Alerta Epidemiológica: COVID-19 en personal de salud - 31 de agosto de 2020 / Epidemiological Alert: COVID-19 in health personnel - August 31, 2020

Ante el incremento de casos y defunciones por COVID-19 en personal de salud de los países y territorios de la Región de las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) a través de esta alerta insta a los Estados Miembros a fortalecer las capacidades de los servicios de salud en todos sus niveles y mantener a los profesionales de salud dotados de los recursos y capacitación, asegurando una respuesta adecuada y oportuna de los sistemas de salud ante la pandemia.

La infección cadavérica en Chile, muerte en el anfiteatro anatómico / The cadaverous fever in Chile, death in the anatomical amphitheater

Resumen La infección cadavérica es una entidad nosológica poco conocida y que afectaba a los disectores en la práctica y enseñanza de la anatomía. La disección de cadáveres supone riesgos como la ocurrencia de heridas corto-punzantes causantes de infecciones e incluso la muerte asociadas a la manipulación de los mismos. La presente investigación nace por el relato sobre un alumno herido en el pabellón de disección en 1937 en el Instituto de Anatomía de la Universidad de Chile. Se indagaron los antecedentes históricos asociados al fallecimiento de alumnos en la práctica habitual con cadáveres, a través de escritos y relatos desde los inicios de la docencia anatómica en Chile, en 1833. Se relatan las condiciones que han modificado la epidemiología de esta afección, según los avances médicos. Por lo anterior, se concluye que la designación de un disector, el uso de productos desinfectantes y guantes, además del avance en el uso de productos de conservación cadavérica han disminuido drásticamente el riesgo biológico de adquirir alguna infección por el contacto con cadáveres para disección de uso docente.

Cadaverous infection is a little-known nosological entity that affected the dissectors in the practice and teaching of anatomy, since working on the dissection of cadavers entails risks in relation to the occurrence of sharps injuries that produce infections and even death associated with the manipulation of them. The present investigation is motivated by a story about a student who was injured in the dissemination ward in 1937 at the Institute of Anatomy of the U. of Chile. Historical background is investigated associated to the death of students in the usual practice with cadavers through writings and stories since the beginning of the anatomical teaching in Chile since 1833, identifying the conditioning factors that modify the epidemiology of this condition according to medical advances. Therefore, it is concluded that the designation of a dissector, the use of disinfectants and gloves, as well as the advance in the use of cadaveric preservation products, drastically reduce the biological risk of acquiring an infection known as cadaverous in the permanent contact of the students with cadaverous material for dissection of teacher use.

Experiência de vigilância no setor canavieiro: desafios para interromper a "maratona" perigosa dos canaviais / Surveillance experience in the sugarcane sector: challenges in disrupting the perilous "marathon" of the sugarcane plantations

O setor sucroalcooleiro cresce anualmente com participação expressiva do estado de São Paulo que concentra atualmente cerca de 42,9 % das usinas do país. A cadeia produtiva é objeto de preocupação de órgãos públicos e da sociedade civil por expor trabalhadores migrantes a riscos decorrentes do processo de trabalho. Em São Paulo, de 2006-2009, a Vigilância em Saúde do Trabalhador construiu duas iniciativas para enfrentar problemas relacionados às condições de trabalho e moradia de trabalhadores da cana. O objetivo do artigo apresentado na modalidade de ensaio é analisar as experiências em seu contexto. O método usado associa análise documental à percepção dos autores que participaram das ações. As experiências possibilitaram melhorias nessas condições e início de debate público sobre as condições do trabalho exaustivo. As intervenções resultaram na definição de normas sanitárias e iniciativas no nível legislativo e judiciário, mas mesmo aquelas mais exitosas não conseguiram alcançar os determinantes organizacionais, especialmente a remuneração por produção, que desafia a ação tradicional de vigilância e tem seus impactos agravados pela fragilidade da representação dos trabalhadores.

The sugar-alcohol sector is growing year by year, especially in the state of Sao Paulo where approximately 42.9% of the sugar-ethanol plants are concentrated. The production chain is a subject for concern to public agencies and to civil society by exposing migrant workers to risks arising from the work process. In Sao Paulo, from 2006-2009, Occupational Health Surveillance (VISAT) set up two initiatives to address problems related to the housing and working conditions of sugarcane workers. The objective of this article presented in the form of an essay is to analyze the experiences in their context. The methodology used combines document analysis with the perception of the authors who participated in the actions. The experience led to improvements in these conditions and fostered public debate on the conditions of such physically demanding work. The interventions resulted in a definition of sanitary norms and initiatives at the legislative and judicial level, but even the most successful measures failed to attain the organizational targets, especially a production remuneration structure that challenges the traditional action of surveillance and the impacts were weakened due to the fragility of worker representation for the sector.

Radiation Exposure and Cancer Mortality Among Nuclear Power Plant Workers: a Meta-analysis / 예방의학회지

OBJECTIVES: We conducted a meta-analysis to investigate the relationship between low external doses of ionizing radiation exposure and the risk of cancer mortality among nuclear power plant workers. METHODS: We searched MEDLINE using key words related to low dose and cancer risk. The selected articles were restricted to those written in English from 1990 to January 2009. We excluded those studies with no fit to the selection criteria and we included the cited references in published articles to minimize publication bias. Through this process, a total of 11 epidemiologic studies were finally included. RESULTS: We found significant decreased deaths from all cancers (SMR = 0.75, 95% CI = 0.62 - 0.90), all cancers excluding leukemia, solid cancer, mouth and pharynx, esophagus, stomach, rectum, liver and gallbladder, pancreas, lung, prostate, lymphopoietic and hematopoitic cancer. The findings of this meta-analysis were similar with those of the 15 Country Collaborative Study conducted by the International Agency for Research on Cancer. A publication bias was found only for liver and gallbladder cancer (p = 0.015). Heterogeneity was observed for all cancers, all cancers excluding leukemia, solid cancer, esophagus, colon and lung cancer. CONCLUSIONS: Our findings of low mortality for stomach, rectum, liver and gallbladder cancers may explained by the health worker effect. Yet further studies are needed to clarify the low SMR of cancers, for which there is no useful screening tool, in nuclear power plant workers.

Enfermedades profesionales: una aproximación a su frecuencia / Professional diseases: an approach to its frequency

En Chile se desconoce la magnitud de las enfermedades de causa laboral. En este estudio se realizó una estimación de la mortalidad e incidencia de estas enfermedades usando como parámetros de referencia fracciones atribuibles de mortalidad y tasas de incidencia obtenidas en la literatura. Los resultados muestran que se producirían, en el mejor de los escenarios, 3.778 muertes y 38.621 casos incidentes de enfermedades profesionales. Como es esperable, la mortalidad y morbilidad predominan en el sexo masculino. Las limitaciones son analizadas y se relacionan con la aplicabilidad de los parámetros usados a la realidad laboral del país y la inclusión de enfermedades para las cuales existía información disponible. Nuestros resultados confirman la importante carencia de datos en el país y la relevancia de estas entidades para los trabajadores y las empresas.

In Chile the magnitude of work-caused diseases is unknown. In this paper an estimate was made of the mortality rate and incidence of these diseases using as reference parameters attributable fractions of mortality rates and incidence rates obtained from literature. The results show that, in the best of scenarios, 3,778 deaths and 38,621incident cases of professional diseases would occur. As expected, mortality rate and morbidity prevail in the masculine gender. Limitations are analyzed and related with the applicability of parameters used to work reality of the country and the inclusion of diseases for which there was information available. Our results confirm the significant lack of data in the country and the relevance of these entities for workers and companies.

Occupational factors and mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer (JACC).

Occupational factors and mortality were assessed in the Japan Collaborative Cohort Study for evaluation of cancer. Overall an elevated risk of death from all causes, all cancers and circulatory disease, particularly in males, was found for those who were unemployed or to a lesser extent, self-employed. Certain cancers also showed links. There was no difference in the risk of total death or death due to cancers between office workers and manual workers. However, manual workers of both sexes have a decreased risk of death due to colon cancer and of breast in females. In males, rotating shift work increased risk of total death and ischemic heart diseases. Slight increase overall with dusty and noisy environments, perceived stress linked with IHD and CVD.

Nervous system cancer mortality in an industrialized area of Brazil 1980 - 1993

OBJECTIVES: The industrialization process and nervous system cancer (NSC) mortality in a urban region of Brazil. METHOD: From registries of the State System of Data Analysis Foundation (SEADE), 103 males deaths by NSC (ICD-9) in Baixada Santista (BS), from 1980 to 1993 were selected. Mortality ratios were calculated comparing the standardized mortality rate for ages over 10 years old (G1) and for the age group from 35 to 64 years old, in the industrialized and non-industrialized areas in three periods: 1980-1993, 1980-86, 1987-93. RESULTS: A statiscally significant high mortality was observed in the industrialized area, for ages over 10 in all periods and only from 1980 to 1993 for ages from 34 to 64. The highest mortality ratio occurred from 1980-86 for ages over 10 - 4.12 (CI 1.79-9.42). CONCLUSION: High mortality was probably related to the environmental and occupational exposure to many organic and inorganic chemical substances, considered carcinogenics, such as aliphatic and aromatic hydrocarbons, organochlorinated, formaldehyde, nitrogenated compounds and heavy metals, found in the port and industrial complex. We discuss the importance of case-control studies in characterizing the association of these and other risk factors in the determination of NSC.

Mortalidad en trabajadores siderúrgicos: estudio retrospectivo 1985-1994 / Mortality among steel workers: a 10 years follow up

Background: Some studies have reported an increased incidence of lung, kidney and colon cancer among steel workers, however this has not been an universal observation. Aim: To study the causes of death in a group of Chilean steel workers. Subjects and methods: Between January 1985 and December 1994, 4718 steel workers were followed. Their crude and standardized death rates, adjusted for age and diagnosis, were calculated. Results: During the study period 153 deaths were registered (3.2 percent), 78 in active workers (2.7 percent), 68 in retired workers (5.9 percent) and 7 in hired workers (1 percent). Main causes of death were liver cirrhosis (19 percent), gastric cancer (9.2 percent) and myocardial infarction (8.5 percent). Cirrhosis was the only cause with a significantly higher standardized adjusted rate (=171). Conclusions: We did not find elevated standardized mortality rates for respiratory diseases, lung or kidney cancer in this group of steel workers. Thus, our results did not show a specific occupational risk among these workers

Acidentes e doenças do trabalho no Estado da Bahia, de 1970 a 1992 / Labour accidents and occupational diseases in the state of Bahia from 1970 trough 1992

A ocorrência de acidentes e doenças do trabalho nas últimas duas décadas no Estado da Bahia, foi analisada com base em dados da Dataprev e IBGE. Observou-se uma diminuiçäo de oitenta e um por cento no número de acidentes do trabalho no período estudado, apesar do aumento da taxa de letalidade por acidente de 16/10.000(1970) para 226/10.000(1992). Isto deve significar uma evidência do sub-registro dos acidentes, principalmente dos menos severos. Setenta e três por cento das doenças do trabalho (1502 casos), nos últimos vinte e três anos, foram registrados a partir de 1988, quando iniciaram-se as atividades do Centro de Estudos de Saúde do Trabalhador-CESAT. Analisou-se ainda o padräo peculiar do Estado da Bahia quanto à concessäo dos benefícios por incapacidade permanente,que sugere grande restriçäo da concessäo do recém-extinto auxilio suplementar e do auxílio acidente. Finalmente, o estudo ressalta a necessidade da intensificaçäo das açöes de vigilância em saúde do trabalhador

Bronquitis industriales

La bronquitis industrial es un término recientemente introducido, pero poco utilizado relativamente desconocido. Su definición se refiere a aquellos pacientes que cumplen los criterios de bronquitis crónica con o sin obstrucción al flujo aéreo, no fumadores y que tienen como único antecedente la exposición industrial o ambiental. Con el desarrollo social, tecnológico y la creación de industrias, desde la época de la revolución industrial, el ser humano ha tenido que enfrentarse a un medio ambiente laboral polucionado, consecuentemente ha desarrollado enfermedades pulmonares. El impacto sobre el sistema respiratorio ha sido relevante y éste a su vez redunda en la reducción de la productividad. Para aplicar las medidas de prevención y control deben primero conocerse las entidades. Por ello la presente revisión.

Epidemiologia dos acidentes do trabalho fatais em área metropolitana da regiäo sudeste do Brasil, 1979-1989 / Epidemiology of fatal work accidents in a metropolitan area of Southeastern Brazil from 1979 to 1989

Foram localizados e analisados 476 prontuários de acidentes do trabalho fatais arquivados na Agência de Campinas do INSS, ocorridos nos Municípios de Campinas, Cosmópolis, Paulínia, Sumaré e Valinhos, Estado de Säo Paulo, Brasil, no período de 1979 a 1989. Mediante as informaçöes contidas na Comunicaçäo de Acidente de Trabalho (CAT), Boletim de Ocorrência (BO) e atestados de óbito, foram analisados os acidentes do trabalho segundo características das empresas, do acidentado e do acidente propriamente dito. Através dos dados disponíveis no Ministério do Trabalho/RAIS, sobre o número de trabalhadores registrados segundo ramo de atividade e ocupaçäo dos municípios, estimou-se o risco de acidente de trabalho. A Densidade de Incidência foi maior para os "carpinteiros" (94,3 óbitos por 100.000 trabalhadores/ano), seguida dos "condutores de veículo" (69,6) e "pedreiros" (63,3). Comparada aos "técnicos", estes profissionais têm de três a cinco vezes mais probabilidade de morrer em funçäo da atividade desempenhada (Razäo de Densidade de Incidência). A Construçäo Civil (22,1 por cento) e Transportes (14,9 por cento), sendo os ramos de atividade que mais contribuíram na mortalidade dos acidentados, apresentaram elevada Densidade de Incidência, de 59,8 e 57,3 óbitos por 100.000 trabalhadores/ano, respectivamente, se comparada ao do Comércio Varejista (9,4)