Application of the ALARA principle for radon at work: feedback from the European ALARA network.

The Council Directive 2013/59/Euratom has introduced binding requirements for the management of radon in the workplace in Member States of the European Union. How does it work in practice? In 2021, the European ALARA Network created a working group on ALARA for Radon at Work with the objective of collecting and sharing experiences from the field. A survey was developed to detail each step of the national regulations for the control of radon and to describe case studies showing implementation. This article presents a qualitative analysis of the answers received from seven countries. There are no two similar national regulations and, at each step, different provisions, protocols, techniques etc are applicable or recommended. This diversity contributes to the richness of the results and can inform about interesting and good practices, where 'good' is defined by what is appropriate in the nationally and locally prevailing circumstances. All national regulations follow a graded approach, which is a key component for the implementation of the optimisation (ALARA) principle, yet several potential weak points that may be challenging to ALARA have been identified and are discussed, namely the radon risk assessment, the focus on numerical values, uncertainties in the measurement, how to obtain economically efficient remediation, and the interface with other regulations. Strengthening collaboration between risk prevention and radiation protection actors could help to provide and build expertise on radon management in the workplace, especially when exposure is managed as a planned exposure situation.

Factores asociados a la calidad de la atención en población adulta afiliada a la Seguridad Social: El caso peruano / Factors associated with the quality of care in the adult population affiliated to Social Security: the Peruvian case

Objetivo: Identificar factores asociados a calidad percibida de atención en la población adulta afiliada al Seguro Social en Salud (EsSalud). Material y métodos: Analizamos la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. La calidad percibida fue evaluada en consultorio externo, hospitalización y emergencias. Reportamos razones de medias ajustadas (RMa) estimadas mediante regresión de Poisson múltiple. Resultados: Estar empleado (RMa=0,98; IC95% 0,96-0,99), no conocer los servicios que brinda EsSalud (RMa=0,97; IC95% 0,95-1,00), no recibir información sobre los derechos como usuarios (RMa=0,95; IC95% 0,93-0,98), valorar como bajo el nivel de accesibilidad al EESS (RMa=0,97; IC95% 0,95-0,99) y no sentirse cómodo en el EESS al que acude (RM=0,92; IC95% 0,91-0,94) fueron factores asociados a menor puntaje de calidad percibida en consultorio externo. En hospitalización, tener entre 40-59 años (RMa=0,93; IC95% 0,88-0,97), contar con un índice de riqueza bajo (RMa=0,92; IC95% 0,87-0,97), no haber recibido información sobre los derechos como usuarios (RMa=0,90; IC95% 0,84-0,95) y no sentirse cómodos en el EESS (RMa=0,92; IC95% 0,89-0,96) se asociaron a menor puntuación de calidad. En emergencia, no sentirse cómodo en el EESS (RMa=0,89; IC95% 0,93-1,00) fue el único factor asociado a una menor puntuación de calidad percibida. Conclusiones: Identificamos factores relativos a los usuarios y a la oferta de servicios independientemente asociados a calidad percibida de atención, los cuales pueden ser considerados por los tomadores de decisiones para la mejor gestión de EsSalud.

Objetive: To identify factors associated with perceived quality of care in the adult population affiliated with Social Security Health (EsSalud) Material and methods: We analyzed the National Socioeconomic Survey of Access to Health of the EsSalud Insured. Perceived quality of health care was evaluated in ambulatory care, hospitalization and emergency medical services. We reported adjusted ratios of means (RMa) estimated by multiple Poisson regression. Results: Being employed (RMa=0.98; IC95% 0.96-0.99), not knowing the services provided by EsSalud (RMa=0.97; IC95% 0.95-1.00), not receiving information about right to health (RMa=0.95; IC95% 0.93-0.98), perceiving as low the level of accessibility to the health facility (RMa=0.97; IC95% 0.95-0.99) and not feeling comfortable in the health facility of EsSalud (RM=0.92;IC95% 0.91-0.94) were factors associated with lower scores of perceived quality in ambulatory care. In hospitalization, being between 40-59 years old (RMa=0.93; IC95% 0.88-0.97), having a low wealth index (RMa=0.92; IC95% 0.87-0.97), not having received information about right to health (RMa=0.90; IC95%0.84-0.95) and not feeling comfortable in the health facility of EsSalud (RMa=0.92; IC95% 0.89-0.96) were associated with lower quality score. In emergency, not feeling comfortable in the health facility of EsSalud (RMa=0.89; IC95% 0.93-1.00) was the only factor associated with a lower perceived quality score. Conclusions: We identified factors related to users and service offerings independently associated with perceived quality of care, which can be considered by decision makers for better management of EsSalud.

Health Survey in a Peruvian health system (ENSSA): design, methodology and general results.

OBJECTIVE: To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS: There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS: The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS: This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.

Health survey in a peruvian health system (ENSSA): design, methodology and general results / Encuesta de salud en un sistema sanitario peruano (ENSSA): diseño, metodología y resultados generales

ABSTRACT OBJECTIVE To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.

RESUMEN OBJETIVO Reportar el diseño, metodología y resultados iniciales de la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. MÉTODOS La Encuesta se ejecutó en los 24 departamentos del país. Los temas investigados fueron: características de la vivienda y miembros del hogar, educación, salud, empleo e ingreso y gastos del hogar. Se realizó un tipo de muestreo bi-etápico: la unidad primaria de muestreo estuvo conformada por conglomerados compuestos por una manzana dentro del ámbito de cobertura del centro asistencial; la unidad secundaria de muestreo fueron viviendas particulares donde habitaba al menos un asegurado a EsSalud. Se analizaron los datos de 62,659 afiliados y se muestran porcentajes ajustados por el factor de expansión. Para las comparaciones, se utilizó la prueba de chi-cuadrado. RESULTADOS Se entrevistaron 25000 viviendas, encuestándose a 79,874 personas, de las cuales 62,659 eran afiliados a EsSalud. Los afiliados son principalmente varones (50.6%) con un nivel de educación técnico superior (39.7%). La población afiliada cuenta mayoritariamente con vivienda independiente (95.0%) y propia (68.1%). Solo el 34.5% de los asegurados practica algún deporte o ejercicio físico. El 14.0% de la población padece de alguna enfermedad crónica; el 3.5% presenta diabetes; y el 7.1%, hipertensión arterial. En los últimos tres meses, el 35.4% de los afiliados necesitaron atención médica; de estos, solo el 73.1% recibieron atención sanitaria y el 10.9% restante se atendieron en farmacias o servicios no formales de atención en salud. CONCLUSIONES Esta encuesta es la primera realizada en la población de afiliados a EsSalud, aplicada a nivel nacional, y cuenta con datos socioeconómicos y demográficos de los asegurados, su distribución, factores de riesgo de la salud, prevalencia de los problemas de salud y el grado de acceso a los servicios de salud.

A national survey on radon remediation in Switzerland.

We present and discuss the results of a national survey on radon remediation. The main purpose of the survey was to evaluate the rate of radon remediation in Switzerland and to identify the main reasons for not taking action in cases of high radon levels. Switzerland is strongly affected by radon problems and extensive efforts have been made to map the radon potential and to investigate the most effective methods to reduce radon levels in different buildings. However, since the radon remediation of buildings has been given over to experts in the private sector, and since there is no obligation to report a finished remediation to the authorities, it is difficult for the Federal Office for Public Health (FOPH) to track activities in this field. In order to improve this situation, the FOPH has launched a survey. We find a radon remediation rate of 46%. The most often applied method is aeration of the cellar and improvement in the tightness of floor slabs. The respondents indicate that concerns regarding the financial and/or invasive magnitude of the work are the most significant reasons for not taking action. We discuss the different outcomes of the survey in the three linguistic regions in Switzerland and identify aspects of our communication with the public, which should be improved in view of our findings.

A DISCUSSION ON DIFFERENT APPROACHES FOR ASSESSING LIFETIME RISKS OF RADON-INDUCED LUNG CANCER.

Lifetime risks of radon induced lung cancer were assessed based on epidemiological approaches for Canadian, Swiss and Chinese populations, using the most recent vital statistic data and radon distribution characteristics available for each country. In the risk calculation, the North America residential radon risk model was used for the Canadian population, the European residential radon risk model for the Swiss population, the Chinese residential radon risk model for the Chinese population, and the EPA/BEIR-VI radon risk model for all three populations. The results were compared with the risk calculated from the International Commission on Radiological Protection (ICRP)'s exposure-to-risk conversion coefficients. In view of the fact that the ICRP coefficients were recommended for radiation protection of all populations, it was concluded that, generally speaking, lifetime absolute risks calculated with ICRP-recommended coefficients agree reasonably well with the range of radon induced lung cancer risk predicted by risk models derived from epidemiological pooling analyses.

Reference values of olfactory function for Mexico City inhabitants.

BACKGROUND AND AIMS: Olfactory testing is useful in the differential diagnosis of age-related pathologies. To provide baseline reference values for clinical use in Mexico City we investigated the relation between olfactory capabilities and the principal population parameters of age, sex, and smoking habits in a large sample of healthy inhabitants. METHODS: We applied the internationally recognized and commercially available Sniffin' Sticks test battery to 916 men and women from across the adult life span. The Sniffin' Sticks test evaluates three key aspects of olfactory function: 1) ability to detect an odor, 2) to discriminate between odors, and 3) to identify odors. RESULTS: We found a significant decline in olfactory function from the 5th decade of age, and that detection threshold was the most sensitive measure of this. We did not find a significant difference between men and women or between smokers and non-smokers. In confirmation of our previous studies of the negative effect of air pollution on olfactory function, Mexico City inhabitants had poorer overall performance than corresponding subjects previously tested in the neighboring but less polluted Mexican state of Tlaxcala. CONCLUSIONS: Although we basically confirm findings on general demographic patterns of olfactory performance from other countries, we also demonstrate the need to take into account local cultural, environmental and demographic factors in the clinical evaluation of olfactory performance of Mexico City inhabitants. The Sniffin' Sticks test battery, with some adjustment of stimuli to correspond to Mexican culture, provides an easily administered means of assessing olfactory health.

Major influencing factors of indoor radon concentrations in Switzerland.

PURPOSE: In Switzerland, nationwide large-scale radon surveys have been conducted since the early 1980s to establish the distribution of indoor radon concentrations (IRC). The aim of this work was to study the factors influencing IRC in Switzerland using univariate analyses that take into account biases caused by spatial irregularities of sampling. METHODS: About 212,000 IRC measurements carried out in more than 136,000 dwellings were available for this study. A probability map to assess risk of exceeding an IRC of 300 Bq/m(3) was produced using basic geostatistical techniques. Univariate analyses of IRC for different variables, namely the type of radon detector, various building characteristics such as foundation type, year of construction and building type, as well as the altitude, the average outdoor temperature during measurement and the lithology, were performed comparing 95% confidence intervals among classes of each variable. Furthermore, a map showing the spatial aggregation of the number of measurements was generated for each class of variable in order to assess biases due to spatially irregular sampling. RESULTS: IRC measurements carried out with electret detectors were 35% higher than measurements performed with track detectors. Regarding building characteristics, the IRC of apartments are significantly lower than individual houses. Furthermore, buildings with concrete foundations have the lowest IRC. A significant decrease in IRC was found in buildings constructed after 1900 and again after 1970. Moreover, IRC decreases at higher outdoor temperatures. There is also a tendency to have higher IRC with altitude. Regarding lithology, carbonate rock in the Jura Mountains produces significantly higher IRC, almost by a factor of 2, than carbonate rock in the Alps. Sedimentary rock and sediment produce the lowest IRC while carbonate rock from the Jura Mountains and igneous rock produce the highest IRC. Potential biases due to spatially unbalanced sampling of measurements were identified for several influencing factors. CONCLUSIONS: Significant associations were found between IRC and all variables under study. However, we showed that the spatial distribution of samples strongly affected the relevance of those associations. Therefore, future methods to estimate local radon hazards should take the multidimensionality of the process of IRC into account.

Sintomatología persistente en trabajadores agrícolas expuestos a plaguicidas órgano-fosforados / Persistent symptoms in agricultural workers exposed to organophosphate pesticides

Objetivo: evaluar la prevalencia de estos síntomas y analizar su relación con la exposición a plaguicidas y el nivel de colinesterasa en trabajadores agrícolas. Metodología: se realizó un estudio transversal analítico con 106 jornaleros en un campo agrícola en México. Se determinó el nivel decolinesterasa y los síntomas según la exposición. La exposición se delimitó con un índice constituido por 15 variables. Resultados: la prevalencia de síntomas fue de 52 por cada 100 trabajadores. 31% refirió de 1 a 3, 16% de 4 a 9 síntomas y el 5% presentó más de 10. Hubo asociaciónentre días de exposición y síntomas persistentes p = 0.03.También entre nivel de exposición y presencia de síntomas probables y específicos. Los más expuestos tuvieron una probabilidad 20% mayor de tener síntomas. La concentraciónde colinesterasa estuvo dentro de rangos normales. Se detectó anemia en el 28% de la población. Esta fue tresveces más frecuente en las mujeres p < 0,001. Conclusiones: en este grupo fue posible identificar el aumento de síntomas persistentes en jornaleros con niveles de colinesterasa dentro derangos habitualmente considerados normales.

Objective: to evaluate the prevalence of these symptoms and their relationship with pesticide exposure and the cholinesterase levels in agricultural workers. Methodology: an analyticalcross-sectional study conducted in Mexico. Cholinesterase concentration and symptom frequency were assessed for 106 agricultural workers. Exposure was defined with a composed index of 15 variables. Results: symptom prevalence was 52 out of 100 workers. 31% of workers had 1 to 3 of thesymptoms, 16% had 4 to 9 of them and 5% had 10 or more of the symptoms. There was an association, p = 0.03, between days of exposure and persistent symptoms. Likewise, therewas an association between exposure level and the presence of probable and specific symptoms. Patients with the highest exposure level had 20% more chances of exhibiting symptoms.Cholinesterase concentration ranges were normal. Anemia was detected in 28% of the population. It was three times as frequent in females as in males (p < 0.001). Conclusions: it was possible to identify the increase of persistent symptoms in workers with cholinesterase levels that are usually considered to be normal.