Prevalência das Lesões Músculo-Esqueléticas em Trabalhadores Industriais: uma Revisão Integrativa da Literatura

Introduction According to the World Health Organization, in 2017, musculoskeletal diseases were the major contributors to global disability. Considering the exercise of functions in a professional context as an essential component in the daily life of human beings, it is in this environment that many of these injuries arise. The serious economic, labour and social repercussions that this type of injuries can cause brings us to the importance of analysing the current prevalence of these events in several industries, as well as the most affected body areas. Methods A literature search was carried out in the Pubmed and Web of Science databases, of articles published after 2015. The keywords used were “employee”, “skeletal muscle”, “injuries” and “industry/ sector”. This research resulted in 132 articles, of which 37 were revised to the full text and assessed their quality, which allowed the selection of 15 articles for a consequent analysis. Results Among the various industries, the tanning industry was the one with the highest global prevalence of musculoskeletal injuries (89.1%), 94.5% in females and 85% in males. In general, the prevalence of this type of injury in workers from different industries was around 70%. In most of the industries analysed (such as food, construction and textiles), the back/ lumbar area was the area most described as the origin of these injuries, with the exception of the printing industry, which reported a higher prevalence at the shoulder level. However, the back was the least identified region in the printing industry, being replaced, in this case, by the shoulder region. Discussion / Conclusion In general, and according to the data obtained, industrial workers are affected by a prevalence of musculoskeletal injuries that can vary between about 55% and 90%. The most affected regions of the body include the back, followed by shoulders, lower limbs and neck. The female sex was shown to be the most susceptible gender to contract musculoskeletal injuries, with respect to industrial workers.

Em época de Pandemia: Covid-19 como Doença Profissional- a experiência de um Instituto Português de Oncologia

INTRODUCTION The novel coronavirus, called SARS-CoV-2, has as its main factor of the disease spreading the transmission between humans. COVID-19 is the name given by the World Health Organization (WHO) to identify the disease caused by this agent. Portugal is currently experiencing the pandemic Mitigation phase, in which, in addition to community transmission, it is assumed that there is local transmission in a closed environment. This disease was recognized by the WHO and by the Portugal Directorate-General of Health as Occupational Disease in a health care environment. OBJECTIVE Evaluate and characterize the presumed cases of occupational disease caused by SARS-CoV-2, among workers with COVID-19, considering the respective interpretation of the causal nexus, individually. METHODS Retrospective, descriptive, observational study (case-series), carried out between march and july 2020 in workers of a Portuguese oncology institute, dedicated to provide care for patients with cancer, reviewing files in the clinical processes of the occupational health service software (UTILSST®). It was considered the infection of workers with SARS-COV-2, as an inclusion criterion. RESULTS 41 workers were diagnosed with COVID-19, with an average age of 43.70 ± 11.63 years. Of these, 87.80% (n= 36) were female. The professional category with the highest infection rate in the institution was the auxiliaries of nursing [46.34%, n= 19], followed by nurses [39.02%, n = 16]. The most affected service was a Medical Oncology Service [31.4%, n= 11]. In the studied population, the prevalence of cases presumed to be Occupational Disease was 80.49% (n= 33). Of these, 48.5% (n= 16) were by direct contact with an infected patient, 30.3% (n = 10) without a known index case, but with a diagnosis obtained in “Disease mitigation phase” and 21.2% (n=7) by contact with an infected worker. In 19.51% (n= 8) of all the cases, no Occupational Disease was presumed, due to contact with an infected index case in a social/ family environment. CONCLUSION The main sources of nosocomial transmission with an assumed causal nexus are patients with COVID-19. It is essential to put into practice and ensure the maintenance of adequate collective and individual protection measures to combat this disease, as well as ensuring a permanent update of the institution’s infection control program so that the risk of exposure is controlled.

Danos Ocupacionais associados ao Crómio, com ênfase no setor da Conservação e Restauro de Obras de Arte

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.

Avaliação Ergonómica das tarefas executadas no Setor da Tatuagem: podem usar-se os Métodos OWAS e REBA?

Introduction/ background/ objectives Given that the Tattoo sector is still poorly studied in the context of Occupational Health, the aim of this work was to briefly assess the sector’s Ergonomic Risk, special because in complex and/ or extensive/ time-consuming Tattoos, the professional may need to perform his work with forced/ maintained postures and repetitive movements, for prolonged periods and, in some cases, protection measures are not always properly developed. Methodology After listing the main generic tasks in the Tattoo sector, two methods for summary ergonomic analysis were applied: OWAS (Ovaco Working Analysis System) and REBA (Rapid Entire Body Assessment). Content Due to the OWAS method, it was found that the initial tasks (drawing the pattern on paper or looking for the pattern on the computer and transferring it to decal sheets) obtained the lowest levels of risk (that is, 1); all other tasks considered reached Action Level 2, except for the possibility of the Tattooist having to help the client in the case of syncope/ lipothymia and, in view of the posture/ load bearing, obtained a rating of 4. However, when weighted with the time that each task usually occupies in percentage, in relation to the work shift, the situation has changed, that is, that Action Level 4 disappeared because the Tattoo Artist would be able to put himself and the client, in a few seconds or, at most, a few minutes, in a less forced posture and without load support. In addition, about half of Action Levels 2 went to 1, remaining in that stages the tasks of drawing the pattern to tattoo directly on the skin, injecting pigment into the skin, cleaning the excess pigment and applying other chemical agents to the skin remaining at the first value, as well as the cleaning/ disinfection / sterilization of work surfaces and work tools (also including their accommodation). In turn, the REBA methodology gave rise to different results. None of the tasks considered had Action Level 0 and only one had the highest level, that is, 4 (helping the client in case of lipothymia/ syncope). At Action Level 2, the tasks considered were shave, disinfect/ sterilize the skin, transfer the decal sheet, put chemical agents on the skin during the tattoo and clean/ disinfect/ sterilize work surfaces. On the other hand, at Action Level 3, there remains the alternative task of drawing the pattern that will be tattooed directly on the skin, inserting the designs on the decal sheets, preparing the workbench/ work tray, injecting the pigment into the skin, cleaning the skin of the excess pigment and clean/ disinfect/ sterilize/ accommodate the work instruments. Conclusions It was noticed that the OWAS methodology was able to better value the risk, considering the time that this task occupies, when compared to the REBA technique. Overall, the different results would eventually be attenuated if these major tasks were subdivided into subtasks, considering movement by movement; however, this would greatly increase the complexity of these ergonomic assessments, even in low-diversified jobs and with relatively few major tasks. In addition, another condition may have significantly biased the results- or the investigator assess with rigor only and exactly a single moment (running the risk of biasing whether the professional has positioned himself correctly or not and not considering the risk that other postures would bring the same task, in other moments of the Tattoo and/ or even with other Tattoo Artists) or, to try to guard against such, consider the most serious possibility for each task. As the objective was to portray the Tattoo sector globally (and not one or the other studio in particular), it was decided to cover all situations and, being several possible, always considered the most serious. In addition, even though these methods allow some subjectivity to be mitigated in the risk assessment, it cannot be eliminated. In situations of doubt between two hypotheses of the scale, it will be possible for a less experienced evaluator at one time to choose one and, in another equivalent task, choose the other or until this happens by repeating the evaluation of exactly the same task, at different times. Even so, these methods and constitute a valuable aid in the Occupational Health Risk Assessment.

Dermatite de Contato Alérgica aos (Meta)Acrilatos- estudo retrospetivo de sete anos num Hospital Público Português

Introduction Acrylates are salts or esters of the acrylic acid, widely used as part of cosmetic or dental products, surgical equipment, medical devices, household items, building materials and printing inks. Allergic contact dermatitis (ACD) caused by (metha)acrylates could be described in occupational settings, mainly in beauticians using acrylic manicure and, specifically, the photo-bonded long-lasting nail polish. The use of gloves, fingertips made of Polyethylene/ Ethylvinyl-alcohol, mask, safety glasses and an appropriate uniform are recommended in these cases. Materials and methods We present a retrospective study of ACD to acrylates diagnosed at an Hospital in Braga (Portugal), between January 2012 and March 2018. In all cases the epicutaneous patch tests used included the Portuguese Contact Dermatitis Research Group baseline series and an extended series of (meth)acrylates. Results A total of 39 female patients had a sensitization to (metha)acrylates, aged between 21-66 years, with personal history of atopic eczema and allergic rhinitis in 23 and 26% of cases, respectively. The most frequent presentation was hand eczema (87%). Dorsal and palms were affected in an equal percentage of cases (38%) and nail dystrophy in 8% of patients. Ectopic lesions on the face were detected in 33% of cases, mostly with the involvement of the eyelids. Occupational related exposure due to (metha)acrylates was found in 69% of cases, mostly of them beauticians/ artificial nail technicians. The most common sensitizers among the 39 allergic individuals were 2-hydroxyethyl methacrylate (HEMA; positive in 97% of cases) and ethyleneglycol dimethacrylate (positive in 69% of cases). Conclusion In our population, we highlight the high number of cases of ACD from (meth)acrylates in relation to artificial nails. Concerning to the health and safety of workers, it certainly deserves better preventive measures at the occupational level and specific regulation from the authorities concerned with the safety of consumers. HEMA was the most frequent positive allergen (above 90% of tests) and, in agreement with previous studies, can be considered a good screening allergen.

A Influência do Trabalho Noturno no Controlo da Diabetes: Revisão Integrativa da Literatura

Helena Alves, Tiago Alves, Ana Costa, Sidónia Pacheco, Germano Couto Introduction Diabetes mellitus is a chronic disease with a high and growing prevalence, particularly among the younger population. The increase in disease among the active population can lead to a greater risk of incapacity for work and a high rate of absenteeism. Methods This study consists of an integrative literature review. After establishing the inclusion and exclusion criteria, four cross-sectional studies were selected. Results Although there is not enough evidence, there seems to be a trend towards higher blood glucose levels in diabetic and non-diabetic workers who do night work. Studies have shown that night workers have more cardiovascular risk factors, which can influence glycemic control and is in line with studies that associate night shift work with an increased prevalence of metabolic syndrome, which consists of the junction of lipid alteration (decreased good cholesterol or HDL and increased triglycerides), increased blood pressure, abdominal obesity and altered blood glucose. Discussion / Conclusion There is a need to develop randomized controlled studies. However, more aggressive glycemic control in night workers can be important to avoid complications of the disease. There is a need to invest in diabetes prevention programs with workers in Occupational Health services and develop/ implement targeted and effective interventions to help workers better manage their disease, since the prevalence of type 2 diabetes in the working age population continues to increase. It may be necessary to adapt the therapeutic and dietary regime to diabetic workers who work at night.

Métodos para Avaliação Global de Risco em Saúde Ocupacional: sabemos o suficiente?

Introduction / background / objectives Risk assessment in the workplace is a fundamental step towards obtaining safer and healthier jobs. The Security Technicians are generally the most experienced in this context; however, not all the professionals that carry out Occupational Health activities present well-structured and/ or practical knowledge about most of these methods. The purpose of this review was to summarize the main techniques used in this context. Methodology This is a review, initiated through a survey conducted in April 2020, in the RCAAP database (Open Access Scientific Repositories in Portugal). Content The author made some practical considerations about MARAT (Methodology for Risk Assessment and Accidents at Work), William Fine, MIAR (Integrated Methodology for Risk Assessment) and FMEA (Failure Mode and Effect Analysis), valuing with explanatory tables and highlighted the slight discrepancies between the documents consulted. Conclusions The key-words used were related to the methods that the author briefly know; in the documents found, sometimes, other techniques have been included; this obviously implies a bias selection. We easily find articles in indexed databases that mention these methods, but due to the limits imposed by most journals, relating to the size of the document, almost all authors only mention the name of the method or, at most, use a very synthetic description of it. In turn, in some Master’s or Doctorate Theses (where this problem does not exist) we can find a more methodological description, but still, sometimes you cannot always get the practice knowledge of how to use all methods or if the items are slightly different, result of adaptations, consideration of different subtypes or a mixture of methods, carried out over the decades. Any professional on an Occupational Health Team will have a reasonable sense of what the most damaging tasks will be; however, presenting this evidence, attenuating subjectivity and making use of the hierarchy that mathematical scales can offer, it becomes more accepted as valid by employers/ representatives/ workers and, consequently, increase the receptivity to proposed measures to mitigate/ correct the problem and reassess it, after introducing corrective measures. It would be desirable for all professionals in the field to have (at least) a generic idea of ​​the existing methods and where they can seek more information, in order to execute these techniques, when necessary.

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

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.