Tatuadores: principais Fatores de Risco e Riscos Laborais, Doenças Profissionais associadas e Medidas de Proteção recomendadas

2020 ◽  
Vol 10 ◽  
pp. 1-58
Author(s):  
Mónica Santos

Introduction/ objectives Over the last few decades getting tattoos has been progressively better accepted by society in most countries; thus, the number of establishments and professionals in the area has also increased. However, since it is a recent activity and with heterogeneous norms/ licensing, these individuals often escape the evaluation by Occupational Health. The literature on this subject is scarce. This review was intended to characterize the profession of tattoo artist with regard to: vocational training; main risk factors/ occupational risks; more prevalent semiology and associated major diseases; work accidents; collective/ individual protection measures adopted and associated legislation. Methodology This is a Scoping Review, initiated through a survey conducted in April 2019 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Science Direct, Web of Science, SCOPUS and RCAAP. Content In most countries, a person can work in the area without having specific qualifications; the products can be purchased via internet and the rules for opening the establishment vary locally. Given the absence of norms that parameterize the necessary qualifications to exercise, the same happens in the process of teaching in this sector. The main occupational risks/ risk factors are the quimical and biological agents, vibrations, noise, forced/ maintained postures, repetitive movements, visual effort, handling needles and sharps and prolonged shifts. Musculoskeletal semiology is very prevalent. Discussion / Conclusions / Limitations / Projects for the Future The risk factors are very similar to other professional sectors, such as dental medicine, which has already been studied in detail. Most of the few published documents on Tattoo Artists have a simplistic methodology and the samples are small. In addition, the absence of uniform labor standards and licensing undermines safe work. It would be very important that these arise and be progressively perfected. In a post-implementation phase, it would be desirable to have an institution with the capacity and authority to monitor compliance and to require the correction of identified problems. Similarly, it would also be interesting if the education process were also formalized and compulsory, perhaps starting at a technical level and evolving (if the progression of the sector allows or requires), to other degree.

2020 ◽  
Vol 10 ◽  
pp. 1-16
Author(s):  
Mónica Santos ◽  
Armando Almeida

Introduction and Objective The Conservation and Restoration sector has not yet been fully or comprehensively addressed by Occupational Health, so there are several knowledge gaps. The authors aimed to collect and summarize all the information they found on the topic. The main risks associated with Chromium are spread across a variety of medical settings (albeit with different consensos) on cardiovascular, nephrological, hepatic, oncological, dermatological, otorhinolaryngological, pneumological, ophthalmic and haematological pathology. Methodology A survey was conducted in January 2019, considering Scopus search engines; PubMed / MedLine; Web of Science; Science Direct; Academic Search Complete; CINALH; Database of Abstracts and Reviews; Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Nursing and Allied Health Collection; MedicLatina and RCAAP. Content / Results and Discussion No documents were found mentioning details concerning Chromium toxicity in this sector. For other professional areas information was scarce. Workers in the glass industry may also be exposed as well as in metallurgy/ welding and the chemical industry. Limitations The authors made efforts to try to make their research exhaustive but, once completed, they realised that they did not find relevant data on Chromium dosing in Conservation and Restoration work environments, nor an indication of which techniques can be used and which are the preferred ones, including biological evaluation. No articles were found describing collective or individual protection measures, even in a generic way. Conclusions Concrete and serious harms associated with Chromium have long been known. However, the Conservation and Restoration sector is still very little studied in the context of Occupational Health and the risks of eventual contact with this agent are no exception. It would be very pertinent to have motivated teams to study this sector and to address some of the limitations not developed in the international literature.


2020 ◽  
Vol 9 ◽  
pp. S101-S111
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes ◽  
Tiago Oliveira

Introduction / framework / objectives Electromagnetic fields are already very extensively developed in the scientific literature, however, doing so through a generalist approach and/ or highlighting the possible consequences for human health. There are few documents that, under this theme, describe specific protection measures. The authors conducted a research with the objective of elaborating a synthesis what was written about this subtheme. Methodology This is a Scoping Review, initiated at September 2019, in the databases “CINALH plus with full text, Medline with full text, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Web of Science, SCOPUS and RCAAP”. Content Many activities create these fields. In most workplaces exposure is discrete and there is no relevant risk. In all other cases, however, the risk dissipates with distance from the source. In addition, as most of these situations originate from an electrical appliance, when it is switched off, the problem no longer exists. Particularly exposed individuals may be pregnant women and individuals with active medical devices (cardiac stimulators, defibrillators, cochlear and brain stem implants, neurostimulators, drug infusion pumps and retinal coders). In terms of collective protection measures, the shielding/ insulation with metal, ceramic, plastic or glass plate or mesh can be highlighted;as well as protection with light curtains; reading apparatus and pressure sensitive mats; restriction of access by guards, barriers, signs, magnetic field signaling/ ionizing radiation, especially to individuals with active or metallic medical implants; prohibition of conductive objects; appoint the person responsible for safety management; training about body position during work and limitation of movements to attenuate induction of electric fields. While it is not difficult to shield electric fields, mitigating the effects of magnetic fields is more complicated. Furthermore, it is generally not possible to use effective Personal Protective Equipment uniformly: if it protects a range of frequencies, it will hardly protect for others. Examples include insulation footwear (thick rubber sole, non-steel); suitable gloves in isolation/ driving, glasses and full suit. Conclusions Given the omnipresence of the electromagnetic fields (although generally at intensities of low concern), it would be relevant for occupational health practitioners to have some notions of how to approach the subtheme. In addition, it would be important for some teams to have the opportunity to investigate in this context, improve customer service and, by publishing their data, contribute to a better understanding of the national reality and somehow evolve scientific knowledge in this area.


2020 ◽  
Vol 9 ◽  
pp. S137-S148
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes ◽  
Tiago Oliveira

Introduction / framework / objectives Vibrations and noise are two reasonably prevalent occupational risk factors and, in many situations, present together. If a pathophysiological association between them is real, it will be very relevant to verify this, in order to readjust, if necessary, the vibration and noise limits considered safe. Methodology This is an Scoping Review, initiated by a September 2019 survey of the “Cochrane Central Register of Controlled Trials databases, CINALH plus with full text, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Science Direct, SCOPUS and RCAAP.” Content Some researchers have quantified higher hearing losses in workers simultaneously exposed to noise and vibrations; however, workers exposed to vibration from work instruments are generally also exposed to higher levels of noise. If there is a pathophysiological link between these two occupational risk factors, it is believed that this may be related to the theory of sympathetic vasoconstriction (observed in white-finger syndrome) and may also damage the cochlea, producing ischemic damage to the hair cells. Another hypothesis points out that some work tools may give rise to vibrations that can reach the inner ear directly, through bone conduction (especially at the temporal level). Conclusions Most of the studies consulted did not have a very robust methodology that allows a rigorous evaluation of whether the most intense hypoacusis in individuals simultaneously exposed to vibration results from a true pathophysiological association, or if it is only a statistical bias. It would be interesting for occupational health teams to investigate on clients with workers simultaneously exposed to these two risk factors (and, if possible, with combinations of different intensities), in order to produce knowledge capable of enhancing occupational health and safety.


2020 ◽  
Vol 9 ◽  
pp. S91-S100
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes ◽  
Tiago Oliveira

Introduction / background / objectives The use of anti-vibration gloves is not as frequent as other individual protective equipment, so it becomes an area in which the professionals that exercise in the Occupational Health teams (and even employers and workers) have less contact and experience. In addition, when starting to research the topic, it is easy to see that there are contradictory data published, so there are many doubts about the benefit or not on its use. This review intends to summarize the most recent and pertinent articles published on this topic. Methodology This is an Integrative Bibliographic Review, initiated through a research carried out in December 2019 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina, SCOPUS and RCAAP ”. Content For a glove be considered anti-vibration, it must comply with the criteria defined by the International Standardization Organization. The sensitivity to damage associated with vibrations has some variability between individuals. Vibrations can cause vascular, neurological and musculoskeletal changes; overall, the situation referred to as hand-arm vibration syndrome; this becomes more frequent with increasing exposure time and intensity. In addition to the direct protection that may exist in relation to vibrations, by keeping the hands dry and warm, vibratory damage can be indirectly attenuated. In addition, regardless of the vibration issue, the worker is also more protected from cuts, burns, chemical and biological agents. The greatest risk may then be to give the employer and employee a sense of protection when it is not real. In addition, some researchers believe that certain collective protection measures are more effective than gloves. Conclusions The published data are contradictory and the studies generally used small samples, so it is difficult to generalize the results with safety. In addition, it is easy to see that the protection, absence of it or even potentiation of vibrations will depend on numerous variables, namely working instrument, type of vibrations, model/ material and glove thickness in the palm and fingers, as well as grip strength exercised by the worker and its anthropometric dimensions. It is therefore a protective equipment that, in no way, can be considered as an added value, for any task or worker.


2020 ◽  
Vol 10 ◽  
pp. S172-S182
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes

O setor da dança está pouco retratado em contexto de Saúde Ocupacional e a bibliografia é razoavelmente escassa. Neste setor o profissional pode apenas efetuar ensaios e atuações (a solo ou em equipa), pode dar aulas para eventuais futuros colegas e/ ou para leigos ou acumular ambas as vertentes. Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em agosto de 2020 nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. A dança é uma arte complexa, cujo instrumento é o corpo. Conjuga movimento com a emoção, servindo também como forma de comunicação. Em alguns estilos de dança a rotina de treinos é muito exigente e competitiva, de forma a aperfeiçoar departamentos como força, resistência, velocidade, flexibilidade, equilíbrio e controlo. Aos treinos intensos, por vezes, associam-se algias e lesões concretas. Por exemplo, no Ballet clássico, a exigência técnica é muito elevada e desafiante e, na bibliografia selecionada, é certamente a dança mais estudada neste contexto. A escassa bibliografia encontrada incide sobretudo nas principais lesões associadas (quer acidentes de trabalho, quer doenças profissionais); sendo que alguns artigos também destacam o eventual consumo de substâncias psicoativas em algumas modalidades específicas. Os autores elaboraram uma descrição dos principais Fatores de Risco/ Riscos Laborais deste setor, no geral; bem como listaram as Medidas de Proteção (coletivas e individuais) que consideram ser mais adequadas. O setor da dança está muito pouco estudado pela Saúde Ocupacional, sendo pertinente a análise da realidade portuguesa, sobretudo em alguns estilos muito desenvolvidos no nosso país e sobre os quais não se encontrou qualquer bibliografia específica (mesmo em contexto internacional). PALAVRAS-CHAVE: dança, bailarino, saúde ocupacional e medicina do trabalho.


2020 ◽  
Vol 9 ◽  
pp. S40-S47
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes ◽  
Tiago Oliveira

Introduction/ background/ objectives There are some manuals of Good Practices, in some professional sectors, that highlight the need to stop use jewelry at work (such as finger rings, watches, bracelets and/ or equivalent), relating to the potentialization of contact with biological agents and/ or chemical. The studies dedicated to this theme are very scarce and all related to health professionals; although, in many other sectors, it is a relevant topic, like in food production, tattooing, preparation of equipment that needs to be sterile and any sector that deals with chemical agents, for example. Methodology It is an Scoping Review, initiated through a research conducted in December 2019 in the databases “CINALH plus with full text, Medline with full text, Database of Effects Review Abstracts, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Record, Nursing and Allied Health Collection: comprehensive, MedicLatina, Scopus and RCAAP ”. Content The use of finger rings decreases efficacy of hand washing, since some bacteria can remain in microscopic irregularities under the ring. In addition, they can tear the protective gloves; even so, the use of this individual protective equipment attenuates the microbial load of the rings. However, some investigators argue that there is no statistical evidence that the use of rings will alter postoperative infraction rates. Those with smooth surfaces, like classic wedding rings, do not appear to be so problematic. As for watches and bracelets, it appears that they do not contribute to a significant increase in the rate of infringement; yet some researchers recommend that they be removed, before hand washing. The use of nail varnish decreases efficacy of hand washing, since some bacteria can remain in the microscopic irregularities of the varnish; however, there is no robust statistical evidence that the use of varnishes alters the rate of postoperative infection. Long nails have a higher microbial load, especially if recovered by irregular varnish (with a few days). In addition, big nails can also increase the likelihood of tearing the glove, whether natural or artificial. So it makes sense that some professionals use them short. Since scientific evidence that correlates hospital infection to the use of artificial jewelry or nails among healthcare professionals is not very robust, the norms at some institutions are in the format of recommendations only. Conclusions Studies are scarce and do not appear to be concordant or robust on several occasions, so it would be useful that Occupational Health teams, from companies with biological and/ or chemical risk, design and carry out studies and, subsequently, publish it to specialty magazines. In doubt, until clear evidence appears, objects such as finger rings, rings, watches and bracelets should be removed before work and hand washing and the size of long/ artificial nails or varnish must be carefully pondered.


2020 ◽  
Vol 10 ◽  
pp. 1-20
Author(s):  
Mónica Santos ◽  
Armando Almeida

Introduction and objective The authors aimed to collect and summarize all the information they found on the subject, as a starting point for other projects that are considered pertinent in the context of the occupational health of these professionals. The main risks associated with Cadmium are distributed through diverse medical contexts (although with different consensos) in neurology, cardiovascular system, reproduction/ obstetrics, pediatrics, nephrology, oncology, pulmonology, ophthalmology, gastrointestinal tract, endocrinology and orthopedics/ rheumatology. Methodology This scoping review used search engines as PubMed; Web of Science; Science Direct; Academic Search Complete; CINALH; MedLine; Database of Abstracts and Reviews; Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Nursing and Allied Health Collection; MedicLatina and RCAAP. Content or Results In this professional context, one document was found mentioning that in the eighteenth and nineteenth centuries pigments associated with cadmium, although toxic, but still used today, were discovered; the most relevant are (in frequency and toxicity) yellow and red cadmium, used since 1820 and 1910, respectively. Another article emphasized that during the 19th century yellow pigments were created with cadmium sulphide, and this color also depended on the addition of elements such as zinc, selenium and barium. Discussion There is so little bibliography on Cadmium’s medical risks in Conservators-Restorers that the authors have chosen to include in this section some data regarding other professionals who may also contact with this agent. Among these, the artists who elaborate (or have elaborated in the past) works of art with pigments with Cadmium, may be the most adequate, although also on these the bibliography is very reduced. It is believed that famous painters were exposed, namely Rubens, Renoir, Duffy and Klee. Limitations The authors made efforts to make their research exhaustive but, once completed, they realized that they did not find relevant data on Cadmium dosing in Conservation and Restoration workplaces in general, nor did they indicate which techniques may be used or which are preferable, such as biological monitoring. No evaluation of the associated risk was found for this professionals. Collective or individual protection measures were not mentioned in the bibliography consulted (even in generic terms, let alone specifying models and/ or materials). Conclusions It has long been known that concrete and serious harm is associated with Cadmium. However, the Conservation and Restoration sector is still very little studied in the context of Occupational Health and the risks of eventual contact with Cadmium are no exception. It would be very pertinent to have motivated teams to study this sector and to fill some of the limitations found, not developed in the international literature.


2020 ◽  
Vol 10 ◽  
pp. 1-66
Author(s):  
Mónica Santos

Introduction / background / objectives Work-related Musculoskeletal Injuries are prevalent and relevant. There are several methods for detecting risk, depending on the tasks performed. However, not all professionals working in the Occupational Health teams have well-structured knowledge or practical experience in most of these methods. Methodology It is a Review, initiated through a survey conducted in April 2020, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP ”. Content There are several categories of methods for assessing the risk of Musculoskeletal Lesions Related to Work. For that we have, in a very synthetic way, the self-assessment questionnaires (completed by the workers), the observational methods (more or less complex) and the direct methods. This work describes in detail OWAS, RULA, REBA, NIOSH Equation and Strain Index. Conclusions Articles are easily found in indexed databases that mention that they used them, but due to the limitations imposed by most journals in view of the size of the document, almost all authors only mention the name of the method they used and, at most, make a description very synthetic of it. In turn, in some Master’s or Doctoral Theses (where this problem does not exist), a more detailed methodological description can be found, but even so, it is not always possible to understand in practice how to use all methods or we find discreetly different versions, result of adaptations or a mixture of methods, carried out over the decades. Any professional on an Occupational Health Team will have a reasonable sense of what are the most damaging tasks; however, presenting this evidence, attenuating subjectivity and making use of the hierarchy that mathematical scales can offer, makes evaluations more scientific, rigorous and easier to be accepted as valid by the Employer/ Representatives/ Workers and, consequently, increase the receptivity to proposed measures to mitigate/ correct the problem and reassess it after this phase. It would be desirable for all professionals in the field to have at least a generic idea of ​​the existing methods and to know where they can go to obtain more information, in order to execute these techniques, if necessary.


2020 ◽  
Vol 9 ◽  
pp. S82-S90
Author(s):  
Mónica Santos ◽  
Armando Almeida ◽  
Catarina Lopes ◽  
Tiago Oliveira

Introduction / framework / objectives Noise is an occupational risk factor extensively addressed in the Occupational Health literature. However, its pathophysiological consequences have traditionally been emphasized, sometimes neglecting more detailed explanations concerning personal protective equipment and collective protective measures. Methodology This is a Scoping Review, initiated by a September 2019 search of the databases “CINALH plus with full text, Medline with full text, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, Academic Search Ultimate, Science Direct, SCOPUS and RCAAP.” Content There are several collective protection measures (at the workspace structure/ design and use of various materials/ devices) that are able to attenuate noise exposure. When exceeding the lower exposure value (80 decibels) the employer must provide hearing protection; if the upper exposure value (85 decibels) is reached or exceeded its use is required (after prior enhancement of collective protective measures). However, workers and their representatives have to be consulted to choose the model. In selecting the latter, account should be taken of European Community certification, appropriate attenuation, compatibility with tasks and other protective equipment used simultaneously; as well as the physical condition of the worker, acceptability and comfort that it will generate. The effectiveness of these will depend on time of use, correct utilization, shape/ size, fit to the ear, pressure (head and/ or ear), resistance to extreme temperatures and material. Conclusions Occupational health team professionals generally need up-to-date information on individual and collective protection measures to mitigate the effects of noise in the workplace. The bibliography (in indexed databases) on these two themes is not very abundant and / or easily accessible. However, these measures, well used, can attenuate noise, promoting safer and healthier work. It would be pertinent for Occupational Health teams who deal with clients with different noise levels, to investigate which of these techniques are most appropriate to each situation and how employees adhere better to the process and perform their part more effectively.


2017 ◽  
Vol 30 (12) ◽  
pp. 835
Author(s):  
Mariana Alves ◽  
Miguel Bigotte Vieira ◽  
João Costa ◽  
António Vaz Carneiro

Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.


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