Concentrações de metais em poeira depositada em casas de trabalhadores informais e domiciliares da cadeia produtiva de joias e bijuterias de Limeira, SP: avaliação de risco à saúde infantil / Metal concentrations in dust deposited in the homes of informal and home-based workers in the jewelry and fashion jewelry production of Limeira, SP: risk assessment for children's health

Introdução: O trabalho informal é acompanhado de diversas particularidades, além do manuseio de produtos químicos sem equipamentos adequados, pode acontecer a exposição passiva de familiares ou amigos próximos, como por exemplo as crianças. Na cidade de Limeira, no interior de São Paulo, há a produção informal de joias e bijuterias, envolvendo atividades que vão desde a montagem de peças até a solda. Objetivos: este estudo avaliou a exposição de crianças à poeiras contendo metais, nas residências de trabalhadores informais e domiciliares da cadeia produtiva de joias e bijuterias de Limeira. Método: foram coletadas amostras de poeira com lenços eletrostáticos em 21 domicílios do grupo exposto e 23 do grupo controle e determinados os Elementos Potencialmente Tóxicos (EPT) Cr, Sn, Mn, Ni, Cu, Zn, Cd, Pb e As, nos ambientes. As análises foram realizadas no Instituto de Pesquisas Tecnológicas do Estado de São Paulo (IPT), por ICP-MS. Também, foram cedidos os resultados das concentrações de EPT no sangue de uma subamostra de crianças, presentes na população de estudo, pela coordenadora do projeto (KPKO). Resultados: As concentrações de Cr, Mn, Ni, Cu, Zn, As, Cd e Sn na poeira doméstica foram significativamente maiores no grupo exposto (<0,05), assim como as concentrações de Pb e Cd no sangue das crianças do grupo exposto (<0,05). As concentrações de EPT na poeira doméstica e no sangue das crianças apresentaram correlação moderada para Cr (Coeficiente de Correlação de Spearman (Rho) 0,40), Zn (Rho -0,43) e As (Rho 0,40), e uma forte correlação para Cd (Rho 0,80) (p <0,05). Conclusões: Os resultados do estudo apontaram riscos para a exposição infantil ao Cd, As e Cr durante a produção informal e doméstica de joias e bijuterias, salientando a importância de proteger a saúde infantil através da promoção de ações de segurança. Adicionalmente, os lenços eletrostáticos se mostraram ferramentas de baixo custo e eficazes para avaliação da exposição a EPT.

Introduction: Informal work is followed by several particularities, besides the handling of chemicals without proper equipment, there may happen the passive exposure of family members or close friends, such as children. In the city of Limeira, in the interior of São Paulo, there is informal jewelry production, involving activities ranging from assembling pieces to welding. Objectives: This study evaluated the exposure of children to dust containing metals in the homes of informal and home-based workers in the jewelry production industry in Limeira. Method: dust samples were collected with electrostatic cloths from 21 households in the exposed group and 23 in the control group, and the Potentially Toxic Elements (PTE) Cr, Sn, Mn, Ni, Cu, Zn, Cd, Pb, and As were determined in the environments. The analyses were carried out at the Technological Research Institute of the State of São Paulo (IPT), by ICP-MS. Also, the results of PTE concentrations in the blood of a subsample of children, present in the study population, were provided by the project coordinator (KPKO). Results: Concentrations of Cr, Mn, Ni, Cu, Zn, As, Cd and Sn in household dust were significantly higher in the exposed group (<0.05), as were concentrations of Pb and Cd in the blood of children in the exposed group (<0.05). PTE concentrations in house dust and children's blood showed moderate correlation for Cr (Spearman's Correlation Coefficient (Rho) 0.40), Zn (Rho -0.43) and As (Rho 0.40), and a strong correlation for Cd (Rho 0.80) (p <0.05). Conclusions: The results of the study indicated risks for children's exposure to Cd, As and Cr during informal, domestic jewelry production, highlighting the importance of protecting children's health by promoting safety actions. Additionally, electrostatic cloths proved to be low-cost and effective tools for assessing exposure to PTE.

Avaliação de saúde e do perfil metabólico de mulheres trabalhadoras inseridas no arranjo produtivo domiciliar e informal de joias e bijuterias de Limeira, SP / Evaluation of health and metabolic profile of working women inserted in the local productive, home based and informal arrangement of jewelry and fashion jewelry

Introdução: A cidade de Limeira-SP contempla um relevante polo produtivo de joias e bijuterias, bem como um cenário de flexibilização do trabalho, por meio da informalidade e terceirização. Os trabalhadores, assim como a população podem ser expostos a diversos elementos, dentre eles, a elementos potencialmente tóxicos (EPT), como o Arsênio (As), Chumbo (Pb), Mercúrio (Hg), Cádmio (Cd), Níquel (Ni), Zinco (Zn), Cromo (Cr), Cobre (Cu) e Estanho (Sn). Esses EPTs podem ser identificados e quantificados no organismo humano, por meio da análise metabolômica, a qual quantifica os metabólitos relacionados ao metabolismo humano. Objetivo: Descrever o perfil de saúde de trabalhadoras e perfil metabolômico por HPLC-MS de soldadoras inseridas no arranjo produtivo local, informal e domiciliar da produção de joias e bijuterias na cidade de Limeira, SP, e identificar as doenças associadas aos metabólitos encontrados. Metodologia: Este estudo de delineamento transversal incluiu 129 participantes, sendo divididas em dois grupos, denominado "Exposto" (n=72) e "Controle" (n=57). A partir da amostra inicial, foi selecionada uma sub amostra de 15 participantes de cada grupo, "Exposto" e "Controle", para o desenvolvimento da análise metabolômica untargeted no plasma. Todas as participantes responderam questionários de doenças referidas, adaptados do Inquérito Domiciliar sobre Comportamentos de Risco e Morbidade Referida de Agravos não Transmissíveis para coletar informações sobre saúde, hábitos de vida e informações gestacionais. Amostras de sangue foram coletadas para análise de metais e uma subamostra foi selecionada para análise metabolômica untargeted por HPLC-MS. Testes exatos de Fischer foram aplicados aos dados de doenças autorreferidas e consumo de grupos alimentares (p<0,05), bem como teste de comparação de médias para as concentrações de EPT. Para os dados cromatográficos foram aplicados a análise multivariada pelos métodos de análise de Componentes Principais (PCA) e a análise discriminante por mínimos quadrados e parciais (PLS-DA). Resultados: Ao analisar todas as mulheres do estudo, foi encontrada uma diferença estatisticamente significante das doenças respiratórias (p=0,04) para o grupo Exposto, enquanto as mulheres do grupo Controle referiram mais frequentemente tosse seca (p=0,02) e diabetes gestacional (p=0,02). A análise das condições socioeconômicas mostrou que as mulheres de ambos os grupos têm remuneração abaixo do salário-mínimo da época da coleta (2017), embora as mulheres do grupo Exposto apresentem maior remuneração. Para o grupo de soldadoras foi identificada uma maior concentração de Pb no sangue (mediana Exposto= 13,8 µg L-1; mediana Controle=8,3 chumbo µg L-1; p= 0,02; U=58). Conclusão: O total de pessoas do sexo feminino do grupo Exposto referiu doenças respiratórias, enquanto a análise estatística realizada para as amostras metabolômicas não foi capaz de mostrar qualquer padrão de diferenciação entre os grupos de mulheres soldadoras e não soldadoras.

Introduction: The city of Limeira-SP includes a relevant production chain for jewelry and fashions jewelry, as well as a homebase work scenario, through informality and outsourcing. Workers as well as the population can be exposed to various elements, including potentially toxic elements (PTE), such as Arsenic (As), Lead (Pb), Mercury (Hg), Cadmium (Cd), Nickel (Ni), Zinc (Zn), Chromium (Cr), Copper (Cu) and Tin (Sn). These PTEs can be identified and quantified in the human body, through metabolomic analysis, which quantifies metabolites related to human metabolism. Objective: To describe the health profile of female workers and the metabolic profile by HPLC-MS of welders inserted in the local, informal and household production arrangement for the production of jewelry and fashion jewelry in the city of Limeira, SP, and to identify the diseases associated with the metabolites found. Method: This cross- sectional study included 129 participants, being divided into two groups, called "Exposed" (n = 72) and "Control" (n = 57). From the initial sample, a sub-sample of 15 participants from each group, "Exposed" and "Control", was selected for the development of untargeted metabolomic analysis in plasma. All participants answered questionnaires on referred diseases, adapted from the Household Survey on Risk Behaviors and Referred Morbidity of Non- Communicable Diseases to collect information on health, lifestyle and gestational information. Blood samples were collected for metals analysis and a subsample was selected for untargeted metabolomic analysis by HPLC-MS. Fischer's exact tests were applied to data on self-reported diseases and consumption of food groups (p <0.05), as well as a means comparison test for PTE concentrations. For the chromatographic data, multivariate analysis using the Principal Component analysis methods (PCA) and the discriminant analysis by least squares and partials (PLS-DA) were applied. Results: When analyzing all the women in the study, a statistically significant difference was found in respiratory diseases (p = 0.04) for the Exposed group, while women in the Control group reported more frequently dry cough (p = 0.02) and gestational diabetes (p = 0.02). The analysis of socioeconomic conditions showed that women in both groups have remuneration below the minimum wage at the time of collection (2017), although women in the Exposed group have higher remuneration. For the welders' group, a higher concentration of Pb in the blood was identified (median Exposed = 13.8; median Control = 8.3; p = 0.02; U = 58). Conclusion: The total number of females in the Exposed group reported respiratory diseases, while the statistical analysis performed for the metabolomic samples was not able to show any pattern of differentiation between the groups of welder and non-welder women.

Implicações do uso de adornos por profissionais de saúde na biossegurança da assistência ao paciente / Implication of the use of adornments by health professionals in the biosafety of patient care

Introdução: as infecções relacionadas à assistência à saúde (IRAS) são consideradas um problema de saúde global, pois colocam em risco a segurança do paciente e a qualidade assistencial. Considera-se que a principal via de disseminação de microrganismos relacionados a IRAS ocorre pelas mãos dos trabalhadores de saúde, destacando-se a utilização de adornos por profissionais de saúde como um agravante no âmbito a disseminação de microrganismos. Estudos revelam que a utilização desses objetos, principalmente anéis e alianças, propiciam maior impacto na carga bacteriana nas mãos dos trabalhadores. A Norma Regulamentadora 32 (NR32) visa estabelecer as diretrizes básicas para a implementação de medidas de proteção à segurança e à saúde dos trabalhadores dos serviços de saúde, dentre essas medidas está a proibição do uso de adornos por profissionais de saúde que prestam cuidados aos pacientes, principalmente profissionais que mantem contato com materiais biológicos. Objetivos: Analisar o uso de adornos por profissionais de saúde e as suas implicações na carga bacteriana das mãos e anéis após a realização de técnicas de higienização das mãos com uso de preparação alcoólica em gel a 70% ou com água e sabonete líquido. Método: Trata-se de um estudo, realizado em duas etapas. Na primeira realizou-se um estudo observacional e de prevalência por meio de inquérito realizado via mídia social para determinar se o uso de adornos por profissionais de enfermagem no ambiente hospitalar relaciona-se as variáveis sociodemográficas e ocupacionais, e os motivos da não adesão a NR32 por esses profissionais. Na segunda etapa realizou-se um experimento microbiológico por meio de contaminação artificial das mãos e alianças com Lactobacilos casei e posteriormente o protocolo de higienização das mãos para verificar a carga bactéria encontrada nas mãos e anéis de profissionais e estudantes da área da saúde. Resultados: A utilização de adornos por profissionais de enfermagem é frequente, pincipalmente o uso de aliança, relógio e brincos. Embora a 85% dos participantes conheça as normativas da NR32 referentes a remoção de adornos para a realização das atividades laborais, 15% profissionais informaram desconhecimento total ou parcial dessa recomendação o que remete a necessidade de revisão das práticas formativas e do frequente oferecimento de capacitação em serviço/treinamento. Com relação os resultados do experimento sobre o uso de alianças por profissionais de saúde constataram-se que não houve diferença entre a contaminação bacteriana das mãos dos participantes com e sem aliança. Porém, verificou-se que entre os grupos que higienizaram as mãos com o uso de preparação alcoólica em gel a 70% ou com água e sabonete líquido houve redução na carga bacteriana das mãos quando comparados ao grupo controle, grupo que higienizou as mãos com água e sabonete líquido demonstrou uma redução ainda maior das Unidades Formadoras de Colônias (UFC) Conclusão: A utilização de adornos por profissionais da enfermagem ainda é fonte de preocupação para as instituições de saúde devido a frequência do uso desses objetos mesmo diante do desencorajamento de uso e das recomendações legais. Pode-se perceber que a falta de capacitação em serviço/treinamento e de cobrança para remoção dos adornos são fatores dificultadores nesse processo. No que diz respeito ao uso de aliança por profissionais de saúde durante o procedimento de higienização das mãos fica evidente as implicações do seu uso principalmente quando a higienização não é realizada por remoção mecânica da sujidade, como é o caso da higienização das mãos com preparação alcoólica em gel a 70%.

Introduction: healthcare-related infections (HAI) are considered a global health problem, as they put patient safety and quality of care at risk. It is considered that the main way of dissemination of microorganisms related to HAI occurs through the hands of health workers, highlighting the use of adornments by health professionals as an aggravating factor in the scope of the spread of microorganisms. Studies reveal that the use of these objects, especially rings and wedding rings, provide a greater impact on the bacterial load on workers' hands. Regulatory Standard 32 aims to establish the basic guidelines for the implementation of measures to protect the safety and health of workers in health services, among these measures is the prohibition of the use of adornments by health professionals who provide care to patients, especially professionals that maintains contact with biological materials. Objectives: To analyze the use of adornments by health professionals and its implications on the bacterial load on hands and rings after performing hand hygiene techniques with the use of an alcoholic preparation in gel at 70% or with water and liquid soap. Method: This is a carried out in two stages. In the first, an observational and prevalence study was carried out through a survey conducted via social media to determine whether the use of adornments by nursing professionals in the hospital environment is related to sociodemographic and occupational variables, and the reasons for non-adherence to NR32 by these professionals. In the second stage, a microbiological experiment was carried out through artificial contamination of the hands and alliances with Lactobacilli casei and later the hand hygiene protocol to verify the bacterial load found in the hands and rings of health professionals and students. Results: The use of adornments by nursing professionals is frequent, especially the use of wedding rings, watches and earrings. Although 85% of the participants are aware of the NR32 regulations regarding the removal of adornments for the performance of work activities, 15% professionals reported total or partial lack of knowledge of this recommendation, which points to the need to review training practices and the frequent offer of training in service/training. Regarding the results of the experiment on the use of rings by health professionals, it was found that there was no difference between bacterial contamination of the hands of participants with and without rings. However, it was found that among the groups that cleaned their hands using an alcoholic preparation in gel at 70% or with water and liquid soap, there was a reduction in the bacterial load on the hands when compared to the control group, a group that cleaned their hands with water and liquid soap showed an even greater reduction in Colony Forming Units (CFU). Conclusion: The use of adornments by nursing professionals is still a source of concern for health institutions due to the frequency of use of these objects even in the face of discouragement of use and of the legal recommendations. It can be seen that the lack of in-service training/training and charging for the removal of adornments are hindering factors in this process. With regard to the use of a wedding band by health professionals during the hand hygiene procedure, the implications of its use are evident, especially when the cleaning is not carried out by mechanical removal of dirt, as is the case of hand hygiene with alcoholic preparation in 70% gel

Impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en el personal de salud / Impact of the use of rings and nail polish on hand hygiene quality in healthcare workers

Resumen Introducción: Las infecciones asociadas a la atención de salud son un problema frecuente en el ambiente hospitalario. La higiene de manos es la medida más efectiva para su prevención. El uso de ciertos accesorios en las manos podría disminuir su efectividad y favorecer la transmisión horizontal de agentes infecciosos. Objetivo: Revisar los estudios publicados que evalúan el impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en trabajadores de la salud. Métodos: Búsqueda no sistemática en base de datos PUBMED/MEDLINE (1978-2018) de estudios en los cuales se mide la calidad de la higiene de manos o lavado quirúrgico, mediante cultivos cuantitativos o tinciones fluorescentes. Resultados: Uso de anillos: Trece de 51 artículos cumplían los criterios de inclusión. Siete fueron realizados en unidades clínicas, y en todos ellos éste se asoció a menor calidad de la higiene de manos (la mayoría de baja calidad). Contrariamente, en tres de cuatro estudios primarios realizados en pabellón (de baja calidad), su uso no impactó en la calidad del lavado quirúrgico. Igualmente, dos revisiones sistemáticas obtuvieron similares conclusiones. Uñas esmaltadas: siete de 54 artículos fueron incluidos. En cuatro hubo resultados discordantes (la mayoría de baja calidad). En un estudio controlado se observó reducción en la calidad del lavado quirúrgico sólo cuando el esmalte estaba dañado. El esmalte gel se asoció a menor calidad de la higiene de manos en dos estudios experimentales. Conclusiones: No existe evidencia de calidad suficiente para asociar el uso de estos accesorios con reducción en la calidad de la higiene de manos. Tampoco queda demostrada su inocuidad. En base a la evidencia disponible (la mayoría de baja calidad), se observó un impacto negativo del uso de anillos en unidades clínicas y también de uñas con esmalte dañado en pabellones quirúrgicos. Se requieren estudios de mejor calidad para abordar estos relevantes tópicos.

Abstract Background: Health-care-associated infections are a frequent problem in hospital environments. Hand hygiene is the most effective measure to prevent outbreaks. The use of certain accessories could decrease its effectiveness, facilitating horizontal transmission of pathogens. Objective: Analyze the evidence that assess the impact of the use of rings and nail polish on hand hygiene quality in healthcare workers. Methods: Non-systematic search in PUBMED/MEDLINE database (1978-2018) of studies in which the quality of hand hygiene or surgical washing is measured, using quantitative cultures or fluorescent stains. Results: Wearing rings: 13 studies met the inclusion criteria. Seven were carried out in general wards. In all of them the use of rings was associated with lower quality of hand hygiene (the majority of low quality). Contrarily, in 3 of 4 primary studies carried out in the operating rooms (of low quality), their use did not affect the quality of surgical washing. Similarly, two systematic reviews obtained similar conclusions. Nail polish: 7 of 54 studies met the inclusion criteria. In four of them there were discordant results (the majority of low quality). One RCT showed a reduction in the quality of surgical washing only when the nail polish was damaged. Gel nail polish was associated with lower quality in two experimental studies. Conclusions: There is insufficient evidence to associate the use of these accessories with the reduction in the quality of hand hygiene. Its safety was not proven neither. Based on the available evidence (the majority of low quality), a negative impact of the use of rings in clinical units and also of damaged nail polish in operating rooms was observed. Better quality studies are required to address these relevant issues.

Metodologias formativas: contribuição para o desenvolvimento colaborativo da cadeia de semijoias de Limeira / Formative methodologies contribution to the collaborative development of the costume jewelry productive chain in Limeira

Introdução - A cadeia de produção de semijoias e bijuterias em Limeira é responsável por um processo produtivo complexo que, chega ao domicílio residencial e, gera trabalho infantil e adolescente. Graves problemas de saúde podem surgir para as famílias que produzem semijoias e bijuterias dentro de casa, além dos riscos ocupacionais e de acidentes. Objetivo - Compreender o aprendizado expansivo coletivo de modo a possibilitar a colaboração e a integração entre os diferentes atores da rede de sistemas de atividades da COMETIL - Comissão Municipal de Erradicação do Trabalho Infantil e Adolescente de Limeira. Método - Coleta de dados utilizando entrevistas, reuniões, oficinas de apresentação, observações da atividade. Posteriormente, utiliza-se o método Laboratório de Mudanças (LM), que se apoia na Teoria da Atividade Histórico Cultural e na Aprendizagem Expansiva, para a compreensão das atividades interinstitucionais da COMETIL, com gravação e filmagem das sessões para análise. Resultados - Divididos em 2 artigos e 1 capítulo de livro. No primeiro artigo, as hipóteses são de que contradições existentes no sistema de atividades da cadeia produtiva não permitem transpor o desafio de sustentabilidade da cadeia, aumentando a precarização do trabalho e os riscos à saúde e segurança das famílias que, por não encontrarem outra alternativa, produzem semijoias e bijuterias em casa. No segundo, apresenta-se uma análise dos resultados do LM que permitiu elevar o nível de agência transformativa entre os participantes da COMETIL, além de fornecer visualização das ações com a elaboração de novos instrumentos de trabalho. No terceiro, evidencia-se que a agência transformativa efetiva-se através da compreensão de que há necessidade de atuação coletiva e integrada, entre instituições públicas e privadas, confirmando o processo de aprendizagem expansiva desencadeado pelo método. Conclusão - O LM permitiu visualizar que a COMETIL pode ser entendida como uma plataforma ou um macro sistema de atividades e que possibilita novos processos organizacionais de ações das instituições públicas de erradicação e controle do trabalho infantojuvenil junto a este setor produtivo de semijoias e bijuterias

The costume jewelry production chain in Limeira is responsible for a complex production process that gets the residential homes and creates child and adolescent labor. Consequently, severe health problems can emerge for families that produce costume jewelry inside their houses, besides the occupational risks and accidents. Objective - To understand the collective expansive learning towards the collaboration and the integration between the actors of the activity systems of COMETIL - Committee for Eradication of Child Labor and Adolescent Work Protection of Limeira. Methods - Data collection using interviews, meetings, introductory workshops, and observations of activity. Subsequently, the Change Laboratory (CL) method, based on the Cultural-Historical Activity Theory and the Expansive Learning, was carried out to comprehend the interorganizational activities of the COMETIL with video recording for analysis. Results - These are divided into two papers and one book chapter. In the first paper, the hypotheses are that the existing contradictions in the activity systems of the production chain do not allow to meet the sustainability challenge, increasing the precariousness and the health and safety risks for families that are forced to produce costume jewelry at home because of an absence of other choices. The second text presents the analysis of the CL results that promoted the transformative agency among the COMETIL participants and provided the visualization of actions with the elaboration of new work instruments. The third paper supports that the transformative agency becomes effective through the comprehension of the need for a collective and integrated action between public and private institutions, confirming the learning expansive process resulting from the method. Conclusions - The CL allowed visualizing that the COMETIL can be understood as a platform or a macrosystem of activities and it promoted a new organizational process of actions of public institutions of eradication and monitoring the child labor with this costume jewelry production sector

Outbreak investigation of lead neurotoxicity in children from artificial jewelry cottage industry

BACKGROUND@#Although lead neurotoxicity is a known phenomenon, it can often be missed at a primary or secondary care level especially if detailed environmental exposure history is missed.@*METHODS@#This is an outbreak investigation where we observed 15 pediatric cases with neurologic signs and symptoms clustered in a slum area known for an unorganized artificial jewelry industry. Their clinical, biochemical, and epidemiological features were compared with 14 other children from the same region reporting with non-neurological symptoms who were considered as unmatched controls.@*RESULTS@#Cases with neurological manifestations had a higher in-house lead smelting activity [OR 7.2 (95% CI 1.4-38.3)] as compared to controls. Toddlers below 3 years of age were more vulnerable to the effects of lead.@*CONCLUSION@#This study emphasizes that many focal sources of lead poisoning still remain especially in the unorganized sector. In cases presenting with unexplained neurotoxicity, specific occupational and environmental inquiry for chemical poisoning, with special consideration for lead, should be actively pursued.

Famílias inseridas no arranjo produtivo informal da produção de jóias e bijuterias de Limeira, SP: a exposição ocupacional a contaminantes químicos em ambiente domiciliar / Families inserted in local productive arrangement of the productive chain of jewelry and fashion jewelry from Limeira, SP the occupational exposure to chemical contaminants in a home setting

Introdução: A informalidade no mercado de trabalho assola muitas economias em desenvolvimento e é uma característica notável da produção de joias e bijuterias em Limeira, São Paulo, um dos maiores polos de produção de joias e bijuterias do Brasil. A produção de joias e bijuterias envolve o manuseio de produtos que podem ter em sua composição elementos com potencial tóxico à saúde humana. Em Limeira, a atividade de produção ocorre dentro dos domicílios, o que significa que o trabalhador e seus familiares podem estar expostos a elementos potencialmente tóxicos (EPT) oriundos da atividade ocupacional. Objetivos: Este estudo investigou a exposição ocupacional aos EPTs Cromo (Cr), Manganês (Mn), Níquel (Ni), Cobre (Cu), Zinco (Zn), Arsênio (As) Cádmio (Cd), Antimônio (Sb), Estanho (Sn), Mercúrio (Hg) e Chumbo (Pb), dos trabalhadores domiciliares e de seus familiares inseridos no arranjo produtivo de joias e bijuterias na cidade de Limeira - SP e discutiu os riscos identificados no ambiente de trabalho domiciliar versus a legislação ocupacional vigente. Métodos: Este estudo incluiu 52 famílias (n=165 indivíduos), divididas em grupo Exposto (n=112) e grupo Controle (n=53). Foram coletadas amostras de sangue (n=165) dos trabalhadores e seus familiares, e amostras de ar da zona de respiração de soldadores (n=9). As concentrações de EPTs foram determinadas por espectrometria de massas com plasma indutivamente acoplado (ICP-MS). Questionários foram aplicados para obter informações sociodemográficas, detalhes das condições do local de trabalho e dos materiais utilizados. As informações relevantes para compor a avaliação do ambiente de trabalho frente aos requisitos legais vigentes foram obtidas a partir destes questionários. Além disso, a análise de componentes principais (PCA), formação de clusters e regressão logística foram realizadas. Resultados: Os elementos Cd, Ni e Cu apresentaram concentração no ar maiores do que as diretrizes ocupacionais americanas. Foi encontrada diferença estatisticamente significativa para a concentração de Pb entre os grupos Exposto e Controle e entre os sexos (p <0,05), já para o Cu e Sb foram encontradas diferenças apenas entre os sexos (p <0,05). Conclusões: As concentrações de EPTs encontradas no ar são preocupantes, uma vez que os familiares dos trabalhadores, incluindo as crianças, estão no mesmo cenário de exposição. Condições inadequadas de trabalho foram observadas nas residências, revelando a necessidade de implementar ações públicas urgentes para proteger essas famílias de trabalhadores. A avaliação do cenário de exposição revelou que os trabalhadores e familiares estão sob os mesmos riscos de exposição, uma vez que a produção de joias é realizada sem nenhuma proteção do trabalhador e em ambiente geralmente compartilhado dentro das casas. Ações públicas e remodelagem do fluxo produtivo são necessárias para proteção social e de saúde destes trabalhadores e seus familiares com foco em melhoria das condições de trabalho e regularização profissional.

Introduction: Informality in the occupational segment devastated many developing economies and is a notable feature of the production of jewelry and fashion jewelry in Limeira city, São Paulo, one of the largest poles of jewelry and fashion jewelry production in Brazil. The production of jewelry and fashion jewelry involves the manipulation of chemical products that may have in their composition potentially toxic elements (PTE) to human health. In Limeira, the production activity occurs inside the households, which means that worker and family members could be exposed to PTE from the occupational activity. Objective: This study investigated occupational exposure to PTE Chromium (Cr), Manganese (Mn), Nickel (Ni), Copper (Cu), and Zinc (Zn), Arsenic (As), Cadmium (Cd), Antimony (Sb), Tin (Sn), Mercury (Hg), and Lead (Pb), household workers and their families included in the production of jewelry and fashion jewelry in Limeira, and discussed the risks identified in the households\' occupational environment assessment versus the current occupational legislation. Methods: This study included 52 families (n = 165 individuals), divided into Exposed group (n = 112) and Control group (n = 53). Blood samples (n = 165) were collected from the workers and their relatives, and air samples from the breathing zone of welders (n = 9). Concentrations of EPTs were determined by ICP-MS. Questionnaires were applied to collect sociodemographic information, details of the workplace conditions and the materials used. The relevant information to compose the occupational environment assessment against the current legal requirements were obtained from these questionnaires. In addition, the principal component analysis (PCA), clusters formation and logistic regression were performed. Results: Cd, Ni, and Cu elements presented higher air concentration than the American occupational guidelines limits. A statistically significant difference was found for the Pb concentration between the exposed and control groups and between the sexes (p <0.05), whereas for Cu and Sb only differences between the sexes were found (p <0.05). Conclusions: Concentrations of EPT found in the air raise concern, since workers' relatives, including children, are in the same exposure scenario. Inadequate working conditions were observed in the houses, revealing the need to implement urgent public actions to protect these families and the workers. The exposure assessment revealed that workers and family members are at the same risk of exposure as the production of jewelry is carried out without any individual protection and, generally, is performed in the shared environment inside the houses. Public actions and remodeling the productive flow are necessary for the social and health protection of these workers and the families with a focus on improving working conditions and professional regularization.

Coiling method combined with bloodletting from the corpus cavernosum for penile incarceration with a metal ring: A case report and literature review / 中华男科学杂志

Objective@#To explore the treatment of penile incarceration with a metal ring.@*METHODS@#Based on our experience in the successful management of a case of penile incarceration with a metal ring by coiling and bloodletting from the corpus cavernosum, we reviewed the relevant literature and analyzed the indications, advantages and disadvantages of different methods for the treatment of penile incarceration with a circular foreign body.@*RESULTS@#The clamping and cutting methods were non-invasive, fast, effective, and with few complications, which could be applied to the treatment of penile strangulation at all levels. However, clamping was not desirable enough for a hard metal ring and the cutting method took a longer time and might increase the risk of unnecessary damage to the penile skin, urethra and cavernous body. Prepuce edema decompression and the thin tube-coiling method, with the advantages of minimal invasiveness, simple operation and no need of special tools, were suitable for penile strangulation injury under level 3, but might cause penile skin injury and potential postoperative erectile dysfunction. Surgical resection, as an invasive procedure, could be applied to severe penile strangulation at level 4 or 5.@*CONCLUSIONS@#The principle for the treatment of penile incarceration with a circular foreign body is to remove the foreign object as soon as possible and not to add secondary damage.

Systemic sclerosis due to crystalline silica exposure among jewelry workers in Korea: two case reports

BACKGROUND: Occupational exposure to crystalline silica is a potential risk factor for various systemic autoimmune diseases including systemic sclerosis. The etiology of systemic sclerosis is not conclusively known, but there are epidemiological studies that show the relationship between exposure to crystalline silica and risk of systemic sclerosis. Here we report, for the first time, two cases of crystalline silica-related systemic sclerosis in patients who worked in crystal processing in the jewelry-manufacturing field. CASE PRESENTATION: Case 1 is a 57-year-old man who had worked mainly in crystal processing for multiple jewelry-processing companies for 17 years, since the age of 15 years. He contracted tuberculosis at the age of 25 years and showed Raynaud's phenomenon of both the hands and feet at age 32 years. Digital cyanosis and sclerosis developed at approximately age 41 years. The patient was diagnosed with systemic sclerosis at age 48 years. Case 2 is a 52-year-old man who worked in crystal processing for various jewelry-processing companies for 7 years, since the age of 23 years. He first showed signs of cyanosis in the third and fourth digits of both hands at age 32 years, was diagnosed with Raynaud's syndrome at age 37 years, and was diagnosed with systemic sclerosis at age 38 years. Crystal processing is a detailed process that involves slabbing and trimming the selected amethyst and quartz crystals, which requires close proximity of the worker's face with the target area. In the 1980s and 1990s, the working hours were 12 h per day, and the working environment involved 15 workers crowded into a small, 70-m2 space with poor ventilation. CONCLUSION: Two workers who processed crystals with a maximum crystalline silica content of 56.66% developed systemic sclerosis. Considering the epidemiological and experimental evidence, exposure to crystalline silica dust was an important risk factor for systemic sclerosis. An active intervention is necessary to reduce exposure in similar exposure groups in the field of jewelry processing.

Sporotrichosis in an unusual location - Case report

Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii, and the infection is usually acquired by traumatic inoculation. We describe a case of sporotrichosis in an uncommon location with an unusual mode of transmission. A 49-year-old female patient who lived in an urban area of Rio de Janeiro presented with involvement of the left ear. No history of contact with soil, plants or animals was elicited. The suspected source of infection was a pair of handmade wooden earrings. The delay in the diagnosis and treatment resulted in higher morbidity, unsightly scarring and loss of ear lobe.

A construção de políticas públicas em rede intersetorial para a erradicação do trabalho infantil em Limeira-SP / The construction of public policies on intersectoral network for the eradication of child labor in Limeira-SP

Limeira-SP é uma cidade que abriga um dos principais pólos de produção de joias e bijuterias, que tem como característica o uso da mão de obra informal nos domicílios, envolvendo crianças e adolescentes nas atividades de montagem, soldagem e cravação de peças. Pesquisa no município revelou que 27por cento dos alunos da rede estadual de ensino trabalham montando e soldando joias e bijuterias, uma população 8.340 indivíduos envolvidos em tarefas repetitivas e perigosas para a saúde. O diagnóstico desta situação motivou a mobilização de instituições públicas e da sociedade civil na criação de uma rede intersetorial articulada pela Comissão Municipal de Erradicação do Trabalho Infantil de Limeira COMETIL que opera desde 2007. O objetivo deste projeto é avaliar o alcance, limites e possibilidades das ações intersetoriais desenvolvidas pela COMETIL, no período de 2007 2010, de modo destacar as estratégias utilizadas e avaliar as mesmas. Foi empregada metodologia qualitativa do tipo estudo de caso baseadas em: a) participação de pesquisadores que são membros da COMETIL (nos moldes de pesquisa-ação); b) análise de documentos e; c) entrevistas semiestruturadas com 13 indivíduos na identificação de problemas socias; o papel da mídia na divulgação dos dados; a relevância de ações pautadas na promoção da saúde que visam a sensibilização da população e o desenvolvimento de habilidades técnicas entre os servidores público; a proeminência da articulação intersetorial e, sobre tudo, o apoio de instituições como o Ministério Público do Trabalho e Ministério do Trabalho e emprego; a necessidade de avançar nas ações de vigilância em saúde; e, por fim, a potencialidade da estratégia de territorialização para o desenvolvimento de ações no campo da Saúde e do Desenvolvimento Social. A Análise dos resultados possibilitou perceber as estratégias exitosas adotadas pela Comissão, bem como constatar os limites da articulação em rede em curso e apontar novos rumos para a superação dos...

Non-destructive management of white spot lesions by using tooth jewelry

Although several methods including composite resin restoration and microabrasion have been used for management of white spot lesion, tooth jewelry can be considered as another noninvasive option. This case report describes the management of white spot lesions by using tooth jewelry. This report also highlights the patients' preference for tooth jewelry as an esthetic concern.

Simulated microbe removal around finger rings using different hand sanitation methods / 国际口腔科学杂志·英文版

<p><b>AIM</b>It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only "recommend" removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes.</p><p><b>METHODOLOGY</b>A gloved rubber hand manikin was made and fitted with a fresh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20 degrees C and 40 degrees C water alone, or with liquid hand soap. Light levels (in lux) of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance (ANOVA) was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey's post hoc honestly significant difference (HSD) test was applied to significant factors to examine pair-wise differences between factor levels.</p><p><b>RESULTS</b>It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings.</p><p><b>CONCLUSION</b>The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.</p>

Heavy metal exposure; jewelers and automobile workers

There are various metals that concern us because of occupational of residential exposure. Majority of these are heavy metals. Small amount of these elements are common in environment and diet that are actually necessary for good health but large amount of any of them may cause acute or chronic toxicity. Historical association and provocative findings of blood Cu and Cd levels at short and long term Cu and Cd exposure shows Cu and Cd pollution. A study was carried out to determine the blood metals levels. In this study 44 samples were analyzed using flame atomic absorption spectrometer A 1800 Hitachi Japan. Whole blood cadmium levels found in jewelers, automobile workers were 398 +/- 183pg/100ml, 768 +/- 180pg/100ml respectively. Whole blood copper levels in jewelers, automobile workers were 710 +/- 139mcg/100ml, 746 +/- 89mcg/100ml. The control subjects were not occupationally exposed and healthy appearances have Cu and Cd levels 641 +/- 45mcg/100ml, 353 +/- 190mcg/100ml respectively. Copper levels were significantly raised [P < 0.05] in automobile workers compared with control. On the other hand Cd levels although raised but not significant. Results show that our control subjects have raised Cu and Cd levels when compared with WHO criteria 160-270mcg/100ml and 160-220mcg/100ml respectively

A Case of Hepatitis after Occupational Exposure of Trichloethylene / 대한간학회지

Trichloroethylene (TCE) is currently used as a degreasing agent in the jewelry manufacturing industry. The characteristic sign arising after the exposure of TCE are hepatitis and contact dermatitis. The incidence of toxicity is relatively rare, therefore, the mechanism of occurrence is considered as hypersensitivity. A previously healthy 21-year-old male began to work at jewelry industry. The solvent used in that place was TCE. Over the next month, he experienced symptoms of weakness, fever, dry skin, red rash and bumps, peeling face, and jaundice. At that time, he had marked liver enzyme elevation with evidence of cholestasis. After two weeks of avoidance of TCE exposure, his liver enzymes showed a marked reduction in ALT from a peak of 1132 to 131 IU/L. The total bilirubin reduced from 9.3 to 4.6 mg/dL. Tests for hepatitis A, B, and C, CMV, HIV were all negative. The patch test showed primary irritant reaction to TCE and its metabolite, trichloroethanol. This is the second report of TCE induced hepatotoxicity in Korea. We consider this case as a TCE induced hepatotoxicity due to possibly hypersensitivity mechanism.