The Pleural Mesothelioma Cases and Mortality in Portugal in 2014-2020: A Descriptive Study.

BACKGROUND: The incidence and mortality of pleural mesothelioma (PM) reflect the production and consumption of asbestos over time. However, despite the current global concern, these data remain to be known. OBJECTIVE: Our aim was to carry out a descriptive analysis of PM cases and mortality from some Portuguese databases between 2014 and 2020. METHODS: A retrospective observational study was carried out between 2014 and 2020. Data on the number of PM cases were provided by the Portuguese Cancer Registry, and data on mortality were from the Portuguese Death Certificate Information System. RESULTS: Between 2014 and 2020, 315 cases of PM were reported, with 222 (70.5%) men. The average age of patients was 72.1, with the highest number of cases in patients aged >70 years (n = 198; 62.9%). The highest number of cases was reported in 2018 (n = 62; 19.7%). Regarding mortality, 169 deaths were reported, with 126 (74.6%) men and mostly in individuals aged >70 years (n = 109; 64.5%). It is estimated that around 520 years of potential life were lost. The highest number of deaths occurred in 2015 (n = 33; 19.5%). CONCLUSION: It is mandatory to reinforce the need for surveillance programs that allow us to gather real and reliable data and eliminate asbestos-related diseases.

The modifying role of major cardiovascular risk factors in the association between retirement and cardiovascular disease: Results from SHARE Portugal.

BACKGROUND: Despite the actual demographic trends and the global burden of cardiovascular diseases, there is little knowledge concerning the effects of retirement on this health outcome. OBJECTIVE: We aimed to quantify the associations between retirement, and retirement age, with cardiovascular disease (heart disease and stroke) in the Portuguese population. METHODS: We used data from the first Portuguese wave of the Survey of Health Ageing and Retirement in Europe. Logistic regression was applied to quantify the associations. The major risk factors for cardiovascular diseases and several features of retirement were considered as possible confounders or effect modifiers. Analysis was restricted to retirees in retirement process (retired for 5 years or less) and not retired because of illness. RESULTS: An opposite direction of the association between retirement and heart disease was observed according to hypertension status, although not significant. Early retirement increased the odds of having a stroke, merely in individuals without heart disease (OR = 8.87; 95% CI 1.63-48.26). On the contrary, in individuals with heart disease, decreased the odds of having a stroke (OR = 0.08; 95% CI 0.01-0.68). CONCLUSIONS: Our findings suggest that retirement and retirement age may be beneficial or harmful, respectively, in the presence or absence of major risk factors for heart disease and stroke. We suggest that work-related stress affecting differently workers with and without these risk factors may eventually explain these findings.

Telework during the COVID-19 epidemic in Portugal and determinants of job satisfaction: a cross-sectional study.

BACKGROUND: Telework satisfaction is a Public Health concern, intensified by the COVID-19 pandemic, and its determinant factors may be related with the negative health effects of teleworking. However, there is still little research exploring this issue. This study aimed to characterize telework during the first wave of the COVID-19 epidemic in Portugal and to identify the major predictors of telework satisfaction. METHODS: This is a cross-sectional study aimed at all teleworkers working in Portugal, during the first wave of the COVID-19 epidemic. Data were collected through a Google Forms platform online questionnaire distributed by a snowball method on social networks. Descriptive statistics included crude and relative frequency data. The associations between sociodemographic characteristics, self-perceived health, organization of working time, concentration at work, work-life balance, work disconnection, working conditions, and organizational demands (flexibility and organizational trust based on E-work Life Scale) with telework satisfaction were estimated through logistic regression. RESULTS: This study included 1004 participants. Teleworkers satisfaction levels were high (69%). Better concentration at work (OR = 1.54; 95%CI 1.01-2.34); the satisfaction with the balance between work life and extra work when teleworking (OR = 1.79; 95%CI 1.17-2.74); and higher work flexibility (OR = 2.26; 95%CI 1.46-3.49) were good predictors of greater levels of satisfaction with telework. However, its major predictors were the company's trust in teleworkers (OR = 4.50; 95%CI 2.89-7.02) and feeling good in the workspace at home (OR = 3.72; 95%CI 1.46-9.49). CONCLUSIONS: Our findings point that work environment and organizational culture play a crucial role in affecting telework satisfaction. More studies are needed to monitor telework satisfaction and its effects on physical and mental health, so that Public and Occupational Health (and Safety) can be able to identify and implement the best interventions that allow promoting individual health and foster a healthy work environment for teleworkers.

Prevalence of COVID-19 in health professionals and occupational psychosocial risks.

INTRODUCTION: Health professionals who provide clinical care are exposed to patients potentially infected by the severe acute respiratory syndrome coronavirus 2 SARS-CoV-2), namely physicians and nurses; consequently, these professionals face higher risks of infection. OBJECTIVES: This study aimed to describe the prevalence of coronavirus disease 19 (COVID-19) cases among health professionals and the frequencies of risk factors and psychosocial risk. METHODS: This is a cross-sectional study targeted at health professionals working in Portugal during the current COVID-19 pandemic. Data were obtained through a self-administered questionnaire available online at the websites of medical and nursing boards, among other sources. We performed a univariate analysis, calculating absolute and relative frequencies, and a bivariate analysis with a Pearson's chi-squared test. RESULTS: We studied 4,212 health professionals, of which 36.7% (n = 1,514) worked in areas dedicated to the treatment of sick or suspected COVID-19 patients. Of these, 2.11% tested positive for SARS-CoV-2. Among all participants, 76.7% and 79.1% presented moderate to severe levels of fatigue and anxiety, respectively. Fatigue levels were significantly higher in professionals working in areas dedicated to the treatment of patients with COVID-19 (80.5% p = 0.01), but this difference was not observed regarding anxiety (79.5% p = 0.681). CONCLUSIONS: The percentage of health professionals who tested positive for SARS-CoV-2 was 2.11%. The reported high levels of fatigue and anxiety should determine a better protection of the health and safety of those who provide health care in the current pandemic.

Working time and upper limb musculoskeletal symptoms: a longitudinal study among assembly line workers.

This study followed assembly line workers during 7 months, comprising a 4-wk season holidays. The main purposes were to determine the potential effect of working time on the presence and intensity of upper limb musculoskeletal symptoms, as to verify the effect of 4 wk of job interruption in the upper limb musculoskeletal symptoms presence and intensity. Data was collected during 6 moments. Generalized estimating equations analyses were used. For the effect estimates, odds ratio with corresponding 95% confidence intervals were reported for each outcome/model. The upper limb musculoskeletal symptoms showed a significant increase (p=0.001), especially after the 4 wk off. In all data collection points there was a significant positive association between the upper limb musculoskeletal symptoms and general health status (p<0.001). Considering symptoms' intensity, significant relations were found (p<0.001). Work time had a negative effect on the work-related upper limb musculoskeletal symptoms over 7 months (OR 0.909, 95% CI 0.861-0.960, p=0.001). For the intensity of upper limb symptoms, the effect of time was also statistical significant (OR 0.115, 95% CI 1.031-1.220, p=0.008). A 4-wk job interruption did not show an immediately positive effect on upper limb musculoskeletal symptoms presence.

Self-Reported Variables as Determinants of Upper Limb Musculoskeletal Symptoms in Assembly Line Workers.

BACKGROUND: Assembly lines work is frequently associated to work-related upper limb musculoskeletal disorders. The related disability and absenteeism make it important to implement efficient health surveillance systems. The main objective of this study was to identify self-reported variables that can determine work-related upper limb musculoskeletal symptoms-discomfort/pain-during a 6-month follow-up. METHODS: This was a prospective study with a 6-month follow-up period, performed in an assembly line. Upper limb musculoskeletal discomfort/pain was assessed through the presence of self-reported symptoms. Uni- and multivariate logistic regression analyses were used to evaluate which self-reported variables were associated to upper limb symptoms after 6 months at the present and to upper limbs symptoms in the past month. RESULTS: Of the 200 workers at baseline, 145 replied to the survey after 6 months. For both outcomes, "having upper limb symptoms during the previous 6 months" and "education" were possible predictors. CONCLUSION: Our results suggest that having previous upper limb symptoms was related to its maintenance after 6 months, sustaining it as a specific determinant. It can be a hypothesis that this population had mainly workers with chronic symptoms, although our results give only limited support to self-reported indicators as determinants for upper limb symptoms. Nevertheless, the development of an efficient health surveillance system for high demanding jobs should implicate self-reported indicators, but also clinical and work conditions assessment should be accounted on the future.

Functional effects of differentially expressed microRNAs in A549 cells exposed to MWCNT-7 or crocidolite.

Multi-walled carbon nanotubes (MWCNT) are engineered nanomaterials widely used in industrial and biomedical applications. Yet, MWCNT inhalation may induce pulmonary adverse effects, and the MWCNT-7 (Mitsui-7) has been classified as possibly carcinogenic to humans. However, its molecular mechanisms of action are poorly understood and there are no biomarkers of exposure for occupational monitoring. Several pulmonary diseases, including lung cancer, have been associated with alterations in microRNA expression that are used as biomarkers of disease progression, and differentially-expressed microRNAs (DE miRNAs) can also allow understanding the molecular effects induced by a toxicant. In this study, we identify DE miRNAs in A549 alveolar epithelial cells following 24 h exposure to MWCNT-7 or crocidolite, as well as their enriched cellular functional pathways. These indicate that both materials change cell survival, differentiation and proliferative properties under the influence of AMPK, FoxO, TGF-ß and Hippo pathways, and their metabolic activity and cell-to-cell communication. In addition, MWCNT-7 affects the actin cytoskeleton, ubiquitin mediated proteolysis, and ECM-receptor interactions; crocidolite the PI3K-Akt and mTOR pathways, endocytosis, and central carbon metabolism. Since deregulation of these pathways may be related to carcinogenesis, an interaction network of DE miRNAs and corresponding target cancer-related genes was constructed, highlighting the carcinogenic potential of Mitsui-7.

Cytotoxicity and genotoxicity of MWCNT-7 and crocidolite: assessment in alveolar epithelial cells versus their coculture with monocyte-derived macrophages.

In the past years, several in vitro studies have addressed the pulmonary toxicity of multi-walled carbon nanotubes (MWCNT) and compared it with that caused by asbestos fibers, but their conclusions have been somewhat inconsistent and difficult to extrapolate to in vivo. Since cell coculture models were proposed to better represent the in vivo conditions than conventional monocultures, this work intended to compare the cytotoxicity and genotoxicity of MWCNT-7 (Mitsui-7) and crocidolite using A549 cells grown in a conventional monoculture or in coculture with THP-1 macrophages. Although a decrease in A549 viability was noted following exposure to a concentration range of MWCNT-7 and crocidolite, no viability change occurred in similarly exposed cocultures. Early events indicating epithelial to mesenchymal transition (EMT) were observed which could explain apoptosis resistance. The comet assay results were similar between the two models, being positive and negative for crocidolite and MWCNT-7, respectively. An increase in the micronucleus frequency was detected in the cocultured A549-treated cells with both materials, but not in the monoculture. On the other hand, exposure of A549 monocultures to MWCNT-7 induced a highly significant increase in nucleoplasmic bridges in which those were found embedded. Our overall results demonstrate that (i) both materials are cytotoxic and genotoxic, (ii) the presence of THP-1 macrophages upholds the viability of A549 cells and increases the aneugenic/clastogenic effects of both materials probably through EMT, and (iii) MWCNT-7 induces the formation of nucleoplasmic bridges in A549 cells.

Workplace Violence in Healthcare: A Single-Center Study on Causes, Consequences and Prevention Strategies.

INTRODUCTION: Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational health prevention and surveillance strategies. MATERIAL AND METHODS: Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test and the Fisher's exact test were used to calculate p values. RESULTS: The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28 [78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it is possible to minimize workplace violence. DISCUSSION: Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our study reflects the negative effects of threatening occupational stressors on mental health. CONCLUSION: Our results show that workplace violence is a relevant risk factor that significantly impacts workers' health in a noxious manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.

Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir estratégias de prevenção e vigilância em saúde ocupacional. Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p. Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o incidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema. Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado reflete o efeito prejudicial da exposição a fontes de stress e ameaça. Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo.

Condições de trabalho e exaustão emocional elevada em enfermeiros no ambiente hospitalar / Working conditions and high emotional exhaustion among hospital nurses

INTRODUÇÃO: Os trabalhadores da saúde estão expostos a muitos estressores diferentes no ambiente de trabalho, alguns deles relacionados com as condições do trabalho dos mesmos. Enquanto a experiência do estresse parece depender da percepção individual, algumas características das unidades de internação podem influenciar a ocorrência de exaustão emocional entre os enfermeiros. O objetivo do presente estudo é identificar características das unidades de internação relacionadas à ocorrência de níveis elevados de exaustão emocional entre profissionais da saúde, a saber, enfermeiros. MÉTODOS: O presente estudo transversal, exploratório e descritivo foi realizado com 108 enfermeiros (83,8% do sexo feminino e com média de 33 anos de idade) alocados em unidades de internação (enfermarias e terapia intensiva) de um hospital universitário em Portugal. Foi administrada a subescala de exaustão emocional do Maslach Burnout Inventory­Human Services Survey (MBI-HSS) e coletados os seguintes dados relativos às unidades de trabalho dos participantes: (1) índice de fatalidade, (2) número de óbitos, (3) déficit de enfermeiros por comparação às diretrizes nacionais, (4) taxa de ocupação e (5) proporção de pacientes idosos internados (>65 anos de idade). RESULTADOS: Identificamos uma associação positiva entre níveis elevados de exaustão emocional e elevado número de óbitos (p=0.012), elevada taxa de mortalidade (p=0.036) e elevada proporção de pacientes idosos (p=0.025). CONCLUSÃO: O número de óbitos, elevada proporção de pacientes idosos e elevada taxa de fatalidade em unidades de internação apresentaram associação com níveis elevados de exaustão emocional entre enfermeiros. Estes achados sugerem que a caracterização das condições objetivas de trabalho em unidades de internação parece ser um aspecto importante a ser levado em conta em programas focados em riscos psicossociais.

BACKGROUND: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. OBJECTIVE: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. METHODS: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory­Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). RESULTS: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). CONCLUSION: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.

Working conditions and high emotional exhaustion among hospital nurses.

BACKGROUND: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. OBJECTIVE: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. METHODS: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). RESULTS: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). CONCLUSION: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs.

INTRODUÇÃO: Os trabalhadores da saúde estão expostos a muitos estressores diferentes no ambiente de trabalho, alguns deles relacionados com as condições do trabalho dos mesmos. Enquanto a experiência do estresse parece depender da percepção individual, algumas características das unidades de internação podem influenciar a ocorrência de exaustão emocional entre os enfermeiros. O objetivo do presente estudo é identificar características das unidades de internação relacionadas à ocorrência de níveis elevados de exaustão emocional entre profissionais da saúde, a saber, enfermeiros. MÉTODOS: O presente estudo transversal, exploratório e descritivo foi realizado com 108 enfermeiros (83,8% do sexo feminino e com média de 33 anos de idade) alocados em unidades de internação (enfermarias e terapia intensiva) de um hospital universitário em Portugal. Foi administrada a subescala de exaustão emocional do Maslach Burnout Inventory­Human Services Survey (MBI-HSS) e coletados os seguintes dados relativos às unidades de trabalho dos participantes: (1) índice de fatalidade, (2) número de óbitos, (3) déficit de enfermeiros por comparação às diretrizes nacionais, (4) taxa de ocupação e (5) proporção de pacientes idosos internados (>65 anos de idade). RESULTADOS: Identificamos uma associação positiva entre níveis elevados de exaustão emocional e elevado número de óbitos (p=0.012), elevada taxa de mortalidade (p=0.036) e elevada proporção de pacientes idosos (p=0.025). CONCLUSÃO: O número de óbitos, elevada proporção de pacientes idosos e elevada taxa de fatalidade em unidades de internação apresentaram associação com níveis elevados de exaustão emocional entre enfermeiros. Estes achados sugerem que a caracterização das condições objetivas de trabalho em unidades de internação parece ser um aspecto importante a ser levado em conta em programas focados em riscos psicossociais.

Percepção dos riscos profissionais em trabalhadores de transporte de valores / Perceived occupational hazards among cash-in-transit guards

Introdução: Realizou-se um estudo no setor de vigilância privada com vigilantes de transporte de valores (VTVA) diante da presença de queixas de saúde a uma organização sindical do setor. Objetivos: Diagnosticar a situação de trabalho desses profissionais, do ponto de vista da saúde e segurança, caracterizando as condições de trabalho e as tarefas desses trabalhadores, identificando elementos da atividade de trabalho com influência em sua saúde e segurança e apontando os principais problemas de saúde autorreportados em três empresas que operam em Portugal. Métodos: Efetivou-se um estudo exploratório, de natureza descritiva, recorrendo a um questionário dirigido a trabalhadores com três dimensões, de acordo com os objetivos no contexto da saúde e segurança do trabalho (SST). O questionário foi aplicado nas empresas pelos representantes do sindicato e sem qualquer participação das direções das empresas. Resultados: A atividade desses funcionários apresenta exigências diversas, nomeadamente de concentração e precisão, carga física elevada, horários atípicos, exposição a situações emocionalmente fortes e ainda violência. Evidencia­se, por parte dos trabalhadores, influência negativa do trabalho em sua saúde e segurança, tanto no nível físico como no psicológico. Conclusão: Identifica-se uma importante variabilidade de condições e exigências do trabalho nas empresas observadas, que determina a necessidade de intervenção no contexto da SST, designadamente por meio de sensibilização sobre a legislação existente no sentido da prevenção das doenças ligadas ao trabalho e também dos acidentes de trabalho

Background: Given reports of health complaints by cash-in-transit (CIT) guards to their trade union, we conducted a study at private security companies. Objectives: To establish the health and safety at work (HSW) conditions to which employees from three companies in Portugal were subjected, characterize their working conditions and tasks, and identify aspects of their activity with influence on their health and safety, as well as self-reported health problems. Methods: We performed an exploratory and descriptive study based on a questionnaire with three dimensions corresponding to the study aims. The questionnaire was applied by workers' representatives in the workplace without any participation of employers. Results: The job of CIT guards poses several demands as concentration and precision, involves high physical load, atypical schedules, and exposure to emotionally disturbing situations and violence. The workers rated negative the influence of work on their physical and mental health and safety. Conclusion: We found considerable variability in working conditions and work demands between the analyzed companies. Such diversity points to the need to intervention on HSW through sensitization toward the legislation in force for the prevention of work related diseases and accidents

Evaluating the genotoxicity of cellulose nanofibrils in a co-culture of human lung epithelial cells and monocyte-derived macrophages.

Cellulose nanofibrils (CNF) are manufactured nanofibres that hold impressive expectations in forest, food, pharmaceutical, and biomedical industries. CNF production and applications are leading to an increased human exposure and thereby it is of utmost importance to assess its safety to health. In this study, we screened the cytotoxic, immunotoxic and genotoxic effects of a CNF produced by TEMPO-mediated oxidation of an industrial bleached Eucalyptus globulus kraft pulp on a co-culture of lung epithelial alveolar (A549) cells and monocyte-derived macrophages (THP-1 cells). The results indicated that low CNF concentrations can stimulate A549 cells proliferation, whereas higher concentrations are moderately toxic. Moreover, no proinflammatory cytokine IL-1ß was detected in the co-culture medium suggesting no immunotoxicity. Although CNF treatment did not induce sizable levels of DNA damage in A549 cells, it leaded to micronuclei formation at 1.5 and 3 µg/cm2. These findings suggest that this type of CNF is genotoxic through aneugenic or clastogenic mechanisms. Noteworthy, cell overgrowth and genotoxicity, which are events relevant for cell malignant transformation, were observed at low CNF concentration levels, which are more realistic and relevant for human exposure, e.g., in occupational settings.

Conventional and novel "omics"-based approaches to the study of carbon nanotubes pulmonary toxicity.

The widespread application of carbon nanotubes (CNT) on industrial, biomedical, and consumer products can represent an emerging respiratory occupational hazard. Particularly, their similarity with the fiber-like shape of asbestos have raised a strong concern about their carcinogenic potential. Several in vitro and in vivo studies have been supporting this view by pointing to immunotoxic, cytotoxic and genotoxic effects of some CNT that may conduct to pulmonary inflammation, fibrosis, and bronchioloalveolar hyperplasia in rodents. Recently, high throughput molecular methodologies have been applied to obtain more insightful information on CNT toxicity, through the identification of the affected biological and molecular pathways. Toxicogenomic approaches are expected to identify unique gene expression profiles that, besides providing mechanistic information and guiding new research, have also the potential to be used as biomarkers for biomonitoring purposes. In this review, the potential of genomic data analysis is illustrated by gene network and gene ontology enrichment analysis of a set of 41 differentially expressed genes selected from a literature search focused on studies of C57BL/6 mice exposed to the multiwalled CNT Mitsui-7. The majority of the biological processes annotated in the network are regulatory processes and the molecular functions are related to receptor-binding signalling. Accordingly, the network-annotated pathways are cell receptor-induced pathways. A single enriched molecular function and one biological process were identified. The relevance of specific epigenomic effects triggered by CNT exposure, for example, alteration of the miRNA expression profile is also discussed in light of its use as biomarkers in occupational health studies. Environ. Mol. Mutagen. 59:334-362, 2018. © 2018 Wiley Periodicals, Inc.

Perceived occupational hazards among cash-in-transit guards.

BACKGROUND: Given reports of health complaints by cash-in-transit (CIT) guards to their trade union, we conducted a study at private security companies. OBJECTIVES: To establish the health and safety at work (HSW) conditions to which employees from three companies in Portugal were subjected, characterize their working conditions and tasks, and identify aspects of their activity with influence on their health and safety, as well as self-reported health problems. METHODS: We performed an exploratory and descriptive study based on a questionnaire with three dimensions corresponding to the study aims. The questionnaire was applied by workers' representatives in the workplace without any participation of employers. RESULTS: The job of CIT guards poses several demands as concentration and precision, involves high physical load, atypical schedules, and exposure to emotionally disturbing situations and violence. The workers rated negative the influence of work on their physical and mental health and safety. CONCLUSION: We found considerable variability in working conditions and work demands between the analyzed companies. Such diversity points to the need to intervention on HSW through sensitization toward the legislation in force for the prevention of work-related diseases and accidents.

INTRODUÇÃO: Realizou-se um estudo no setor de vigilância privada com vigilantes de transporte de valores (VTVA) diante da presença de queixas de saúde a uma organização sindical do setor. OBJETIVOS: Diagnosticar a situação de trabalho desses profissionais, do ponto de vista da saúde e segurança, caracterizando as condições de trabalho e as tarefas desses trabalhadores, identificando elementos da atividade de trabalho com influência em sua saúde e segurança e apontando os principais problemas de saúde autorreportados em três empresas que operam em Portugal. MÉTODOS: Efetivou-se um estudo exploratório, de natureza descritiva, recorrendo a um questionário dirigido a trabalhadores com três dimensões, de acordo com os objetivos no contexto da saúde e segurança do trabalho (SST). O questionário foi aplicado nas empresas pelos representantes do sindicato e sem qualquer participação das direções das empresas. RESULTADOS: A atividade desses funcionários apresenta exigências diversas, nomeadamente de concentração e precisão, carga física elevada, horários atípicos, exposição a situações emocionalmente fortes e ainda violência. Evidencia-se, por parte dos trabalhadores, influência negativa do trabalho em sua saúde e segurança, tanto no nível físico como no psicológico. CONCLUSÃO: Identifica-se uma importante variabilidade de condições e exigências do trabalho nas empresas observadas, que determina a necessidade de intervenção no contexto da SST, designadamente por meio de sensibilização sobre a legislação existente no sentido da prevenção das doenças ligadas ao trabalho e também dos acidentes de trabalho.

Tendinite do manguito rotador em operadores de caixa de supermercado: contributos para a vigilância de saúde / Rotator cuff tendinitis in supermarket cashiers: contributions to health surveillance

Contexto: A tendinite do manguito rotador (TMR) é frequente em operadores de caixa de supermercado devido às exigências do trabalho. É, de facto, frequente a realização de movimentos repetitivos de abdução e flexão dos membros superiores, muitas vezes em carga, que podem causar inflamação dos tecidos periarticulares do ombro, desencadeando sinais e sintomas de TMR. Objetivos: Conhecer a prevalência de TMR em operadores de caixa de supermercado por meio da avaliação de sintomas, sinais e ecografia. Métodos: Participaram 44 trabalhadores com idades entre 28 e 47 anos. Eles preencheram um questionário de queixas autorreferidas aos ombros e realizaram exame objetivo (manobras do arco doloroso, do conflito subacromial e abdução resistida do ombro) e ecografia de tecidos moles. Resultados: Identificaram-se queixas de dor no ombro em 26 operadores à direita (59,1%) e em 16 (36,4%) à esquerda. Ao exame objetivo, 15 e 11 trabalhadores (34,1% à direita e 25,0% à esquerda, respetivamente) apresentaram positividade nas três manobras. Na ultrassonografia foram encontradas alterações no ombro direito e esquerdo em 16 e 17 operadores (36,4 e 38,6%, respetivamente). Não foi encontrada concordância estatística entre as três abordagens. A "manobra de abdução resistida do ombro" revelou boa relação com as queixas de dor no ombro (χ2 Wald (1)=7,260; p=0,007). Obtiveram-se resultados semelhantes de associação entre essa manobra e a avaliação ecográfica (χ2 Wald (1)=6,854; p=0,009; ROC=0,714, sensibilidade 75%; especificidade 67,9%). Conclusões: Os resultados obtidos sugerem que a "manobra de abdução resistida do ombro" é preditiva de TMR na vigilância médica desses trabalhadores. Tal deverá ser verificado em futuros estudos, designadamente envolvendo amostras de maiores dimensões.

Background: Rotator cuff tendinitis (RCT) is common among supermarket cashiers due to their work demands. Repetitive movements of shoulder abduction and flexion are frequent, which might cause inflammation of the periarticular tissues of the shoulder, triggering signs and symptoms of RCT. Objectives: To investigate the prevalence of RCT in supermarket cashiers by means of assessment of symptoms, signs and ultrasound. Methods: Forty-four workers aged 28 to 47 years old participated in the study. The participants were subjected to a self-report shoulder complaints questionnaire, clinical examinations ("painful arc test", "empty can test" and "Hawkins-Kennedy impingement test") and soft tissue ultrasound. Results: A total of 26 participants reported shoulder pain on the right side (59.1%) and 16 (36.4%) on the left side. During clinical assessment, 15 and 11 workers (34.1% right and 25.0% left, respectively) had positive results on all three tests. Ultrasound showed alterations in the right and left shoulder in 16 and 17 participants (36.4 and 38.6%, respectively). No statistical correlation was found between the three approaches. The "empty can test" exhibited strong correlation with shoulder pain (χ2 Wald (1)=7.260, p=0.007). Similar results were obtained for the association between this test and ultrasound (χ2 Wald (1)=6.854, p=0.009, ROC=0.714, sensitivity 75%, specificity 67.9%). Conclusions: The results suggest that the "empty can test" is predictive of RCT in the medical surveillance of supermarket cashiers. This finding should be verified in future studies, especially with larger samples.

Risk factors for health care-associated infections: From better knowledge to better prevention.

BACKGROUND: Health care-associated infections (HCAIs) are preventable with adoption of recognized preventive measures. The first step is to identify patients at higher risk of HCAI. This study aimed to identify patient risk factors (RFs) present on admission and acquired during inpatient stay which could be associated with higher risk of acquiring HCAI. METHODS: A case-control study was conducted in adult patients admitted during 2011 who were hospitalized for >48 hours. Cases were patients with HCAIs. Controls were selected in a ratio of 3:1, case matched by the admission date. The likelihood of increased HCAI was determined through binary logistic regression. RESULTS: RFs identified as being the more relevant for HCAI were being a man (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7), being aged >50 years (OR, 2.9; 95% CI, 1.3-6.9), and having an insertion of a central venous line during hospital stay (OR, 12.4; 95% CI, 5.0-30.5). CONCLUSIONS: RFs that showed statistical significance on admission were the patient's intrinsic factors, and RFs acquired during hospitalization were extrinsic RFs. When a set of RFs were present, the presence of a central venous line proved to be the more relevant one.

Hospital nurses tasks and work-related musculoskeletal disorders symptoms: A detailed analysis.

BACKGROUND: Hospital work-related musculoskeletal disorders (WRMSDs) symptoms are highly prevalent and nurses are considered the health care professional group more often affected by WRMSDs. OBJECTIVES: Understanding the effects of nursing tasks on WRMSDs symptoms. METHODS: Portuguese nurses answered to a modified Nordic Musculoskeletal symptoms Questionnaire. The increased likelihood of having WRMSDs symptoms was estimated from a daily working task schedule and the probability of suffering from lumbar WRMSDs symptoms intensity was also estimated. RESULTS: Hospital nurses studied (n= 1.396) were mainly females (75.8%), and most of them reported more than 1 symptom (88%). Low-back pain was the most prevalent complaint (60.9%). Tasks performed more than 10 times a day, such as invasive procedures (OR = 2.142); care of hygiene and patient comfort in bed (OR = 2.484); patient mobilization in bed (OR = 2.022); and patient feeding (OR = 2.186) had an effect on dorsal and lumbar symptoms (p< 0.05).Those tasks involving invasive procedures were just the only ones producing symptoms simultaneously on every studied body part, such as lumbar, dorsal, wrist/hand and ankles/feet areas. CONCLUSIONS: Tasks with a greater effect on low-back pain intensity were patient bed feeding and patient hygiene and care. We found, when analysing simultaneously the effects of every task on the likelihood of having low-back symptoms, that involving invasive procedures were that only ones affecting simultaneously the presence of almost all WRMSDs symptoms studied.

Endemic methicillin-resistant Staphylococcus aureus: Nurses' risk perceptions and attitudes.

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care-associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.