industriais, principalmente no Estado da Bahia (11%; n=206) e Minas Gerais (18%; n=327). Artigo 2: descreve um estudo metodológico com as etapas de tradução, síntese, retrotradução, relatório de retrotradução, revisão, teste piloto e tradução final proposto pelo European Organisation for Research and Treatment of Cancer. O instrumento foi dividido em 11 domínios conforme a característica das perguntas do instrumento original. O pré-teste foi realizado num hospital de referência em oncologia do Estado do Paraná, Brasil, com 15 participantes que foram os pacientes com câncer nasal e dos seios paranasais e cinco familiares, entre julho e setembro de 2021. O instrumento obteve um índice de 94% de concordância entre os juízes, que fizeram sugestões de inclusão, manutenção semântica e substituição em 11 domínios. No pré-teste os participantes fizeram confirmação do entendimento sobre as perguntas e os domínios de 100% (n=15), entretanto, todos tiveram dificuldade de interpretação da palavra "popper", e 53% (n= 8) fizeram proposições de melhoria no questionário. Um participante solicitou a inclusão do narguilé nos hábitos de fumo. Artigo 3: consiste num relato de séries de casos de um hospital de oncologia do Estado do Paraná, no Sul do Brasil, no período de 2005 a 2021. Foram incluídos pacientes com idade acima de 18 anos, de ambos os sexos, com CID C30 e o grupo C31, que estavam em acompanhamento de saúde nos últimos 12 meses na instituição hospitalar, ou familiares (no caso de óbito do paciente) com idade superior ou igual a 18 anos. Os participantes foram entrevistados com o Questionário sobre o Histórico de Trabalho e os Hábitos de Vida, com os dados obtidos analisados por frequência simples e absoluta Resultados: O Artigo 3 teve 52 participantes eram do sexo masculino (56%; n= 29), casados (31%; n= 16), com ensino fundamental completo (23%; n= 12) e sem histórico de tabagismo (27%; n= 14), onde a localização prevalente foi C30.0 em homens (33%; n=17) com carcinoma de células escamosas (40,3%; n= 21). A exposição carcinogênica com poeira da madeira (29,8%; n=17), cromo e níquel (17,5%; n=10) e com couro e derivados (14%; n=8). Conclusão: a frequência do câncer nasal e dos seios paranasais foi maior no sexo masculino, com ensino fundamental, nos trabalhadores agropecuários e da indústria de transformação e tiveram exposição ao agente carcinogênico; o estudo poderá motivar as reflexões acerca do acometimento do câncer nasal e dos seios paranasais no contexto brasileiro, principalmente de origem ocupacional, conforme as monografias do International Agency for Research on Cancer, que enfatiza a importância de utilizar um instrumento de investigação com informações complexas e essenciais do histórico ocupacional e dos hábitos de vida direcionado para o câncer nasal e dos seios paranasais.

Abstract: This study, presented in the form of an article, is part of the Care Process in Health and Nursing research line of the Postgraduate Program in Nursing, and the Multiprofessional Research Group in Adult Health at the Universidade Federal do Paraná. Introduction: nasal and paranasal sinus cancer corresponds to less than 1% of other types of cancer, has etiological factors resulting from the environment, occupational activities and lifestyle, and a latency period varying up to 20 years for the onset of neoplastic symptoms. Objectives: to characterize the sociodemographic, clinical and occupational profile of Brazilians with sinonasal cancer; translate, culturally adapt and validate the Questionario Sulla Storia di Lavoro e Sulle Abitudini di Vita used by the Registro Tumori Seni Nasali e Paranasali from Lombardy, Italy, for the Brazilian cultural context; to examine the sociodemographic, clinical and occupational profile of patients with sinonasal cancer, and relate the occupation to exposure to leather dust,wood dust, chromium and nickel. Article 1: is an observational, descriptive, retrospective study using secondary data from the Hospital Cancer Registry Integrator from 2007 to 2019 with ICDs: C30.0 and C31.0 to C31.9. Analysis of 1,803 records was performed, highlighting that 1,161 (64%) were male, predominant age group of 50-59 years (26%; n=298), white race/color (46%; n=535) , single (55%; n=640), incomplete primary education (40%; n=461), with incidence of neoplasia in the maxillary sinus (52%; n=943), and clinical staging grade IV (32%; n=575). The occupations registered in Brazilians with sinonasal cancer were in Group 6 (64.7%; n=701) - agricultural, forestry and fishing workers, and in Group 8 (26.7%; n=289) - workers in the production of industrial goods and services, mainly in the states of Bahia (11%; n=206) and Minas Gerais (18%; n=327). Article 2: describes a methodological study with the steps of translation, synthesis, back-translation, back-translation report, review, pilot test and final translation proposed by the European Organization for Research and Treatment of Cancer. The instrument was divided into 11 domains according to characteristics of the questions in the original instrument. The pre-test was carried out between July and September 2021 in a reference hospital in oncology in the state of Paraná, Brazil, with 15 participants that were patients with nasal and paranasal sinus cancer, and five family members. The instrument obtained an index of 94% agreement among judges, who made suggestions for inclusion, semantic maintenance and replacement in 11 domains. In the pre-test, although participants confirmed their 100% (n=15) understanding of questions and domains, all had difficulty interpreting the word "popper", and 53% (n=8) made suggestions for improvements in the questionnaire. One participant requested the inclusion of hookah in smoking habits. Article 3: consists of a case series report from an oncology hospital in the state of Paraná, southern Brazil, from 2005 to 2021. Patients of both sexes aged over 18 years, with ICD C30 and group C31, under healthcare in the last 12 months at the hospital, or family members (in the case of patient's death) aged 18 years or older were included. Participants were interviewed using the Work History and Lifestyle Questionnaire. The data obtained were analyzed by simple and absolute frequency. Results: Article 3 had 52 participants that were male (56%; n= 29), married (31%; n= 16), with complete primary education (23%; n= 12) and no history of smoking (27 %; n=14), and the prevalent location was C30.0 in men (33%; n=17) with squamous cell carcinoma (40.3%; n=21). Carcinogenic exposure to wood dust (29.8%; n=17), chromium and nickel (17.5%; n=10), and leather and leather products (14%; n=8). Conclusion: the frequency of nasal and paranasal sinus cancer was higher in males with primary education, in agricultural workers and in the manufacturing industry who were exposed to the carcinogenic agent; the study may motivate reflections on the involvement of nasal and paranasal sinus cancer in the Brazilian context, mainly of occupational origin, according to monographs of the International Agency for Research on Cancer, which emphasizes the importance of using a research instrument with complex and essential information of occupational history and lifestyle habits directed to nasal and paranasal sinus cancer.

Enfermedades de origen laboral en docentes escolares: una revisión sistemática

Introducción. La docencia es una de las principales profesiones vinculadas con el desarrollo de una sociedad; como cualquier labor, se encuentra expuesta a diferentes factores de riesgo que pueden generar una enfermedad de origen laboral. Objetivo. Identificar y caracterizar la literatura actual que presente las principales enfermedades de los docentes escolares como consecuencia de su trabajo y/o las condiciones laborales. Materiales y Métodos. Revisión sistemática con búsqueda en las bases de datos Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS y Open Grey. Se realiza selección pareada independiente bajo criterios de inclusión y análisis de forma narrativa, incluyendo generalidades, información de la enfermedad y desenlaces en docentes. Resultados. Se incluyeron 47 estudios, de los cuales el 25,5 % fueron publicados en 2015; Brasil fue el país con mayor aporte temático. La mayoría de los estudios agrupó a los docentes escolares sin distinción de su ciclo (primaria, bachillerato y media). Las principales enfermedades identificadas fueron trastornos de la voz 51,1 %, musculoesqueléticos 23,4 % y psicosociales 21,3 %. Adicionalmente, se identificó que al menos el 50 % de los reportes por país estuvieron relacionados con trastornos de la voz; Brasil e India fueron los países de mayor representatividad. Conclusiones. Las principales enfermedades laborales docentes fueron las relacionadas con trastornos de la voz, musculoesqueléticos y psicosociales; a su vez, estas se relacionan con riesgos físicos, condiciones de seguridad, riesgos biomecánicos y psicosociales en el contexto escolar.

Introduction. Teaching is one of the main professions linked to the development of a society, and like any other labor it is exposed to different risk factors that can generate an occupational disease. Objective. To identify and characterize the current literature on the main illnesses suffered by schoolteachers as a result of their work and/or working conditions. Methodology. Systematic review with search in the databases Academic Search Complete (EBSCOHOST), APA - PSYCNET, ERIC (Education Resources Information Center), MEDLINE (PubMed), SCOPUS and Open Grey. We performed independent paired selection under inclusion criteria and narrative analysis including generalities, disease information and outcomes in teachers. Results. Forty-seven studies were included, 25.5% of which were published in 2015, and Brazil was the country with the largest thematic contribution. Most of the studies grouped schoolteachers regardless of their cycle (primary, secondary and high school). The main illnesses identified were voice disorders 51.1%, musculoskeletal disorders 23.4% and psychosocial disorders 21.3%. In addition, it was found that at least 50% of the reports per country were related to voice disorders, with Brazil and India being the most representative. Conclusions. The main occupational illnesses identified were related to voice, musculoskeletal and psychosocial disorders; these in turn are related to physical, safety, biomechanical and psychosocial risks in the school context.

Ambiente de trabalho seguro e sustentável: como a ergonomia de conscientização e participativa se aplica aos servidores públicos? / Safe, sustainable work environment: how awareness and participatory ergonomics can be applied to public servers? / Un entorno de trabajo seguro y sostenible: ¿cómo aplicar la sensibilización y la ergonomía participativa a los servidores públicos?

Introdução: As práticas ergonômicas de conscientização e de participação assumem importante papel na prevenção das doenças ocupacionais. Entretanto, os métodos utilizados pelos programas de prevenção das instituições e empresas visam a correção dos riscos ergonômicos, não observando o fator humano detentor da execução da tarefa. Objetivo: Analisar a utilização das Ergonomia de Conscientização e Participa- ção como programa de educação visando a prevenção primária e a conscientização dos riscos ergonômicos das lesões por esforço repetitivo (LER) e distúrbios osteomusculares relacionadas ao trabalho (DORT). Metodologia: Revisão crítica de literatura, sintetizando o embasamento teórico pertinente ao tema, com documentação técnica, normas, decretos, portarias e dados estatísticos atualizados de afastamento; formando, assim, à análise documental. Resultados e Discussão: Os dados estatísticos mostram a importância de uma mudança nos hábitos, nos programas e nas intervenções ergonômicas no ambiente laboral do trabalhador, visando minimizar os impactos socioeconômicos dos altos índices de afastamento para organizações, empresas privadas e, principalmente, serviços públicos de ensino superior devido a maior precariedade dos ambientes de trabalho. Práticas ergo- nômicas de conscientização e participação dos trabalhadores podem proporcionar uma melhora nos desconfortos do ambiente laboral. Ressalta-se a escassez de pesquisas que priorizem a relação custo-benefício e a eficácia a longo prazo na área de Ergonomia. Conclusões: Novas análises devem ser observadas para promover melhora da qualidade de vida do trabalhador, diminuição das perdas econômicas, contribuindo para um trabalho seguro, decente e sustentável como preconiza principalmente o Objetivo 8 da Agenda 2030 da Organização das Nações Unidas.

Introduction: Ergonomic awareness and participation practices play an im- portant role in the prevention of occupational diseases. However, the methods used by institutions and companies' prevention programs aim to correct ergonomic risks and do not observe the human factor responsible for carrying out the task. Purpose: To analyze the use of Participation and Awareness Ergonomics as an education program aimed at raising awareness of ergonomic risks for the prevention of repetitive strain injuries (RSI) and work-related musculoskeletal disorders (WRMD). Methodology: Critical literature review, summarizing the theoretical basis relevant to the topic, with technical documen- tation, norms, decrees, ordinances, and updated statistical data on leave; thus forming the documental analysis. Results and discussion: Statistical data show the importance of changing habits, programs, and ergonomic interventions in the work environment of the worker, in order to minimize the socioeconomic impacts of the high removal rates of organizations, private companies, and, mainly, public higher education due to more pre- carious work environments. Ergonomic practices of awareness and participation of work- ers can improve the work environment's discomfort. The lack of research that prioritizes the cost-benefit ratio and long-term effectiveness in Ergonomics is highlighted. Conclu- sions: New studies must promote a significant improvement of the quality of life of work- ers, reduction of economic losses and, thus contribute to a safe environment, decent and sustainable, as advocated by Objective 8 of the United Nations 2030 Agenda.

Introducción: Las prácticas de sensibilización y participación ergonómicas desempeñan un papel importante en la prevención de las enfermedades profesionales. Sin embargo, los métodos utilizados por los programas de prevención de instituciones y em- presas tienen como objetivo corregir los riesgos ergonómicos y no observan el factor hu- mano responsable de la realización de la tarea. Propósito: Analizar el uso de la Ergonomía de Participación y Concienciación como programa educativo dirigido a la concienciación de los riesgos ergonómicos para la prevención de las lesiones por esfuerzos repetitivos (LER) y los trastornos musculoesqueléticos de origen laboral (TME). Metodología: Re- visión lit-eratura crítica, resumiendo la base teórica relevante al tema, con documentación técnica, normas, decretos, ordenanzas, y datos estadísticos actualizados sobre bajas la- borales; conformando así el análisis documental. Resultados y discusión: Los datos es- tadísticos demuestran la importancia del cambio de hábitos, programas e intervenciones ergonómicas en el ambiente de trabajo del trabajador, para minimizar los impactos soci- oeconómicos de los altos índices de desvinculación de organizaciones, empresas privadas y, principalmente, de la enseñanza superior pública, debido a la mayor precariedad de los ambientes de trabajo. Práticas ergonómicas de conscientização e par-ticipação dos tra- balhadores podem melhorar a incomodidade do ambiente de trabalho. Se destaca la falta de re-investigación que priorice la relación costo-beneficio y la eficacia a largo plazo en Ergonomía. Conclusiones: Nuevos estudios deben promover una mejora significativa de la calidad de vida de los trabajadores, la reducción de las pérdidas económicas y, así contribuir a un entorno seguro, digno y sostenible, como propugna el Objetivo 8 de la Agenda 2030 de las Na-ciones Unidas.

Uso de técnicas de aprendizado de máquina para classificação de fatores que influenciam a ocorrência de dermatites ocupacionais / Using machine learning techniques to classify factors that influence the occurrence of occupational dermatitis

Resumo Introdução: realizar a predição de doenças relacionadas ao trabalho é um desafio às organizações e ao poder público. Com as técnicas de aprendizado de máquina (AM), é possível identificar fatores determinantes para a ocorrência de uma doença ocupacional, visando direcionar ações mais efetivas à proteção dos trabalhadores. Objetivo: predizer, a partir da comparação de técnicas de AM, os fatores com maior influência para a ocorrência de dermatite ocupacional. Métodos: desenvolveu-se um código em linguagem R e uma análise descritiva dos dados e identificaram-se os fatores de influência de acordo com a técnica de AM que demonstrou melhor desempenho. O banco de dados foi disponibilizado pelo Serviço de Dermatologia Ocupacional da Fundação Oswaldo Cruz e contém informações de trabalhadores que apresentaram alterações cutâneas sugestivas de dermatite ocupacional no período de 2000-2014. Resultados: as técnicas com melhor desempenho foram: neural network, random forest, support vector machine e naive Bayes. As variáveis sexo, escolaridade e profissão foram as mais adequadas para os modelos de previsão de dermatite ocupacional. Conclusão: as técnicas de AM possibilitam predizer os fatores que influenciam a segurança e a saúde dos trabalhadores, os parâmetros que subsidiam a implantação de procedimentos e as políticas mais efetivas para prevenir a dermatite ocupacional.

Abstract Introduction: to predict work related diseases is a challenge for organizations and the governmental authorities. By means of machine learning (ML) techniques it is possible to identify factors that determine the occurrence of an occupational disease, aiming at taking more effective actions to protect workers. Objective: to predict, by comparing ML techniques, the factors which highly influence the occurrence of occupational dermatitis. Methods: we developed a code in R language and a descriptive analysis of the data and identified the influence factors according to the ML technique that presented the best performance. The database was made available by the Occupational Dermatology Service of Oswaldo Cruz Foundation and assembles information of the workers who experienced cutaneous alterations suggestive of occupational dermatitis between 2000-2014. Results: the techniques which presented the best performance were: neural network, random forest, support vector machine, and naive Bayes. Sex, schooling, and profession were the most adequate variables for the occupational dermatitis prediction models. Conclusion: ML techniques allowed to predict the factors that influence the workers' safety and health, as well as the parameters that subsidize the procedures implementation, and the most effective policies to prevent occupational dermatitis.

Respirable crystalline silica dust exposure and regulated occupational respiratory diseases in the Zambian copper mining sector: a review and recommendations

Background: Exposure to respirable dust is widespread in the mining industry. One of the significant components in dust is respirable crystalline silica (RCS), which causes pulmonary silicosis; RCS exposure is also associated with tuberculosis. The health effects of exposure to RCS in Zambian copper miners are unclear. Objectives: This review describes RCS exposure, associated occupational respiratory diseases, and existing dust exposure management programmes in the Zambian copper mining industry. Research gaps are also identified. Methods: Online search engines (Google Scholar, PubMed, and Web of Science) were used to identify relevant published literature, and governmental databases and websites were searched for information. Results: Only two studies have reported RCS dust exposure in the Zambian copper mining industry, and seven studies describe related diseases. The Zambian Ministry of Health reports on only two occupational respiratory diseases: silicosis and tuberculosis (TB). Zambia does not have an occupational health policy or programmes that protect workers in dusty operations from exposure to RCS. Conclusion: Little is known about exposure to RCS and related occupational diseases in the Zambian copper mining industry. The absence of legislative guidelines for an RCS monitoring programme places copper miners at risk of developing respiratory diseases because of high and uncontrolled RCS levels. An RCS management programme should be developed and implemented to investigate the exposure of miners to RCS, and to promote the implementation of control measures

Analysis of the clinical characteristics of 69 cases of occupational melanosis / 中国职业医学

Objective To summarize the clinical characteristics of patients with occupational melanosis. Methods Diagnostic data of 69 patients with occupational melanosis was analyzed using retrospective analysis. Results The main occupational hazards for the 69 patients with occupational melanosis were coal tar, petroleum and its fractionated products, pigments and dyes and their intermediates, rubber additives and rubber products. The median length of occupational exposure and disease latency were 8.0 and 6.0 years, respectively, with a highly positive correlation between them (Spearman correlation coefficients=0.962, P<0.01). Skin lesions were mainly found on exposed areas such as the face-to-neck and limbs, prevalence of 94.2% and 75.4% respectively. And 78.3% of patients had skin lesion on more than two sites. The lesions were mostly in the form of irregular flakes (59.4%), with a gray-black color (44.9%). About 43.5% of patients experienced skin itching. Complete blood count, liver function, and kidney function were all within normal ranges. Skin biopsy results showed that epidermal hyperkeratosis, thinning of the spinous layer, liquefaction degeneration of basal cells, increased superficial dermal melanocytes, and infiltration of lymphocytes, histiocytes, and melanocytes around the blood vessels. Reflectance confocal microscopy (RCM) detection showed focal liquefaction degeneration of basal cells in the lesions, with a significant infiltration of melanocytes and inflammatory cells in the dermal papillae and superficial layers. Conclusion The primary target organ of occupational melanocytes is the skin, and no damage to other organs was identified thus far. Results from skin biopsies and RCM examinations can be used for differential diagnosis.

Evaluation on the timeliness of occupational disease online reporting and review in Guangdong Province, 2014-2022 / 中国职业医学

Objective To analyze the timeline of occupational disease online reporting and reviewing in Guangdong Province from 2014 to 2022. Methods Data and review information from the Occupational Diseases and Hazards Monitoring Information System under China Disease Prevention and Control Information System were collected to analyze the reporting timeline, review status, and timeline of review of "Occupational Disease Report Cards" for the years 2014 to 2022 in enterprises located in Guangdong Province. Results A total of 9 929 occupational disease report cards were recorded in Guangdong Province from 2014 to 2022, and the timely reporting rate of occupational diseases was 84.10%, with an overall upward trend. There was a statistically significant difference in the reporting time among different years (P<0.05), and the reporting time showed a downward trend. In 2022, the timely reporting rate of all cities reached over 80.00%. The final review rate of occupational disease report cards was 85.02%, and the review rate and timely review rate at the county level showed an increasing trend. The occupational disease report card audit timeliness rate from high to low was provincial, district county and city level (61.26% vs 43.87% vs 36.72%, all P<0.05). Conclusion The timeline of occupational disease reporting in Guangdong Province is relatively high, and the review at all levels is generally good. However, further improvement is needed for timely review at the municipal and county levels.

Analysis of labor relationship in the diagnosis of occupational diseases / 中国职业医学

Unclear labor relationship is the most common challenging issue in occupational disease diagnosis. At present, there are three main errors in the understanding regarding labor relationship in the process of occupational disease diagnosis. Firstly, labor relationship does not need to be considered in occupational disease diagnosis. Secondly, labor relationship must exist in order to initiate the occupational disease diagnosis procedure. Lastly, there is an overreach in handling labor relationship issues beyond one's authority. Labor relationship is the basic and antecedent problem which cannot be avoided in occupational diseases diagnosis. While officially, labor relationship issue should be considered in occupational disease diagnosis, they are not a necessary condition. The occupational diseases diagnosis requires actual labor and employment relations. If the workers with actual labor-relation are suspected to have health injuries caused by occupational hazards in the workplace, they are eligible for occupational diseases diagnosis. But it is not the responsibility of health department to judge the labor relationship. When a dispute arises between a worker and an employer regarding labor relationship, the resolution of the relevant dispute shall be submitted to the human resources and social services department or the labor and personnel arbitration committee, or submitted to the court for adjudication according to law. In the process of occupational disease diagnosis, the two reasonable disposal procedures for verifying actual labor and employment relationship involve workers submitting evidence of their labor relationship with the employer, and the employer's verification. If the employer disputes the labor relationship as presented by the worker, the occupational disease diagnosis institution should inform the worker to apply for labor dispute arbitration. However, it is important to note that arbitration or mediation documents from the court cannot be used as evidence in occupational disease diagnosis.

Epidemiological characteristics of pneumoconiosis deaths in a certain area from 1961 to 2020 / 中华劳动卫生职业病杂志

Objective: To investigate the epidemiological characteristics of pneumoconiosis deaths in Putuo District of Shanghai, and to provide evidence for prevention and management of pneumoconiosis in the future. Methods: In June 2021, the data of 263 patients with pneumoconiosis who died from January 1961 to December 2020 in Putuo District of Shanghai were retrospectively analyzed. Trend χ(2) test, analysis of variance and Spearman rank correlation methods were used to analyze the basic information, age of exposure to dust, promotion period, course of disease and direct cause of death of patients with pneumoconiosis. Results: Among the 263 cases of pneumoconiosis patients who died in Putuo District of Shanghai from 1961 to 2020, 260 cases (98.86%) were male. The main types of pneumoconiosis were foundry worker pneumoconiosis (53.23%, 140/263) and silicosis (43.73%, 115/263). The main types of pneumoconiosis were sand cleaner (36.50%, 96/263). The age of onset was (53.42±10.13) years old, the age of death was (76.14±9.12) years old, and the age of exposure to dust was (20.91±8.99) years. The duration of dust exposure was negatively correlated with the duration of disease (r(s)=-0.24, P<0.001). With the increase of pneumoconiosis stage, the mortality of silicosis and foundry worker pneumoconiosis also showed an increasing trend (χ(2)(trend)=4.22, 3.87, P=0.040, 0.049). 31.94% (84/263) of pneumoconiosis patients died directly from pneumoconiosis, ranking first among the direct causes of death. Conclusion: The death cases of pneumoconiosis in Putuo District of Shanghai are mainly foundry worker pneumoconiosis and silicosis, and pneumoconiosis is the main cause of death.

Analysis of clinical diagnostic characteristics of 26131 patients with pneumoconiosis in Hunan Province / 中华劳动卫生职业病杂志

Objective: To analyze the clinical diagnostic characteristics of pneumoconiosis patients of migrant workers in Hunan Province, and to provide scientific basis for the prevention and treatment of pneumoconiosis. Methods: In February 2022, through the Hunan Provincial Medical Treatment and Assistance Information Platform for Pneumoconiosis Migrant Workers, the cases of irresponsible subjects with pneumoconiosis that were first diagnosed clinically in Hunan Province from January 2017 to December 2021 were collected, and analyzed their gender, age, length of service, types of pneumoconiosis, stages of pneumoconiosis, and comorbidities. Results: From January 2017 to December 2021, there were a total of 26131 cases of irresponsible pneumoconiosis patients diagnosed clinically in Hunan Province, with males accounting for 99.8% (26072 cases) and an average age of (60.66±8.04) years old. Among the 26131 patients, coal workers' pneumoconiosis and silicosis were the main causes, with 16816 and 9078 cases respectively, accounting for 99.1% of the diagnosed cases. There were 8640 cases (33.1%) of stageⅠpneumoconiosis, 6601 cases (25.2%) of stage Ⅱ pneumoconiosis, and 10890 cases (41.7%) of stage Ⅲ pneumoconiosis. 2051 patients experienced complications. The average age of exposure to dust of 26131 patients was (17.81±9.69) years, and the age of exposure to dust in silicosis patients was (14.60±9.62) years. The working age of coal worker's pneumoconiosis was (19.60±9.26) years. Compared with coal workers' pneumoconiosis patients, silicosis patients had a shorter working time exposed to dust, and the difference was statistically significant (P<0.05) . Conclusion: Coal workers' pneumoconiosis and silicosis are mainly diagnosed for the first time in migrant workers' pneumoconiosis patients in Hunan Province. Pneumoconiosis patients should be diagnosed in time, which is conducive to treatment and rehabilitation.

Design for online monitoring of occupational hazard factors based on internet of things / 中华劳动卫生职业病杂志

At present, there are disadvantages with the detection for occupational hazard factors, such as insufficient monitoring data, poor timeliness, weak representativeness, long detection cycles, and inability to continuously monitor. Taking advantages of internet of things technology, an online monitoring platform for occupational hazard factors has been designed. The platform collects the concentration (intensity) of hazard factors through sensors, transmits the occupational hazards data collected online in realtime. The online monitoring cloud center for occupational hazard factors processes and analyzes online monitoring data in realtime, stores the hazard factors data to form database management, and provides user application services to form an intelligent online monitoring service model for occupational hazard factors. Based on the online monitoring platform of occupational hazard factors, multi-level government health supervision departments and employers can grasp the status of hazard factors in real time, which is conducive to improving the level of occupational hazard supervision.

Analysis of 14 cases of melanosis caused by 1, 8-dinitronaphthalene and 1, 8-diaminonaphthalene / 中华劳动卫生职业病杂志

14 workers in the 1, 8-diaminonaphthalene workshop of a chemical company in Nantong City had symptoms or signs of varying degrees of pruritus and pigmentation of the face, neck and waist. Pathological examination of skin biopsies showed hyperkeratosis, the basal cells were liquefied and denatured. Seven workers were eventually diagnosed with occupational melanosis. To explore the causes of occupational melanosis caused by exposure to 1, 8-dinitronaphthalene and 1, 8-diaminonaphthalene, and to provide reference for the prevention and treatment of occupational melanosis in the future, this paper reported 14 cases of melanosis in the skin of workers in chemical industry.

Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China / 中华劳动卫生职业病杂志

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

Analysis of the prevalence and social security situation of pneumoconiosis in non-coal mine industry in Jiangsu Province / 中华劳动卫生职业病杂志

Objective: To understand the social security situation of current cases of pneumoconiosis in non-coal mine industries in Jiangsu Province, and to provide reference for the treatment and security work of pneumoconiosis patients. Methods: From January to October 2020, a follow-up survey was conducted on 4038 cases of pneumoconiosis in non-coal mine industries of the province from October 1949 to December 2019. The age, type of pneumoconiosis, industry type, and social security status of the patients were collected. Namely, work-related injury insurance, employer compensation, basic medical insurance for urban and rural residents, major illness insurance, etc. SPSS 19.0 was used for statistical description and analysis. Results: The cases of pneumoconiosis in non-coal mine industries in Jiangsu Province ranged in age from 36 to 105 (70.78±8.43) years old, and had been exposed to dust for 1 to 55 (19.27±9.29) years. Silicosis was the main form (3875 cases, 95.96%), and non-metallic mining and dressing industry was the main form (2618 cases, 64.83%). A total of 3991 cases (98.84%) of pneumoconiosis patients enjoyed social security, most of them were urban and rural residents with basic medical insurance (3624 cases, 89.75%), but there were still 47 patients without any social security. 15 cases (0.37%) enjoyed the subsistence allowance, with the monthly allowance amount ranging from 104 to 3960 yuan, with the average amount of 954.87 yuan/month. Conclusion: In Jiangsu Province, the proportion of pneumoconiosis patients in non-coal mine industries enjoying social security is relatively high, but there are still patients who do not enjoy any social security, and the difference in the amount of subsistence allowance is slightly larger. It is necessary to further improve the medical security of pneumoconiosis patients and improve their quality of life.

Analysis of the status of occupational disease prevention and control of enterprises in mining and manufacturing industries in China in 2019 / 中华劳动卫生职业病杂志

Objective: To analyze the status of prevention and treatment of occupational diseases among mining and manufacturing industries in China in 2019, provide the scientific basis for the formulation and revision of policies and standards of prevention and treatment of occupational diseases. Methods: In May 2022, Collecting data of a project named Surveillance of Occupational Hazards in the Workplace in 2019 through the National Surveillance System for Occupational Hazards in the workplace. Compare the status of prevention and treatment of occupational diseases in 63 563 enterprises of mining and manufacturing industries among different dimensions. Results: The training rate of managers was 76.17% and that of occupational health managers was 76.97%. The rate of reporting of occupational diseases hazardous items was 67.58%, the rate of launching of the detection of occupational hazards was 57.16%, and the rate of launching of occupational health examination was 62.42%. Excluding the distribution rate of dust mask, the installation rate of various occupational prevention facilities and the distribution rate of gas mask and hearing protector were less than 80%. The differences in all the indicators among different areas, enterprise scales, economic types were statistically significant (P<0.05) . Conclusion: There are still some enterprises which are relatively weak in the ability of the prevention and treatment of occupational diseases in China. Measures such as special support, guidance and strengthen supervision should be taken towards those enterprises toimprove the awareness of prevention and treatment of occupational diseases and the level of that.

Two cases of airway dysfunction related to diacetyl exposure / 中华劳动卫生职业病杂志

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

Quantitative risk assessment of occupational exposure to PCDD/Fs in the waste incineration industry / 中华劳动卫生职业病杂志

Objective: To analyze the level of PCDD/Fs exposure of occupational workers in the waste incineration industry and explore the risk of occupational exposure. Methods: In September 2021, literature on environmental PCDD/Fs exposure in waste incineration plants published from the establishment of the database to February 10, 2021 was retrieved from CNKI database. A total of 1365 literatures were retrieved, and 7 met the criteria for inclusion. The US Environmental Protection Agency (EPA) inhalation risk model was used to assess and analyze carcinogenic and non-carcinogenic risks of PCDD/Fs exposure among occupational workers in the waste incineration industry. Results: A total of 86 sampling sites were included in incineration plants in 7 regions. The study of Wuhan area showed that the concentration of working environment near the waste incinerator in the same factory was the highest, followed by the rest and office area in the factory. The concentration of PCDD/Fs in waste incinerators was the highest in Southwest China (4880.00-24880.00 pg TEQ/m(3)), and the lowest in Shenzhen (0.02-0.44 pg TEQ/m(3)). According to the cancer risk assessment, with the increase of exposure years, the risk of cancer increased. The highest risk of cancer was found in the waste incineration plants in Southwest China. When the exposure period was 1 year, the risk was moderate (22.40×10(-6)-114.20×10(-6)). When the exposure time was more than 5 years, the risk of cancer was high. In Jinan, workers working near the incinerator had a moderate risk of cancer after five years of exposure. In Zhejiang, workers were at medium risk of cancer after exposure for more than 20 years. Workers in Wuhan, Shanghai, Zhejiang Province, Shenzhen and the Pearl River Delta were still at low risk of cancer after 40 years of occupational exposure. HQ>1 of workers working near the waste incinerators in Jinan, Zhejiang Province and Southwest China, and the qualitative evaluation results showed that the non-carcinogenic risk was unacceptable. Conclusion: There are great differences in PCDD/Fs of occupational exposure in waste incineration industry, and the occupational exposure exceeding the occupational exposure limit has higher carcinogenic and non carcinogenic risks.