Cochrane Methodology Register Research Articles

Suberose- a Doença Profissional mais Portuguesa

Introduction/ background/ objectives Portugal is the world’s largest producer of cork. It is derived from the cork oak (quercus suber) and consists of dead cells with cellulose. The tasks with the highest load are usually assigned to the male and the most repetitive to the female; this implies a different occupational exposure, meaning that exposures of higher risk generally occur almost exclusively in male positions. The first reference to Suberose (cork = suber) was in 1947. However, most studies in the sector were carried out in companies with good working conditions, so the conclusions may not be easily extrapolated to most cork workers. The aim of this bibliographic review is to summarize the most relevant information about the topic. Methodology This is a Bibliographic Review, initiated through a survey conducted in October 2020 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP ”. Content The first articles related to the Cork sector highlight the role that some microorganisms have, like Penicillium glabrum (formerly known as frequentans); more recent documents add Chrysonilia Sitophila and Mucor. In places with less humidity the fungal concentration decreases. Workers with Suberosis had skin reactions to the fungus in question and the inhalation of the respective aerosols caused the characteristic symptoms. Some authors also believe that some mites may have some relevance in cork asthma (such as P notatum, Cladosporium, A fumigatus, Alternaria alternata, Acarus siro and Tyrophagus putrescentiae). The suberin found abundantly in cork, may also be associated with some symptoms. Workers are also exposed to cork dust; yet it is less prevalent in the workplace than fungi. Suberose is a pathology of the pulmonary interstitium caused by repeated exposure to dust and mold from cork; in fact, it is the most prevalent disease of the pulmonary interstitium in the north of the country. However, Asthma may also be associated with a lower prevalence. Depending on the size of the fungal spores, Asthma or Hypersensitivity Pneumonitis will be more likely, that is, if smaller (1 to 2 micromers), an alveolar response (alveolitis) will appear more frequently; if larger, a bronchial response, like asthma, can occur. Conclusions The cork industry is reasonably developed in some areas of the country, but knowledge about Suberosis is not always abundant. It would be relevant that all professionals in the Occupational Health Teams with clients in this area were comfortable in the way how to approach the sector; in addition, it is very relevant to develop recent research, disseminating it internationally, not least because Portugal is the country that most developed the sector, worldwide.

Teletrabalho na perspectiva da Saúde Ocupacional

Introduction/ background/ objectives The possibility of doing work at home dates back several centuries; however, technological development has allowed for the creation of new jobs based on it and eventually fully executed outside the employer’s premises. In addition, the pandemic situation associated with SARS-COV-2 (COVID-19) has encouraged many institutions to initiate or intensify telework. The purpose of this review was to summarize the most relevant data about the topic, in the context of Occupational Health. Methodology This is a Review, initiated through a survey conducted in April 2020, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina, SCOPUS and RCAAP”. Content Telework is working at home, or at least outside the employer’s conventional facilities, but in a previously stipulated and approved location, using technology. In this review, data on the historical evolution of the work were summarized, highlighting the various Industrial Revolutions. Some national and especially international statistics were also included in the context of Telework. The main sub-types of Telework are also briefly described and what are the desirable characteristics in teleworkers and telemanagers. Finally, the main advantages and disadvantages mentioned in the consulted bibliography are highlighted. Conclusions Generally speaking, the perception of advantages and disadvantages depends on the employee’s characteristics (such as personality, flexibility, autonomy, competence, need for socialization, posture and commitment to work); characteristics of the employer (management, malleability, valorization of human resources, means and procedures); the tasks themselves (ease or not of being teleworked); family characteristics (number of elements, age of children and relational quality); the household (size, lighting, furniture, equipment, area exclusive or not for the Telework); traffic, pollution and urban safety; as well as consequences for the relationship with the company, work and personal life (family and society); that is, the same aspect can be considered both an advantage and a disadvantage, depending on the global context. Furthermore, in reality, Telework has such a diversity of conditions and characteristics, that consensus conclusions are not possible. It is necessary for each institution to analyze the advantages and disadvantages of inserting the Telework and, if it decides to proceed, have a sense of what are the factors that can enhance and compromise the success of the project.

Métodos para detetar o Risco de surgirem Lesões Músculo-Esqueléticas relacionadas com o Trabalho- sabemos o suficiente?

Introduction / background / objectives Work-related Musculoskeletal Injuries are prevalent and relevant. There are several methods for detecting risk, depending on the tasks performed. However, not all professionals working in the Occupational Health teams have well-structured knowledge or practical experience in most of these methods. Methodology It is a Review, initiated through a survey conducted in April 2020, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP ”. Content There are several categories of methods for assessing the risk of Musculoskeletal Lesions Related to Work. For that we have, in a very synthetic way, the self-assessment questionnaires (completed by the workers), the observational methods (more or less complex) and the direct methods. This work describes in detail OWAS, RULA, REBA, NIOSH Equation and Strain Index. Conclusions Articles are easily found in indexed databases that mention that they used them, but due to the limitations imposed by most journals in view of the size of the document, almost all authors only mention the name of the method they used and, at most, make a description very synthetic of it. In turn, in some Master’s or Doctoral Theses (where this problem does not exist), a more detailed methodological description can be found, but even so, it is not always possible to understand in practice how to use all methods or we find discreetly different versions, result of adaptations or a mixture of methods, carried out over the decades. Any professional on an Occupational Health Team will have a reasonable sense of what are the most damaging tasks; however, presenting this evidence, attenuating subjectivity and making use of the hierarchy that mathematical scales can offer, makes evaluations more scientific, rigorous and easier to be accepted as valid by the Employer/ Representatives/ Workers and, consequently, increase the receptivity to proposed measures to mitigate/ correct the problem and reassess it after this phase. It would be desirable for all professionals in the field to have at least a generic idea of ​​the existing methods and to know where they can go to obtain more information, in order to execute these techniques, if necessary.

Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review

ObjectiveTo investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews.DesignSystematic review.Eligibility criteriaStudies that compared the association between conflicts...

Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations.

Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are recommended. Similarly, clinical guidelines and narrative reviews may be funded by industry sources resulting in conflicts of interest. To investigate to what degree financial and non-financial conflicts of interest are associated with favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. We searched PubMed, Embase, and the Cochrane Methodology Register for studies published up to February 2020. We also searched reference lists of included studies, Web of Science for studies citing the included studies, and grey literature sources. We included studies comparing the association between conflicts of interest and favourable recommendations of drugs or devices (e.g. recommending a particular drug) in clinical guidelines, advisory committee reports, opinion pieces, or narrative reviews. Two review authors independently included studies, extracted data, and assessed risk of bias. When a meta-analysis was considered meaningful to synthesise our findings, we used random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs), with RR > 1 indicating that documents (e.g. clinical guidelines) with conflicts of interest more often had favourable recommendations. We analysed associations for financial and non-financial conflicts of interest separately, and analysed the four types of documents both separately (pre-planned analyses) and combined (post hoc analysis). We included 21 studies analysing 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews. We received unpublished data from 11 studies; eight full data sets and three summary data sets. Fifteen studies had a risk of confounding, as they compared documents that may differ in other aspects than conflicts of interest (e.g. documents on different drugs used for different populations). The associations between financial conflicts of interest and favourable recommendations were: clinical guidelines, RR: 1.26, 95% CI: 0.93 to 1.69 (four studies of 86 clinical guidelines); advisory committee reports, RR: 1.20, 95% CI: 0.99 to 1.45 (four studies of 629 advisory committee reports); opinion pieces, RR: 2.62, 95% CI: 0.91 to 7.55 (four studies of 284 opinion pieces); and narrative reviews, RR: 1.20, 95% CI: 0.97 to 1.49 (four studies of 457 narrative reviews). An analysis combining all four document types supported these findings (RR: 1.26, 95% CI: 1.09 to 1.44). One study investigating specialty interests found that the association between including radiologist guideline authors and recommending routine breast cancer screening was RR: 2.10, 95% CI: 0.92 to 4.77 (12 clinical guidelines). We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.

Dietary interventions with or without omega-3 supplementation for the management of rheumatoid arthritis: a systematic review protocol.

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterised by swollen and painful joints. It is hypothesised that changes in lifestyle factors such as consuming a healthier diet may reduce the severity of RA symptoms. People living with RA commonly make alterations to their dietary intake with the hope of improving their symptoms. This systematic review aims to discuss the effects of dietary interventions with and without omega-3 supplementation for the management of rheumatoid arthritis. Methods: A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register) and CINAHL will be searched from inception without using date restrictions. Primary outcomes will include measures of disease activity, inflammation and quality of life among adults living with RA. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological appraisal of the studies will be assessed independently by two different reviewers (TR and AG) using the Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomised Studies Tool for NRCTs. Ethics and dissemination: Ethical approval is not required for this systematic review. Only publically available data from previously published studies will be used. The findings of this systematic review will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. PROSPERO registration: CRD42020147415 (11/02/2020).

Comparison of the perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement: A protocol for a systematic review and meta-analysis.

Background:Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement.Methods:All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss.Results:The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals.Conclusion:We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement.Trial registration number:PROSPERO 2020 CRD42020172087.

Luvas antivibratórias: qual a evidência científica?

Introduction / background / objectives The use of anti-vibration gloves is not as frequent as other individual protective equipment, so it becomes an area in which the professionals that exercise in the Occupational Health teams (and even employers and workers) have less contact and experience. In addition, when starting to research the topic, it is easy to see that there are contradictory data published, so there are many doubts about the benefit or not on its use. This review intends to summarize the most recent and pertinent articles published on this topic. Methodology This is an Integrative Bibliographic Review, initiated through a research carried out in December 2019 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina, SCOPUS and RCAAP ”. Content For a glove be considered anti-vibration, it must comply with the criteria defined by the International Standardization Organization. The sensitivity to damage associated with vibrations has some variability between individuals. Vibrations can cause vascular, neurological and musculoskeletal changes; overall, the situation referred to as hand-arm vibration syndrome; this becomes more frequent with increasing exposure time and intensity. In addition to the direct protection that may exist in relation to vibrations, by keeping the hands dry and warm, vibratory damage can be indirectly attenuated. In addition, regardless of the vibration issue, the worker is also more protected from cuts, burns, chemical and biological agents. The greatest risk may then be to give the employer and employee a sense of protection when it is not real. In addition, some researchers believe that certain collective protection measures are more effective than gloves. Conclusions The published data are contradictory and the studies generally used small samples, so it is difficult to generalize the results with safety. In addition, it is easy to see that the protection, absence of it or even potentiation of vibrations will depend on numerous variables, namely working instrument, type of vibrations, model/ material and glove thickness in the palm and fingers, as well as grip strength exercised by the worker and its anthropometric dimensions. It is therefore a protective equipment that, in no way, can be considered as an added value, for any task or worker.

COVID-19: o que foi publicado nas últimas semanas em Revistas Científicas

Introduction / background / objectives Given the devastating impact that the COVID-19 pandemic is causing and will cause, it was intended to summarize in this bibliographic review the most relevant data published in scientific journals. Methodology It is a Scoping Review, initiated through a survey conducted in March 2020 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP ”. Content Some health professionals were alerted by an abnormal number of pneumonias that appeared in the city of Wuhan (Hubei Province, China), during the month of December 2019. COVID-19 is believed to have presented zoonotic transmission from a local market through live wild animals, keep in badly hygienic conditions. However, although speculated on the exact host, there are no certainties. Like other coronaviruses, the incubation period can range from two to fourteen days (an average of 5.2 days). Contagion is thought to occur through contact with contaminated respiratory secretions, namely aerosols, droplets and/ ou direct contact and later touching the mouth, nose and maybe eyes. Contagion is more likely at less than two meters. The microorganism can also be present in the stool (especially if there is diarrhea) and urine. Individuals with milder symptoms did not seek medical attention so much, so they will be very likely to spread the disease; in addition, there is also the possibility of infectiousness before any symptoms appear. The clinical presentation varies from an asymptomatic situation, passing through mild symptoms to situations of fatal pneumonia, sometimes also involving other organs and systems (such as the gastrointestinal tract, skeletal and neurological muscle) or even sepsis/ septic shock. The most common symptoms are fever (98% of cases), cough (82%) without sputum and dyspnea (55%). These symptoms are common to many bacterial and viral infections, usually self-limiting. Generally the most symptomatic are the most contagious, but contagion is possible with asymptomatic individuals. Diagnostic methods can use techniques associated with ELISA (Enzyme Linked Immunosorbent Assay) or Western Blot methodology. Molecular techniques such as RT-PCR (Real Time Protein Chain Reaction) or Northern Blot hybridization can also be used. Viral antigens can be detected using IFA (Immune Fluorescent Assay) technology. Among these, the RT-PCR method is used more frequently to detect viruses in respiratory secretions; that is, through sputum, smears from the oropharynx/ tracheal or in samples of lower respiratory secretions, for example obtained by bronchoalveolar lavage. Regarding treatment, there is currently no approved drug. It is therefore based on ventilatory support, hydration and antipyretics. If bacterial infection develops, antibiotics may be used. Several researchers are trying to get a vaccine, but none have yet been approved. Most severe cases occur in the elderly population; part of it needs hospitalization and eventually dies. The overall associated mortality rate is about 2 to 4%; among hospitalized patients it is about 10 to 14%. Mild cases usually recover after a week; serious situations progressively evolve to respiratory failure due to alveolar damage, which can be fatal, especially at older ages and/ or with a relevant clinical history. A fifth of individuals require hospitalization and a fifth of these will have criteria to access the Intensive Care Unit. Conclusions COVID-19 is not the first or even second pandemic associated with coronavirus (although these have passed unnoticed by many) and it will almost certainly not be the last, associated with this family of viruses or any other. The incredible ease of alteration in the genetic material of microorganisms randomly creates many new mutations; a small protein difference in a capsule/ membrane/ elements that contribute to adherence, will change the organisms that there is possibility of “hosting” and/ or causing disease and thus causing an impact as brutal as we are seeing, at human, social and economic levels. Microorganisms have been around for a longer time than humans and they will stay longer, as they are incredibly better adapted to the environment. After this distressing, it is necessary to rethink the way we manage some issues and invest in technological development at the drug level (whose evolution is incredibly slower than the microorganisms), pre and/ or post exposure vaccines and software installed on mobile phones, to identify contacts with confirmed or suspected cases and mathematical/ epidemiological management of these data.

Campos Eletromagnéticos: ênfase nas Medidas de Proteção Coletiva e Individual

Introduction / framework / objectives Electromagnetic fields are already very extensively developed in the scientific literature, however, doing so through a generalist approach and/ or highlighting the possible consequences for human health. There are few documents that, under this theme, describe specific protection measures. The authors conducted a research with the objective of elaborating a synthesis what was written about this subtheme. Methodology This is a Scoping Review, initiated at September 2019, in the databases “CINALH plus with full text, Medline with full text, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Web of Science, SCOPUS and RCAAP”. Content Many activities create these fields. In most workplaces exposure is discrete and there is no relevant risk. In all other cases, however, the risk dissipates with distance from the source. In addition, as most of these situations originate from an electrical appliance, when it is switched off, the problem no longer exists. Particularly exposed individuals may be pregnant women and individuals with active medical devices (cardiac stimulators, defibrillators, cochlear and brain stem implants, neurostimulators, drug infusion pumps and retinal coders). In terms of collective protection measures, the shielding/ insulation with metal, ceramic, plastic or glass plate or mesh can be highlighted;as well as protection with light curtains; reading apparatus and pressure sensitive mats; restriction of access by guards, barriers, signs, magnetic field signaling/ ionizing radiation, especially to individuals with active or metallic medical implants; prohibition of conductive objects; appoint the person responsible for safety management; training about body position during work and limitation of movements to attenuate induction of electric fields. While it is not difficult to shield electric fields, mitigating the effects of magnetic fields is more complicated. Furthermore, it is generally not possible to use effective Personal Protective Equipment uniformly: if it protects a range of frequencies, it will hardly protect for others. Examples include insulation footwear (thick rubber sole, non-steel); suitable gloves in isolation/ driving, glasses and full suit. Conclusions Given the omnipresence of the electromagnetic fields (although generally at intensities of low concern), it would be relevant for occupational health practitioners to have some notions of how to approach the subtheme. In addition, it would be important for some teams to have the opportunity to investigate in this context, improve customer service and, by publishing their data, contribute to a better understanding of the national reality and somehow evolve scientific knowledge in this area.

Os Telemóveis implicam risco biológico?

Introduction / background / objectives Mobile phones are used more frequently, both in a personal and professional context. Several researchers have presented evidence that they are objects that generally contain several microorganisms, some of which are possibly pathogenic. There will be some professional sectors where this issue may become problematic, namely between hospital health institutions (not only due to the type of microorganisms that exist, but also due to the immunosuppression and/ or general bad medical conditions of the individuals present). The aim of this review is to understand what is described in terms of biological risk for workers who handle mobile phones, although almost all published studies convert to the Health sector and the emphasis is given to patients (and secondarily to the community) and not to the workers themselves. Methodology It is a Scoping Review, initiated through a survey conducted in April 2019 in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content The temperature of the mobile phone can create good conditions for the development of some microorganisms. From here they can pass to the user’s face, eyes and mouth. In addition, some of the mobile phones used at work are not just for one person, but are passed between shifts; in some countries they are shared by several members of the family and/ or lent to children, to play. In addition, many use this object during meals/ in the kitchen and even when they are in the bathroom, which enhances the microbiological load. Smartphones appear to be more contaminated, due to being generally larger and providing more interaction and handling; simultaneously, those with a touch screen have less colonization than keyboards (possibly due to the homogeneity of the surface). Some researchers have hypothesized that there is a relationship between the colonization of some mobile phones and that which exists inside women’s bags, where they are usually transported. Conclusions Although the studies were very dispar in relation to looking for any type of microorganisms or just bacteria or viruses and in addition to the real microbiological diversity between countries, the different cultivation techniques certainly made it possible for some strains to grow and others not to be viable. Although these biases can justified some significant percentage differences, it was also clear that all cell phones contain numerous microorganisms, although most of these are not relevant for immunocompetent individuals, bet all articles were written before the Pandemic by Covid-19 . Thus, in the context of Occupational Health, there seems to be no significant risk for workers who are not immunosuppressed. However, the exceptions, simultaneously, can become relevant: for Employees with changes in the functioning of the immune system, for microorganisms with multidrug resistance to conventionally used drugs and, obviously, at this stage (april 2020 ) for new strains, for which there is still no natural immunity (by previous infection) or provided by an effective vaccine and, therefore, capable of causing very extensive disease in populations and, although the number of serious cases is small, given the contagion dimension, this acquires a very relevant amplitude, for all its human, emotional, technical, labor and economic implications. For this reason, it is recommended to use the phone very carefully (especially in circumstances where biological contamination is more likely and/ or intense), both at work and in a personal context; as well as the proper and regular disinfection of these objects, by 70% alcohol.

Vibrações, Ruído e Hipoacusia: associação fisiopatológica ou não?

Introduction / framework / objectives Vibrations and noise are two reasonably prevalent occupational risk factors and, in many situations, present together. If a pathophysiological association between them is real, it will be very relevant to verify this, in order to readjust, if necessary, the vibration and noise limits considered safe. Methodology This is an Scoping Review, initiated by a September 2019 survey of the “Cochrane Central Register of Controlled Trials databases, CINALH plus with full text, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Science Direct, SCOPUS and RCAAP.” Content Some researchers have quantified higher hearing losses in workers simultaneously exposed to noise and vibrations; however, workers exposed to vibration from work instruments are generally also exposed to higher levels of noise. If there is a pathophysiological link between these two occupational risk factors, it is believed that this may be related to the theory of sympathetic vasoconstriction (observed in white-finger syndrome) and may also damage the cochlea, producing ischemic damage to the hair cells. Another hypothesis points out that some work tools may give rise to vibrations that can reach the inner ear directly, through bone conduction (especially at the temporal level). Conclusions Most of the studies consulted did not have a very robust methodology that allows a rigorous evaluation of whether the most intense hypoacusis in individuals simultaneously exposed to vibration results from a true pathophysiological association, or if it is only a statistical bias. It would be interesting for occupational health teams to investigate on clients with workers simultaneously exposed to these two risk factors (and, if possible, with combinations of different intensities), in order to produce knowledge capable of enhancing occupational health and safety.

Agentes Químicos Ototóxicos (para além dos Solventes)

Introduction / framework / objectives Classically in Occupational Health Hypoacusis is associated to noise exposure; however, there are several chemical agents with this capability. Among these, the most frequently associated are solvents, although not always with irrefutable scientific evidence for some cases. Within other classes of chemical agents the data is even scarcer and less robust. The aim of this review was to summarize the most recent and pertinent publications on ototoxic agents (other than solvents). Methodology This is an Integrative Bibliographic Review, initiated at September 2019 on the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Science Direct, Web of Science, SCOPUS and RCAAP”. Content The most commonly mentioned classes are solvents (there is already an article published in this journal related to the risk of hypoacusis), heavy metals, asphyxiants and pesticides. It is also described that some antibiotics, anticancer drugs and diuretics may be ototoxic directly. In turn, hydrogen cyanide and carbon monoxide can have a synergistic effect with noise, as well as some heavy metals, asphyxiants and pesticides. However, in contexts where there is noise and ototoxic chemical agents, it is difficult to understand the contribution of each, and synergism may occur. Moreover, the situation seems to be clearer in animals; In humans some researchers assume that further studies are needed and the levels at which injury arises are not known clearly. At higher concentrations, hypoacusis seems evident, but for smaller amounts, data are not always consensual. There is also no consensus on the lowest dose that will induce damage. In addition, in most occupational situations exposure includes several chemical agents and not one isolated. Animal is not equivalent to human metabolism, so generalizations of results should be made with reservations. At work level, there are fewer standards for chemical versus noise agents in the context of hearing loss. Global ototoxicity is believed to be related to oxidative stress; not only due to the formation of reactive oxygen species, but also through the attenuation of antioxidant defense mechanisms. Discussion, Limitations, and Conclusions Most of the published studies on this subject are not very robust, besides that they have heterogeneous conditions among themselves. Hence, the conclusions of these studies cannot be generalized directly to the population of workers exposed to ototoxic agents. Still, among the latter there are some that seem to associate more clearly with hearing loss. Whenever the association is proven and/ or suspected, the Occupational Health team should provide measures that mitigate exposure to provide the safest and healthiest working environment possible. It would be relevant to know more about the national reality and to have published data of professionals working in companies with these agents, comparing the effect of different concentrations/ products and/ or simultaneous exposure to noise (possibly at different intensities), depending on the existing production process.

Fatores que influenciam a transição saudável para a reforma: revisão integrativa

Enquadramento: a reforma envolve uma dimensão individual e social, constituindo um marco no desenvolvimento do indivíduo. Planear esta transição torna-se fundamental para melhorar a satisfação e qualidade de vida. Objetivos: identificar os fatores facilitadores do processo de transição saudável para a reforma. Metodologia: a revisão integrativa envolveu a pesquisa nos motores de busca: CINAHL Complete; MEDLINE; Nursing & Allied Health Collection; Cochrane Central Register of Controlled Trials; Cochrane Methodology Register; Library, Information Science & Technology Abstracts e MedicLatina, tendo-se obtido inicialmente 231 produções científicas que, após a análise segundo os critérios de inclusão, foram elegidos 7 artigos. Resultados: os fatores determinantes para o sucesso desta transição são: idade, género, escolaridade, saúde, rede social, estilo de vida que antecede a reforma, satisfação com a vida ativa e condição financeira. A literacia em saúde e preparação para a reforma influencia essa transição, traduzindo-se na forma como os beneficiários enfrentam os problemas de saúde, económicos e sociais. Conclusão: preparar a reforma com antecedência é fundamental. Desenvolver programas de preparação para a reforma, baseados no projeto pessoal do futuro reformado, é determinante, traduzindo-se em ganhos para a saúde, maior bem-estar e qualidade de vida.

Radiação Ótica Artificial em contexto de Saúde Ocupacional- a Scoping Review

Introduction / framework / objectives Most workers and professionals working in Occupational Health teams will not particularly value this occupational risk factor, especially when compared with others that may also exist in the workplace; therefore, knowledge about this area is not particularly developed, nor is the bibliography abundant. The aim of this review is to summarize the most recent and pertinent publications on the subject. Methodology This is a Scoping Review, initiated by a September 2019 search of the databases “CINALH plus with full text, Medline with full text, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, MedicLatina, Academic Search Ultimate, Science Direct, Web of Science, SCOPUS and RCAAP”. Content Many workers are exposed to this radiation, particularly through lighting and computer displays; therefore, the rule of suppressing exposure (as sometimes attempted to do with other risks) does not have the same applicability in this context. In areas such as Health and in some Shows/ Art manifestations the limits of the directives can be overcome. Any artificial light, internal or external, also fits in this concept (even from motor vehicles). It is particularly frequent in the following professional sectors/ tasks: high temperature work (glass or metal), graphic work, aesthetic treatments, indoor work with powerful lighting, sterilization, welding, laser welding in plastic manufacturing, activities material processing (cutting, marking, drilling/ photolithography), optical measurement, communications, optical information storage and spectroscopy. Conclusions The theme does not adresses the same attention as other occupational risk factors, so it is poorly developed and some of the population will not even know it exists. It would be interesting for national Occupational Health teams, with clients with large numbers of employees exposed, to better investigate the issue, quantifying the knowledge of workers/ managers and employers, recording the semiology and associated pathologies, clarifying which radiation subtypes are involved in the various tasks, also suggesting valid collective and individual protection measures (specifying model and/ or materials).

Ruído: Medidas de Proteção Coletivas e Individuais

Introduction / framework / objectives Noise is an occupational risk factor extensively addressed in the Occupational Health literature. However, its pathophysiological consequences have traditionally been emphasized, sometimes neglecting more detailed explanations concerning personal protective equipment and collective protective measures. Methodology This is a Scoping Review, initiated by a September 2019 search of the databases “CINALH plus with full text, Medline with full text, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: Comprehensive, Academic Search Ultimate, Science Direct, SCOPUS and RCAAP.” Content There are several collective protection measures (at the workspace structure/ design and use of various materials/ devices) that are able to attenuate noise exposure. When exceeding the lower exposure value (80 decibels) the employer must provide hearing protection; if the upper exposure value (85 decibels) is reached or exceeded its use is required (after prior enhancement of collective protective measures). However, workers and their representatives have to be consulted to choose the model. In selecting the latter, account should be taken of European Community certification, appropriate attenuation, compatibility with tasks and other protective equipment used simultaneously; as well as the physical condition of the worker, acceptability and comfort that it will generate. The effectiveness of these will depend on time of use, correct utilization, shape/ size, fit to the ear, pressure (head and/ or ear), resistance to extreme temperatures and material. Conclusions Occupational health team professionals generally need up-to-date information on individual and collective protection measures to mitigate the effects of noise in the workplace. The bibliography (in indexed databases) on these two themes is not very abundant and / or easily accessible. However, these measures, well used, can attenuate noise, promoting safer and healthier work. It would be pertinent for Occupational Health teams who deal with clients with different noise levels, to investigate which of these techniques are most appropriate to each situation and how employees adhere better to the process and perform their part more effectively.

Regresso ao Trabalho após Acidente Laboral

Introduction / background / objectives Most Occupational Health teams do not have concrete experience in developing an action plan that aims to enhance the return of injured employees, especially when the work limitations are reasonable. The purpose of this review was to summarize the most recent and pertinent published data on the subject. Methodology This is a Scoping Review, initiated through a survey conducted in December 2019, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina, SCOPUS and RCAAP”. Content The articles that addressed this subject were scarce and not exhaustive. In the selected documents, some circumstances/ conditions were highlighted that can modulate the return to work; sometimes the authors did not specify the meaning of that influence, but in other cases they made it clear whether it enhanced or impaired the issue. Work accidents cause significant morbidity and costs worldwide, considering both direct and indirect expenses (such as lost productivity, changes in the insurer’s wages, employee turnover and training, investigation of the event and possible compensation, depending on the legislation of each country). Conclusions It seems that the return to work is facilitated with a fair and quick injury management, a team with experience to guide these process, good communication between the different parties involved, less serious injuries, less physically burdensome tasks, absence of economic/ social interests to delay return, good copping skills and healthier self-perception of the general medical condition. It would be very pertinent for some Occupational Health teams, that work with large clients and/ or with a reasonable number of occupational accidents that have resulted in considerable absences and/ or limitations, to investigate which are the best postures/ conditions that facilitate the return to work, subsequently publishing its conclusions.

Physical therapy interventions for cervicogenic dizziness in a military-aged population: protocol for a systematic review

BackgroundTraumatic cervicogenic dizziness is dizziness that is temporally associated with neck pain and injury after other causes of dizziness have been excluded. It can lead to activity limitations and participation restrictions that may include lost duty or work days. The objective of this systematic review is to determine which interventions are most effective in decreasing dizziness or vertigo and neck pain in military-aged adults with traumatic cervicogenic dizziness.MethodsThe literature will be systematically searched using the following online databases: MEDLINE, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, CENTRAL, Cochrane Methodology Register), CINAHL, SCOPUS, Web of Science, and J-STAGE. The review will include randomized controlled trials (RCTs), including cluster RCTs and controlled (non-randomized) clinical trials or cluster trials, and observational studies (including prospective and retrospective comparative cohort and case–control or nested case–control studies) and determine the effectiveness of physical therapy interventions for the treatment of traumatic cervicogenic dizziness in military-aged adults. Assessment of methodological quality will be performed by two independent, blinded reviewers using the PEDro scale. The level of evidence will be determined using the GRADE scale. The primary outcome measures will be change in dizziness and neck pain and disability from baseline to the last available follow-up, measured using the Dizziness Handicap Inventory and Neck Disability Index. Other relevant outcome measures will include self-reported change in symptoms, time to return to duty or work, and quality of life.DiscussionThis systematic review will identify, evaluate, and integrate the evidence on the effectiveness of physical therapy interventions for cervicogenic dizziness in a military-aged population. We anticipate our findings may inform individual treatment and future research. Clinical recommendations generated from this systematic review may inform military physical therapy treatment of individuals with cervicogenic dizziness.Systematic review registrationIn accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 21 January 2020 (registration number CRD42020150853). In the event of protocol amendments, the date of each amendment will be accompanied by a description of the change and the rationale.

927 Traction-Assisted Endoscopic Submucosal Dissection Reduces Procedure Time and Risk of Adverse Events: A Meta-Analysis

INTRODUCTION: Endoscopic submucosal dissection (ESD) is superior to endoscopic mucosal resection (EMR) for treatment of superficial gastrointestinal neoplasia because it is associated with increased en bloc resection and lower rates of local recurrence. However, ESD is a technically demanding procedure with increased procedure time and has potential for serious adverse events. To overcome the procedural difficulty of ESD, Various traction methods such as clip-line method, clip and snare method and internal traction method, have been developed to provide countertraction to expose the dissection plane and allow safe and effective submucosal dissection. A number of studies have compared efficacy of traction-assisted ESD (T-ESD) and conventional ESD (C-ESD) but results are conflicting. We conducted a meta-analysis to assess the efficacy of T-ESD. METHODS: All clinical studies published up to April 2019 comparing the efficacy and safety of T-ESD and C-ESD were identified using electronic bibliographic searches of PubMed, Medline, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Web of Science (Science and Social Science Citation Index). Outcomes of interests included procedure time (minutes), rate of en bloc and R0 resections, and rates of adverse events (bleeding and perforation). Random effect model was used to calculate pooled mean difference (MD) for continuous variables and Odds ratios (ORs) for categorical variables. RESULTS: Of 621 articles identified, 18 studies [939 T-ESD and 963 C-ESD procedures] met inclusion criteria for final analysis [6 randomized controlled trials and 12 observational studies]. Overall, T-ESD significantly reduced procedure time (MD = - 16.63 min, 95% CI - 24.65 to - 8.60, P < 0.0001, I 2 = 68) and complication rates (OR = 0.56, 95% CI 0.36 - 0.87, P = 0.009, I 2 = 0) compared to C-ESD. En bloc resection and R0 resection rates were similar in both groups (OR = 2.36; 95% CI 0.58 - 9.55; P = 0.23, I 2 = 0 and OR = 1.45; 95% CI 0.76 - 2.77; P = 0.25, I 2 = 0; respectively). No publication bias was detected by funnel plot. CONCLUSION: Traction techniques facilitate submucosal dissection, reduce procedure time and improve its safety. These techniques are simple and can be performed using readily available accessories in the endoscopy unit. Application of traction method improves feasibility of ESD and may enable the widespread use of ESD in the West.

Effects of acupuncture on rates of ovulation and pregnancy in women with unruptured follicular luteinization syndrome: A protocol for systematic review and meta-analysis.

BackgroundAs a fabulous part of Oriental Medcine, acupuncture and moxibustion possesses the advantage of high safety, convenience and less adverse effects. Unruptured follicular luteinization syndrome is a common cause of infertility in women of reproductive age, which seriously affects the physical and mental health of patients. Certain studies have reported that acupuncture can improve the rate of pregnancy in women with unruptured follicular luteinization syndrome. In this protocol, the effects of acupuncture on rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome will be further explored.MethodsElectronic bibliographic databases such as: MEDLINE, EMBASE, PsycINFO, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), Health Technology Assessment Database, and Web of Science (Science and Social Science Citation Index), PubMed, Chinese Biomedical Databaseare, Chinese VIP Information, Chinese National Knowledge Infrastructure (CNKI), all helpful to identify relevant randomized controlled trials (RCTs) of effects of acupuncture on rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome. The pooled odds ratio of achieving a clinical pregnancy, ongoing pregnancy, or live birth were used as the main outcome and the secondary outcome includes the changes of ovarian artery dynamics before and after treatment, so as to the adverse reactions of treatment. We will use RevMan 5.3 software to help us to analyze all data and use the Cochrane evaluation manual 5.1.0 to help us to assess the methodological quality for incorporated RCTs.ResultThis systematic review will provide evidence for assessing the effects of acupuncture on rates of ovulation and pregnancy in women with unruptured follicular luteinization syndrome.ConclusionThe results of this study will be a useful reference for clinical treatment with acupuncture to improve rates of ovulation and pregnancy among women with unruptured follicular luteinization syndrome.