Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo / Mortalidade por câncer em trabalhadores com risco de exposição ocupacional à radiação ionizante em empresa do setor nuclear sediada em São Paulo

ABSTRACT Objective: To compare cancer mortality among workers exposed to gamma and X radiation and the general population of the city of São Paulo, as well as that of the subgroup monitored with those not monitored for gamma and X radiation in a work unit with ionizing radiation based in the city of São Paulo. Methods: Between 2016 and 2021, a retrospective open cohort study was carried out with workers who were employed from 08/31/1956 to 12/31/2016 based on data collected at the company and in official institutions. Standardized mortality ratios (SMR) were calculated by sex, age and calendar period of cancers grouped according to type, risk factor and organ system in two analyses: in the external analysis, the mortality of the study population was compared with that of the general population of the city of São Paulo; In the internal analysis, the mortality of the monitored subgroup was compared with that of the subgroup not monitored for gamma and X radiation. Results: The external mortality analysis showed SMR=0.224 (95%CI 0.208-0.240) and the healthy worker effect, while the internal mortality analysis showed SMR=0.685 (95%CI 0.618-0.758). Conclusion: This study showed lower cancer mortality among exposed workers when compared to mortality in the general population and the healthy worker effect. Among workers monitored for gamma and X radiation, cancer mortality was lower when compared to those not monitored.

RESUMO Objetivo: Comparar a mortalidade por câncer entre trabalhadores expostos à radiação gama e X e a população geral do município de São Paulo, bem como a do subgrupo monitorado com o não monitorado para radiação gama e X em uma unidade de trabalho sediada no município de São Paulo. Métodos: Entre 2016 e 2021 foi realizado estudo de coorte aberta retrospectiva com trabalhadores que tiveram vínculo empregatício desde 31/08/1956 até 31/12/2016 a partir de dados coletados na empresa e em instituições oficiais. Foram calculadas as razões de mortalidade padronizadas (RMP) por sexo, idade e período calendário de cânceres agrupados segundo o tipo, o fator de risco e o sistema orgânico em duas análises: na análise externa, comparou-se a mortalidade da população de estudo com a da população geral do município de São Paulo; já na análise interna, comparou-se a mortalidade do subgrupo monitorado com a do subgrupo não monitorado para radiação gama e X. Resultados: A análise externa de mortalidade mostrou RMP=0,224 (IC95% 0,208-0,240) e o efeito do trabalhador sadio, enquanto a análise interna de mortalidade mostrou RMP = 0,685 (IC95% 0,618-0,758). Conclusão: Este estudo mostrou menor mortalidade por câncer entre os trabalhadores expostos quando comparada com a mortalidade da população geral e o efeito do trabalhador sadio. Entre os trabalhadores monitorados para radiação gama e X, a mortalidade por câncer foi menor quando comparada com a dos não monitorados.

Serological and vaccine evaluation for hepatitis B among Community Health Workers / Avaliação sorológica e vacinal para hepatite B entre Agentes Comunitários de Saúde / Evaluación serológica y vacuna para la hepatitis B entre Agentes Comunitarios de Salud

Abstract Objective: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. Method: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. Results: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. Conclusion: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.

Resumo Objetivo: identificar a situação vacinal e sorológica contra hepatite B entre agentes comunitários de saúde; vacinar contra o vírus da hepatite B e avaliar a resposta imunológica dos agentes susceptíveis. Método: fase I, estudo transversal e descritivo, entre agentes comunitários de saúde de uma capital da região Centro-oeste, por meio de questionário autoaplicável, conferência do cartão vacinal e coleta de sangue para testagem dos marcadores sorológicos para hepatite B. Fase II, estudo de coorte realizado em trabalhadores vacinados não imunes e identificados na fase I. Estes receberam uma dose da vacina (dose desafio) e teste sorológico. Resultados: participaram do estudo 109 agentes. A maioria tinha registro de vacinação (97; 89,0%) e completude vacinal (75; 77,3%), já o marcador anti-HBs (anticorpos contra o vírus da hepatite B) isolado foi detectado em 78 (71,6%) agentes. A prevalência de exposição ao vírus da hepatite B foi de 8,2%. Dos dez agentes vacinados não imunes, após a dose desafio, um permaneceu susceptível. Conclusão: apesar da maioria dos trabalhadores estarem vacinados e apresentarem resposta imunológica para hepatite B, a suscetibilidade após a dose desafio foi identificada. Portanto, é necessário que haja um programa de vigilância da situação vacinal e estado sorológico para este vírus, para promover a segurança destes trabalhadores.

Resumen Objetivo: identificar la situación de la vacunación y serología contra la hepatitis B entre agentes comunitarios de la salud, vacunar contra el virus de la hepatitis B y evaluar la respuesta inmunológica de los agentes susceptibles. Método: fase I, estudio transversal y descriptivo, entre agentes comunitarios de la salud de una capital de la región centro oeste, por medio de cuestionario autoadministrado, verificación del carné de vacunación y extracción de sangre para comprobar los marcadores serológicos para la hepatitis B. Fase II, estudio de cohorte realizado en trabajadores vacunados no inmunes e identificados en la Fase I; estos recibieron una dosis de la vacuna (dosis de desafío) y realizaron el test serológico. Resultados: participaron del estudio 109 agentes. La mayoría tenía registro de vacunación (97; 89,0%) y de cobertura de vacunación (75; 77,3%); el marcador anti-HBs (Anticuerpos contra el virus de la hepatitis B) aislado fue detectado en 78 (71,6%) de los agentes. La prevalencia de exposición al virus de la hepatitis B fue de 8,2%. De los diez agentes vacunados no inmunes, después de la dosis desafío, uno permaneció susceptible. Conclusión: a pesar de que la mayoría de los trabajadores estaban vacunados y presentaron respuesta inmunológica para la hepatitis B, la susceptibilidad, después de la dosis desafío, fue identificada. Por tanto, es necesario que exista un programa de vigilancia de la situación de vacunación y estado serológico para este virus, para promover la seguridad de estos trabajadores.

Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health / Atuação da enfermagem em unidades dedicadas e não dedicadas à COVID-19: implicações na saúde ocupacional / Trabajo de enfermería en unidades dedicadas y no dedicadas al COVID-19: consecuencias para la salud ocupacional

Abstract Objective: to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. Method: a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. Results: the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. Conclusion: the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Resumo Objetivo: analisar as implicações da pandemia sobre a saúde ocupacional da equipe de enfermagem conforme a atuação em unidades dedicadas e não dedicadas à COVID-19. Método: estudo multicêntrico, de método misto, estratégia explanatória sequencial. Participaram 845 profissionais na primeira etapa, respondendo a um formulário eletrônico contendo variáveis sociodemográficas, laborais, sobre a pandemia e sua saúde e o Self-Reporting Questionnaire. Na segunda etapa, 19 profissionais foram entrevistados. Os dados quantitativos foram submetidos à estatística analítica e os qualitativos à análise temática de conteúdo, sendo integrados por conexão. Resultados: os impactos da pandemia sobre a saúde dos profissionais ocorreram tanto nas áreas dedicadas como nas não dedicadas à COVID-19. Contudo, a composição das equipes apresentou características distintas entre as áreas, bem como as percepções de risco e das exigências no trabalho. Conclusão: os profissionais que atuam em áreas dedicadas e não dedicadas à COVID-19 estão igualmente adoecidos, mas com exposição laboral distinta quanto às exigências no trabalho nas unidades dedicadas e o medo da contaminação nas unidades não dedicadas.

Resumen Objetivo: analizar las consecuencias que tuvo la pandemia en la salud ocupacional de los enfermeros según si se desempeñaban en unidades dedicadas y no dedicadas al COVID-19. Método: estudio multicéntrico, método mixto, estrategia explicativa secuencial. En la primera etapa participaron en total 845 profesionales que respondieron un formulario electrónico que contenía variables sociodemográficas, ocupacionales, sobre la pandemia y la salud y el Self-Reporting Questionnaire. En la segunda etapa, fueron entrevistados 19 profesionales. Los datos cuantitativos fueron sometidos a estadística analítica y los datos cualitativos al análisis de contenido temático, posteriormente, ambos fueron integrados por conexión. Resultados: los impactos de la pandemia en la salud de los profesionales se produjeron tanto en las áreas dedicadas como en las no dedicadas al COVID-19. Sin embargo, la composición de los equipos presentó distintas características entre las áreas, así como también diferentes percepciones de riesgo y exigencias en el trabajo. Conclusión: los profesionales que trabajan en áreas dedicadas y no dedicadas al COVID-19 se enfermaron por igual, pero tuvieron diferente exposición ocupacional debido a las exigencias que presentaba el trabajo en las unidades dedicadas y al miedo al contagio en las unidades no dedicadas.

Primer caso de transmisión de mpox mediante toma de muestra por desteche en Chile

Mpox es una zoonosis vírica que causa síntomas similares a la viruela, aunque menos graves. La infección fue descrita inicialmente en África central y occidental. Luego del brote multinacional ocurrido el año 2022, ya no es considerada una emergencia de salud pública de importancia internacional. El mecanismo de transmisión es por contacto físico estrecho o directo con lesiones cutáneas de individuos infectados. Presentamos el caso clínico de una enfermera que se infectó por mpox tras un accidente cortopunzante durante la toma de muestra de una lesión por desteche con bisturí en un paciente con VIH. La transmisión percutánea tuvo un período de incubación corto, seguido de una lesión cutánea y síntomas sistémicos. Aunque infrecuente, se destaca el riesgo de transmisión ocupacional de mpox en la atención clínica. Es importante que el personal sanitario adhiera estrictamente a las medidas de prevención, como el uso de equipo de protección personal y la práctica segura en la toma de muestra.

Monkeypox is a viral zoonosis that causes symptoms similar to smallpox, but less severe. The infection was initially described primarily in central and western Africa. After multi-country outbreak in 2022; it is currently no longer a public health emergency of international concern. The main mode of transmission is through close or direct contact with the skin lesions of an infected individual. We report a case of a nurse was infected with mpox after a needlestick injury during a skin sample collection from an HIV-positive patient. Percutaneous transmission resulted in a short incubation period, followed by a skin lesion and systemic symptoms. This case highlights the risk of occupational transmission of mpox in healthcare settings. It is important for healthcare workers to take rigorous prevention measures, such as the use of appropriate personal protective equipment and safe sample collection practices.

Exposição ocupacional ao Sars-CoV-2: investigação das condições de saúde/segurança dos trabalhadores essenciais para subsidiar ações de mitigação de risco da Covid-19 / Occupational exposure to SARS-CoV-2: investigation of the health/safety conditions of essential workers to support COVID-19 risk mitigation actions

RESUMO Em janeiro de 2020, a Organização Mundial da Saúde declarou a Covid-19 como emergência de saúde pública no mundo. Diante da ausência de medidas farmacológicas, a única prevenção adotada foi o distanciamento físico. Porém, trabalhadores essenciais ficaram submetidos às políticas de gestão de saúde e segurança das empresas. O objetivo deste artigo é investigar as condições de saúde e segurança dos trabalhadores expostos ao Sars-CoV-2, por meio da aplicação de ferramentas de inovação tecnológica, para dar suporte e subsidiar ações de mitigação de risco da doença. Trata-se de estudo transversal, conduzido na plataforma REDCap, por instrumento autoaplicável de comunicação de risco de trabalhadores em atividade presencial e remota, no Brasil. Participaram 2.476 trabalhadores, dos quais, 723 foram aceitos por análise de consistência das respostas. A idade média foi de 43,5 anos, sexo feminino (53,3%), cor branca (62%), carga de 21-40 horas semanais (60%) e Covid-19 em 27,4% da amostra. A maioria (75,2%) considerou que a transmissão ocorreu no trabalho e que medidas de proteção coletiva foram insuficientes. Os achados apontam deficiências nos planos de contingência das empresas, que repercutem em insegurança e risco de exposição ao Sars-CoV-2, reduzindo a eficácia das medidas sanitárias e transformando o trabalho em lócus de disseminação do vírus.

ABSTRACT In January 2020, the World Health Organization declared COVID-19 a public health emergency worldwide. Given the absence of pharmacological measures, the only prevention adopted was physical distancing. However, essential workers were subject to the health and safety management policies of companies. The aim of this article is to investigate the health and safety conditions of workers exposed to SARS-CoV-2, using the application of technological innovation tools, to support and subsidize disease risk mitigation actions. This is a cross-sectional study, conducted in the Redcap platform, by a self-administered instrument of risk communication of workers in face-to-face and remote activities, in Brazil. A total of2,476 workers took part, 723 of whom were accepted by analysis of consistency of responses. The average age was 43.5 years, female (53.3%), white (62%), working 21-40 hours a week (60%) and Covid-19 in 27.4% of the sample. Most (75.2%) considered that the transmission occurred at work and the collective protection measures were insufficient. The findings point to deficiencies in the contingency plans of the companies, which have repercussions on the insecurity and risk of exposure to SARS-CoV-2, reducing the effectiveness of sanitary measures and transforming the work into locus of dissemination of the virus.

Seropositividad de Chlamydia psittaci en trabajadores expuestos a aves y revisión de la literatura: evidencia de circulación en Antioquia / Chlamydia psittaci seropositivity in workers exposed to birds and review of the literature: Evidence of circulation in Antioquia

Introducción. La psitacosis es una enfermedad zoonótica causada por Chlamydia psittaci. Esta bacteria es catalogada como un agente con potencial bioterrorista y ha causado múltiples brotes en trabajadores con exposición laboral a aves en diferentes lugares del mundo. En Colombia, no se hace seguimiento epidemiológico de la infección y existe una gran brecha en el conocimiento. Objetivos. Determinar la frecuencia de anticuerpos contra C. psittaci en trabajadores con exposición laboral a aves y sus factores asociados. Además, revisar la literatura en relación con los estudios sobre el tema realizados en Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo, transversal, con intención analítica, en trabajadores en contacto con aves y se revisó la literatura científica relacionada en Colombia. Se detectaron anticuerpos IgM e IgG contra C. psittaci en suero por microinmunofluorescencia. La descripción de las características sociodemográficas y de exposición se hizo con frecuencias y medidas de resumen. Se exploraron factores asociados por análisis bivariados y multivariados. La revisión de la literatura científica y gris se hizo con búsqueda estructurada. Resultados. Se analizaron 54 trabajadores en contacto con aves y se encontró una prevalencia de anticuerpos del 31,5 %. El ejercer funciones de sacrificio y faenado de las aves sin ser médico veterinario fue un factor de riesgo para la presencia de anticuerpos. Solo se encontraron cuatro estudios previos sobre C. psittaci hechos en Colombia. Conclusiones. Este estudio constituye la primera evidencia de la circulación de C. psittaci en trabajadores en contacto con aves en Antioquia y el segundo reporte en el país. Estos hallazgos aportan desde la salud pública a la estrategia One Health.

Introduction. Psittacosis is a zoonotic disease caused by Chlamydia psittaci, a bacterium classified as an agent with bioterrorist potential. It has caused multiple outbreaks in exposed poultry workers around the world. Colombia has no epidemiological follow-up of the infection and a big knowledge gap. Objectives. To determine the antibodies' frequency against C. psittaci in workers with occupational exposure to birds and to review the literature on studies conducted in Colombia. Materials and methods. We conducted a cross-sectional descriptive study with analytical intent on workers in contact with birds and reviewed the related literature in Colombia. IgM and IgG serum antibodies against C. psittaci were detected by microimmunofluorescence. The sociodemographic and exposure characteristics were expressed as frequencies and summary measures. Associated factors were explored by bivariate and multivariate analysis. The scientific and gray literature review was done with a structured search. Results. We analyzed 54 workers in contact with birds. Antibody prevalence was 31.5%. Slaughtering and evisceration by non-veterinarians was a risk factor for antibody presence. There are only four previous studies on C. psittaci in Colombia. Conclusions. Here, we present the first evidence of C. psittaci circulation among workers exposed to birds in Antioquia and the second report in the country. These findings contribute to the "One Health" public health strategy.

Riesgos psicosociales laborales: una propuesta de definición / A definition proposal for psychosocial risks at work

BACKGROUND: In 1984, the joint WHO/ILO committee, postulated a definition of psychosocial risks at work, responding to a need in a specific context. However, with the evolution of the working and personal conditions of workers, this definition is progressively considered to be insolvent, ambiguous, with false breadth and omissions. AIM: To analyze the concept of «psychosocial risk at work» and to establish a clear definition based on evidence from the existing literature. MATERIAL AND METHODS: An analysis of the concept, based on Walker and Avant's proposal was carried out. It encompasses eight steps, namely the selection of the concept, determination of the objectives or purposes of the analysis, identification of all possible uses of the concept, determination of defining attributes, identification of a model case, identification of borderline cases, identification of background and consequences and definition of empirical references. RESULTS: The defining attributes of the construct are quantity, rhythm, complexity, content, control, diversity, schedule, flexibility or meaning of the work, perceived as inappropriate by the worker. Also, preoccupation associated with domestic chores and attention to the needs of others, lack of clarity about the role in the job position, deficient personal and professional development of the worker, adverse work environment, organizational aspects that harm the worker, technological demands incompatible with the worker's capabilities and needs and finally, inadequate social relations at work. CONCLUSIONS: The construct background is grouped into elements attributed to the worker and attributed to the labor. The concept attributes were organized into eight dimensions, and the consequences were classified as the personal effects on the worker and those associated with the labor.

Autoavaliação de saúde e fatores relacionados ao trabalho dos professores da educação básica no Brasil / Self-rated health and factors related to the work of basic education's teachers in Brazil

Resumo O objetivo deste artigo é analisar a associação entre a autoavaliação de saúde dos professores e as condições que eles encontram para trabalhar nas escolas da Educação Básica no Brasil. Estudo transversal, realizado entre 2015 e 2016, representativo dos professores da Educação Básica do País, cuja variável desfecho foi a autoavaliação de saúde (AAS). As variáveis explicativas foram as características relacionadas ao trabalho. Para avaliar os fatores associados à AAS foi utilizado o Modelo de Regressão Logística de Chances Proporcionais. A prevalência de AAS ruim foi de 27%. A probabilidade de pior AAS foi significativamente maior para o grupo que informou episódios de violência verbal (OR=1,26; IC95% 1,09-1,44), pressão laboral (OR=1,18; IC95% 1,04-1,33), e deslocamento para escola superior a 50 minutos (OR=1,19; IC95% 1,03-1,38). A probabilidade de pior AAS foi significativamente menor para aqueles que relataram dispor de tempo suficiente para cumprir suas tarefas (OR=0,77; IC95% 0,64-0,92), apoio social (OR=0,79; IC95% 0,69-0,89) e satisfação com o próprio trabalho (OR=0,79; IC95% 0,69-0,91). Ações sobre o ambiente e a organização escolar e melhorias no transporte dos professores para o trabalho são desejáveis.

Abstract The scope of this article is to analyze the association between teachers' self-rated health and the conditions in which they work in Basic Education schools in Brazil. It involved a cross-sectional study, carried out between 2015 and 2016, representative of Basic Education teachers in the country, the outcome variable of which was self-rated health (SRH). The explanatory variables were the work-related characteristics. To assess the factors associated with SRH, the Proportional Odds Logistic Regression Model was used. The prevalence of poor SRH was 27%. The probability of poor SRH was significantly higher for the group that reported episodes of verbal violence (OR=1.26; 95%CI 1.09-1.44), work pressure (OR=1.18; 95%CI 1, 04-1.33), and a commute to school of more than 50 minutes (OR=1.19; 95%CI 1.03-1.38). The probability of poor SRH was significantly better for those who reported having enough time to complete their tasks (OR=0.77; 95%CI 0.64-0.92), social support (OR=0.79; 95%CI 0.69-0.89) and satisfaction with their workload (OR=0.79; 95%CI 0.69-0.91). Actions on the school environment and organization and improvements in the transport of teachers to work are desirable.

Construction and validation of an algorithm for disinfection of ambulances transporting patients with contagious infectious diseases / Construcción y validación de algoritmo para desinfección de ambulancia para transporte de pacientes con enfermedades transmisibles / Construção e validação de algoritmo para desinfecção de ambulância para transporte de pacientes com doenças infectocontagiosas

ABSTRACT Objectives: to develop and validate an algorithm to guide professionals in cleaning and disinfecting ambulances after transferring patients with contagious infectious diseases. Methods: the study was conducted between September and November 2021. The developed algorithm was validated by 104 judges, including nurses, physical therapists, and physicians who care for patients with contagious infectious diseases. It used the Delphi technique and content validity index. Results: in the first evaluation, the judges considered the algorithm "unsuitable" and "fully suitable". The algorithm reviewed according to the judges' suggestions was rated between "suitable" and "fully suitable" in the second evaluation. The overall content validity index was 0.960 and 0.998 in the first and second evaluations. Conclusions: the algorithm to guide the cleaning and disinfection of ambulances after transferring patients with contagious infectious diseases was developed and validated by specialists in the field, with consensus among the judges in the second evaluation.

RESUMEN Objetivos: desarrollar y validar algoritmo para orientar profesionales en la limpieza y desinfección de ambulancia tras transferencia de paciente con enfermedades transmisibles. Métodos: estudio realizado entre septiembre y noviembre de 2021. El algoritmo desarrollado fue validado por 104 jueces, incluyendo enfermeros, fisioterapeutas y médicos que asisten a pacientes con enfermedades transmisibles. Utilizada técnica Delphi e índice de validez de contenido. Resultados: en la primera evaluación, los jueces consideraron el algoritmo entre "inadecuado" y "totalmente adecuado". El algoritmo revisado conforme sugestiones de los jueces fue clasificado entre "adecuado" y "totalmente adecuado" en la segunda evaluación. El índice de validez de contenido general fue de 0,960 y 0,998 en la primera y segunda evaluación, respectivamente. Conclusiones: el algoritmo para orientar en la limpieza y desinfección de ambulancia tras transferencia de paciente con enfermedades transmisibles fue construido y validado por especialistas en el área, habiendo consenso entre los jueces en la segunda evaluación.

RESUMO Objetivos: desenvolver e validar um algoritmo para orientar profissionais na limpeza e desinfecção de ambulância após transferência de paciente com doenças infectocontagiosas. Métodos: estudo realizado entre setembro e novembro de 2021. O algoritmo desenvolvido foi validado por 104 juízes, incluindo enfermeiros, fisioterapeutas e médicos que prestam assistência aos pacientes com doenças infectocontagiosas. Utilizaram-se a técnica Delphi e o índice de validade de conteúdo. Resultados: na primeira avaliação, o algoritmo foi considerado pelos juízes entre "inadequado" e "totalmente adequado". O algoritmo revisado segundo as sugestões dos juízes foi classificado entre "adequado" e "totalmente adequado" na segunda avaliação. O índice de validade de conteúdo geral foi de 0,960 e 0,998 na primeira e segunda avaliação, respectivamente. Conclusões: o algoritmo para orientar na limpeza e desinfecção de ambulância após transferência de paciente com doenças infectocontagiosas foi construído e validado por especialistas na área, havendo consenso entre os juízes na segunda avaliação.

Estresse ocupacional em nutricionistas atuantes na área de alimentação coletiva / Occupational stress in nutritionists working in the área of colletctive food / Estrés laboral em nutricionistas que trabajan em el área de alimentación colectiva

Objetivo: identificar o nível de estresse ocupacional de nutricionistas atuantes na alimentação coletiva. Método: estudo transversal e quantitativo realizado com nutricionistas da área de alimentação coletiva, de ambos os sexos. Os dados foram obtidos por meio da aplicação de questionário online, auto preenchido pelo voluntário. Resultados: verificou-se nível moderado e alto de estresse nos nutricionistas estudados. Esses resultados são preocupantes, sendo necessário ações aliadas a programas de prevenção. Os principais estressores são: deficiência nos treinamentos e pouca perspectiva de crescimento na carreira. A variável estresse apresentou associação estatística com as variáveis filhos (p=0,0152) e renda mensal (p=0,0387). Conclusão: torna-se fundamental consolidar ações de intervenções visando prevenir e minimizar tal resultado, por meio de ações de orientação no processo de formação ao ingressar na organização bem como no desenvolvimento de habilidades de enfrentamento.

Objective: to identify the level of occupational stress of nutritionists working in collective feeding. Method: cross-sectional and quantitative study carried out with nutritionists in the área of collective feeding, of both sex. Data were obtained through the application of an online questionnaire, self-completed by the volunteer. Results: moderate and high levels of stress were found in the nutritionists studied. These results are worrying, requiring actions combined with prevention programs. The main stressors are: deficiency in training and little prospecto f career growth. The stress variable showed a statistical association with the child variables (p=0.0152) and monthly income (p=0.0387). Conclusion: it becomes essential to consolidate intervention actions aimed at preventing and minimizing this result, through guidance actions in the training process when joining the organization as well as in the development of coping skills.

Objetivo: identificar el nivel de estrés laboral de nutricionistas que trabajan en alimentación colectiva. Método: estudio transversal y cuantitativo realizado con nutricionistas del área de alimentación colectiva, de ambos sexos. Los datos se obtuvieron mediante la aplicación de un cuestionario em línea, autocompletado por el voluntario. Resultados: se encontraron niveles moderados y altos de estrés em los nutricionistas estudiados. Estos resultados son preocupantes, requiriendo acciones combinadas con programas de prevención. Los principales factores de estrés son: deficiencia em la formación y pocas perspectivas de crecimiento profesional. La variable estrés mostro asociación estadística com las variables hijo (p=0,0152) e ingresso mensual (p=0,0387). Conclusión: se hace imprescindible consolidar acciones de intervención encaminadas a prevenir y minimizar este resultado, a través de acciones de orientación en el proceso de formación al ingresso a la organización así como em el desarrollo de habilidades de afrontamiento.

Total electric field intensity in workplace of high-voltage direct current converter stations / 环境与职业医学

Background The converter stations of high-voltage direct current (HVDC) transmission lines generate special total electric fields. At present, few investigations have been conducted on total electric fields in the workplace of converter stations from an perspective of occupational health. Objective To understand the current situation of total electric field strength in the workplace of converter stations. Methods Using purposive sampling, a calibrated HDEM-1 direct current (DC) total electric field strength measurement system was used to measure the total electric fields of 12 converter stations serving 6 DC lines in Southeast and Southwest China according to the Measurement method for total electric field strength and ion current density of the converter stations and DC transmission lines (DL/T 1089—2008). The results were evaluated according to occupational exposure limits recommended by The limits of electromagnetic environment at ±800 kV UHV DC converter station (DL/T 275—2012), the American Conference of Governmental Industrial Hygienists (ACGIH), and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Results A total of 615 check points were planned, the total electric field strength was 0.05-37.05 kV·m−1, and the median was 10.45 kV·m−1. The total electric field strength of 39 check points (6.3%) exceeded 25 kV·m−1 (the limits of ACGIH and ICNIRP), and the total electric field strength of 12 check points (2.0%) exceeded 30 kV·m−1 (the limit of DL/T 275—2012). There were statistically significant differences in the total electric field strength values and the proportions of exceeding 25 kV·m−1 between the neutral regions and the positive regions and between the neutral regions and the negative regions (P < 0.01). The proportion of total electric field strength exceeding 30 kV·m−1 in the negative regions was higher than that in the positive regions (P < 0.01). There were no significant differences in the total electric field strength of converter stations at different voltage levels and different altitudes (P > 0.05). There were no significant differences in the proportions of total electric field exceeding 25 kV·m−1 and exceeding 30 kV·m−1 in converter stations at different voltage levels and different altitudes (P > 0.05). Conclusion The total electric field in some workplace of converter stations exceeds selected limits. Converter station operators may be exposed to high-strength total electric field for a short time.

The investigation and analysis of eye lens dose to interventional radiology workers in China from 2019 to 2021 / 中华放射医学与防护杂志

Objective:To investigate and analyze the eye lens dose to interventional radiology workers in China from 2019 to 2021.Methods:The monitoring data on eye lens dose to interventional radiology workers from 31 province-level units during 2019-2021 were collected through the National Radiological Health Information Platform. The eye lens dose evaluation indicator was Hp(3), with each monitoring period of no more than 3 months. Kusall-Wallis H test was used for the comparison of multiple groups and pairwise. Results:A total of 6 643 interventional radiology workers were investigated from 2019 to 2021. The average annual eye lens dose was 1.03 mSv, with the median of 0.17 mSv and the maximum of 94.88 mSv. The annual eye lens dose to 59 workers exceeded 20 mSv. It was also found that the annual eye lens dose to the doctors in 2019 and 2020 was slightly higher than that to nurses (rank mean difference=118.29, 129.71, P<0.01), and the lens dose to interventional radiology workers who performed cardiac interventions in 2019 was higher than that to workers who performed peripheral vascular interventions (rank mean difference=46.52, P<0.05). Conclusions:The lens dose to interventional radiology workers is lower than the limits given in Chinese national standard currently in effect, but exceed the latest internationally recommended limit for a few ones. In order to protect the occupational health of interventional radiology workers, the monitoring of lens dose should be strengthened.

Factors influencing the levels of occupational exposure in medical radiation workers in China, 2021 / 中国辐射卫生

Objective To analyze the factors influencing the levels of occupational exposure in medical radiation workers in China, and to provide a scientific basis for determining the key points of radiation protection in the medical sector. Methods The individual monitoring data on occupational external exposure in medical radiation workers in 2021 were collected from the “National Individual Dose Registry”. The Chi-squared test and logistic regression were used to analyze the factors influencing the levels of occupational exposure in medical radiation workers. Results The Chi-squared test showed that gender, occupational category, medical institution category, region, number of radiation workers per thousand population, and regional per capita GDP were significantly associated with occupational exposure in medical radiation workers exceeding the annual effective dose of 5 mSv and an annual effective dose limit of 20 mSv (χ2 = 21.456−262.329, 7.601−78.650, P < 0.05). The logistic regression analysis further showed that gender, occupational category, region, and number of radiation workers per thousand population were factors influencing the occupational exposure in medical radiation workers exceeding the annual effective dose of 5 mSv (χ2 = 14.621−170.857, P < 0.05); gender, occupational category, region, and regional per capita GDP were factors influencing the occupational exposure in medical radiation workers exceeding the annual effective dose of 20 mSv (χ2 = 5.401−48.709, P < 0.05). Conclusion Male radiation workers in interventional radiology and in central China have high risks of exceeding annual effective doses of 5 and 20 mSv. Moreover, high number of radiation workers per thousand population and regional per capita GDP are associated with low risks. Medical institutions should maintain a sufficient number of radiation workers and strengthen training on radiation protection knowledge for male and interventional radiology workers to enhance their radiation protection awareness. Investigation of the factors contributing to the high occupational exposure in central China should be intensified, and targeted effective measures should be conducted to reduce the occupational exposure in medical radiation workers.

Analysis on the characteristics and liver function of occupational hepatotoxicants exposed population / 中国职业医学

Objective To investigate the characteristics and liver function of the population with occupational exposure to hepatotoxicants. Methods A total of 17 093 workers with occupational hepatotoxicants exposure who underwent occupational medical examination during their employment in a occupational medical examination institution of Shanghai in 2021 were selected as the research subjects by judgement sampling method. Occupational medical examination data were collected, and the prevalence of abnormal liver function and fatty liver were analyzed. The association between hepatotoxicants exposure and abnormal liver function were analyzed. Results The median and the 0th-100th percentiles of the duration of exposure to hepatotoxicants was 6.5(1.0-42.0) years. The prevalence of fatty liver was 48.4% and the incidence of abnormal liver function was 23.7%. Among the workers with fatty liver, the prevalence of abnormal liver function was higher in workers exposed to metals, metalloids and their compounds than in unexposed workers (33.9% vs 30.0%, P<0.01). The results of multivariate logistic regression analysis demonstrated that the risk of abnormal liver function increased with the number of different hepatotoxicants mixed exposures (all P<0.01), after correcting for confounding factors including gender, age, years of exposure, marital status, drinking, hypertension, fatty liver and blood sugar. Conclusion Exposure to hepatotoxicants is a risk factor for abnormal liver function. The more diverse types of hepatotoxicants an individual is exposed to, the stronger the association with this risk.

Research progress on occupational exposure to carbon nanotubes and carbon nanotubes-induced pulmonary fibrosis / 中国职业医学

Carbon nanotube (CNT), as a new nanomaterial, is widely used in commercial and industrial production. The occupational exposure of workers involved in CNT production and manufacturing is gradually increasing. CNT mainly enters the human body through the respiratory system, and mainly exerts toxic effects on the respiratory system, including decreased lung function, lung inflammation, and pulmonary fibrosis. Pulmonary fibrosis, as one of the important diseases caused by CNT exposure, has attracted attention and been studied. The process of pulmonary fibrosis induced by CNT has four stages: acute pulmonary inflammatory response, structural destruction and parenchymal injury of lung tissue, impaired lung tissue repair and pulmonary fibrosis. The molecular mechanisms of CNT induced pulmonary fibrosis may be related to cell proliferation, epithelial-mesenchymal transition, fibroblast-myofibroblast differentiation, pulmonary inflammation, immune response and oxidative stress. In the future, it is needed to explore the pathogenesis of pulmonary fibrosis caused by CNT through animal experiments, and carry out large sample and multi-center epidemiological studies for verification.

Visual analysis of occupational health and safety research among medical staff / 中国职业医学

Objective: To study the current status, hotspots and frontiers in the field of occupational health and safety (OHS) research among medical staff. Methods: A comprehensive search on OHS of domestic and international literature on medical staff was conducted using the China National Knowledge Infrastructure and Web of Science databases from 2002 to 2022. The collected literature was subjected to bibliometric analysis and visualized using CiteSpace 6.1.R6 software. Results: A total of 5 858 articles related to medical personnel OHS comprising 2 144 Chinese articles and 3 714 English articles, were included. The publication of Chinese articles showed an initial increase followed by a decline, while English articles exhibited a sustained increase followed by a sudden decline. Domestic research mainly focused on hospitals and academic institutions, with few collaboration between institutions and regions in China. Research abroad demonstrated strong collaboration and exchange between countries and institutions. The OHS related research hotspots were occupational exposure, occupational health, and occupational safety of medical personnel at home and abroad. The key department of interest was operating rooms, and the key group personnel was nurses. Advanced research in foreign countries has extended to fields such as personal protective equipment and medical personnel sleep issues. Conclusion: There is still a gap on OHS research among medical staff between China and foreign countries. Domestic scholars need to grasp the academic frontiers, strengthen collaboration and exchange among domestic institutions, regions, and international counterparts, enlarge the research scope and content to ensure the OHS of medical personnel.

A survey on the prevalence and associated factors of arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province, China / 中华皮肤科杂志

Objective:To investigate epidemiological characteristics of arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province.Methods:A cross-sectional study was conducted. From October 2016 to January 2017, all residents aged over 18 years (except pregnant women) were enrolled from 3 villages in Baiyun Town, Shimen County, Hunan Province by using a cluster-sampling method. Demographic information was collected through a face-to-face questionnaire interview. All residents received skin examination performed by professional dermatologists, and blood, urine, and hair samples were collected for the measurement of arsenic levels. Non-conditional logistic regression analysis was performed to analyze factors associated with arsenic poisoning-related skin lesions.Results:A total of 1 092 eligible residents in the arsenic tailing area were recruited in this study, and 756 (69.2%, 95% CI: 66.5%, 72.0%) presented with arsenic poisoning-related skin lesions, including hyperkeratosis, hypo- or hyper-pigmentation. The median ( Q1, Q3) arsenic levels were 0.31 (0.14, 0.74) μg/g in hair samples ( n = 1 079), 0.84 (0.67, 1.10) μg/L in blood samples ( n =1 091), and 60.31 (41.71, 91.52) μg/L in urine samples ( n =1 092). Multivariable analysis showed that the occurrence of arsenic poisoning-related skin lesions was associated with age, residential location, and occupational arsenic exposure history, but was not associated with gender, ethnicity, education levels, migration history, arsenic levels in hair, blood, or urine. Compared with the group aged 18 - 39 years, the group aged 40 - 59 years and the group aged over 60 years showed significantly higher risks of arsenic poisoning-related skin lesions (adjusted OR = 11.34, 95% CI: 5.98, 21.50, P < 0.001; adjusted OR = 71.82, 95% CI: 35.81, 144.05, P < 0.001, respectively). Compared with the residents in the Wangyangqiao village, residents in the Heshan village and Huangchang village showed significantly higher risks of arsenic poisoning-related skin lesions (adjusted OR = 2.89, 95% CI: 2.05, 4.08, P < 0.001; adjusted OR = 4.13, 95% CI: 1.94, 8.78, P < 0.001, respectively). The risk of arsenic poisoning-related skin lesions was significantly higher in residents with occupational exposure history than in those without (adjusted OR = 1.99, 95% CI: 1.04, 3.83, P = 0.039) . Conclusion:Nearly 70% of the residents presented with arsenic poisoning-related skin lesions in an arsenic tailing area in Hunan Province, and the duration and previous degree of arsenic exposure were associated with the risk of arsenic poisoning-related skin lesions.

Paternal occupational exposures and infant congenital heart defects in the Japan Environment and Children's Study

BACKGROUND@#Few prospective studies have investigated the association between paternal occupational exposures and risk of infant congenital heart defects (CHDs). We investigated the associations between paternal occupational exposures, frequency of use, and concurrent or sequential exposure to a mixture of compounds and the risk of infant CHDs.@*METHODS@#Our study examined 28,866 participants in the Japan Environment and Children's Study. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associated with paternal occupational exposures during the 3 months until pregnancy was noticed after adjustment for potential confounding factors of the infant CHDs. CHD diagnosis was ascertained from medical record.@*RESULTS@#In total, 175 were diagnosed with infant CHDs. The number of fathers who were exposed to the following substances at least once a month were: 11,533 for photo copying machine/laser printer, 10,326 for permanent marker, 8,226 for soluble paint/inkjet printer, 6,188 for kerosene/petroleum/benzene/gasoline, 4,173 for organic solvents, 3,433 for chlorine bleach/germicide, 2,962 for engine oil, 2,931 for insecticide, 2,460 for medical sterilizing disinfectant, 1,786 for welding fumes, 1,614 for dyestuffs, 1,247 for any products containing lead-like solder, 986 for herbicide, 919 for radiation/radioactive substances/isotopes, 837 for lead-free solder, 341 for microbes, 319 for formalin/formaldehyde, 301 for agricultural chemical not listed above or unidentified, 196 for general anesthetic for surgery at hospital, 171 for anti-cancer drug, 147 for chromium/arsenic/cadmium, 88 for mercury and 833 for other chemical substances. Paternal occupational exposure regularly to photo copying machine or laser printer and soluble paint/inkjet printer were associated with higher risks of infant CHDs: the adjusted ORs (95%CIs) were 1.38 (1.00-1.91) and 1.60 (1.08-2.37), respectively. The higher risks were also observed for occasional exposure to engine oil, any products containing lead-like solder lead-free solder, and microbes; the adjusted ORs (95%CIs) were 1.68 (1.02-2.77), 2.03 (1.06-3.88), 3.45 (1.85-6.43), and 4.51, (1.63-12.49), respectively.@*CONCLUSIONS@#Periconceptional paternal occupational exposure was associated with a higher risk of infant CHDs. Further studies using biomarkers of the association between paternal occupational exposure and infant CHDs are warranted.

Benchmark Dose Assessment for Coke Oven Emissions-Induced Mitochondrial DNA Copy Number Damage Effects / 生物医学与环境科学（英文）

OBJECTIVE@#The study aimed to estimate the benchmark dose (BMD) of coke oven emissions (COEs) exposure based on mitochondrial damage with the mitochondrial DNA copy number (mtDNAcn) as a biomarker.@*METHODS@#A total of 782 subjects were recruited, including 238 controls and 544 exposed workers. The mtDNAcn of peripheral leukocytes was detected through the real-time fluorescence-based quantitative polymerase chain reaction. Three BMD approaches were used to calculate the BMD of COEs exposure based on the mitochondrial damage and its 95% confidence lower limit (BMDL).@*RESULTS@#The mtDNAcn of the exposure group was lower than that of the control group (0.60 ± 0.29 vs. 1.03 ± 0.31; P < 0.001). A dose-response relationship was shown between the mtDNAcn damage and COEs. Using the Benchmark Dose Software, the occupational exposure limits (OELs) for COEs exposure in males was 0.00190 mg/m 3. The OELs for COEs exposure using the BBMD were 0.00170 mg/m 3 for the total population, 0.00158 mg/m 3 for males, and 0.00174 mg/m 3 for females. In possible risk obtained from animal studies (PROAST), the OELs of the total population, males, and females were 0.00184, 0.00178, and 0.00192 mg/m 3, respectively.@*CONCLUSION@#Based on our conservative estimate, the BMDL of mitochondrial damage caused by COEs is 0.002 mg/m 3. This value will provide a benchmark for determining possible OELs.

Guideline for the prevention and control of occupational exposure risks to cytotoxic drugs in medical institutions / 中国药房

To provide prevention and control strategies of occupational exposure risks to cytotoxic drug in medical institutions， improve the awareness of protection among medical staff，and reduce potential occupational exposure risks，the Guidelines for the Prevention and Control of Occupational Exposure Risk to Cytotoxic Drugs in Medical Institutions is developed. Based on the World Health Organization Guidelines Development Manual，the exposure risk issues of the cytotoxic drug collected from the time that it entered the hospital to the several stages after delivery to hospital，such as transportation，receipt，storage，unpacking，dispensing，use of finished products，and waste disposal. Delphi method is used to construct identification of clinical issues，and evidence-based research method is used to develop relevant evidence. Quality evaluation is conducted by using the recommended GRADE method. The consensus is reached on the recommendation opinions and evidence levels through expert consensus method. By combining engineering controls，administrative controls and personal protective equipment at different levels，a graded control approach is established. A total of 37 clinical issues are identified，resulting in 36 recommendations. This guideline provides reference and supplementation for the formulation of cytotoxic drug prevention and control measures in medical institutions.