Clinical neurological examination vs electrophysiological studies:Reflections from experiences in occupational medicine

Seventy-five percent of upper limb disorders that are related to work are regarded as diagnostically unclassifiable and therefore challenging to the clinician.Therefore it has been generally less successfully toprevent and treat these common and frequently disabling disorders.To reach a diagnosis requires the identification of the responsible pathology and the involved tissues and structures.Consequently,improved diagnostic approaches are needed.This editorial discusses the potentials of using the clinical neurologic examination in patients with upper limb complaints related to work.It is argued that a simple but systematic physical approach permits the examiner to frequently identify patterns of neurological findings that suggest nerve afflictions and their locations,and that electrophysiological studies are less likely to identify pathology.A diagnostic algorithm for the physical assessment is provided to assist the clinician.Failure to include representative neurological items in the physical examination may result in patients being misinterpreted,misdiagnosed and mistreated.

COVID-19 vaccination and associated factors in Turkish healthcare workers practicing chest medicine

Objective: To evaluate the COVID-19 vaccination status and related characteristics of Turkish healthcare workers practicing chest medicine.Methods: A cross-sectional online survey was conducted among the Turkish Thoracic Society members. The survey was started on May 17, 2021, and kept open for seven weeks. The 39-item survey included the COVID-19 vaccination status and demographic, clinical, and occupational characteristics. Results: Of 378 healthcare workers participated in the survey, 354(93.7%) reported receiving at least one dose of the COVID-19 vaccine. A total of 323(91.2%) healthcare workers received CoronaVac vs. BioNTech/Pfizer in 31(8.8%). In the CoronaVac group, 77(23.8%) contracted COVID-19 when not fully vaccinated, and 13(4.0%) when fully vaccinated;however, 16(51.6%) healthcare workers in the BioNTech/Pfizer group got COVID-19 when not fully vaccinated, but any fully vaccinated participants did not contract COVID-19(P=0.003). Regarding vaccine dosing, 328(86.8%) were fully vaccinated, while 50(13.2%) were not. Multiple regression analysis for being a non-fully vaccinated healthcare worker demonstrated a significant relationship with having any SARS-CoV-2 infection history(adjusted OR 9.57, 95% CI 3.93-23.26, P<0.001) and being a non-physician healthcare worker(adjusted OR 5.86, 95% CI 2.11-16.26, P=0.001), but a significant negative relationship with full-time working at the time of survey(adjusted OR 0.13, 95% CI 0.03-0.56, P=0.006). Conclusions: Although a majority of healthcare workers were fully vaccinated, occupational and non-occupational characteristics were related to being non-fully vaccinated. Active surveillance regarding the COVID-19 vaccination in healthcare workers is necessary to address specific parameters as barriers to vaccination.

Work Ability Index and Work Ability Score: A Comparation between both Scores in a Persistent COVID-19 Cohort

Aims: The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI) with another questionnaire base only on the use of WAI’s first item, termed as the “Work Ability Score” (WAS). Study design: A cohort of 384 Spanish workers included in a Post COVID-19 condition or persistent COVID-19 multicenter research was utilized. Place and Duration of Study: This cohort was enlisted in four hospitals (Hospital Universitario 12 de Octubre, Madrid;Hospital Universitario Virgen Macarena, Sevilla, Andalucía;Hospital Universitario Gregorio Marañón, Madrid and Complejo Asistencial Universitario de Salamanca, Castilla y León), since 2021 until 2022. Methodology: 384 Spanish workers (176 men and 208 women;aged 20 to 70 years) with Post COVID-19 condition or persistent COVID-19 were included. Descriptive analysis of primary scores was conducted. Given the non-normal distribution of data, the Mann-Whitney and Kruskal-Wallis tests were employed. Spearman and Kendall correlations were employed to assess the relationship between WAI and WAS, also used weighted Kappa to estimate the degree agreement between WAI and WAS. Logistic regression models were utilized to study determinants influencing WAI and WAS, categorized as poor or moderate. Results: WAI had an average score of 32.98 (SD = 10.28), whereas WAS had an average of 5.95 (SD = 2.77). Significant differences were observed in both WAI and WAS across the same variables. Strong and statistically significant correlations were evident between WAI and WAS (rs = 0.83, p < 0.001). All the variables used in the logistic regression model (gender, the sector employment, and previous chronic diseases) were statistically significant in both questionnaires. Conclusion: WAS questionnaire could be used as a tool for reliable assessment of work ability among Spanish workers with Post COVID-19 condition or Persistent CO-VID-19.

Parental Occupational Exposure and Risk of Acute Leukemia in Children: A Tunisian Population-Based Case-Control Study

Background: In recent decades, the incidence of children’s hematological malignancies has been increasing worldwide including Tunisia. Their severity is reflected in the importance of the medical, social and economic impact. This increase remains fully unexplained, and the involvement of genetic, environmental and occupational factors is strongly suspected. Materials and methods: Our study was a cross-sectional survey of the type case-control conducted in the University Hospital of Farhat Hached of Sousse during the period ranging between 1 July 2011 and 30 June 2012, and which included children with acute leukemia compared to children unharmed by neoplastic disease. Cases and controls were matched by age and gender. Our objective was to describe the socio-occupational characteristics of the parents of children with acute leukemia and to identify potential occupational factors implicated in the genesis of acute leukemia. Results: The number of acute leukemia cases in the Hematology Service and day hospital of the University Hospital of Farhat Hached during the study period was 66 cases divided into in 40 boys and 26 girls with a sex ratio of 1.53. Our cases and controls were matched by age and gender. The risk of incidence of leukemia in children from smoking fathers was higher (p = 0.02, OR = 2.24, IC = [1.11 - 4.52]). The risk of incidence of leukemia in children from alcoholic fathers was higher with p = 0.009, OR = 3.9;CI = [1.33 - 11.39]. After adjusting different variables, the difference persisted significantly with pa = 0.03 and ORa = 3.5, ICa = [1.09 - 11.6]. 25.7% of cases had a family history of blood disease and neoplasia, whereas no control presented that. The difference was statistically significant (p = 0.006, OR = 1.46, IC = [1.38 - 1.56]). The parental occupational exposures associated to the occurrence of acute leukemia in children were pesticides with a statistically significant difference (p = 0.03, OR = 2.94, IC = [1.06 - 8.13]). This difference persisted after adjustment with different variables pa = 0.01, ORa 3.75;ICa = [1.27 - 11.03]. This difference had become significant after adjustment with the different variables pa = 0.03, ORa = 2.67, ICa = [1.06 - 6.7]. Conclusion: Our results showed some support for a positive association between childhood acute leukemia risk and parental occupational exposure to pesticides and cement. Additionally, acute leukemia risk among children might be increased with parental alcohol consumption.

Proposed Occupational Vulnerability Index COVID-19

Introduction: Vulnerable is someone who can be hurt or receive injury, physically or morally. The work environment appears as one of the dimensions in which social vulnerability develops and social and occupational vulnerability is defined. The literature does not include an assessment of quantified occupational vulnerability as it already exists in the case of social vulnerability. The aim of this paper is to identify and quantify the variables included in the Protocol for the Assessment of Vulnerability to COVID-19 in such a way that the result can be quantified and allows for a predictive effect on the degree of vulnerability. Methodology: The starting point is the design of a protocol proposal that includes 29 variables. Data is collected from a sample of 420 workers, quantifying the results according to each variable, the overall scores for each group of aspects assessed and, finally, the total score that estimates the degree of vulnerability according to established ranges. Results: Variables that have the highest coefficient and, therefore, the greatest weight in the probability of reaching a group of high or medium vulnerability are cardiovascular disease, cancer, and coagulation alteration. The weight of the labour aspects due to inadequate working conditions stands out. Conclusions: The results obtained with this protocol allow us to make a quantified assessment of labour vulnerability to COVID-19 by integrating individual variables of the worker, his working conditions and the preventive actions of his company against COVID-19, and can be useful as an Occupational Vulnerability Index (OVI).

Symptoms, Pathologies, Accidents and Expectations, Regarding the Occupational Doctor and Safety Technician, in a Representative Sample of Portuguese Tattoo Artists

Introduction/Objectives: As Tattoo is being more accepted, more professionals dedicate to it. A study was designed with the aim of analysing the perception of Tattoo Artists regarding their Occupational Health/Safety team (opinion about the support provided);as to find out what type accidents, symptoms and occupational diseases they have, in order to provide a better service. Methods: This is a mixed exploratory study, containing a quantitative observational (analytical, cross-sectional) and a qualitative component (Case Study). For the statistical analysis, predominantly non-parametric tests were used. The project was approved by the Ethics Committee and informed consent was obtained. Results: In terms of symptomatology/illnesses, musculoskeletal pathology is the most reported. In terms of accidents, cuts stand out. Several statistically significant relationships were found between the variables analysed. Discussion/Conclusions: The Occupational Health and Security services are considered insufficient by most of the Tattoo artists. It would be desirable that the Occupational Doctor has concrete knowledge regarding Tattooing, in particular semiology/pathology;makes recommendations in pharmacology and/or indicates which exams could be useful. In relation to the Safety Technician, it would be desirable also to have specific knowledge about the sector, making plausible suggestions for improvement.

How to Pool Medical Services in Preventive Medicine Unit at 01/01/18 of Orleans Metropole/Orleans City Hall Structure: A Multi Disciplinary Network

To reform the unit of preventive medicine in Orleans metropole, the Director of the Administration decided to co-sign an agreement to optimize the organization of a common preventive medicine service: we made a deliberation model to permit for others towns which wanted to join us. The cost evaluated to reach the service was the cost for medical examination, regardless of the professional which included staff costs and operating costs (social benefits, costs of supplies and materials, training costs). A statement of the tasks performed for the beneficiary community was kept daily by the SMP. A strong will of the Metropolis and municipalities is to develop a synergy around health and safety at work. A joint Metropolis of Orleans, an organization chart since 1/2/2016 integrates the preventive medicine service within a Quality of Life at Work service: a multi-disciplinary service composed of prevention specialists, social workers, responsible for social action and SMP, a Department of Preventive Medicine was developed and itself multidisciplinary in accordance with the law of July 20, 2011: including doctors, nurses, psychologists, sophrologist, and a dietician. A new and active network of health is now operant with specialist correspondents. An audit is programmed in April 2018 to assess the efficacy of this network.

Evaluation of Formaldehyde as a Potential Cause of Olfactory Dysfunction in Hairdressers

Objective: The aim of this study was to compare the olfactory function between hairdressers exposed to formaldehyde and unexposed controls, as exposure to toxic agents is a potential cause of olfactory disorders in humans. Hairdressing professionals frequently encounter formaldehyde, a component found in hair products that are known to have various toxic effects on the human body, including alterations in the sense of smell. Methods: A total of 32 hairdressing volunteers exposed to formaldehyde and 32 non-exposed volunteers matched for age, sex, education and smoking status underwent the University of Pennsylvania Smell Identification Test (UPSIT®). Results: The findings demonstrated a decrease in UPSIT® olfactory test scores and a higher degree of olfactory loss among hairdressers exposed to formaldehyde (mean UPSIT® scores: 30.6 vs 35.1, p Conclusion: Occupational exposure of hairdressers to formaldehyde is associated with diminished olfactory function. Education approach and promotion of personal protective equipment usage should be encouraged.

Evaluation of Formaldehyde as a Potential Cause of Olfactory Dysfunction in Hairdressers

Objective: The aim of this study was to compare the olfactory function between hairdressers exposed to formaldehyde and unexposed controls, as exposure to toxic agents is a potential cause of olfactory disorders in humans. Hairdressing professionals frequently encounter formaldehyde, a component found in hair products that are known to have various toxic effects on the human body, including alterations in the sense of smell. Methods: A total of 32 hairdressing volunteers exposed to formaldehyde and 32 non-exposed volunteers matched for age, sex, education and smoking status underwent the University of Pennsylvania Smell Identification Test (UPSIT®). Results: The findings demonstrated a decrease in UPSIT® olfactory test scores and a higher degree of olfactory loss among hairdressers exposed to formaldehyde (mean UPSIT® scores: 30.6 vs 35.1, p Conclusion: Occupational exposure of hairdressers to formaldehyde is associated with diminished olfactory function. Education approach and promotion of personal protective equipment usage should be encouraged.

Fit to fight——from military hygiene to wellbeing in the British Army

This paper reviews the historical evolution of the language and organization surrounding the health of personnel in the British Army from‘hygiene’through to‘wellbeing’.It starts by considering the health of the army in the midnineteenth century and the emergence of military hygiene as a professional subject.It continues by looking at advances in military hygiene in the two world wars.Hygiene was replaced by the term‘health’in the 1950 s as the collective noun used by professionals working in this field.This unity split when the professions of occupational medicine and public health established separate faculties and training pathways.However,the health issues for the armed forces remain fundamentally unchanged.Going forward,the term‘wellbeing’is helping to refresh the close relationships between executives,their medical advisers and those within the population of health professions charged with keeping the British Army healthy.The core theme is the collaborations between civil society,executive leadership and medical services in maximizing the health of the military population from recruitment through to life as a veteran.

Current status of emergency treatment of chemical eye burns in workplaces

Chemical eye burns present an avoidable,but frequent,occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured.A periodical review of guidelines is required to assure the optimal emergency management.We reviewed the literature with emphasis on current German guidelines,primarily MEDLINE.If the crucial first-line measure,the injury prevention has failed and an eye burn has been sustained,the immediate and copious rinsing of the eye is the pivotal emergency treatment modality.Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous,there is an ongoing debate about the benefits and risks of specific rinsing solutions,and regular updates on guidelines and recommendations for the emergency treatment are warranted.The easiest and readily available rinsing solution is tap water,which fulfils the crucial criteria conveniently in most industrialized countries:purity,sterility,and neutral p H.Other rinsing solutions are proposing higher osmolality to stabilize the physiological p H,because of their superior buffering capacity.However,there is no compelling evidence for a substantial benefit,and some reports suggest that there could be unwanted side effects.In combination with the substantially increased expenditure and a more complex handling procedure,currently a general recommendation of any other solution than tap water is not warranted.

Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital:A factor analytical study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide.Hospital workers play a key role in averting the collapse of the health system,but the mental health of many has deteriorated during the pandemic.Few studies have been devoted to identifying the needs of workers on frontline duty.AIM To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital.METHODS This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo.We invited all hospital employees to respond to an online survey between July and August 2020,during the first peak of the pandemic.Data of 1000 participants who completed the survey were analyzed(83.9%were women and 34.3%were aged 30 to 40).Hospital workers selfreported the presence of symptoms of depression,anxiety,trauma-related stress,and burnout through the Patient Health Questionnaire-9,the Generalized Anxiety Disorder-7,the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively.Responses were assembled and subjected to exploratory factor analysis to reveal workers’core emotional distress.Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation,threatening events,and institutional support.RESULTS Around one in three participants in our sample scored above the threshold of depression,anxiety,post-traumatic stress disorder,and burnout.The factor analysis revealed a three-factor structure that explained 58%of the total data variance.Core distressing emotional domains were avoidance and re-experience,depression-anxiety,and sleep changes.Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions(βrange=-0.41 to-0.20,P<0.001).However,participants’personal motivation to work in healthcare service was not associated with these emotional domains.Moreover,the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict.CONCLUSION Distressing emotional domains among hospital workers were avoidance and re-experience,depression and anxiety,and sleep changes.Improving working conditions through institutional support could protect hospital workers'mental health during devastating public health crises.

Science on the Development of Standards and Their Compliance in a Representative Sample of Portuguese Tattoo Artists

Introduction: The number of Tattoo artists has been increasing and there are important Occupational Risks associated. The aim of this article was to describe the position of these professionals regarding the Recommendations and to analyze their compliance when working alone or accompanied. Methodology: It is a Mixed Exploratory Study, involving a quantitative component (Observational Analytical of transversal nature), operated through an online survey and, in a second phase, a qualitative one (Case Study), through the use of interviews. A representative sample of the population under study was obtained, considering a 90% confidence interval. The research project was approved by a Ethics Committee and informed consent was obtained. Presentation and Discussion of the Results: The sample considered 207 questionnaires and nine interviews. The compliance with Standards increases with experience;those who reported that they do not always comply are those who use less the Personal Protective Equipment (t = 2.659;p = 0.008). Compliance is also influenced by the Perception of Risk, information, social pressure (more accentuated by COVID19) and motivation to increase profit. Those who considered the Recommendations to be adequate were statistically associated with compliance with Collective Protection Measures. Regarding the compliance when working alone or not, 86.0% stated that they maintained the same posture;of those who answered the opposite, 85.7% complied more alone. Those with less education were statistically associated to less compliance with the rules when alone (X2 = 12.763;p = 0.005). Final Considerations: Previously unpublished data has been obtained, valuable to act effectively in this professional sector. It is fundamental to invest in training, as well as to elaborate Standards (developed jointly by Doctors/Safety Technicians and Tattoo artists). The organization of the Conventions should guarantee adequate conditions (area, access to disinfection/sterilization methods) and share Standards, promoting inspection and punishments for non-compliance, since they are the most unsafe places.

Proposed Protocol for Neuropathic Pain Assessment

Introduction: Pain with neuropathic characteristics is one of the most limiting as a consequence of injury or disease that affects the somatosensory system. Objective: An assessment protocol is proposed to quantify the impact of neuropathic pain integrating personal, clinical, work and social aspects and to establish guidelines in its management and evolutionary control. Method: The medical literature on neuropathic pain and its impact is reviewed as a basis for including the variables that must be part of the protocol. Results: The variables are quantified individually and by groups of factors. The final result is stratified into four grades (mild, moderate, severe, extreme), which will serve for the subsequent control, monitoring and prevention of risks. Conclusion: The proposed protocol evaluates the impact of neuropathic pain in all aspects of the person who suffers it and quantifies the results establishing degrees for its control, follow-up and clinical, social and occupational intervention.

Proposed Protocol for Risk Assessment and Stratification

Introduction: COVID-19 disease is a highly contagious viral infection caused by the SARS-CoV-2 coronavirus. There is growing interest in Public Health and Occupational Health in identifying the COVID-19 prognostic factors, needed to stratified patients by risk being necessary to consider occupational variables as well as individual and clinical factors of the workers. Objective: The aim of this study was to perform a tool to identify the more vulnerable workers for COVID-19 that will be useful to value their work limitations. Methods: A review of medical literature about the vulnerability for COVID-19 is taken into account occupational risks and occupational preventive measures. Results: It is proposed an index of vulnerability criteria for COVID-19 in workers based on quantifying individual characteristics, pre-existing medical conditions and its control, high risk of occupational exposure, and prevention and protection strategies in the workplace. The final result is stratified into three degrees of vulnerability that will serve to propose the most appropriate preventive measures. Conclusion: This proposal protocol assesses about the vulnerability for COVID-19 infection in workers to help decide the preventive management at workplace in this pandemic situation.