17º Congresso Nacional da ANAMT: valores essenciais frente às transformações do trabalho: hoje e amanhã / 17th ANAMT National Congress: essential values in the face of the transformations of work: today and tomorrow

O fio condutor do plano de trabalho foi o elenco das competências essenciais requeridas para o exercício da especialidade, na versão atualizada em 2018. Constituíram eixos orientadores a nuvem de palavras, fruto de uma pesquisa qualitativa com diversos associados, e o tema central ­ "Valores Essenciais Frente às Transformações do Trabalho, Hoje e Amanhã". Desse exercício coletivo nasceu uma programação complexa, densa e variada, que busca despertar e facilitar a discussão dos múltiplos campos de interesses e práticas ­ características da Medicina do Trabalho praticada no Brasil. Publica em seu número especial o produto científico do Congresso, com os resumos expandidos de temas que serão abordados nas sessões de Conferências e Semiplenárias. A edição também publica as contribuições dos participantes e congressistas, que submeteram suas experiências como resumos de trabalhos científicos e irão apresentar seus resultados, discussões e conclusões ao longo dos dias do evento.

La ergonomía de la persona. la medicina del trabajo en la aviación y en el trabajo médico / Work medicine and the ergonomics of the person

La Organización Internacional de Trabajo (OIT) señala que la magnitud de las lesiones, enfermedades y muertes ocasionadas por el trabajo indica la necesidad imperiosa de los Estados de proseguir la acción para reducirlas. Medicina del trabajo y ergonomía de la persona. Importancia de los exámenes médicos en la prevención de accidentes y enfermedades laborales.

The International Labour Organization (ILO) indicates that the magnitude of work-related injuries, illnesses and deaths caused by work, indicates the imperative need for States to continue to reduce them. Medicine the work and ergonomics of the person, importance of medical examinations in prevention of accidents and labor diseases.

Commentary on the contributions and future role of occupational exposure science in a vision and strategy for the discipline of exposure science.

Exposure science is a holistic concept without prejudice to exposure source. Traditionally, measurements aimed at mitigating environmental exposures have not included exposures in the workplace, instead considering such exposures to be an internal affair between workers and their employers. Similarly, occupational (or industrial) hygiene has not typically accounted for environmental contributions to poor health at work. Many persons spend a significant amount of their lifetime in the workplace, where they maybe exposed to more numerous chemicals at higher levels than elsewhere in their environment. In addition, workplace chemical exposures and other exogenous stressors may increase epigenetic and germline modifications that are passed on to future generations. We provide a brief history of the development of exposure science from its roots in the assessment of workplace exposures, including an appendix where we detail current resources for education and training in exposure science offered through occupational hygiene organizations. We describe existing successful collaborations between occupational and environmental practitioners in the field of exposure science, which may serve as a model for future interactions. Finally, we provide an integrated vision for the field of exposure science, emphasizing interagency collaboration, the need for complete exposure information in epidemiological studies, and the importance of integrating occupational, environmental, and residential assessments. Our goal is to encourage communication and spur additional collaboration between the fields of occupational and environmental exposure assessment. Providing a more comprehensive approach to exposure science is critical to the study of the "exposome", which conceptualizes the totality of exposures throughout a person's life, not only chemical, but also from diet, stress, drugs, infection, and so on, and the individual response.

[Current trends in occupational dermatology]. / Aktuelle Trends in der Berufsdermatologie.

In clinical practice occupational skin diseases usually present as hand dermatitis. Occupationally acquired contact allergies are of eminent relevance in many work place products e.g. skin care products, dyes and paints, epoxy resins or protective gloves. However, not infrequently, a range of other dermatoses of different etiology and localization can be occupationally induced and, at least in Germany, thus be medically treated and--if necessary--compensated for with full coverage by the statutory employers' liability insurance. Examples regarding non-eczematous skin diseases triggered by external factors are psoriatic lesions, cutaneous type-1-allergies, occupationally acquired infections, and dermatoses in other localizations which are occupationally exposed to irritant influences (e.g. feet in workers wearing occlusive safety boots). Moreover, outdoor workers deserve specific attention by the dermatologist if squamous cell carcinomas including precursor lesions like actinic keratoses or Bowen disease have occurred. In Germany, recently the scientific advisory committee to the Ministry of Labor has recommended including these skin cancers caused by occupational solar UV exposure in the national list of occupational diseases. The framework for dermatological preventive care of occupationally-induced inflammatory dermatoses has been continuously improved in the last years. The aim is to reach a similar level of care and preventive measures for patients with occupational skin cancer, including primary preventive workers' education.

[Chronic central nervous system effects of pesticides: state-of-the-art]. / Effets chroniques des pesticides sur le système nerveux central : état des connaissances épidémiologiques.

BACKGROUND: Given the neurotoxic properties of pesticides, suggested by experimental results and clinical observations, many epidemiological studies have investigated neurological effects following acute or chronic exposure to pesticides. This review provides an overview of current knowledge about pesticide effects on the central nervous system: neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis), cognitive disorders, and psychiatric disorders (mood disorders, anxiety, depression and suicide). RESULTS: Parkinson's disease, the most widely studied in relation with pesticide exposure, particularly with insecticides and herbicides, was observed to be a risk factor of the disease. Evidence is scarce for Alzheimer's disease and amyotrophic lateral sclerosis, but quite consistent. Cognitive and psychiatric disorders were often observed in relation with organophosphate insecticide exposure. Cognitive disorders were found associated with acute and chronic exposures, and psychiatric disorders mostly with poisonings. These epidemiologic studies were limited by a lack of detailed and reliable exposure assessment. The role of genetic susceptibilities has been recently observed, but must be further investigated.

¿Se debe considerar al dengue una enfermedad profesional? / Should be considered on occupational disease dengue?

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti, originario de África. En la actualidad este mosquito es cosmopolita, aunque en otros continentes, otras especies de mosquitos del genero Aedes han sido involucradas en la transmisión del dengue. Casi todas las infecciones por virus dengue son subclínicas. La fiebre del dengue es autolimitada, similar a un proceso gripal pero en algunas personas presenta una respuesta inmunopatológica que desarrolla el síndrome de fiebre hemorrágica por dengue.

Dengue is a viral disease transmitted by the Aedes aegypti mosquito bite, a native insect from Africa. At present this mosquito is cosmopolitan, but in other continents, other species of the genus Aedes have been involved in the transmission of dengue. Almost all dengue virus infections are subclinical. Dengue fever is self-limiting, flulike process, but in some people has an immunopathological response syndrome that develops DHF.

[Structure of human resources and activities of occupational medicine service in Poland in 2009 and dynamics and trends in recent years]. / Struktura kadr i dzialalnosc sluzby medycyny pracy w Polsce w 2009 r. oraz dynamika i kierunki zmian w ostatnich latach.

BACKGROUND: The main objective of the study was to provide the most important results concerning the state of human resources and activities of occupational medicine services in Poland in 2009 and their dynamics and trends in the recent years. MATERIALS AND METHODS: Information about the state of human resources and activities of occupational medicine services has been obtained from statistical forms (more than 10,000) filled by occupational physicians carrying out the preventive g care of workers, and health care centers (or their separate parts), which are the primary occupational medicine units and regional occupational medicine centers (forms: MZ-35A, MZ-35B and MZ-35). RESULTS: In 2009, essential changes were noted in the structure of the primary occupational medicine units. 'Ihere was a significant decrease in the number of public health care centers. This phenomenon has resulted from the transformation of public health care centers into non-public structures. CONCLUSIONS: The range of occupational medicine services has reached the level sufficient enough to achieve the objectives of the occupational health care mandatory assignment. However, the structure of the tasks actually performed by regional occupational medicine centers greatly varies, from focusing on the statutory tasks to their marginalization.

[Changes in medical rehabilitation of the German Statutory Pension Insurance Scheme]. / Veränderungstrends in der medizinischen Rehabilitation der gesetzlichen Rentenversicherung.

Medical rehabilitation in Germany has changed continuously since its inception following the Bismarck Legislation. This article describes its development up until the millennium and discusses quantitative and qualitative changes that followed. Central quantitative changes are demonstrated using the examples of rehabilitation utilization, spectrum of diseases, setting, and postacute rehabilitation. Important qualitative changes in medical rehabilitation pertain to the significance of research for the advancement of rehabilitation, the emphasis on work-related problems in rehabilitative concepts, patient orientation as a new paradigm, integration of rehabilitation into the health system, and prevention. The article ends with an outlook on future developments, such as the anticipated increase in rehabilitation need due to demographic changes and extended working life. Changes in the work environment lead to complex requirements for the development of rehabilitation. In view of increasingly scarce resources, continuous adaptation of rehabilitation concepts is mandatory to maintain health and earning capacity of the population.

[Prospects of hi-tech medicine development in occupational pathology (exemplified by joints diseases model)].

Recommendations for patients with occupational locomotory disorders include ultrasonography, diagnostic and therapeutic arthroscopy, target therapy of systemic osteoporosis with monohydrate zoledronic acid (aclasta)--that enables prolong remission (up to 46.2 months).

[Pathomorphosis and contemporary evolution of occupational and occupationally mediated diseases].

The authors present results of studies concerning pathomorphosis mechanisms underlying contemporary forms of occupational and occupationally mediated diseases. Systemic general pathologic approach enabled to specify importance of universal homeostatic mechanisms disorders at various structural and functional levels in pathogenesis of major disease types.

[Therapy of occupational skin diseases]. / Therapie berufsbedingter Hauterkrankungen.

Hand eczema is one of the most frequent skin diseases. About 5-10% of population has chronic hand eczema. In addition, hand eczema accounts for more than 90% of occupational skin diseases. The therapy of hand eczema is expensive and often leads to a loss in quality of life. The therapy is complex, not always successful and can lead in the worst case to the patient being forced to give up or change their profession. We review the therapeutic options to treat occupational hand eczema.

From clinical activities to didactics and research in occupational medicine.

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

[Toxicogenomics. New perspectives for the molecular toxicology]. / Toksykogenomika. Nowe perspektywy toksykologii molekularnej.

Gene expression in the cellular genome is subject to changes caused by internal and external factors. Due to different expression of gene sets (polymorphism), cells show different morphological and functional characteristics. Environmental and occupational toxic agents may influence cells at the level of transcription and translation. The functional toxicogenomics attempts to explain those influences. Due to recent developments in molecular biology and bioinformatics, it has become possible to analyze protein transcript (toxicogenomics) and profile (toxicoproteomics). This work reports new opportunities to study gene sequencing and expression by means of the DNA chip technique (rapid analysis of the genetic polymorphism) and the microarrays technique (simultaneous analysis of hundreds or thousands of genes). The authors report examples of some practical applications of toxicogenomics in the assessment of the effects of pathological exposures to environmental and occupational toxic (carcinogenic, hepatotoxic and/or neurotoxic) agents, due to the development of new groups of biomarkers, such as biomarkers of individual susceptibility, biomarkers of toxic effects combined with the assay of the relationship between a toxic agent and its dose, and the effect measured at the level of the cellular genome and results of histopathological and biochemical tests.