Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin.

OBJECTIVES: Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS: We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS: There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION: Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.

Ciberseguridad en servicios de apoyo al médico ocupacional de la ciudad de Lima. Estudio piloto / Cybersecurity in the support services to occupational physicians in the city of Lima. A pilot study

RESUMEN Recientes investigaciones destacan la importancia de la ciberseguridad en la creciente era digital. El 83% de las organizaciones han experimentado brechas de seguridad en el 2022, costándoles en promedio 4,35 millones de dólares americanos por incidente. En Perú, la ciberseguridad está regulada por diversas normas, estableciendo medidas de protección de datos y la seguridad informática. Objetivo Describir la situación de la ciberseguridad en los servicios de apoyo al médico ocupacional (SAMO). Material y métodos Se incluyeron 11 SAMO. Se elaboró un cuestionario no validado para recolectar la información consentida sobre la gestión de la ciberseguridad de los SAMO que brindaban servicio a un importante proyecto de construcción en Lima Metropolitana. Resultados La mayoría de los establecimientos de salud (más del 80%) tuvo planes de respuesta a incidentes de seguridad cibernética para garantizar una respuesta rápida ante un ataque cibernético; realizaban copias de seguridad de los datos críticos con regularidad y los almacenaban en un lugar diferente a establecimiento; y actualizaban regularmente los sistemas operativos y programas de softwares buscando asegurar que se utilizan versiones seguras. Conclusión Existe una gestión de la seguridad informática predominantemente reactiva. El reporte discute la importancia de la ciberseguridad, resaltando la exposición de la información médica y los servicios a riesgos cibernéticos y planteamos retos futuros para la ciberseguridad, subrayando la importancia de la preparación ante amenazas futuras en un entorno en constante transformación digital.

SUMMARY Recent investigations emphasize the importance of cybersecurity in the growing digital era; 83% of organizations experienced breaks in cyber security in 2022, spending a mean of 4,35 million dollars per incident. Cybersecurity in Peru is regulated by legal norms aimed at protecting data and providing informatic security. Objective To describe cybersecurity in the support services to occupational physicians (SSOP) in the city of Lima. Methods A non-validated survey was created and distributed to 11 SSOPs in Lima that provide a service to an important building project in Lima. Results More than 80% of health care establishments had a response plan against cybernetic attacks; security copies of the data were done regularly storing them in a different place than the establishment and regularly updated security software's. Conclusion The cybersecurity program is reactive. We discuss the importance of cybersecurity and analyze future challenges as well as emphasize the importance of preemptive preparedness in an environment of constant digital transformation.

A Epidemiologia e a área de Saúde do Trabalhador / Epidemiology and the area of Worker's Health

Resumo Este ensaio aborda a relação conflituosa entre o instrumental epidemiológico teórico e o aplicado nos serviços de saúde, incluindo as dificuldades em se apreender a determinação social ligada ao modelo neoliberal e às subjetividades do trabalhador no seu processo criativo de resistir ao modelo de exploração da força de trabalho, que caracteriza o atual mundo laboral. É apresentado e discutido o papel da Epidemiologia no âmbito dos marcos teóricos da relação entre saúde e trabalho a partir da década de 1970: Medicina do Trabalho, Saúde Ocupacional e Saúde do Trabalhador. Embora existam críticas, identificou-se avanço metodológico nas publicações até o início dos anos 2000, quando as pesquisas se voltaram para um instrumental mais conservador e insuficiente para contextualizar as determinações sociais do processo de trabalho. No Brasil, ainda que haja suporte legal, a operacionalização da Epidemiologia a serviço da Saúde do Trabalhador no Sistema Único de Saúde (SUS) ainda adota abordagens voltadas para mensuração de riscos. Tais abordagens se distanciam dos modelos que apreendem os reflexos da organização social, propostos por investigadores da América Latina, os quais ainda não se expressam nas publicações e nos serviços de Saúde do Trabalhador do Brasil.

Abstract This essay addresses the conflicting relation between the theoretical and applied epidemiological health services instruments, including the difficulties in apprehending the social determination linked to the neoliberal model and workers' subjectivities in their creative process of resisting the model of exploitation of their workforce that characterizes the current world of work. The role of Epidemiology in the following theoretical frameworks of the relations between health and work from the 1970s onward is described and discussed: Occupational Medicine, Occupational Health, and Worker's Health. Despite the criticisms, studies from the beginning of the 2000s showed methodological advances when research turned to a more conservative set of instruments that insufficiently contextualized the social determinations of the work process. Even with legal support in Brazil, the operationalization of Epidemiology at the service of Workers' Health in the Unified Health System still adopts approaches toward measuring risks. Such approaches lie far from the models that apprehend the reflexes of social organization proposed by researchers from Latin America, which are yet to be expressed in the studies and services of Worker's Health in Brazil.

Manifestaciones de trastornos musculoesqueléticos en moldeadores manuales metalúrgicos

Introducción: Los trastornos musculoesqueléticos en el contexto laboral metalúrgico repercuten negativamente desde la perspectiva personal, económica y social de los trabajadores. Objetivo: Identificar las manifestaciones de trastornos musculoesqueléticos en los moldeadores manuales metalúrgicos del área de fundición de la empresa Holmeca de la provincia Holguín, Cuba, en el período comprendido enero-marzo de 2021. Método: Se realizó un estudio observacional, no experimental de corte transversal en 19 moldeadores manuales metalúrgicos, en el que se incluyeron variables sociodemográficas, ubicación de zonas dolorosas, intensidad del dolor, tiempo de aparición y duración del trastorno. Se emplearon métodos teóricos, empíricos. Fue utilizado el Cuestionario Nórdico estandarizado de Kuorinka y la Escala Visual Analógica. El procesamiento de la información se llevó a cabo mediante la estadística descriptiva. Resultados: Se identificaron las zonas dolorosas y la prevalencia más alta de dolor musculoesqueléticos en: muñeca/mano (94,74 %), hombro (89,47 %), dorsal/lumbar (89,47 %) y codo/antebrazo (84,21 %). La intensidad del dolor fue determinada como intenso en el 36,84 % y moderado en el 42,11 % de los trabajadores; mientras que en el 21,05 % fue leve. El tiempo de padecimiento delos trastornos fue de 3-38 años,que aparecieron luego de 5 a 7 años de haber comenzado las labores en el área de estudio. Conclusiones: La prevalencia de manifestaciones de trastornos musculoesqueléticos en los moldeadores manuales metalúrgicos del área de fundición de la empresa Holmeca de Holguín es elevada. Se identifican en mano/muñeca, hombro, lumbar y codo/antebrazo, como las zonas anatómicas más afectadas en este grupo poblacional.

Introduction: Musculoskeletal disorders in the metallurgical work context have a negative impact from the personal, economic and social perspective of workers. Objective: To identify the manifestations of musculoskeletal disorders in metallurgical manual molders in the foundry area of the Holmeca company in the province of Holguín, Cuba, in the period from January to March 2021. Method: An observational, non-experimental study was carried out. cross-sectional study in 19 metallurgical manual shapers, which included sociodemographic variables, location of painful areas, pain intensity, time of onset and duration of the disorder. Theoretical and empirical methods were used. The standardized Kuorinka Nordic Questionnaire and the Visual Analog Scale were used. The information processing was carried out using descriptive statistics. Results: The painful areas and the highest prevalence of musculoskeletal pain were identified in: wrist/hand (94.74%), shoulder (89.47%), dorsal/lumbar (89.47%) and elbow/forearm (84.21%). The intensity of the pain was determined as intense in 36.84% and moderate in 42.11% of the workers; while in 21.05% it was mild. The duration of the disorders was 3-38 years, which appeared after 5 to 7 years after beginning work in the study area. Conclusions: The prevalence of manifestations of musculoskeletal disorders in metallurgical manual molders in the foundry area of the Holmeca company in Holguín is high. They are identified in the hand/wrist, shoulder, lumbar and elbow/forearm, as the anatomical areas most affected in this population group.

Introdução: As lesões osteomusculares no contexto do trabalho metalúrgico têm um impacto negativo na perspectiva pessoal, económica e social dos trabalhadores. Objetivo: Identificar as manifestações de distúrbios osteomusculares em moldadores manuais metalúrgicos da área de fundição da empresa Holmeca, na província de Holguín, Cuba, no período de janeiro a março de 2021. Método: Foi realizado um estudo observacional, não experimental. estudo transversal em 19 modeladores manuais metalúrgicos, que incluiu variáveis sociodemográficas, localização das áreas dolorosas, intensidade da dor, tempo de início e duração do distúrbio. Foram utilizados métodos teóricos e empíricos. Foram utilizados o Questionário Nórdico Kuorinka padronizado e a Escala Visual Analógica. O processamento das informações foi realizado por meio de estatística descritiva. Resultados: As áreas dolorosas e as maiores prevalências de dores musculoesqueléticas foram identificadas em: punho/mão (94,74%), ombro (89,47%), dorsal/lombar (89,47%) e cotovelo/antebraço (84,21%). A intensidade da dor foi determinada como intensa em 36,84% e moderada em 42,11% dos trabalhadores; enquanto em 21,05% foi leve. A duração dos distúrbios foi de 3 a 38 anos, surgindo após 5 a 7 anos após o início do trabalho na área de estudo. Conclusões: É elevada a prevalência de manifestações de distúrbios musculoesqueléticos em moldadores manuais metalúrgicos na área de fundição da empresa Holmeca em Holguín. São identificadas na mão/punho, ombro, lombar e cotovelo/antebraço, como as áreas anatômicas mais acometidas neste grupo populacional.

Lesiones en tejidos dentarios y trastornos de la salud bucal en el examen médico ocupacional de trabajadores del sector construcción de Lima, Perú / Lesions in dental tissues and oral health disorders in the occupational medical examination of workers in the construction sector in Lima, Peru / Lesões nos tecidos dentários e perturbações da saúde oral no exame médico ocupacional dos trabalhadores do sector da construção em Lima, Peru

RESUMEN Objetivo: Describir las lesiones en tejidos dentarios y trastornos de la salud bucal encontradas durante el examen médico ocupacional en trabajadores del sector construcción de Lima, Perú. Material y métodos: Estudio epidemiológico transversal realizado en 150 trabajadores del sector construcción, seleccionados mediante muestreo aleatorio simple. Se realizó una evaluación estomatológica mediante observación directa y se empleó un instrumento de evaluación odontológico-ocupacional con índices para caries dental, severidad de caries y traumatismos dentales e indicadores de consecuencias clínicas de caries no tratada (patología pulpar) y lesiones no cariosas. Resultados: La experiencia de caries de los operadores sin estudio superior (CPOD = 14,99) y con estudio superior (CPOD = 13,06) fue superior frente a los supervisores (CPOD = 8,23) y administrativos (CPOD = 5,08). Los trabajadores operadores sin estudio superior (SiC = 18,04) y con estudio superior (SiC = 17,17) presentaron peores indicadores de significancia de caries frente a los supervisores (SiC = 13,67) y administrativos (SiC = 8,25). Además, los operadores sin estudio superior presentaron mayor carga de consecuencias clínicas de caries no tratada (PUFA = 2,35; severidad = 9,2%) en comparación con los operativos con estudio superior (PUFA = 1,91; severidad = 8,4%), los supervisores (PUFA = 0,53; severidad = 2,1%) y los administrativos (PUFA = 0,46; severidad = 1,8%), así como mayor frecuencia de lesiones no cariosas (47,3 %) y traumatismos dentales (21,3 %). Conclusiones: La salud dental, sus consecuencias clínicas y la estructura de los tejidos dentarios de los trabajadores operativos de una empresa constructora se encuentran más afectadas en comparación con los otros grupos laborales de la misma empresa.

ABSTRACT Objective: To describe the lesions in dental tissues and oral health disorders found during the occupational medical examination of workers in the construction sector in Lima, Peru. Material and methods: A cross-sectional epidemiological study was carried out on 150 workers in the construction sector, selected by simple random sampling. A stomatological evaluation was carried out by direct observation, and a dental-occupational evaluation instrument was used with indexes for dental caries, caries severity and dental trauma, and indicators of clinical consequences of untreated caries (pulp pathology) and non-carious lesions. Results: The caries experience of operators without higher education (CPOD = 14.99) and with higher education (CPOD = 13.06) was higher than that of supervisors (CPOD = 8.23) and administrative workers (CPOD = 5.08). The operators without higher education (SiC = 18.04) and with higher education (SiC = 17.17) presented worse caries significance indicators compared to supervisors (SiC = 13.67) and administrative workers (SiC = 8.25). In addition, operators without higher education had a higher burden of clinical consequences of untreated caries (PUFA = 2.35; severity = 9.2%) compared to operators with higher education (PUFA = 1.91; severity = 8.4%), supervisors (PUFA = 0.53; severity = 2.1%) and administrators (PUFA = 0.46; severity = 1.8%), as well as a higher frequency of non-carious lesions (47.3%) and dental trauma (21.3%). Conclusions: Dental health, its clinical consequences, and the structure of the dental tissues of the operative workers of a construction company are more affected compared to the other labor groups of the same company.

RESUMO Objetivo: Descrever as lesões nos tecidos dentários e os distúrbios de saúde oral encontrados durante o exame médico ocupacional em trabalhadores do sector da construção em Lima, Peru. Material e métodos: Foi realizado um estudo epidemiológico transversal em 150 trabalhadores do sector da construção, selecionados por amostragem aleatória simples. Foi realizada uma avaliação de estomatologia por observação direta e foi utilizado um instrumento de avaliação dentária ocupacional com índices de cárie dentária, gravidade da cárie e traumatismo dentário e indicadores das consequências clínicas da cárie não tratada (patologia pulpar) e lesões não cariosas. Resultados: A experiência de cárie dos operadores sem ensino superior (CPOD = 14,99) e com ensino superior (CPOD = 13,06) foi maior em comparação com os supervisores (CPOD = 8,23) e trabalhadores administrativos (CPOD = 5,08). Os operadores sem ensino superior (SiC = 18,04) e com ensino superior (SiC = 17,17) apresentaram piores indicadores de significância da cárie quando comparados aos supervisores (SiC = 13,67) e aos funcionários administrativos (SiC = 8,25). Além disso, os operadores sem ensino superior apresentaram maior carga de consequências clínicas da cárie não tratada (PUFA = 2,35; severidade = 9,2%) em relação aos operadores com ensino superior (PUFA = 1,91; severidade = 8,4%), supervisores (PUFA = 0,53; severidade = 2,1%) e administradores (PUFA = 0,46; severidade = 1,8%), bem como maior frequência de lesões não cariosas (47,3%) e traumatismos dentários (21,3%). Conclusões: A saúde dentária, as suas consequências clínicas e a estrutura dos tecidos dentários dos operários de uma empresa de construção civil são mais afetadas em comparação com os outros grupos de trabalho da mesma empresa.

Lactancia materna exclusiva y trabajo. Su importancia en la medicina del trabajo / Exclusive breastfeeding and work. Its importance in occupational health

En todos los ámbitos laborales, sin excepción, es imprescindible la vigencia ineludible del derecho irrestricto de toda madre a ejercer, practicar, su lactancia con su bebé. Y las razones médicas debieran formar parte de campañas incesantes para que este derecho de las mamás esté absolutamente naturalizado en todos los niveles y en cada rincón del país. La lactancia materna protege al bebé de enfermedades infecciosas y le da la nutrición ideal para una vida más sana. Es fundamental desde el primer día de vida extrauterina hasta los 6 meses con exclusividad y luego continúa con suplementos vitamínicos y nutrientes apropiados. En todo lugar de trabajo deben existir lactarios como una estrategia de Salud Pública y en Medicina del Trabajo. (AU)

In all areas of work, without exception, the unavoidable validity of the unrestricted right of every mother to exercise, practice, breastfeeding with her baby is essential. And the medical reasons should be part of incessant campaigns so that this right of mothers is absolutely naturalized at all levels and in every corner of the country. Breastfeeding protects the baby from infectious diseases and gives it the ideal nutrition for a healthier life. It is essential from the first day of extrauterine life until 6 months exclusively and then continues with appropriate vitamin and nutrient supplements. In every workplace there must be lactation rooms as a strategy of Public Health and Occupational Medicine. (AU)

From Acute Phase to Long COVID: A Cross-Sectional Study of the Epidemiological Profile and Clinical Evaluation of SARS-CoV-2 Infection in Employees at a Pediatric Hospital.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic began in Brazil on 26 February 2020. By 6 May 2023, 37.4 million cases had been confirmed, causing 701 thousand deaths in the country. We aimed to describe the epidemiological profile and clinical development of COVID-19 cases among the employees of a health institution, from acute infection to long COVID. METHODS: This was a longitudinal study using a retrospective and prospective approach via questionnaires referring to epidemiological investigation, which was the inclusion criteria, and about long-term symptoms. RESULTS: A total of 809 employees were detected with SARS-CoV-2 infection via RT-PCR, 466 of them answered the epidemiological investigation, and 101 completed the Long COVID Symptom Questionnaire. The most commonly affected employees were women (88.6%) working in patient care (68.6%). Headache, myalgia, cough, odynophagia, and runny nose were the most frequent symptoms. Only three employees (0.6%) required hospitalization, while the other employees required outpatient management due to mild symptoms. We identified 19 (4.1%) cases of reinfection, and 42 (41.6%) employees reported long-term symptoms, such as myalgia, dyspnea, and headache. CONCLUSIONS: Although most cases were mild with good outcomes, long COVID cases identified are noteworthy, as these symptoms may impact quality of life even months after SARS-CoV-2 infection.

Telecommuting and COVID-19: how has the pandemic changed workers' perception on physical and mental health?

Due to the current pandemic situation, work from home, or telecommuting, has been implemented as part of public health measures to prevent the spread of SARS-CoV-2. Although this measure was introduced rapidly, it is likely to remain in effect for some time to prevent further outbreaks of COVID-19. Despite being few, various studies have addressed the relationship between telecommuting and workers' health in the context of the current pandemic. Some aspects observed include fatigue, dietary changes, reduced levels of physical activity, and pain. Other conditions observed are associated with "techno-stress," namely work overload, invasion of privacy, pace of information technology changes, decreased job autonomy, emotional exhaustion, and being constantly in electronic contact with work. Generally speaking, the COVID-19 pandemic has created a new environment for considering work and family life within the discussion on telecommuting. Likewise, a contextualized understanding of factors related to physical and mental well-being is essential to ensure positive impacts on workers. It is important to develop studies and discussions within organizations that allow knowing, analyzing and reformulating strategies and policies aimed at aspects such as changes in workers' physical and mental well-being in the pandemic context and the way how occupational environments at home affect these components.

Debido a la situación actual de la pandemia, el trabajo en casa, o home office, se ha implementado como parte de las medidas de salud pública para prevenir la propagación del SARS-CoV-2. Aunque esta medida se introdujo rápidamente, es probable que permanezca en vigor durante algún tiempo para evitar nuevos brotes de la COVID-19. A pesar de ser pocos, diversos estudios han abordado la relación entre el home office y la salud de los trabajadores en el contexto de la pandemia actual. Algunos aspectos observados incluyen fatiga, alteraciones en la dieta, reducción de la actividad física y dolor. Otras condiciones observadas se encuentran asociadas con el tecnoestrés, a saber: sobrecarga de trabajo, invasión de la privacidad, ritmo del cambio de las tecnologías de la información, menor autonomía laboral, agotamiento emocional y contacto electrónico constante con el trabajo. En términos generales, la pandemia de COVID-19 ha creado un nuevo entorno para considerar la vida laboral y familiar dentro de la discusión del home office. Así mismo, realizar una lectura en contexto de los factores que se relacionan con el bienestar físico y mental es fundamental para garantizar impactos positivos en los trabajadores. Es importante realizar estudios y discusiones al interior de las organizaciones que permitan conocer, analizar y reformular estrategias y políticas orientadas a aspectos como las alteraciones en el bienestar físico y mental de los trabajadores en el contexto de la pandemia y la forma en que los entornos ocupacionales en el hogar afectan estos componentes.

Validation of the Cornell Musculoskeletal Discomfort Questionnaires in textile workers in Peru.

Introduction: Musculoskeletal complaints are considered occupational health problems in developing countries with manufacturing companies. In our country there are no validated questionnaires that can be used to screen for musculoskeletal complaints. Objectives: To adapt and validate the Cornell Musculoskeletal Discomfort Questionnaires instrument into Spanish. A cultural adaptation and validation of the questionnaire was carried out in the following stages: translation, expert review, retranslation, and validation of the adapted version. The study was conducted with workers from a textile company in Lima, Peru. Methods: Content validation was carried with 10 experts; criterion validity, with 42 workers; discriminant validity and internal consistency, with 35 textile workers and 35 non-textile; and, finally, test-retest reliability, with 30 workers. Results: The results obtained showed content validity, with the value of Aiken's V for each question being greater than 0.7 for clarity, relevance, and sufficiency, and criterion validation obtained correlation values greater than 0.7 in most items. Moreover, sensitivity 97.1% for body parts, 17.1% for right hand, and 28.6% for left hand, whereas specificity was 0% for body parts, 14.3% for left hand, and 28.6% for right hand. Finally, test-retest Spearman's correlation was 0.69. Conclusions: The study allows us to conclude that the Cornell Musculoskeletal Discomfort Questionnaire-JAH is a valid and reliable instrument for the exploration of musculoskeletal discomfort amongst workers in the textile sector.

Introducción: Las molestias musculoesqueléticas son consideradas problemas de salud laboral en países con empresas manufactureras y en vías de desarrollo, y en Perú no se cuenta con cuestionarios validados que puedan utilizarse para tamizar molestias musculoesqueléticas. Objetivos: Adaptar y validar al español el instrumento Cornell Musculoskeletal Discomfort Questionnaires. Se realizó una adaptación cultural y validación de cuestionario en etapas: traducción, revisión de expertos, retraducción y validación de la versión adaptada. El estudio se realizó con trabajadores de una empresa textil de Lima, Perú. Métodos: Se realizó la validación de contenido con 10 expertos; la validez de criterio, con 42 trabajadores; la validez discriminante y la consistencia interna, con 35 trabajadores textiles y 35 trabajadores que no pertenecían al sector; y, por último, la fabilidad test-retest, con 30 trabajadores. Resultados: Los resultados obtenidos mostraron validez de contenido, con el valor de V de Aiken para cada pregunta presentando valores superiores a 0,7 tanto para claridad, pertinencia y suficiencia, y la validez de criterio presentó valores de correlación superiores a 0,7 en la mayoría de los ítems. La sensibilidad fue del 97,1% para partes del cuerpo, 17,1% para mano derecha, y 28,6% para mano izquierda, mientras la especificidad fue del 0% para partes de cuerpo 14,3% para mano izquierda, y 28,6% para mano derecha. Finalmente, hubo una correlación de Spearman en el test-retest de 0,69. Conclusiones: El estudio permite concluir que el instrumento Cornell Musculoskeletal Discomfort Questionnaire-JAH es válido y fiable para la exploración de molestias musculoesqueléticas para aplicarlo en trabajadores del sector textil.

The use of lumbar spine imaging to determine fitness for work in asymptomatic workers who perform manual lifting.

In occupational medicine, evidence-based practices are essential for assessing the accuracy, efficacy, and cost-effectiveness of any technologies used in health programs. This opinion article reflects on the use of imaging tests to screen for workers at risk of low back pain disability and to recommend avoiding tasks that involve high biomechanical risk. The limitations of such testing are discussed through basic epidemiological concepts and evidence collected from systematic reviews.

A aplicação da saúde baseada em evidências publicadas ou locais na prática da medicina do trabalho é essencial para avaliação da acurácia, efetividade e custo-efetividade de quaisquer tecnologias de saúde implementadas no programa de saúde ocupacional. Neste artigo de opinião, os autores refletem sobre o uso de exames de imagem para detecção precoce de trabalhadores com maior risco de adoecimento por dor lombar associada a inaptidão para atuar em atividades com maior risco ocupacional biomecânico de dorsalgia. As limitações dessa prática são discutidas por meio de conceitos básicos da epidemiologia e evidências publicadas preferencialmente em revisões sistemáticas. Não recomendamos a sua utilização para os objetivos ocupacionais citados neste artigo.

Assessment of lifestyle, blood pressure, and cholesterol in pharmaceutical industry professionals.

Introduction: Cardiovascular diseases are the leading cause of death worldwide. Objectives: To elucidate the lifestyle of in pharmaceutical company professionals, evaluating cardiovascular risk factors. Methods: This is an observational, longitudinal, and prospective study conducted with 1,875 individuals of both sexes. In addition to a questionnaire to identify participants' lifestyle, calculation of body mass index, blood pressure measurement, and collection of blood samples to measure serum total cholesterol and glycated hemoglobin were performed. Results: 83% of respondents had never smoked; 48.1% did not perform regular physical activity, and women tended to perform less physical activity than men; 57.6% consumed less than two servings of fruits or vegetables per day; 63.8% consumed fish less than once per week; 51.6% consumed less than one glass of sugary drinks per day, with women consuming fewer sugary drinks than men. Most participants had a body mass index from 25 to 29.9 m/kg2 or from 18.5 to 24.9 m/kg2 (43.6%), total cholesterol levels below 200 mg/dL (75.1%), glycated hemoglobin below 5.7% (86.0%), systolic blood pressure from 120 to 139 mmHg (47.6%), and diastolic blood pressure below 80 mmHg (56.1%). Conclusions: The data obtained in this study are consistent with those from the literature, demonstrating that it possible to improve habits such as smoking, diet, and physical activity.

Introdução: As doenças cardiovasculares representam a maior causa de morte em todo o mundo. Objetivos: Elucidar o estilo de vida de profissionais de uma indústria farmacêutica, avaliando os fatores de risco cardiovascular. Métodos: Tratou-se de um estudo observacional, longitudinal e prospectivo, realizado com 1.875 indivíduos de ambos os sexos. Além de questionário para identificar o estilo de vida, foram realizados cálculo do índice de massa corporal, aferição da pressão arterial e coleta de amostra de sangue para dosagem de colesterol total sérico e hemoglobina glicada. Resultados: 83% nunca tinham fumado; 48,1% não faziam atividade física regularmente e mulheres tendiam a realizar menos atividades físicas do que homens; 57,6% consumiam menos de duas porções de frutas ou verduras por dia; 63,8% consumiam peixe menos de uma vez por semana; 51,6% consumiam menos de um copo por dia de bebidas com açúcar, sendo que as mulheres consumiam menos bebidas açucaradas do que homens. A maioria dos participantes apresentou índice de massa corporal entre 25 e 29,9 m/kg2 ou entre 18,5 e 24,9 m/kg2 (43,6%), colesterol total abaixo de 200 mg/dL (75,1%), hemoglobina glicada abaixo de 5,7% (86,0%), pressão arterial sistólica entre 120-139 mmHg (47,6%), e pressão arterial diastólica menor que 80 mmHg (56,1%). Conclusões: Os dados são condizentes com informações de literatura, demonstrando que é possível melhorar hábitos como tabagismo, alimentação e prática de atividade física regularmente.

Offshore medical evacuations due to non-occupational illnesses.

Introduction: Offshore work is a continuous challenge for occupational safety and medicine, as well as for qualification, training, and worksite logistics. In such conditions, any health issue requiring disembarkation incurs a serious burden. Objectives: To evaluate the number and causes of non-occupational medical evacuations among Brazil's offshore units between 2016 and 2019. Methods: The database of consultations performed by the medical services company International Health Care for offshore units on the Brazilian coast of client companies from 2016 to 2019 was reviewed. Results: Of the 1140 identified medical evacuations, 937 were non-occupational. Conclusions: Due to the increase in safety culture, non-occupational illness has become the most common reason for medical evacuations. Without understanding and prevention of such causes, expenses will increase for companies with offshore operations.

Introdução: O trabalho offshore é um constante desafio em termos de segurança e medicina do trabalho. Outro complicador é a necessidade de maior qualificação e treinamentos específicos, fora toda a questão logística para os trabalhadores e para o local de trabalho. Com esse cenário, qualquer agravo de saúde que exija desembarque gera um enorme transtorno. Objetivos: Avaliar o volume e as causas de desembarques provocados por doenças não ocupacionais em unidades offshore no Brasil no período de 2016 a 2019. Métodos: Foi consultada a base de dados dos atendimentos realizados pela empresa de serviços médicos International Health Care para as unidades offshore na costa do Brasil de empresas clientes, no período de 2016 a 2019. Resultados: Foram identificadas 1.140 ocorrências de desembarques por motivos médicos, sendo 937 classificadas como acometimentos de saúde não ocupacionais. Conclusões: Devido à grande cultura de segurança do trabalho, o adoecimento se tornou a causa mais comum de desembarques. O não entendimento e prevenção dessas causas também causam custos às empresas.

Medical shift work: a narrative review.

Shift and night work combine training and practice in medical education, assuming an essential character in some medical specialties. Nevertheless, it is recognized that this work schedule affects biological functions, cognitive performance, and the safety of both patients and workers. The aim of this narrative literature review was to describe current knowledge about the impact of shift and night work in medical professionals. The LILACS, MEDLINE, and SciELO databases were searched for publications between 2010 and 2020 using the terms: "shift work schedule" and "physicians". A total of 12 publications reported outcomes on sleep quality, family relationships, burnout syndrome, and cardiovascular health. Despite these outcomes, the studies highlighted the importance of shift and night work in medical training, reflecting a loss of learning opportunities when limitations are placed on work hours. The studies suggested initiatives to mitigate the effects of shift work, including increased awareness by managers, a culture of respect for resting periods, the encouragement of family support networks, and the availability of natural light in the workplace.

O trabalho em turnos e noturno compõe a formação e a prática da educação médica, assumindo caráter essencial em algumas especialidades. Contudo, esse regime de trabalho é reconhecido por gerar efeitos em funções biológicas, na performance cognitiva e na segurança do paciente e do profissional. O objetivo deste trabalho, caracterizado como revisão narrativa de literatura, foi verificar o conhecimento atual sobre o impacto da jornada de trabalho em turnos e noturno na saúde de profissionais médicos. Foram utilizadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e Scientific Electronic Library Online, no período compreendido de 2010 a 2020, com os Descritores em Ciências da Saúde: "jornada de trabalho em turnos" e "médicos". Foram encontrados 82 artigos e, após aplicação dos critérios de inclusão, foram selecionados 12 artigos para análise. Os estudos demonstraram desfechos na qualidade do sono, nas relações familiares, na possibilidade de síndrome de burnout e na saúde cardiovascular dos profissionais. Sugerem-se iniciativas para amenizar os efeitos do trabalho em turnos, que incluam a sensibilização de gestores, a cultura de respeito pelo período de repouso, o estímulo à rede de apoio familiar e a oferta de estruturas ambientais de trabalho que permitam acesso à luminosidade natural.

Assessing workers with fibromyalgia: what should occupational physicians know?

Fibromyalgia is a chronic pain syndrome with a complex multifactorial etiopathogenesis that more frequently affects women. Although widespread pain is the dominant feature, fibromyalgia incorporates a wide variety of symptoms, such as fatigue, unrefreshed sleep, and cognitive and mood disorders. Central sensitization to pain is a key element in the pathophysiology of this syndrome. Due to its prevalence and repercussions on quality of life and work productivity, fibromyalgia is a common condition in occupational medicine outpatient clinics. Thus, physicians must be attentive to its symptoms to facilitate diagnosis and management. This article will address basic topics about fibromyalgia, including: epidemiology, predisposing factors, pathophysiological considerations, clinical manifestations, classification criteria, differential diagnosis, basic principles of treatment, and the contribution of occupational physicians.

fibromialgia é uma síndrome dolorosa crônica, de etiopatogenia multifatorial complexa, que acomete com maior frequência mulheres. Embora a dor difusa seja o quadro dominante, a fibromialgia incorpora uma ampla variedade de sintomas, como fadiga, sono não reparador, queixas cognitivas e distúrbios de humor. A sensibilização central à dor é um elemento-chave no entendimento da fisiopatologia dessa síndrome. Por ser prevalente e ter reflexos na qualidade de vida e na produtividade no trabalho, a fibromialgia é uma condição recorrente em ambulatórios de saúde ocupacional. Nesse sentido, é importante que o médico do trabalho esteja atento aos sintomas da síndrome para que possa contribuir com seu diagnóstico e manejo. Neste artigo, serão abordados tópicos fundamentais para a compreensão da fibromialgia, incluindo epidemiologia, fatores predisponentes, considerações sobre a fisiopatologia, manifestações clínicas, critérios classificatórios, diagnósticos diferenciais, princípios básicos do tratamento e contribuições do médico do trabalho.

Quality management of the periodic medical examination at a university hospital, from the workers' perspective.

Introduction: Implementation of quality assessment methodologies at healthcare services enables the results achieved to be monitored in terms of established objectives and standards of care delivery. Objectives: To assess the quality of the processes involved in provision of periodic medical examinations at a University Hospital, from the workers' perspective. Methods: This is a cross-sectional study using questionnaires to conduct quality assessment of the periodic medical examination processes, including Net Promoter Score satisfaction questions. Statistical analysis of the results was performed using SPSS version 18. Data on categorical variables are expressed as absolute frequencies and data on continuous variables as means and standard deviations. Chi-square tests and analysis of variance were used to identify associations. A significance level of 0.05 was adopted to determine the statistical relevance of findings. Results: A total of 381 respondents with a mean age of 45.25 years were included, 66% of whom were female. There was a statistically significant (p < 0.001) association between duration of consultations and the number of items assessed in the periodic medical examination. In general, the findings from application of the Net Promoter Score for self-scheduling (45%) and service at reception (42%) indicate a need for process improvement, whereas clinical care (50%) rated as a quality process. Conclusions: This study identified a set of information that can be used to describe, analyze, and improve the care delivered by the institution's occupational health service and to identify opportunities for improvement of periodic medical examination processes.

Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty. AIM: To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital. METHODS: This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers' core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support. RESULTS: Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (ß range = -0.41 to -0.20, P < 0.001). However, participants' personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict. CONCLUSION: Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.

[Reinsertion to the work in workers with partially permanent disability for hand injury]. / Reinserción laboral en trabajadores con incapacidad permanente parcial por lesiones de mano.

Background: Hand injuries resulting from accidents at work are one of the main causes of disability in workers. Every worker ruled with Partial Permanent Disability must legally be reinstated to the same workplace. Objective: To know the prevalence of reintegration and causes of non-reintegration into workers with Partial Permanent Disability due to hand injuries. Material and methods: A descriptive, observational, and retrospective study, which included 100% of the opinions of Parcial Permanent Disability due to hand injuries, generated from 2012 to 2016 at UMF 61 of Veracruz. Results: 143 cases were analyzed, 127 (88.8%) were men and 16 (11.2%) women, with a mean age of 37.3 ± 11.6 years. Labor reintegration in the same company occurred in 60 (42%) of the cases, 50 (35%) were reinstated in another company and 33 (23.1%) were not reinstated to work. Regarding work termination: 51 (35.7%) workers were laid off after their ruling, 13 (9.1%) resigned, 12 (8.4%) terminated their contract, and 7 (4.9%) were retired. Currently 72 (50.3%) workers continue to perform physical work and 18 (12.6%) did not return to work. Conclusions: Labor reintegration occurred in less than half of the cases ruled. The main cause of the non-reintegration was the unjustified dismissal by the company where the accident occurred. Not reintegrating into the same workplace has: legal, economic, medical and social implications to the worker.

Introducción: las lesiones de mano derivadas de accidentes de trabajo constituyen una de las principales causas de discapacidad en los trabajadores. Todo trabajador dictaminado con Incapacidad Permanente Parcial (IPP), jurídicamente debe ser reinsertado a su mismo centro de trabajo. Objetivo: conocer la prevalencia de reinserción y causas de no reinserción laboral en trabajadores con IPP por lesiones de mano. Material y Métodos: estudio descriptivo, observacional y retrospectivo, que incluyó el 100% de los dictámenes de IPP por lesiones de mano, generados del 2012 al 2016 en la UMF 61 de Veracruz. Resultados: se analizaron 143 casos, 127 (88.8%) fueron hombres y 16 (11.2%) mujeres, con edad media 37.3 ± 11.6 años. La reinserción laboral en la misma empresa se presentó en 60 (42%) de los casos, 50 (35%) se reinsertaron en otra empresa y 33 (23.1%) no se reinsertaron al trabajo. Respecto de la terminación laboral: 51 (35.7%) trabajadores fueron despedidos posterior a su dictaminación, 13 (9.1%) renunciaron, 12 (8.4%) finalizaron su contrato, y 7 (4.9%) fueron jubilados. Actualmente 72 (50.3%) trabajadores continúa realizando un trabajo físico y 18 (12.6%) no volvió a trabajar. Conclusiones: la reinserción laboral se presentó en menos de la mitad de los casos. La principal causa de no reinserción fue el despido injustificado por la empresa donde ocurrió el accidente. No reintegrarse al mismo centro de trabajo conlleva implicaciones: legales, económicas, médicas y sociales al trabajador.

Hospital infection control and occupational medicine services in the face of the COVID-19 pandemic in occupational health / Serviços de controle de infecção hospitalar e de medicina do trabalho no enfrentamento à pandemia de COVID-19 na saúde ocupacional

In this article, the actions developed by the Hospital Infection Control Service (HICS) and Occupational Medicine (OM) to face the COVID-19 pandemic and track cases of infection among employees of a large hospital in Belo Horizonte, Minas Gerais, Brazil. Training actions, guidelines on how to collect a swab sample, Code 19 (COVID-19) simulation, dressing/undressing, hand hygiene, the definition of flows, and the quantification of cases infected by COVID-19 among employees in care areas were highlighted. The engagement of HICS and OM in the prevention and promotion of health were fundamental to facing the pandemic. It is estimated that SARS-CoV-2 infection rates among staff at the study hospital were similar to those at other hospitals. The experience report is important for expanding knowledge about action planning in the context of a large hospital (AU).

Neste artigo, são relatadas as ações desenvolvidas pelo Serviço de Controle de Infecção Hospitalar (SCIH) e Medicina do Trabalho (MT) para o enfrentamento da pandemia de COVID-19 e rastreamento dos casos de infecção entre funcionários de um hospital de grande porte de Belo Horizonte, Minas Gerais, Brasil. Destacaram-se as ações de treinamentos, orientações de como coletar amostra de swab, simulação Código 19 (COVID-19), paramentação/desparamentação, higiene das mãos, definição de fluxos e quantificação dos casos infectados por COVID-19 entre funcionários de áreas assistenciais. O engajamento do SCIH e da MT na prevenção e promoção da saúde foi fundamental no enfrentamento da pandemia. Estima-se que os índices de infecção pelo SARS-CoV-2 entre os funcionários do hospital em estudo foram similares aos de outros hospitais. O relato de experiência é importante para a ampliação do conhecimento sobre o planejamento de ações no contexto de um hospital de grande porte (AU).

Confidencialidade em medicina ocupacional: protegendo informações / Confidentiality in occupational medicine: protecting information / Confidencialidad en medicina del trabajo: protección de información

Resumo A confidencialidade é elemento central da relação médico-paciente e está associada à boa qualidade do atendimento. Contudo, pode ser rompida em conformidade com as normas éticas e legais estabelecidas no país. Este estudo objetiva mostrar os principais aspectos da confidencialidade em medicina ocupacional. Para isso, realizou-se revisão narrativa de literatura sobre o tema, utilizando bases de dados de livre acesso e embasando-se nos códigos de ética médica. A atuação do médico do trabalho envolve o trabalhador, outros profissionais não médicos e o empregador, situação capaz de desencadear conflitos, requerendo que o médico conheça suas obrigações e limites ético-legais. A proteção da confidencialidade respeita os direitos humanos, mas dilemas podem surgir, não bastando obedecer aos ditames éticos, mas sendo necessário essencialmente seguir as normas legais. Este estudo busca mostrar os principais aspectos éticos e legais atualizados referentes à saúde ocupacional.

Abstract Confidentiality is a central element of the physician-patient relationship and is associated with good quality of care. However, it may be broken in accordance with the ethical and legal standards established in the country. This study aims to show the main aspects of confidentiality in occupational medicine. For this, a narrative review of the literature on the subject was carried out, using free access databases and based on the codes of medical ethics. The occupational physician's performance involves the worker, other non-medical professionals and the employer, a situation that may trigger conflicts, requiring physicians to know their obligations and ethical-legal limits. The protection of confidentiality respects human rights, but dilemmas may arise, not only to obey ethical precepts, but to follow legal norms. This study seeks to show the main and updated ethical and legal aspects regarding occupational health.

Resumen La confidencialidad es clave en la relación médico-paciente y está asociada a buena calidad de la atención. Sin embargo, está sujeta a una quiebra de conformidad a lo establecido en las normas éticas y legales en el país. Este estudio pretende mostrar los principales aspectos de confidencialidad en la medicina del trabajo. Para ello, se realizó una revisión narrativa de la literatura en las bases de datos de acceso abierto basándose en códigos de ética médica. El actuar del médico del trabajo involucra al trabajador, a profesionales no médicos y al empleador, lo que puede desencadenar conflictos requiriendo que el médico conozca sus obligaciones y límites ético-legales. La protección de la confidencialidad respeta los derechos humanos, pero pueden surgir dilemas y no solo bastará atenerse a los dictámenes éticos, sino seguir fundamentalmente las normas legales. Los resultados mostraron los principales aspectos éticos y legales actualizados relacionados con la salud laboral.

Toluene: correlation between occupational exposure limits and biological exposure indices.

Threshold limit values for chemical substances and biological exposure indices are the main tools used in occupational hygiene and occupational medicine to control worker exposure levels. The correlation between these limits and indicators is of fundamental importance. The setting of new toluene exposure limits has raised discussion about which indicator to use. This article aims to enrich this debate with scientific data. Through a literature review, we provide a broad analysis of the factors that led to the lowering of the occupational exposure limit. Although internationally, biological indicators for toluene were replaced more than a decade ago, Brazilian authorities only began to discuss changing them in 2020. Toluene is a concern due to critical effects observed in exposed individuals, especially miscarriage. Urinary οrtho-cresol was suggested as the main biomarker in 2007. Given the broad data analysis, there are no doubts about the utility of οrtho-cresol as a biological indicator for toluene; what is lacking now is implementation of a monitoring system to comply with the legislation.

Os limites de exposição ocupacional às substâncias químicas e os indicadores biológicos de exposição são as principais ferramentas usadas pela Higiene Ocupacional e Medicina do Trabalho para o controle de exposições dos trabalhadores, e a correlação entre esses parâmetros é de fundamental importância. A adoção de novos limites de exposição ao tolueno abriu o debate sobre qual indicador usar, e este artigo tem como objetivo trazer dados científicos para essa discussão. Através de revisão bibliográfica, foi feita uma análise ampla dos fatores que levaram à redução do limite de exposição ocupacional. Embora, no cenário internacional, a substituição dos indicadores biológicos para o tolueno tenha acontecido há mais de uma década, somente no ano de 2020 as autoridades brasileiras trouxeram à tona essa discussão, com a alteração do indicador biológico de referência na Norma Regulamentadora n.º 7. A preocupação em torno do tolueno está baseada em seus efeitos críticos observados em indivíduos expostos, especialmente a indução de aborto espontâneo. Nesse sentido, já em 2007 foi sugerido o οrto-cresol urinário como principal biomarcador. Diante da ampla análise dos dados, não há dúvidas da representatividade do οrto-cresol como indicador biológico para o tolueno, restando agora a implementação de uma sistemática de monitorização para atender à legislação.