Glutaraldehyde-Induced Allergic Contact Dermatitis: A Case Report and Safety Standards.

Glutaraldehyde (GA), a potent disinfectant and sterilizing agent extensively used in healthcare settings, has garnered attention for its association with contact dermatitis. This occupational skin condition, often induced by repeated exposure to GA, poses significant challenges to the well-being of healthcare professionals and patients alike. Understanding the causes, symptoms, and preventive measures against GA-induced contact dermatitis is essential for promoting a safe and healthy working environment in healthcare facilities. A 28-year-old female presented with a severe burning sensation and dark brown patches in the lower chin region, one day following root canal treatment. Based on the characteristic appearance of patches and the typical burning sensation associated with an allergic reaction, a diagnosis of acute contact dermatitis was made. Patch testing by an expert dermatologist confirmed that the patient was allergic to GA. GA, a popular commercial germicidal product, is widely used as a cold sterilizing agent for operative dental instruments. The patient developed a reaction as the endodontic files used during the root canal procedure were cold sterilized with 2% GA. The lesion experienced significant improvement and ultimately healed following the administration of corticosteroids and antihistamines. This report concerns a case of GA-induced contact dermatitis. As GA is being used more widely, particularly in dental clinics, this case was of interest and is reported in the safety interest of patients and clinicians.

Surgical smoke: a matter of hygiene, toxicology, and occupational health.

The use of devices for tissue dissection and hemostasis during surgery is almost unavoidable. Electrically powered devices such as electrocautery, ultrasonic and laser units produce surgical smoke containing more than a thousand different products of combustion. These include large amounts of carcinogenic, mutagenic and potentially teratogenic noxae. The smoke contains particles that range widely in size, even as small as 0.007 µm. Most of the particles (90%) in electrocautery smoke are ≤6.27 µm in size, but surgical masks cannot filter particles smaller than 5 µm. In this situation, 95% of the smoke particles which pass through the mask reach deep into the respiratory tract and frequently cause various symptoms, such as headache, dizziness, nausea, eye and respiratory tract irritation, weakness, and abdominal pain in the acute period. The smoke can transport bacteria and viruses that are mostly between 0.02 µm and 3 µm in size and there is a risk of contamination. Among these viruses, SARS-CoV-2, influenza virus, HIV, HPV, HBV must be considered. The smoke may also carry malignant cells. The long-term effects of the surgical smoke are always ignored, because causality can hardly be clarified in individual cases. The quantity of the smoke changes with the technique of the surgeon, the room ventilation system, the characteristics of the power device used, the energy level at which it is set, and the characteristics of the tissue processed. The surgical team is highly exposed to the smoke, with the surgeon experiencing the highest exposure. However, the severity of exposure differs according to certain factors, e.g., ventilation by laminar or turbulent mixed airflow or smoke evacuation system. In any case, the surgical smoke must be removed from the operation area. The most effective method is to collect the smoke from the source through an aspiration system and to evacuate it outside. Awareness and legal regulations in terms of hygiene, toxicology, as well as occupational health and safety should increase.

Sinonasal Adenocarcinoma: Clinicopathological Characterization and Prognostic Factors.

Sinonasal (SN) malignancies are rare. Within SN adenocarcinomas, the most frequent are intestinal-type adenocarcinomas (ITACs). ITAC has been associated with wood and leather dust occupational exposure and TP53 mutations. Not much information is available regarding its characterization and treatment. The aim of this study is to characterize the clinicopathologic and prognostic factors of patients with sinonasal adenocarcinomas (SNACs) treated in our tertiary-level hospital. A retrospective, consecutive study including SNAC patients diagnosed between 2004-2023 was conducted. Clinicopathological data was collected, and p53 status was assessed in the tumor specimens. The association between p53 status and clinicopathological variables, as well as their impact on survival, was evaluated. In total, 35 were included, most of them having ITAC (91.4%) with papillary subtype (37.5%); the majority were subjected to occupational risk exposure (82.9%). Overexpression of p53 was identified in 48.6% of the tumors. Papillary and colonic subtypes were associated with higher median progression-free survival (mPFS) than mucinous and solid subtypes (mPFS 37 months, 95% CI, 20.0-54.0, vs. 9 months, 95% CI, 7.15-10.85, p=0.01); the former was also associated with higher median overall survival (mOS) (mOS 64 months, 95% CI, 37.18-90.81 vs. 14 months, 95% CI, 0-41.58, p=0.02). Histologic grade 1-2 and macroscopic complete resection were associated with higher PFS (PFS of five months of 90.9% vs. 33.3%, p=0.01; mPFS of 37 months, 95% CI, 4.93-69.07 vs. 10 months, 95% CI, 6.43-13.57, p=0.04, respectively). Disease recurrence with distant metastases was associated with lower OS (11 months, 95% CI, 6.1-15.9 vs. 53 months, 95% CI, 22.70-83.30, p=0.04). This study reinforces the importance of protective occupational measures. Future studies will be important to validate the best treatment strategy in the advanced stages of this disease and also to identify new prognostic and/or therapeutic target biomarkers in SNAC.

Incidence and Risk Factors for Acute Articular Cartilage Tears in Military and Other Occupational Settings: A Systematic Review.

Damage to the articular cartilage resulting in an acute tear can lead to functional changes within the joint and increase the risk of osteoarthritis developing. There is limited understanding of the association between occupational risk factors and sustaining an acute articular cartilage tear in the military and other physically demanding occupations. Therefore, the aim of this systematic review was to identify and evaluate original research reporting on occupational risk factors associated with sustaining acute articular cartilage tears. METHODS: A systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols was conducted and registered with the Open Science Framework. Key academic databases were searched using terms from the following concepts: risk or cause, paid occupations, and acute articular cartilage tears. RESULTS: Of an initial 941 studies, 2 studies met the eligibility criteria, both reporting data from military contexts; only one evaluated acute articular cartilage tears in both males and females. One paper focused on articular cartilage injury within the knee and the other within the ankle joint with incidence rates being 0.2 and 0.3 per 1000 person-years, respectively. People in more physically active occupations and individuals with an above-normal body mass index were reported as being at higher risk of sustaining an acute articular cartilage tear. CONCLUSION: Physically demanding occupations, such as the military, may increase the risk for acute tears of the articular cartilage. However, the findings of this review indicate there is a paucity of research to underpin understanding of the injury mechanisms and occupational risk factors for acute articular cartilage tears.

COVID-19 in City Council Civil Servants, 1 March 2020-31 January 2023: Risk of Infection, Reinfection, Vaccine Effectiveness and the Impact of Heterologous Triple Vaccination.

Background: The risk of COVID-19 increases in any occupation entailing intense social interactions. This study aimed to investigate the impact of COVID-19 among civil servants of Trieste city council (northeastern Italy) over the entire pandemic. Methods: The crude incidence rate of COVID-19 was estimated from 1 March 2020 to 31 January 2023 by explanatory factors, expressing the estimate as COVID-19 events x 10,000 person-days (P-d) at risk. A multivariable Cox proportional hazard regression model was fitted to examine the risk of primary COVID-19 infection and reinfections, reporting adjusted hazard ratios (aHR) with 95% confidence interval (95% CI). Results: The cohort of Trieste city council was mainly composed of administrative clerks (48.5%), nursery teachers (33%), technicians (9.9%) and local police officers (8.5%). Between 1 March 2020 and 31 January 2023, 1444 (62.4%) employees tested positive for SARS-CoV-2 at least once and 18.1% (=262/1444) at least twice. By the end of this study, 55% (N = 1272) of employees had received at least three doses of COVID-19 vaccine, whereas 19.7% (N = 457) remained unvaccinated. At multiple Cox regression analysis, the adjusted risk of primary COVID-19 events during the entire study period increased in employees aged 40-49 years (aHR = 1.65; 95% CI: 1.01; 2.71), females (aHR = 1.28; 95%CI: 1.12; 1.45), local police officers (aHR = 1.82; 95%CI: 1.50; 2.22) and nursery teachers (aHR = 1.27; 95%CI: 1.13; 1.43). However, whilst the risk of primary infections in police officers increased already during the Alpha transmission period (aHR = 6.82; 95%CI: 4.48; 10.40), progressively reducing across subsequent variants, for nursery teachers, it increased during the Delta wave (aHR = 2.42; 1.70; 3.44), reducing with Omicron (aHR = 1.23; 95%CI: 1.07; 1.40). Compared to unvaccinated colleagues, during the entire study period the risk of primary infections was significantly lower in employees immunized with three (aHR = 0.42; 95%CI: 0.36; 0.47) or four (aHR = 0.30; 95%CI: 0.23; 0.40) doses of COVID-19 vaccine, for a vaccine effectiveness (VE) of 58% and 70%, respectively. The protective effect of vaccination against primary infections was confirmed in the sub-group analysis by main pandemic waves, for a VE of 75% for one dose against 99% for two doses during the Alpha transmission period, slightly reducing to 59% and 70% in Delta time, respectively. During the Omicron wave, the risk of primary SARS-CoV-2 infections diminished significantly with three (aHR = 0.42; 95%CI: 0.36; 0.49) or four vaccine doses (aHR = 0.09; 95%CI: 0.05; 0.16), for a VE of 58% and 91%, respectively. Moreover, the risk of primary SARS-CoV-2 reinfections during the entire study period reduced with one (aHR = 0.47; 95%CI: 0.27; 0.82), two (aHR = 0.42; 95%CI: 0.30; 0.58), three (aHR = 0.32; 95%CI: 0.24; 0.44) or four vaccine doses (aHR = 0.14; 95%CI: 0.05; 0.46), for a VE of 53%, 58%, 68% and 86% against reinfections, respectively. No significant difference in VE was associated with heterologous versus homologous triple vaccination, both against primary infections or reinfections. Conclusions: Primary SARS-CoV-2 infections were more likely among nursery teachers and local police officers. The risk of both primary infections and reinfections reduced with higher number of doses of COVID-19 vaccine, regardless of the pandemic wave. Since city council civil servants were swab tested on demand or for contact tracing, the estimation of COVID-19 risk and VE largely missed aymptomatic SARS-CoV-2 infections. On the one hand, the present study confirmed the protective effect of COVID-19 vaccination against symptomatic SARS-CoV-2 infections; on the other hand, it highlighted not only the importance of continuous booster doses to keep up the humoral immunity over time but also the importance of updated vaccine formulations to prevent and control the spread of a highly mutable virus. Moreover, the protective effect of the first two doses against reinfections confirmed the efficacy of hybrid immunity during Omicron time.

Neurofilament light chain and glial fibrillary acid protein levels are elevated in post-mild COVID-19 or asymptomatic SARS-CoV-2 cases.

Given the huge impact of the COVID-19 pandemic, it appears of paramount importance to assess the cognitive effects on the population returning to work after COVID-19 resolution. Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) represent promising biomarkers of neuro-axonal damage and astrocytic activation. In this cohort study, we explored the association between sNfL and sGFAP concentrations and cognitive performance in a group of 147 adult workers with a previous asymptomatic SARS-CoV-2 infection or mild COVID-19, one week and, in 49 of them, ten months after SARS-Cov2 negativization and compared them to a group of 82 age and BMI-matched healthy controls (HCs). sNfL and sGFAP concentrations were assessed using SimoaTM assay Neurology 2-Plex B Kit. COVID-19 patients were interviewed one-on-one by trained physicians and had to complete a list of questionnaires, including the Cognitive Failure Questionnaire (CFQ). At the first assessment (T0), sNfL and sGFAP levels were significantly higher in COVID-19 patients than in HCs (p < 0.001 for both). The eleven COVID-19 patients with cognitive impairment had significantly higher levels of sNfL and sGFAP than the others (p = 0.005 for both). At the subsequent follow-up (T1), sNfL and sGFAP levels showed a significant decrease (median sNfL 18.3 pg/mL; median sGFAP 77.2 pg/mL), although they were still higher than HCs (median sNfL 7.2 pg/mL, median sGFAP 63.5 pg/mL). Our results suggest an ongoing damage involving neurons and astrocytes after SARS-Cov2 negativization, which reduce after ten months even if still evident compared to HCs.

Consequences and coping strategies of nurses and registered nurses perceiving to work in an environment characterized by workplace bullying.

Aim: The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method: A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results: In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion: Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication: Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.

Cattle transporters' attitudes, indigenous knowledge, and current practices towards animal welfare, occupational well-being, and operational challenges: A survey of five regions in Ghana.

Ghana is a significant cattle producer in Africa with an estimated cattle population of 3 million in 2020 [1]. The role of transporters in linking farms to markets and slaughterhouses is crucial in the livestock value chain. However, cattle transportation subjects the animals to high levels of stress, compromising their welfare, and transporters face challenges such as long working hours and harsh conditions. The objective of this study was to explore current practices, indigenous knowledge, and operational risks pertaining to animal welfare among transporters. The study was conducted in five regions connected by the N16, N10, and N6 Highway, the primary route for cattle transportation from the Ghana-Burkina Faso border to the coastal capital of Accra. A total of 78 transporters participated in the study. Out of the 78 participants in this study, the majority of transporters were young adults (56.5%) with secondary school education (45.9%) and 0-5 years of experience (37.2%). The average distance and time for transporting cattle was 528 km and 18 h, respectively. The transporters highlighted significant challenges encountered during cattle transport, including feed and water shortage, particularly prominent during the dry season (32.1%), as well as the occurrence of diseases and mortality, particularly high during the rainy season (41%). Furthermore, vehicular breakdowns were a common issue reported by transporters, with a substantial majority (88.5%) experiencing breakdowns during their last 10 trips. The results showed that most transporters (84.7%) had limited knowledge of animal welfare and had not received any formal education on livestock transportation. Instead, they gained experience as assistants on other trucks before becoming drivers. The findings of this study highlight the need for improved welfare standards for cattle during transportation and formal training programs for transporters in animal welfare and livestock transportation.

Occupational risk perception of construction workers: a cross sectional study.

Introduction: Construction workers are often exposed to significant injury risk. The aim of our study is to assess their occupational hazards and injury risk perception. Methods: We administered 256 questionnaires to construction workers. The survey was aimed at collecting information regarding occupational risk and hazard exposure perception, risk control and behavioral self-assessment. We analyzed the data obtained in order to highlight any associations between injury risk perception and anamnestic, occupational, behavioral or perceptual factors. Results: Participants were prevalently males (92.37%) aged 21-60 years (94%). They showed a job seniority level of 21.3 (11.51) on average and, ranging from a 1 to 10 score, a danger awareness of 6.8 (2.9), a lack of prevention measures 6.0 (3.3), an improper behavior of 7.3 (2.7), an unpredictable fate of 6.0 (2.9). These factors resulted significantly associated with the injury risk perception. Multivariable analysis highlighted that the injury risk perception was associated with the lack of prevention measure and unpredictable fate. On the other hand, we found a negative association with the workers' improper behaviors. Conclusion: Workers' perception showed fairly uniform average values even when occupational risk was demonstrated. Our analysis suggests a positive correlation between injury risk perception and the idea that injuries are due both to fate and to chance; it also shows a negative correlation between injury risk perception and the idea that injuries are due to improper behavior. A lack of fully comparable studies confirms the need for further studies on the injury risk perception of construction workers.

Exposure to UV Radiation in Lifeguards on Barcelona's Beaches: An Underestimated Occupational Risk. / [Artículo traducido] Exposición a radiación ultravioleta en socorristas de las playas de Barcelona: un riesgo laboral infravalorado.

BACKGROUND: The development of skin cancer is closely related to high exposure to UV radiation. Lifeguards are at an increased risk of excessive sun exposure. OBJECTIVES: The main objective of this study was to measure the exposure of Barcelona's beach lifeguards to UV radiation. METHODS: Measurements in the work chair were taken every 30min on a typical working day from 10:45 am to 19:15 pm. These measurements were carried out on four different days. These data were used to calculate the erythematous doses received during working hours, as well as those potentially received throughout the summer season. Vitamin D production was also estimated for the four days that the radiation received was measured, and the amount generated was calculated for the entire summer season. RESULTS: Exposure to UV radiation among Barcelona lifeguards far exceeds safety limits. In some locations, the exposure to UVB radiation is more than 16 times the minimum erythematous dose for phototype II skin. LIMITATIONS: This study assessed the radiation received during only four days. However, is a much higher number than most of the published papers. CONCLUSION: Although the health risks of excessive exposure to UV radiation are known, Barcelona's beach lifeguards are insufficiently protected.

Impact of social desirability bias on the CoPsoQ-ISTAS 21 psychosocial risk assessment questionnaire.

BACKGROUND: Self-reported test is one of the main psychosocial risk assessment tools. However, this test it is susceptible to certain sources of error, including social desirability. Since psychosocial risks are emerging, there are not many studies on their assessment. OBJECTIVE: The aim of this work is to analyze the impact of social desirability on the short version of the CopSoq-ISTAS 21 assessment tool. METHOD: A total of 563 workers (45.10% women and 54.90% men) participated in this study. The short version of the CoPsoQ-Istas21 questionnaire with four Likert scale questions as markers, which correspond to the Eysenck Personality Lie Scale Questionnaire Revised (EPQ-r), were used. The sample was divided into two halves, and both a confirmatory analysis and an exploratory analysis were carried out to find out the factorial structure of the scale and, with it, apply the bias filtering method. RESULTS: The results indicate that 10% of the scale is biased due to social desirability, and that there are significant differences between the group with bias clean scores and the group with scores without bias control. CONCLUSIONS: The effects of social desirability on the scale are verified, so it is concluded that in a psychosocial risk assessment is not enough to apply a self-report test and interpret its results, being necessary to minimize the sources of error.

Tularemia From Veterinary Occupational Exposure.

Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia.

Environmental and Occupational Factors Associated with Leptospirosis: A Systematic Review.

Background: Leptospirosis is a neglected emerging zoonotic disease with a profound public health impact worldwide with higher burden of disease in resource-poor countries. The environmental and occupational exposures contribute to human and animal transmission, but the interaction was less explored. A deeper understanding of the critical environmental and occupational drivers in different contexts will provide useful information for disease control and prevention measures. Objective: This review aimed to summarize the potential environmental and occupational risk factors associated with leptospirosis infection. Methods: Four databases (Scopus, Web of Science, Ovid MEDLINE, EBSCOhost) were searched for articles published from 2012 to 2021. Eligible articles were assessed using a checklist for assessing the quality of the studies. The quality of the articles was assessed based on the laboratory diagnosis approach and statistical analysis method. Results: A total of 32 studies were included in this systematic review. Water-related risk factors such as natural water as the primary water source (AOR 1.8-18.28), water-related recreational activities (AOR 2.36-10.45), flood exposure (AOR 1.54-6.04), contact with mud (AOR 1.57-4.58) and stagnant water (AOR 2.79-6.42) were associated with increased risk of leptospirosis. Infrastructural deficiencies such as un-plastered house walls and thatched houses presented a higher risk (AOR 2.71-5.17). Living in low-lying areas (AOR 1.58-3.74), on clay loam soil (OR 2.72), agricultural land (OR 2.09), and near rubber tree plantations (AOR 11.65) is associated with higher risk of leptospirosis. Contact with rats (AOR 1.4-3.5), livestock (AOR 1.3-10.4), and pigs (AOR 1.54-7.9) is associated with an increased risk of leptospirosis. Outdoor workers (AOR 1.95-3.95) and slaughterhouse workers (AOR 5.1-7.5) have higher risk of leptospirosis. Conclusion: The environmental and occupational components related to water, infrastructure, landscape, agriculture, and exposed animals play an essential role in leptospirosis transmission. The magnitude of those risk factors differs with geographical region, climate factor, urbanization and population growth, and the country's socioeconomic status.

Interactions between work-related factors, perceived fatigue and musculoskeletal disorders among handicraft artisans: structural equation model analysis.

The cross-sectional study aimed to investigate the relationship between work-related factors, perceived work fatigue (PWF) and musculoskeletal disorders (MSDs) among handicraft artisans. 364 artisans participated in a questionnaire survey, and a structural equation model (SEM) was developed to explore the direct and indirect relationships between these factors using partial least squares analysis. The SEM explained 98.2% of the variance in MSDs and revealed that exposure to biomechanical factors had a direct impact on PWF and MSDs, with PWF mediating the effect of biomechanical factors on MSDs. Additionally, job demand was found to be positively associated with MSDs, while job control and social support reduced the risk of MSDs. The findings underscore the importance of strategic initiatives to mitigate the risk of developing MSDs among artisans. The study also highlights the potential of SEM as a novel framework for understanding the complex pathogenesis of MSDs in occupational health research.Practitioner summary: The study sought to comprehensively examine the intricate relationships among work-related factors, PWF, and MSDs. To achieve this, an SEM approach was employed to capture both direct and indirect relationships between these factors, employing partial least squares analysis. Findings revealed SEM as an innovative framework for understanding the intricate development of MSDs.

Occupational variation in incidence of oropharyngeal cancer in the Nordic countries.

PURPOSE: Evaluate the occupational variation in incidence of oropharyngeal cancer (OPC). METHODS: We calculated standardized incidence ratios (SIRs) of OPC in occupational categories in the Nordic countries relative to the entire national populations. The data covered 6155 OPC cases. RESULTS: Among men high risk of OPC was observed, among else, in waiters (SIR 6.28, 95% CI 4.68-8.26), beverage workers (SIR 3.00, 95% CI 1.72-4.88), and artistic workers (SIR 2.97, 95% CI 2.31-3.76). Among women high risk of OPC was observed in waiters (SIR 2.02, 95% CI 1.41-2.81) and packers (SIR 1.73, 95% CI 1.07-2.64). The lowest SIRs were observed in female gardeners (SIR 0.27, 95% CI 0.12-0.51) and male farmers (SIR 0.30, 95% CI 0.25-0.35). CONCLUSION: The 20-fold variation in incidence of OPC between occupations needs further investigation in studies with detailed information on occupational and non-occupational risk factors.

Consideraciones médico-legales laborales de la fórmula de Balthazard / Occupational medical-legal considerations of the Balthazard formula

La determinación del porcentaje de pérdida en pacientes lesionados con múltiples secuelas por riesgos de trabajo resulta un verdadero reto para el perito, esto adquiere mayor relevancia cuando en el fuero judicial se pueden presentar discrepancias en los criterios para el uso o no de fórmulas matemáticas para el cálculo. La fórmula de suma combinada, creada por el Médico Forense Víctor Balthazard, no es más que un ordenamiento de una regla de tres que ordena los porcentajes otorgados a cada secuela de mayor a menor para evitar que el porcentaje final sobrepase el 100%, o bien que resulte en un porcentaje mayor que una secuela única puntuada en el baremo y que por gravedad en la intensidad de la misma resulte con un porcentaje menor al calculado por la secuela múltiple y que se ha utilizado en fueros laborales y de seguridad social alrededor del mundo. El Baremo contenido en el Código de Trabajo no establece explícitamente la forma en que se calcula el porcentaje de pérdida por secuelas múltiples, lo cual brinda libertad al perito para utilizar fórmulas, como lo es la fórmula de suma combinada, que permite calcular de forma congruente las pérdidas sucesivas sin sobrepasar a la persona más allá de su capacidad general total del 100% o de otorgar porcentajes mayores a secuelas de mayor gravedad que la suma de las pérdidas por el evento que se está valorando.

The determination of the percentage of loss in injured patients with multiple sequelae due to occupational hazards is a real challenge for the expert, this becomes even more relevant when in the judicial system there may be discrepancies in the criteria for the use or not of mathematical formulas for the calculation. The combined sum formula, created by the Forensic Physician Victor Balthazard, is nothing more than an arrangement of a rule of three that orders the percentages given to each sequel from highest to lowest to avoid that the final percentage exceeds 100%, or that it results in a higher percentage than a single sequel scored in the scale and that due to the severity in the intensity of the same results in a lower percentage than that calculated for the multiple sequel and that has been used in labor and social security courts around the world. The Schedule contained in the Labor Code does not explicitly establish the way in which the percentage of loss for multiple sequelae is calculated, which gives the expert the freedom to use formulas, such as the combined sum formula, which allows a congruent calculation of the successive losses without exceeding the person's total general capacity of 100% or to grant higher percentages to sequelae of greater severity than the sum of the losses for the event being valued.

Percepción de la utilidad de los registros dentales como método de identificación humana en profesiones de alto riesgo: el caso de las personas trabajadoras de la Cruz Roja Costarricense / Perception of the usefulness of dental records as a method of human identification in high-risk professions: the case of the Costa Rican Red Cross workers

Introducción: Aquellas personas que brindan atención en situaciones de emergencias están expuestas a un alto riesgo de sufrir lesiones o fallecer durante labores de rescate, sea en accidentes de tránsito, desastres naturales, atentados terroristas o crisis humanitarias generadas por conflictos armados. Esta investigación fue realizada en las personas trabajadoras de la Cruz Roja Costarricense (CRC) para establecer la percepción de la utilidad de los registros dentales como método de identificación y elaborar un formato único de información odontológica antemortem. Materiales y métodos: Un cuestionario piloto fue diseñado y aplicado a 10 personas para ser calibrado y validado. Posteriormente se generó un cuestionario electrónico final en la plataforma Google Forms que fue enviado vía correo electrónico institucional a las personas trabajadoras constituida por 175 individuos, de los cuales 92 respondieron en el período del 20 de noviembre de 2022 al 20 de enero de 2023. Los resultados fueron analizados mediante las distribuciones de frecuencia, cruce de variables, comparación de medias con base en el análisis de variancia. El nivel mínimo de confianza para las comparaciones fue del 95%. Resultados: El cuestionario fue realizado por 92 personas, 75% hombres y 25% mujeres. El rango de edad entre los 36 y 40 años fue el más frecuente (23.9%). El 60,9% labora en la provincia de San José, 58% indica que visitaron al odontólogo hace un año o menos y el 38,6% refiere que nunca les han tomado una radiografía panorámica, un 81,8% dice tener tratamientos dentales como coronas, puentes o implantes; y el 75% considera de gran utilidad los registros dentales como método de identificación, y lo ubican en segundo lugar de conocimiento (89,8%) al compararlo con ADN (97,7%) y dactiloscopia (86,4%). Conclusiones: Las personas trabajadoras de la Cruz Roja Costarricense consideran que los registros odontológicos son útiles en la identificación de seres humanos y cuentan con información antemortem útil para dicho efecto.

Introduction: Those who provide care in emergency situations are exposed to a high risk of injury or death during rescue work, whether in traffic accidents, natural disasters, terrorist attacks, or humanitarian crises generated by armed conflicts. This research was carried out among Costa Rican Red Cross (CRC) workers to establish the perception of the usefulness of dental records as a method of identification and to develop a single format for antemortem dental information. Materials and methods: A pilot questionnaire was designed and applied to 10 persons to be calibrated and validated. Subsequently, a final electronic questionnaire was generated in the Google Forms platform and sent via institutional e-mail to 175 workers, of whom 92 responded during the period from November 20, 2022, to January 20, 2023. The results were analyzed by means of frequency distributions, crossing of variables, and comparison of means based on the analysis of variance. The minimum confidence level for comparisons was 95%. Results: The questionnaire was completed by 92 people, 75% men and 25% women. The age range between 36 and 40 years was the most frequent (23.9%). A total of 60.9% worked in the province of San José, 58% indicated that they had visited the dentist a year ago or less and 38.6% said that they had never had a panoramic X-ray taken, 81.8% said they had dental treatments such as crowns, bridges or implants; and 75% considered dental records to be very useful as a method of identification, and placed it in second place in terms of knowledge (89.8%) when compared with DNA (97.7%) and dactyloscopy (86.4%). Conclusions: Costa Rican Red Cross workers consider dental records to be useful in the identification of human beings and have useful antemortem information for this purpose.

Hepatitis B in Healthcare Personnel: An Update on the Global Landscape.

Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP's knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations.

[Assessment of occupational hazards and their prevention in the work of dental technicians during the COVID-19 pandemic]. / Ocena zagrozen zawodowych oraz ich profilaktyka w pracy techników dentystycznych w czasie pandemii COVID-19.

BACKGROUND: Work of a dental technician is associated with exposure to a number of harmful factors. We can distinguish: chemical, biological, physical and psychophysical factors. They contribute to many diseases, but not all of them are classified as occupational diseases. The main aim of the study was to assess the health hazards that occur in the workplace of a dental technician and their prevention during the COVID-19 pandemic. MATERIAL AND METHODS: An epidemiological cross-sectional study was conducted. A self-created questionnaire form containing 28 questions was used. The link to the survey was shared on social groups associating dental technicians. Participation in the study did not require logging in. During the data collection, the respondents' personal data were not collected and processed. RESULTS: 148 dental technicians participated in the study. The largest group were participants aged 21-25 (32%), the smallest group were people over 50 (6%). The most frequently occupied position was acrylic and plaster. More than 1/3 of those surveyed reported having allergies, most often to acrylic or metal. More than 20% of technicians reported experience of mechanical injuries several times a week or more. 17% of technicians declared professional burnout. 80% of technicians used protective clothing. Personal protective equipment was always used by only 22% of technicians, and as many as 29% of respondents never used the listed protective equipment. CONCLUSIONS: Not all dental laboratories were equipped with the necessary personal protective equipment. The most commonly used personal protective equipment included: disposable gloves, disinfectant liquid and extract. The COVID-19 pandemic contributed to a change in disinfection procedures in more than 1/3 of the respondents. 35% of them started using disinfection only after the outbreak of the pandemic, while most of the changes concerned the improvement of existing procedures. The length of work experience of technicians had an impact on exposure to stress and occupational burnout. Med Pr Work Health Saf. 2023;74(4):289-99.

Global, regional and national burdens of non-melanoma skin cancer attributable to occupational exposure to solar ultraviolet radiation for 183 countries, 2000-2019: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: A World Health Organization (WHO) and International Labour Organization (ILO) systematic review reported sufficient evidence for higher risk of non-melanoma skin cancer (NMSC) amongst people occupationally exposed to solar ultraviolet radiation (UVR). This article presents WHO/ILO Joint Estimates of global, regional, national and subnational occupational exposures to UVR for 195 countries/areas and the global, regional and national attributable burdens of NMSC for 183 countries, by sex and age group, for the years 2000, 2010 and 2019. METHODS: We calculated population-attributable fractions (PAFs) from estimates of the population occupationally exposed to UVR and the risk ratio for NMSC from the WHO/ILO systematic review. Occupational exposure to UVR was modelled via proxy of occupation with outdoor work, using 166 million observations from 763 cross-sectional surveys for 96 countries/areas. Attributable NMSC burden was estimated by applying the PAFs to WHO's estimates of the total NMSC burden. Measures of inequality were calculated. RESULTS: Globally in 2019, 1.6 billion workers (95 % uncertainty range [UR] 1.6-1.6) were occupationally exposed to UVR, or 28.4 % (UR 27.9-28.8) of the working-age population. The PAFs were 29.0 % (UR 24.7-35.0) for NMSC deaths and 30.4 % (UR 29.0-31.7) for disability-adjusted life years (DALYs). Attributable NMSC burdens were 18,960 deaths (UR 18,180-19,740) and 0.5 million DALYs (UR 0.4-0.5). Men and older age groups carried larger burden. Over 2000-2019, attributable deaths and DALYs almost doubled. CONCLUSIONS: WHO and the ILO estimate that occupational exposure to UVR is common and causes substantial, inequitable and growing attributable burden of NMSC. Governments must protect outdoor workers from hazardous exposure to UVR and attributable NMSC burden and inequalities.