Hepatitis B vaccination associated with low response in patients with rheumatic diseases treated with biologics.

BACKGROUND: Hepatitis B virus (HBV) vaccination is recommended for non-immunised patients with rheumatic diseases starting biological disease-modifying antirheumatic drugs (bDMARDs). There is some evidence that HBV vaccination is effective in patients under conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), but it is currently unclear whether this also applies to bDMARDs. OBJECTIVES: To assess the efficacy and safety of HBV vaccination in patients with inflammatory arthritides treated with bDMARDs. METHODS: A prospective cohort with inflammatory arthritides treated with bDMARDs, negative for anti-HBs and anti-HBc and never vaccinated for HBV was recruited. Engerix B was administered at 0, 1 and 6 months and anti-HBs was reassessed ≥1 month after last dose. Response was defined as anti-HBs≥10 IU/L and compared against vaccinated healthy controls. Disease flare, serious adverse events and immune-related disorders not previously present were recorded. RESULTS: 62 patients, most treated with TNF inhibitors (TNFi), and 38 controls were recruited. Most patients were taking csDMARDs (67.7%) and were in remission/low disease activity (59.4%). Only 20/62 patients (32.3%) had a positive response to vaccination, in comparison to 36/38 age-matched controls (94.7%, p<0.001). Response was seen in 19/51 patients treated with TNFi (37.3%) and in 1/11 (9.1%) patients treated with non-TNFi (p=0.07), including 1/6 treated with tocilizumab (16.7%). Among TNFi, response rates ranged from 4/22 (18.2%) for infliximab to 8/14 (57.1%) for etanercept. No relevant safety issues were identified. CONCLUSIONS: HBV vaccination response in patients with rheumatic diseases treated with bDMARDs was poorer than expected. Our data reinforce the recommendation for vaccination prior to starting bDMARDs.

Omega-3 index as risk factor in psychiatric diseases: a narrative review.

Numerous studies have described associations between the omega-3 index (defined as the RBC percentage of EPA and DHA) and mental conditions, but no risk stratification or target value has gathered consensus so far. This narrative review aims to summarize the published data on the association between omega-3 index and mental illness and to contribute to the concept of an omega-3 index in the field of mental health. The bibliographic searches have been carried out in PubMed, Scopus and Web of Science databases to find relevant English language original research studies related to that association. The study search and selection process were registered in a PRISMA flow. Thirty-six studies were included in this review examining the links between omega-3 index and postpartum depression (3), major depression (15), major depression and bipolar disorder (1), bipolar disorder (4), schizophrenia and major depression (1), schizophrenia and other psychosis (5) and dementia (7). Thirty of these studies found either significant differences in omega-3 index between patients and controls or inverse relationships between omega-3 index and disease severity. The published evidence is compelling enough to suggest omega-3 index as a risk factor for some psychiatric diseases, specifically, major depression, postpartum depression, psychosis, and dementia. In occidental populations, we propose a risk threshold of (a) 4-5% in major depression and dementia, (b) 5% in postpartum depression, and (c) 4% for psychosis transition.

Vitamin D status in active duty Navy military personnel: a systematic review.

OBJECTIVES: Active duty Navy military personnel are prone to vitamin D deficiency due to an occupational environment detrimental to sunlight exposure. The main objective of this systematic review is to provide a worldwide overview of vitamin D status in this population. METHODS: The Condition, Context, Population (CoCoPop) mnemonic was used to define the inclusion criteria (vitamin D status; all contexts; active duty Navy military personnel). Studies with recruits or veterans were excluded. Scopus, Web of Science and PubMed/Medline databases were searched from inception to 30 June 2022. Joanna Briggs Institute and Downs & Black checklists were used for quality assessment and data were synthesised in narrative and tabular formats. RESULTS: Thirteen studies published between 1975 and 2022 and conducted in northern hemisphere Navies, including mainly young and male service members, were included. The prevalence of vitamin D deficiency was globally reported as significant. Nine studies included a total of 305 male submariners who performed 30-92 days submarine patrol and reported the effect of sunlight deprivation in the decrease of vitamin D levels. CONCLUSIONS: This new systematic review underlines the high prevalence of vitamin D deficiency in the Navy, especially in submariners, and the need to implement measures to prevent vitamin D deficiency. Serum 25(OH)D data available and the heterogeneity of the studies limited a pooled analysis. Most studies included only submariners, which may limit generalisability to all active duty Navy military personnel. Further research on this topic should be promoted. PROSPERO REGISTRATION NUMBER: CRD42022287057.

Evaluation of personal protective equipment use in healthcare workers exposed to ionizing radiation in a Portuguese university hospital.

Introduction: Increasing use of ionizing radiation in hospitals exposes healthcare workers to health risks, therefore dosimetric surveillance and anti-radiation personal protective equipment are essential. However, low perception of risk has a negative impact on compliance. Objectives: To qualitatively characterize exposure to ionizing radiation and the compliance with anti-radiation personal protective equipment and personal dosimeters by workers, at a university hospital in Portugal. To investigate the impact of attending health examinations or participating in training activities on this compliance. Methods: Cross-sectional study design administering a questionnaire constructed by the authors to all healthcare workers exposed to ionizing radiation (n = 708). Results: A total of 295 workers completed the questionnaire. They worked in 16 different services using eight different types of ionizing radiation-emitting equipment, the most common of which were fluoroscopes. Lead aprons and thyroid protectors were the anti-radiation personal protective equipment with greatest compliance (61.7 and 55.6%, respectively), while fewer respondents used protective glasses (8.1%) and lead gloves (0.7%). Regular use of a dosimeter was reported by 78.3% of workers and use was associated with participation in training and with attending health examinations. The most frequent reasons given for not wearing anti-radiation personal protective equipment were unavailability (glasses and gloves), presence of a protective barrier, and discomfort. The most common reason for not using a dosimeter was forgetting to do so. Conclusions: Workers who attended training and those who attended health examinations were more compliant with use of dosimeters, indicating that these are useful strategies for improving workers' compliance with radiation protection measures.

Burnout in hospital healthcare workers after the second COVID-19 wave: Job tenure as a potential protective factor.

Burnout is an impactful occupational health phenomenon to which doctors and nurses have been more exposed during the COVID-19 pandemic. The objectives of this study were to measure the dimensions of burnout-emotional exhaustion, depersonalization and personal accomplishment-in a hospital healthcare population after the second COVID-19 wave and to study their association with sociodemographic variables and previous COVID-19 infection. We invited 112 healthcare professionals (doctors and nurses) who attended the occupational health department of a tertiary hospital in March-July 2021. Emotional exhaustion, depersonalization and personal accomplishment were measured by the Maslach Burnout Inventory. Linear-regression analyses were conducted to explore relationships between burnout dimensions and sociodemographic variables. Differences between groups according to previous COVID-19 infection were verified using the t-test and when appropriate the Mann-Whitney test (for continuous variables), the chi-square test and when appropriate the Fisher exact test (for categorical variables). We surveyed 106 subjects (95% response rate). High emotional exhaustion and depersonalization were reported by 33.0 and 18.4% of participants, respectively; 21.4% reported low personal accomplishment. Job tenure was associated with depersonalization and personal accomplishment. For each 1-year increase in job tenure, depersonalization decreases 0.14 (95% CI [-0.23, -0.04]) and personal accomplishment increases 0.16 (95% CI [0.06, 0.25]). Gender was associated with emotional exhaustion (being male increases emotional exhaustion 5.62-fold [95% CI: 1.33; 9.92]). The prevalence of high emotional exhaustion, high depersonalization and low personal accomplishment after the second COVID-19 wave was relevant and should not be overlooked. Our findings suggest that job tenure may play a protective role in healthcare workers' burnout.

Vitamin D status in the active duty Navy military personnel: protocol for a systematic review.

INTRODUCTION: Vitamin D is critical for bone health and its deficiency has been linked to increased incidence and severity of multiple diseases. Even so, vitamin D inadequacy is a major public health problem worldwide. The main source of vitamin D is endogenous cutaneous synthesis through exposure to solar ultraviolet B radiation, which is influenced by several factors, including occupational. The active duty Navy military personnel may be prone to vitamin D inadequacy, but a worldwide overview of vitamin D status in this specific population is still lacking. METHODS AND ANALYSIS: The CoCoPop mnemonic will be used for determining the inclusion criteria. Scopus, Web of Science and PubMed/Medline will be searched for all studies including 25-hydroxyvitamin D concentrations of the active duty Navy military personnel. Data extraction and quality assessment (Joanna Briggs Institute's and Downs and Black checklists) will be performed by two reviewers and data will be synthesised in narrative, tabular and map formats. ETHICS AND DISSEMINATION: This study will not involve human or animal subjects and, thus, does not require ethics approval. The outcomes will be disseminated via publication in a peer-reviewed scientific journal and presentation at a scientific conference. PROSPERO REGISTRATION NUMBER: CRD42022287057.

Evaluación de la respuesta inmunológica a tres dosis de la vacuna contra la Hepatitis B en trabajadores de un hospital universitario portugués / Evaluation of the immunological response to three doses of the Hepatitis B vaccine in workers of a Portuguese university Hospital

Objetivos: Evaluar la respuesta a tres dosis de la vacuna contra la Hepatitis B en profesionales de la salud. Analizar su asociación con la edad, género, tabaquismo, índice de masa corporal (IMC), presencia de enfermedades crónicas y tiempo transcurrido entre la vacunación y la medición del AcHBs. Material y Métodos: estudio observacional, transversal. Muestra de trabajadores de un Hospital Universitario Portugués que realizaron medición del AcHBs en 2018 y que tenían esquema de vacunación completo. El proceso clínico individual fue consultado. Fue aplicado el Test Mann-Whitney y Chi-cuadrado y se aceptó un nivel de significancia del 5%. Resultados y Conclusiones: Analizamos resultados de 181 trabajadores, edad media 32,99 años (min. 20 - max. 64), la mayoría mujeres (76,80%). El AcHBs fue positivo en 140 (77.35%) y negativo en 41 (22.65%). La presencia de enfermedades crónicas mostró asociación estadísticamente significativa con AcHBs negativo tras un esquema de vacunación completo (AU)

Objectives: evaluate the response to three doses of the Hepatitis B vaccine in healthcare workers. Analyze its association with age, gender, smoking, body mass index (BMI), presence of chronic diseases and time elapsed between vaccination and the measurement of AcHBs. Material and Methods: observational, cross-sectional study. Sample of workers from a Portuguese University Hospital who measured AcHBs in 2018 and who had a complete vaccination scheme. The individual clinical process was consulted. The Mann-Whitney and Chi-square test were applied and a significance level of 5% was accepted. Results and Conclusions: We analyzed the results of 181 workers, mean age 32.99 years (min. 20 - max. 64), the majority women (76.80%). The AcHBs was positive in 140 (77.35%) and negative in 41 (22.65%). The presence of chronic diseases showed a statistically significant association with negative AcHBs after a complete vaccination scheme (AU)

[Seroprevalence of Measles Antibodies in Healthcare Professionals in a Central Hospital in Portugal]. / Seroprevalência de Anticorpos Contra o Sarampo em Profissionais de Saúde de um Hospital Central em Portugal.

INTRODUCTION: Immunity against measles may result from previous contact with the virus or vaccination. In this study we aimed to evaluate the prevalence of immunity to measles in healthcare professionals of a central hospital. MATERIAL AND METHODS: Retrospective study, with description of the results of measles-specific IgG assay in healthcare professionals, between May 2010 and March 2018. RESULTS: The results of 1339 healthcare professionals were analyzed. The average age was 39.3 ± 10.11 years, 71.1% female. The prevalence of positive IgG was 81.5%, higher among professionals in the age groups 40 - 49 and over 50 years (91.9% and 94.6% respectively). Healthcare professionals who presented negative or equivocal IgG were mostly under 40 years old (83.1%) (p < 0.05). DISCUSSION: The prevalence of serological immunity to measles in healthcare professionals was found to be lower than in other studies. That may be due to differences between the characteristics of the studied samples. Susceptibility to measles was higher in lower age groups. These results may reflect low vaccination coverage in this age group, an incomplete vaccination schedule, or the possibility of older healthcare professionals having the disease, which may confer an immune response with higher IgG levels. CONCLUSION: Knowing the prevalence of susceptibility to measles in healthcare professionals enabled the establishment of prevention strategies for outbreaks that may occur. Vaccination remains the best preventative measure, but a third dose of vaccine may be considered in certain epidemiological contexts, particularly in the youngest exposed healthcare professionals.

Introdução: A imunidade contra o sarampo poderá resultar do contacto anterior com o vírus ou da vacinação. O objetivo deste estudo foi avaliar a prevalência de imunidade contra o sarampo em profissionais de saúde de um hospital central.Material e Métodos: Estudo retrospetivo com caraterização dos resultados do doseamento de imunoglobulina G (IgG) específica contra o sarampo em profissionais de saúde, entre maio de 2010 e março de 2018.Resultados: Analisaram-se os resultados de 1339 trabalhadores, média de idades 39,3 ± 10,11 anos, 71,1% mulheres. A prevalência de IgG positiva foi de 81,5%, mais elevada entre os profissionais nas faixas etárias dos 40 aos 49 e mais de 50 anos (91,9% e 94,6% respetivamente). Por sua vez, 83,1% dos profissionais com IgG negativa ou equívoca tinham maioritariamente idades inferiores a 40 anos (p < 0,05).Discussão: Verificou-se que a prevalência de profissionais imunes ao sarampo foi mais baixa que noutros estudos, podendo, contudo, esse resultado dever-se a diferenças entre as caraterísticas das amostras estudadas. Foi encontrada uma maior suscetibilidade ao sarampo em profissionais nas faixas etárias inferiores. Estes resultados podem refletir uma baixa cobertura vacinal nesta faixa etária, um esquema de vacinação incompleto, ou a possibilidade dos profissionais mais velhos terem tido a doença, o que contribuíu para uma resposta imunitária com níveis de IgG mais elevados.Conclusão: Conhecer a prevalência de profissionais suscetíveis ao sarampo, permitiu definir estratégias de prevenção face aos surtos que possam vir a acontecer. A vacinação continua a ser a melhor medida preventiva, uma terceira dose de vacina poderá vir a ser equacionada em determinados contextos epidemiológicos, especialmente nos profissionais expostos mais jovens.

Intervening on Burnout in Complex Organizations - The Incomplete Process of an Action Research in the Hospital.

Health professionals are at high risk for developing burnout symptoms. Directed at reducing the organizational variables affecting professionals' burnout, an action research was developed in a specific sector of a large hospital, with 59 doctors, 66 nurses, and 42 ancilliary professionals. Researchers conducted 11 interviews, one focus group, and 20 h of in loco observation. Professionals report demotivation and the need to address the emotional part of their job. Nonetheless, the hierarchy blocked the proposed intervention possibilities. Organizational factors are unequivocally relevant, particularly in complex settings with emotionally charged interactions, and the direct hierarchy is pivotal for facilitating organizational change.

A COVID-19 Outbreak in a Rheumatology Department Upon the Early Days of the Pandemic.

Objectives: To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department early in the pandemic. Methods: Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms. Results: 14/34 HCWs (41%; 40 ± 14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28 ± 18 days), viral shedding (31 ± 10 days post-symptom onset, range 15-51), and work absence (29 ± 28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response Higher IgG indexes were observed in individuals over 50 years of age (14.5 ± 7.7 vs. 5.0 ± 4.4, p = 0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalization, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly symptomatic (1/8) HCW. Conclusions: A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognized and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.

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.

Dermatoses associadas ao trabalho em profissionais de saúde de um centro hospitalar português / Occupational dermatoses among healthcare workers in a hospital center in Portugal

Introdução: As patologias cutâneas representam mais de 35% das doenças relacionadas com o trabalho, afetando anualmente 1/1.000 trabalhadores. Objetivos: Caracterizar as dermatoses associadas ao trabalho em profissionais de um centro hospitalar e identificar possíveis agentes desencadeantes e fatores de suscetibilidade. Métodos: Estudo transversal com recolha da informação registrada no processo clínico eletrônico dos trabalhadores observados em exame de saúde periódico no período de um ano. Resultados: Nos 1.741 trabalhadores estudados, 3,56% tinham registro de dermatoses associadas ao trabalho, a maioria mulheres (76,85%). Dos profissionais com dermatoses, 34 (54,84%) tinham dermatite de contato irritativa, 17 (27,42%) urticária ao látex, seis (9,68%) dermatite de contato alérgica e cinco (8,06%) duas dermatoses concomitantes. Encontrou-se diferença estatisticamente significativa entre os vários grupos profissionais (p=0,008), sendo os auxiliares de enfermagem os mais afetados (5,11%). Verificou-se também maior prevalência (8,47%) em profissionais de blocos operatórios (p=0,001). Os principais agentes desencadeantes foram desinfetantes cutâneos, látex, luvas de nitrilo e contato prolongado com água (4,84%). Conclusões: Por tratar-se de um estudo baseado em registros clínicos, a informação está dependente da qualidade destes. Para além disso, os auxiliares de enfermagem foram a maioria representada na amostra no que se refere à população do centro hospitalar, o que limita a extrapolação dos resultados. Este estudo encontrou prevalência de dermatoses de somente 3,56%, o que talvez se deva à implementação de medidas preventivas. Os profissionais mais afetados foram os de blocos operatórios e os auxiliares de enfermagem. Os desinfetantes cutâneos foram os principais agentes apontados como desencadeantes.

Background: Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. Objective: To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. Methods: Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. Results: About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). Conclusion: The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

Lombalgias em auxiliares de enfermagem hospitalares / Low back pain among hospital nursing assistants

Introdução: Os auxiliares de enfermagem (AE) hospitalares constituem um grupo profissional para o qual a lombalgia ocupacional é relevante. Objetivo: Caracterizar os contextos da lombalgia num grupo de AE que, por esse motivo, solicitaram exame médico ocasional. Métodos: Utilizou-se uma entrevista estruturada para a caracterização sociodemográfica, do estado de saúde e do episódio mais relevante de lombalgia e seu enquadramento, seguida de exame objetivo sumário e de consulta do processo individual do Serviço de Saúde Ocupacional (SSO). Resultados: Foram entrevistados 30 AE: predomínio de mulheres de meia-idade, com excesso de peso e sedentárias. Os episódios mais relevantes de lombalgia caracterizaram-se por dor intensa (93,3%), tendo condicionado limitação funcional em 63,3% dos AE. As atividades mais relacionadas com o episódio de lombalgia foram a transferência de doentes (23,3%) e a movimentação/o transporte de cargas >12 kg (20%). Todos eles recorreram a serviços médicos, mas, à data da entrevista, 80% mantinham lombalgia ativa. Ao exame objetivo, oito apresentavam dismetria dos membros inferiores, e 11, escoliose. Os sinais de Lasègue e de Bragard estiveram presentes simultaneamente em 11 casos. Identificaram-se associações significativas (p<0,05) entre a presença de sinais clínicos, a presença de lombalgia atual e a incapacidade para o trabalho. Conclusões: A maioria dos AE afirmou que o episódio agudo de lombalgia ocorreu durante a realização de tarefas exigentes, como transferência de doentes e movimentação/transporte de cargas >12 kg. Assim, apesar da influência dos fatores individuais, a prevenção e o tratamento da lombalgia em AE passam por uma intervenção integrada do SSO, minimizando o seu impacto na saúde e no absentismo.

Background: Occupational low back pain (LBP) is a relevant condition among hospital nursing assistants (NA). Objective: To characterize the context of LBP among NA who sought medical care for this reason. Methods: We conducted structured interviews to characterize the participants' sociodemographic profile, state of health and most relevant LBP episode. Next we subjected the participants to brief objective physical examination and reviewed their occupational health records. Results: We interviewed 30 NA, most of whom were middle-aged women with excess weight and sedentary lifestyle. The most relevant LBP episodes were characterized by severe pain (93.3%) and resulted in functional restrictions for 63.3% of the sample. Job tasks most frequently associated with LBP were patient transfer (23.3%) and lifting/carrying loads >12 kg (20%). Although all the participants had sought medical care, 80% still complained of pain at the time of the interviews. On physical examination, the Lasègue and Bragard signs were found in 11 participants. We found significant association (p<0.05) between clinical signs, ongoing pain and incapacity for work. Conclusions: According to most participants, LBP episodes occurred while performing tasks involving high physical demands, such as patient transfer and lifting/carrying loads >12 kg. The influence of individual factors notwithstanding, prevention and treatment of LBP among NA requires integrated occupational health interventions to minimize its impact on health and absenteeism.

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.

Occupational dermatoses among healthcare workers in a hospital center in Portugal.

BACKGROUND: Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. OBJECTIVE: To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. METHODS: Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. RESULTS: About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). CONCLUSION: The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

INTRODUÇÃO: As patologias cutâneas representam mais de 35% das doenças relacionadas com o trabalho, afetando anualmente 1/1.000 trabalhadores. OBJETIVOS: Caracterizar as dermatoses associadas ao trabalho em profissionais de um centro hospitalar e identificar possíveis agentes desencadeantes e fatores de suscetibilidade. MÉTODOS: Estudo transversal com recolha da informação registrada no processo clínico eletrônico dos trabalhadores observados em exame de saúde periódico no período de um ano. RESULTADOS: Nos 1.741 trabalhadores estudados, 3,56% tinham registro de dermatoses associadas ao trabalho, a maioria mulheres (76,85%). Dos profissionais com dermatoses, 34 (54,84%) tinham dermatite de contato irritativa, 17 (27,42%) urticária ao látex, seis (9,68%) dermatite de contato alérgica e cinco (8,06%) duas dermatoses concomitantes. Encontrou-se diferença estatisticamente significativa entre os vários grupos profissionais (p=0,008), sendo os auxiliares de enfermagem os mais afetados (5,11%). Verificou-se também maior prevalência (8,47%) em profissionais de blocos operatórios (p=0,001). Os principais agentes desencadeantes foram desinfetantes cutâneos, látex, luvas de nitrilo e contato prolongado com água (4,84%). CONCLUSÕES: Por tratar-se de um estudo baseado em registros clínicos, a informação está dependente da qualidade destes. Para além disso, os auxiliares de enfermagem foram a maioria representada na amostra no que se refere à população do centro hospitalar, o que limita a extrapolação dos resultados. Este estudo encontrou prevalência de dermatoses de somente 3,56%, o que talvez se deva à implementação de medidas preventivas. Os profissionais mais afetados foram os de blocos operatórios e os auxiliares de enfermagem. Os desinfetantes cutâneos foram os principais agentes apontados como desencadeantes.

Low back pain among hospital nursing assistants.

BACKGROUND: Occupational low back pain (LBP) is a relevant condition among hospital nursing assistants (NA). OBJECTIVE: To characterize the context of LBP among NA who sought medical care for this reason. METHODS: We conducted structured interviews to characterize the participants' sociodemographic profile, state of health and most relevant LBP episode. Next we subjected the participants to brief objective physical examination and reviewed their occupational health records. RESULTS: We interviewed 30 NA, most of whom were middle-aged women with excess weight and sedentary lifestyle. The most relevant LBP episodes were characterized by severe pain (93.3%) and resulted in functional restrictions for 63.3% of the sample. Job tasks most frequently associated with LBP were patient transfer (23.3%) and lifting/carrying loads >12 kg (20%). Although all the participants had sought medical care, 80% still complained of pain at the time of the interviews. On physical examination, the Lasègue and Bragard signs were found in 11 participants. We found significant association (p<0.05) between clinical signs, ongoing pain and incapacity for work. CONCLUSIONS: According to most participants, LBP episodes occurred while performing tasks involving high physical demands, such as patient transfer and lifting/carrying loads >12 kg. The influence of individual factors notwithstanding, prevention and treatment of LBP among NA requires integrated occupational health interventions to minimize its impact on health and absenteeism.

INTRODUÇÃO: Os auxiliares de enfermagem (AE) hospitalares constituem um grupo profissional para o qual a lombalgia ocupacional é relevante. OBJETIVO: Caracterizar os contextos da lombalgia num grupo de AE que, por esse motivo, solicitaram exame médico ocasional. MÉTODOS: Utilizou-se uma entrevista estruturada para a caracterização sociodemográfica, do estado de saúde e do episódio mais relevante de lombalgia e seu enquadramento, seguida de exame objetivo sumário e de consulta do processo individual do Serviço de Saúde Ocupacional (SSO). RESULTADOS: Foram entrevistados 30 AE: predomínio de mulheres de meia-idade, com excesso de peso e sedentárias. Os episódios mais relevantes de lombalgia caracterizaram-se por dor intensa (93,3%), tendo condicionado limitação funcional em 63,3% dos AE. As atividades mais relacionadas com o episódio de lombalgia foram a transferência de doentes (23,3%) e a movimentação/o transporte de cargas >12 kg (20%). Todos eles recorreram a serviços médicos, mas, à data da entrevista, 80% mantinham lombalgia ativa. Ao exame objetivo, oito apresentavam dismetria dos membros inferiores, e 11, escoliose. Os sinais de Lasègue e de Bragard estiveram presentes simultaneamente em 11 casos. Identificaram-se associações significativas (p<0,05) entre a presença de sinais clínicos, a presença de lombalgia atual e a incapacidade para o trabalho. CONCLUSÕES: A maioria dos AE afirmou que o episódio agudo de lombalgia ocorreu durante a realização de tarefas exigentes, como transferência de doentes e movimentação/transporte de cargas >12 kg. Assim, apesar da influência dos fatores individuais, a prevenção e o tratamento da lombalgia em AE passam por uma intervenção integrada do SSO, minimizando o seu impacto na saúde e no absentismo.

Psychosocial risks in Psychiatry and Anaesthesiology residents in a Portuguese General and University Hospital.

BACKGROUND: Medical Doctors (MD), although at the front line of response to patients and their families, are seldom study subjects for occupational psychosocial risks and work related stress. OBJECTIVES: Assess psychiatry and anaesthesiology residents in a central and university Portuguese Hospital for the presence of psychosocial risks at work. METHODS: We used the Copenhagen Psychosocial Questionnaire version 2 (COPSOQ), which was applied face-to-face in two group settings, in April 2014. It comprised a sample of 19 Psychiatry residents and 20 Anaesthesiology residents. Statistical analysis was done by correlational analysis using Pearson's coefficient (r) and the t-student test for categorical variables. RESULTS: An occupational health risk (red flag) was found for residents in the "Cognitive demands" dimension of COPSOQ and a health risk (red flag) in the "Work influence" dimension for the female Anaesthesiology sub-group. A possible risk (yellow flag) was found in 17 dimensions. Results also showed moderate correlations between various COPSOQ dimensions and the emergency department workload, workload, home study, number of children, year of training and the medical specialty variables. CONCLUSIONS: These results suggest that residents have a health risk which derives from the cognitive demands of their work and that it increases with the workload.  This implicates the need for occupational health measures to be taken to manage and reduce these psychological risks.

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity / La superación de las exigencias laborales para ofrecer una elevada calidad asistencial en el ámbito hospitalario en Europa: papel del trabajo en equipo y la positividad

Health care professionals deal on a daily basis with several job demands - emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demands have a negative impact on the quality of care delivered by health professionals. Backup behaviors had a mediating effect between job demands and quality of care. Also, the positivity ratio of professionals (ratio of positive and negative emotions experienced) was also found as a significant mediator between most job demands and quality of care dimensions. Finally, we found a double mediation between most job demands and quality of care, where backup behaviors influenced the positivity ratio. Quality of care in hospitals is closely related to job demands. Hospital managers should consider the importance of cooperation within health care professionals’ teams and ought to find ways to develop teamwork in order to promote patients’ safety (AU)

Los profesionales de la salud tratan a diario con múltiples exigencias laborales -emocionales, cognitivas, organizacionales y físicas. También deben garantizar la máxima calidad de atención a sus pacientes. El objetivo de este estudio es analizar el impacto de las demandas laborales en la calidad de los cuidados y de investigar los procesos de equipo (backup behaviors) e individuales (positivity ratio) que ayudan a proteger al trabajador de ese impacto. Se recogieron datos de 2.890 médicos y enfermeros en 9 países europeos a través de cuestionarios. Las demandas laborales tienen un impacto negativo en la calidad de los cuidados proporcionados por profesionales de la salud. Los procesos de equipo (backup behaviors) tuvieron un efecto de mediación entre las demandas del trabajo y la calidad de los cuidados. Además, la ratio de positividad de los profesionales (proporción de emociones positivas y negativas) también se encontró como un mediador importante entre la mayoría de demandas de trabajo y la calidad del cuidado. Por último, se encontró una doble mediación entre la mayoría de las demandas de trabajo y calidad de la atención, donde los procesos de equipo influyeron en la ratio de positividad. La calidad de los cuidados proporcionados en los hospitales está muy relacionada con las exigencias del trabajo. Los directores de hospitales deben considerar la importancia de la cooperación entre equipos de profesionales de salud y encontrar formas de desarrollar el trabajo en equipo con el fin de promover la seguridad de los pacientes (AU)