Personal Protective Equipment in COVID-19: Impacts on Health Performance, Work-Related Injuries, and Measures for Prevention.

OBJECTIVE: To assess impact of personal protective equipment (PPE) on healthcare providers (HCPs) in caring for COVID-19 patients. METHODS: A cross-sectional survey was conducted over 50 hospitals in China. Descriptive analyses and Chi-square tests were performed on the collected data. RESULTS: All 104 frontline HCPs report negative impacts of PPE on their clinical performance, 97% of them experienced discomfort and injuries caused by wearing PPE for long hours. Frontline HCPs provided suggestions to alleviate the negative impacts and to enhance communication between healthcare staff and patients. Two hundred eighty two non-frontline HCPs also revealed similar problems; however, we recorded a few discrepancies between answers given by frontline and non-frontline HCPs. CONCLUSIONS: Wearing PPE for long hours degrades health performance. Measures were suggested to improve the design of PPE for protecting HCPs and enhancing their services to COVID patients.

Los Juegos Serios, su aplicación en la Seguridad y Salud de los Trabajadores / Serious Games, their Application in the Health and Safety of Workers

INTRODUCCIÓN: La Seguridad Industrial es una de las áreas multidisciplinarias que más herramientas, técnicas y modelos poseen para intervenir las actuaciones o comportamientos humanos ante el riesgo y para ello de forma estratégica utiliza como fundamento la capacitación, el entrenamiento y aprendizaje permanente de las experiencias vividas. Uno de los aspectos esenciales para mejorar la efectividad de estas acciones es la introducción de tecnología virtual e inmersiva, como un recurso que permite mejorar la rapidez, ubicación y creación de escenarios complejos en los cuales se simulen situaciones muy peligrosas. Dentro de este contexto los juegos serios (SG) han ido ocupando importantes espacios en los procesos asociados con la inducción, la capacitación y el entrenamiento en Seguridad y Salud en el Trabajo. OBJETIVO: Revelar la amplia y versátil aplicación que vienen obteniendo los juegos serios en los diversos campos y enfoques que configuran el alcance de la Seguridad y Salud en el trabajo, resaltando sus beneficios y potencialidades. MATERIAL Y MÉTODO: Revisión descriptiva y narrativa de la información que ha sido publicada a través de textos, revistas y congresos, sobre juegos serios entre los años 2005 y 2018, discriminado por los siguientes enfoques o campos del conocimiento: Seguridad y salud en el trabajo, juegos serios, multimedia, simulación y computación. RESULTADOS Y CONCLUSIÓN: La aplicación de juegos serios se erige como una forma novedosa y efectiva para transformar y reemplazar de manera progresiva la formación tradicional de cumplir los procesos de inducción y entrenamiento, siendo de gran interés para industrias con procesos peligrosos, en especial del sector de la construcción y la industria química

INTRODUCTION: Industrial Safety is one of the multidisciplinary areas that have the most tools, techniques and models to intervene in actions or human behaviors against risk, using for this purpose strategically training and permanent learning as a basis for life experiences. One of the most essential aspects to improve the effectiveness of these actions is the introduction of virtual and immersive technology, allowing a speed increase, location and creation of complex scenarios in which very dangerous situations are simulated. Within this context, Serious Games (SG) have occupied important spaces in those processes associated with induction, training and coaching in Health and Safety at Work. AIM: To reveal the wide and versatile application that Serious Games are being obtained in different fields and approaches that make up the scope of Health and Safety at Work highlighting their benefits and potentialities. MATERIAL AND METHODS: A descriptive and narrative review of the information published in texts, journals and conferences between 2005 and 2018 has been carried out on the following topics: Safety at Work, serious games, multimedia, simulation and computing. RESULTS AND CONCLUSIONS: The application of Serious Games in the processes of induction and training stands as a novel and effective way to transform and gradually replace the traditional training, being of great interest for industries with dangerous processes, especially of the construction sector and the chemical industry. Although it is necessary to improve the effectiveness evaluation on a large-scale application understanding the application process with all the resources that must compromise the trainings, a large part of the Serious Games applied to Occupational Health and Safety have already been developed between the years 2005-2017

A Novel Rubric to Evaluate Wearable Cameras for Assessment of Interrater Reliability.

Research has reported on traditional methods of assessing interrater reliability but, currently, no such standard protocol exists for selection of alternative methods of assessing interrater reliability, such as wearable video cameras. The professions of occupational therapy and occupational science take a unique ecological perspective when evaluating individuals, which focuses on the naturalistic perspective of an individual, ideally resulting in optimal performance. Given current advancements in technology, wearable, low-cost, unobtrusive, first-person view digital video cameras are readily available for use in research. The researchers generated an original rubric for critiquing cameras, then trialed four cameras for use in a future interrater reliability study. This standardized protocol fills a gap in the field and can be used by future researchers searching for a standardized method of camera selection.

Enfermedades profesionales atendidas en el Parc de Salut Mar (Barcelona, España), 2010-2014 / Occupational diseases treated at Parc de Salut Mar (Barcelona, Spain), 2010-2014

No disponible

Desmotivación del personal sanitario y síndrome de burnout. Control de las situaciones de tensión. La importancia del trabajo en equipo / Burnout Syndrome and Demotivation Among Health Care Personnel. Managing Stressful Situations: The Importance of Teamwork

Las personas invertimos casi un tercio de nuestra vida en el lugar de trabajo, donde se desarrollan gran parte de las relaciones interpersonales y las situaciones de tensión. El estrés laboral asociado a estas conlleva consecuencias para la salud física y mental de las personas. El estrés laboral y el síndrome del profesional quemado (burnout) son las principales consecuencias derivadas de las situaciones de tensión constantes en el trabajo. El estrés es la segunda causa de baja laboral en la Unión Europea, y alrededor de un 12% de los trabajadores europeos podría padecer actualmente el síndrome del profesional quemado. Por todo esto, es fundamental la detección en las organizaciones, grandes (hospitales y clínicas) y pequeñas (consultas), del personal desmotivado y estresado, ya que permitirá una prevención e intervención precoz en las situaciones de tensión generadas y una mejora en el funcionamiento de los equipos de trabajo

Almost one-third of our lives is spent in the workplace, where much of our interaction with others takes place and where we are exposed to stressful situations. Work-related stress has consequences for the individual's physical and mental health. Stress and professional burnout syndrome are the main consequences of work situations characterized by a constant state of tension. Stress is the second leading cause of absenteeism in the European Union, and around 12% of European workers are currently affected by burnout syndrome. It is therefore vital to identify demotivated and stressed staff in both large organizations (hospitals and clinics) and smaller centers (private practices) so as to facilitate preventive measures and ensure early intervention in situations of stress, with a view to improving the performance of work teams

A propósito del RD 843/2011 por el que se regula la actividad sanitaria de los Servicios de Prevención y sus modificaciones: ¿Problema o solución? / About the RD 843/2011 by which the activity of health prevention services and amended regulates: Problem or solution?

No disponible

Screening con test inmunoquímico de sangre oculta en heces realizado en trabajadores del Banco de España / Screening study of fecal occult blood by immunochemical test among Banco de España employees

Objetivo: Cribado del cáncer colorrectal mediante la detección de sangre oculta en heces (SOH) con test inmunoquímico, en trabajadores mayores de 50 años. Material y métodos: Estudio descriptivo y transversal de 1.065 trabajadores mayores de 50 años, durante dos años. Se les hizo un test inmunológico de SOH, de muestra única; los que dieron positivo fueron sometidos a colonoscopia completa y estudio anatomopatológico en su caso. Los datos obtenidos se trataron estadísticamente con una regresión logística multivariante, confrontándose la variable dependiente (SOH) con otras independientes (edad, sexo, antecedentes médicos, parámetros bioquímicos, etc.) para comprobar la existencia o no de significación estadística. Resultados: 115 trabajadores (10,8% de la población estudiada) dieron positivo al test de SOH. En 36 casos se detectaron pólipos colorrectales, (28 hombres y 8 mujeres) y se diagnosticó un adenocarcinoma 'in situ' de colon en una mujer. Conclusión: El screening de SOH es coste-efectivo a partir de los 50 años de edad, por lo que se recomienda su empleo en los reconocimientos médico-laborales periódicos (AU)

Objective: Screening of colorectal cancer in a working population, using the fecal occult blood by immunochemical test. Material and methods: it is made a descriptive and transversal study of workers over 50 years old. The population sample consisted in 1,065 people. All of them made the test once. The positive ones were sent to the gastroenterologist in order to have a colonoscopy.The results were studied with a multivariate logistic regression, to determine the existence or not of statistical significance among the test and other variables took into consideration. Results: 115 workers got a positive test. In 36 cases it was found a colonic polyposis affection, and in one case was detected an 'in situ' adaenocarcinoma colonic. Conclusions: The test has high cost effectiveness and that is why it is recommended to apply it as a preventive diagnostic method in workers older 50 years (AU)

Evaluación del entrenamiento continuado en primeros auxilios: intervención educativa en trabajadores del sector construcción, Perú / Evaluation of continuous training in first aid: educational intervention in construction workers, Peru

Objetivos: Determinar la variación del nivel de conocimiento de los trabajadores de una empresa de construcción, posterior a una intervención educativa continuada en primeros auxilios médicos. Métodos: Estudio longitudinal de tipo experimental (intervención educativa), en un grupo de trabajadores de Lima. Se los dividió aleatoriamente y a todos se les dio una misma capacitación basal. Se utilizaron tests validados localmente para la medición del nivel de conocimiento en cada fase. Se analizaron los resultados de la medición del conocimiento adquirido según el tipo de intervención. Resultados: El promedio del nivel de conocimiento teórico basal fue de 1,3 puntos (de 10 puntos posibles), que se triplicó a 4,6, posterior a la primera capacitación y finalmente disminuyó pasados los meses. Se encontró diferencias estadísticamente significativas entre los promedios de notas teóricas según las intervenciones educativas que recibieron (p=0,035), pero los promedios finales teóricos no alcanzaron el objetivo establecido. Conclusiones: Si bien hubo una diferencia en las notas según el tipo de refuerzos, no fue suficiente para obtener un adecuado nivel de conocimientos del tema; es necesario saber si las capacitaciones brindadas aseguran que el trabajador esté adecuadamente entrenado, ya que no basta con capacitarlos, también se tiene que asegurar que retengan el conocimiento adquirido (AU)

Objectives: To determine the variation in the level of knowledge of the employees of a construction company, after a continuous educational intervention in medical first aid. Methods: Longitudinal experimental study (educational intervention) in a group of workers in Lima. They were divided randomly and all were given the same basal training; locally validated tests were used to measure the level of knowledge in each phase. P values were obtained to determine the differences between the averages by type of intervention. Results: The mean level of basal theoretical knowledge was 1.3 points (from 10 possible points), which tripled to 4.6 after the first training and finally reduced after months. Statistically significant differences were found between the averages of theoretical notes according to educational interventions received (p=0.035), but the theoretical final averages were disapproving. Conclusions: While there was a difference in the notes according to the type of reinforcements, it was not sufficient to obtain an adequate level of knowledge of the subject; is necessary to know whether the training ensure that workers are properly trained, and that is not enough to train them, you also have to ensure that they retain the knowledge gained (AU)

Decálogo de buenas prácticas para la protección de datos en Medicina del Trabajo y vigilancia de la salud / Ten tips for best practice for data proteccion in Occupational Medicine and occupational health

La protección de datos está presente en todo el ámbito sanitario. Médicos y enfermeros reciben formación específica en este sentido, dada la importancia que alberga unas buenas prácticas en materia de protección de datos. No obstante, no está demás recordar con cierta periodicidad una serie de cuestiones que ayudan a preservar la intimad y el secreto profesional en el ejercicio del trabajo a desempeñar. En el ejercicio de la Medicina del Trabajo en el aspecto de la vigilancia de la salud igualmente se hace necesario salvaguardar la gran cantidad de datos sobre trabajadores y las empresas atendidas en dicha actividad preventiva. Para ello se pretende dar a conocer un decálogo de buenas prácticas sobre protección de datos en vigilancia de la salud. Existe abundante bibliografía referente a la protección de datos en el ámbito sanitario, pero no tanta relativa a la actividad de la vigilancia de la salud dentro de la Medicina del Trabajo y la Salud Laboral (AU)

Data protection is a key issue for all the sanitary system. Doctors and nurses are thoroughly educated in this area due to the importance of the good practice in data protection. However, it is advisable for the medical and sanitary staff to regularly remind the basic aspects that will help to protect the confidentiality and professional secrecy. In Occupational Health, it is also required to protect the amount of data that are managed about many workers and businesses. This is intended to provide several good practices in this way. There are numerous references in the bibliography regarding general data protection in the healthcare system, but not so many about specific areas such as Occupational Medicine and Occupational Health (AU)

A comparison of instrumentation methods to estimate thoracolumbar motion in field-based occupational studies.

The performance of an inertial measurement unit (IMU) system for directly measuring thoracolumbar trunk motion was compared to that of the Lumbar Motion Monitor (LMM). Thirty-six male participants completed a simulated material handling task with both systems deployed simultaneously. Estimates of thoracolumbar trunk motion obtained with the IMU system were processed using five common methods for estimating trunk motion characteristics. Results of measurements obtained from IMUs secured to the sternum and pelvis had smaller root-mean-square differences and mean bias estimates in comparison to results obtained with the LMM than results of measurements obtained solely from a sternum mounted IMU. Fusion of IMU accelerometer measurements with IMU gyroscope and/or magnetometer measurements was observed to increase comparability to the LMM. Results suggest investigators should consider computing thoracolumbar trunk motion as a function of estimates from multiple IMUs using fusion algorithms rather than using a single accelerometer secured to the sternum in field-based studies.

Ankle brachial index using an automatic blood pressure device in occupational medicine: relevance in routine examination and comparison with Framingham cardio-vascular risk score.

AIM: The aim of this study was to assess the feasibility and relevance of determining ankle brachial index (ABI) using an automatic blood pressure device in subjects seen for their annual routine examination by occupational physicians and to compare the obtained ABI with the Framingham score. PATIENTS AND METHODS: Sixteen physicians randomly recruited 634 subjects in 12 departments of occupational medicine. Subjects aged between 40 and 60 years underwent a determination of ABI using an OMRON HM 722 device and the analysis of Framingham score. Other analysed variables were: sex, age, smoking habit, hypertension, diabetes, hypercholesterolemia, glycaemia, total cholesterol, HDL and LDL cholesterol and triglycerides levels. RESULTS: Mean age of the population studied was 48.1 ± 6.0 years; 73% were men, 36% were smokers, 14% had hypertension, 3.3% diabetes and 22% hypercholesterolemia. Biochemical values were glycaemia 0.90 ± 0.30 g/l, total cholesterol 2.10 ± 0.4 g/l, HDL cholesterol level 0.50 ± 0.20 g/l, LDL cholesterol level 1.30 ± 0.40 g/l, and triglycerides 1.40 ± 1.0 g/l. Mean ABI were 1.1 ± 0.1 in both legs. Mean Framingham score was 8.2 ± 5.4%. Only 20 subjects (3%) had an ABI < 0.90. No relation was found between pathological ABI and Framingham score (abnormal ABI : 9.9 ± 5.5 vs. normal ABI : 8.2 ± 5.4, NS). CONCLUSION: The determination of ABI using a simple commercially available automatic blood pressure device is feasible and easy to implement by preventive or general physicians in all kinds of routine examinations. In our opinion automatic ABI very easy and quick to determine provides, in addition to Framingham score, a simple and useful tool to detect subjects at high cardio-vascular risk.

Evaluation of the ShapeTape for studying biomechanics in the workplace.

Motion capture systems may be difficult to use in harsh environments such as a poultry plant, and therefore should be self-contained, portable, unobtrusive, and not interfere with or be degraded by plant machinery or processes. The purpose of this study was to evaluate the validity, reliability and accuracy of the ShapeTape system as a potential solution. This was accomplished by comparing kinematic data from the ShapeTape against the Vicon system. Subjects performed cyclical movements along a plane angled 45° up from the horizontal using their right arms. Results revealed that the ShapeTape kinematic data was significantly larger than the Vicon data, yet statistically reliable.

Inclined foot switches for surgical microscopes: a comfortable design for seated surgeons: technical note.

During microneurosurgical procedures, surgeons sitting on a stool may experience muscular fatigue in the lower half of the body due to repeat manipulation of foot switches controlling the surgical microscope. The mechanisms contributing to this fatigue were examined and a method developed for fatigue reduction. The switch panel harboring the pedals was originally designed to be placed horizontally, but was inclined toward the surgeon with a sandbag placed under the panel. The modified panel was used in consecutive surgeries by 3 surgeons. Surface electromyographs of the bilateral gastrocnemius and gluteus maximus muscles were obtained during simulated activation of the switches on horizontal and inclined panels using the left foot. Inclined panels facilitated stepping on the pedals, required less muscle power, and lessened fatigue and hip pain. Electromyographs obtained during stepping on the switches on the horizontal panel showed contraction of the left gluteus maximus, and the right gastrocnemius and gluteus maximus, muscles that do not directly contribute to stepping, in addition to contraction of the left gastrocnemius, a main muscle in the stepping motion, i.e. flexion of the ankle. Electromyographs obtained during stepping on the switches on the inclined panel showed muscle contraction was limited to the left gastrocnemius with lower frequency and amplitude motor unit potentials compared to those elicited during use of the horizontal panel. Our simple modification facilitates operating microscope manipulation and reduces surgeon fatigue.

[Pinch assessing in bio mechanical analysis: methodological and applicative aspects dealt by using the new P force Met portable instrument]. / Stima della presa in pinch: approfondimento degli aspetti metodologici ed applicativi mediante l'impiego di un nuovo apparato portatile, P force Met.

BACKGROUND AND OBJECTIVES: Definition and significance of term pinch and related force exerted are still open outside the ergonomic field of interest too. The lack of consent appears relevant in upper limb biomechanical risk assessment. Aim of this study is to focus methodological aspects and applications of pinch, analyzing four actions by a new portable instrument able to measure strain exertion during pinch action. METHODS: A portable apparatus named P-forceMet, produced by OT bioelettronics, Turin (Italy) had been used. It measures the force generated by voluntary muscle contraction both in maximal condition (MCV) and in specific working conditions (Spontaneous Force, SF). We examined four groups of 27 subjects exerting forces of different entity required in 4 technical actions: tightening bolts, writing with a pen, use a brush to spread sealer, wiring cables. The workers were asked to exert the MCV and value was registered to be compared with force simulated on the instruments taking into account the specific experienced action. Data from force analysis by Borg scale and data about upper limb disorders had also collected, as well as the results of risk assessment by checklist OCRA application. RESULTS: Comparing MCV and SF we demonstrated different levels of measured forces: from 2-3% when using the pen to write to 8-12% for cabling and brushing activities to 31% for manual tightening. These results were in good agreement with evaluations by Borg scale, while risk assessment by check list OCRA were discordant (sealing and cable wiring were sometimes at level of mild to medium risk mainly due to posture evaluation of pinch). Workers engaged in writing, sealing and cabling did not suggest disorders to wrist-hand. CONCLUSIONS: Actions with pinch are numerous in working activities and if defined "at risk" only because they require posture of opposition of the first two fingers, we could not classify correctly to the real bio mechanical overload. This study carried out using an instruments able to measure the force exerted during pinch operations demonstrates that the force (and then of possible strain) is diferent in the four activities. It confirms the importance of critical evaluation of different hazards and of their interaction in causing the functional or organic disorder. In our case a remarkable difference of force was demonstrated by instrument p-force in actions involving the same hazard related to posture. Further investigation appears to be necessary to eliminate the residual subjective component of this force measurement method due to the necessity of simulating the force requested by specific action.

[Investigation of the allocation of equipment among the major research agencies for occupational health and medicine].

OBJECTIVE: To understand the allocation of instruments and equipment in major research institutions for occupational health and medicine in China. METHODS: Questionnaire was designed for collecting the information of the equipment used in occupational health and medicine research. Questionnaires were distributed to 78 research agencies to investigate the situation of allocation of instrument and equipment. RESULTS: There was a great diversity of allocation in investigated agencies. The features in three kinds of agencies are different. The occupational health agencies in universities fit out the biological equipment in laboratories. The occupational health laboratories in CDCs were equipped with the chemical analytical devices. The institutes of occupational medicine were equipped with the clinical inspection instruments. CONCLUSION: The protocol of sharing resource and predominance complementation should be established among research institutions for occupational health and medicine in the same region or neighboring provinces.

Minusvalía e incapacidad en la diabetes y sus complicaciones. Una revisión desde la legislación española / Handicap and disability in diabetes and its complications. A review of the Spanish laws

Los conceptos de discapacidad, minusvalía e incapacidad hacen referencia,en su conjunto, a consecuencias de las patologías y/o malformaciones y a susrepercusiones en la vida de las personas. Lo que varía en cada caso es elámbito de repercusión personal, socioambiental o laboral, y con ello las implicacionesque suponen y sus prestaciones. Estos temas, que forman parte delas tareas habituales del médico del trabajo, resultan menos conocidos y utilizadosen el ámbito asistencial, tanto para el médico de atención primaria comopara otros especialistas. Este artículo pretende aproximar a los profesionalessanitarios, partiendo de la legislación vigente en España, la definición deestos conceptos, su manejo y el procedimiento de valoración de la diabetes,entidad patológica que por sí misma, y sobre todo cuando se le añaden complicacionesevolutivas, genera en el paciente una compleja problemática asociadaa sus limitaciones personales, familiares, sociales y laborales, de grantrascendencia en los sistemas públicos sanitarios y de la Seguridad Social,con costes económicos difíciles de cuantificar(AU)

The concepts of disability, handicap and impairment refer, as a whole, to consequencesof diseases and/or malformations and their impact on the lives ofpeople. What varies in each case is scope of the personal, social and environmentalor labour, and thus the implications posed and the benefits that couldresult in. These issues, as part of normal duties of occupational doctors, areless known and used in the level of medical care, either by GPs as well byother specialists. This article aims to bring practitioners health, based on currentlegislation in Spain, the definition of these concepts, their managementand the valuation process of diabetes, pathological entity in itself, especiallywhen other complications evolutionary generated are added in the complexproblems of patients due to due to personal, familiar, social and labour limitations.These limitations have a great repercussion in public health systems andsocial security, which economic costs are very difficult to evaluate(AU)

Efectividad de una estrategia de intervención preventiva, basada en entrevistas telefónicas estructuradas, en una población laboral con riesgo cardiovascular moderado/alto / Effectiveness of a preventive intervention strategy based on structured telephone interviews in a working population with a moderate to high cardiovascular risk

ObjetivoEvaluar la efectividad de una estrategia de intervención preventiva sobre el estilo de vida, basada en entrevistas telefónicas.DiseñoEstudio de intervención cuasiexperimental.EmplazamientoServicio de Prevención de Ibermutuamur (Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social).Participantes4.792 trabajadores con nivel de riesgo cardiovascular (RCV) moderado/alto en el reconocimiento médico laboral (RML) que otorgaron su consentimiento. Se excluyeron los sujetos con antecedentes de enfermedad cardiovascular o que recibían tratamiento antihipertensivo, hipolipemiante o antidiabético.IntervenciónSe pudo contactar telefónicamente con 3.085 trabajadores, a los que se realizó seguimiento en los meses primero, cuarto y octavo tras el RML, enfatizando recomendaciones cardiosaludables. Al resto de trabajadores (n=1.707), solo se les realizó el RML inicial y final.Mediciones principalesEl RCV se estimó según el modelo SCORE europeo. Todos los sujetos recibieron un informe, una carta dirigida a su médico de atención primaria con los factores de RCV detectados, su nivel de riesgo y recomendaciones sobre modificación del estilo de vida(AU)

ResultadosEl 71,5% de los trabajadores eran mayores de 45 años, el 95,0% varones, el 76,6% trabajadores manuales y el 69,7% fumadores. Ambos grupos mostraron mejoría en los parámetros lipídicos, presión arterial, abandono del hábito tabáquico y RCV global en el segundo RML. El grupo A presentó una mayor mejoría en la presión arterial, lípidos (excepto colesterol-HDL), índice de masa corporal, glucemia, abandono del hábito tabáquico (23,5% vs 19,4%, p=0,001) y en el estrato de riesgo (46,6% vs 37,7%, p=0,0001). Un 52,9% de los trabajadores declaró haber llevado la carta informativa a su médico de Atención Primaria, que aconsejó modificar la dieta (47%), o añadir tratamiento antihipertensivo (19,5%), hipolipemiante (16,7%), antidiabético (4,4%) y antitabaco (2,9%).ConclusionesLa estrategia de intervención sobre el estilo de vida, basada en entrevistas telefónicas, en trabajadores de RCV moderado-alto, puede ser efectiva. El envío de información preventiva y la participación de Atención Primaria pueden contribuir, per se, a los cambios positivos observados(AU)

ObjectiveThis study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR).DesignQuasi-experimental study of preventive intervention.SettingIbermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain.ParticipantsA total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded.InterventionA final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B).Principal outcomesCUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters.Principal outcomesCardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level(AU)

ResultsA total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers (“Blue Collar”) and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases.ConclusionsThe results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed(AU)

[Evaluation of work-related biomechanical overload: techniques for the acquisition and analysis of surface EMG signal]. / Tecniche di acquisizione ed analisi del segnale elettromiografico per lo studio del sovraccarico biomeccanico occupazionale.

OBJECTIVES: The aim of this research was to obtain information concerning muscle fatigue and muscle activation levels by measuring quantitative parameters through the surface electromyographic signal, and use such information to integrate the OCRA (Occupational Repetitive Actions) method for risk assessment of upper limb biomechanical overload Along with the main risk factors associated with the development of work-related upper limb musculoskeletal disorders (UL WMSDs) like posture, movement, frequency of action and organizational factors, this method also takes into account the muscular effort. Unlike the other risk factors that can be directly measured during inspections on farms, muscular effort is currently estimated only via a subjective assessment scale (Borg CR-10 scale). METHODS: A new apparatus and new procedures were implemented for synchronized EMG and video acquisition, which guarantee a high degree of inter- and intra-subject repeatability, and an ad hoc software for data elaboration was developed They have been specifically designed for "on the field" applications. The methodology was first tested in the laboratory on a group of 12 healthy subjects, studying a repetitive task, running in two different ways, (high/low OCRA index) and interspersed with isometric tests for an indirect measurement of dynamic fatigue. The methodology was then tested in a working environment to compare the muscular effort required during the use of different types of tools for pruning. RESULTS: Results of the laboratory protocol showed onset of fatigue for Anterior Deltoid, Middle Deltoid and Brachial Triceps muscles only for the high-risk index mode, as demonstrated by the significance of the Bonferroni tests (p < 0.05) on MDF (Median Frequency) calculated from isometric tests. They also showed significant differences in terms of higher level of muscle activation, and thus required force, in the case of high OCRA index work task compared to the one at low risk (Wilcoxon, p < 0.05) for all analysed muscle groups with regard to 10th, 50th and 90th percentile of the APDF (Amplitude Probability Distribution Function). These results clearly defined the differences of subjectively perceived effort. The results of field" application showed that the tested protocol was also easily exportable to a real working environment and that the numerical parameters extracted from the EMG signal can be a useful tool for evaluating effort levels of different muscles of the upper limb and for comparing different work tools, through effort indexes referred to single muscles. CONCLUSIONS: It can therefore be concluded that by integrating the information about the 'FORCE' factor in the OCRA method, the calculated parameters may provide objective information useful in analyzing and designing ergonomic tools and workplaces.

A review of direct neck measurement in occupational settings.

No guidelines are available to orient researchers on the availability and applications of equipment and sensors for recording precise neck movements in occupational settings. In this study reports on direct measurements of neck movements in the workplace were reviewed. Using relevant keywords two independent reviewers searched for eligible studies in the following databases: Cinahal, Cochrane, Embase, Lilacs, PubMed, MEDLINE, PEDro, Scopus and Web of Science. After applying the inclusion criteria, 13 articles on direct neck measurements in occupational settings were retrieved from among 33,666 initial titles. These studies were then methodologically evaluated according to their design characteristics, exposure and outcome assessment, and statistical analysis. The results showed that in most of the studies the three axes of neck movement (flexion-extension, lateral flexion and rotation) were not simultaneously recorded. Deficiencies in available equipment explain this flaw, demonstrating that sensors and systems need to be improved so that a true understanding of real occupational exposure can be achieved. Further studies are also needed to assess neck movement in those who perform heavy-duty work, such as nurses and electricians, since no report about such jobs was identified.