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Background:The relationship between exposure to asbestos and malignant pleural mesothelioma (MPM) is already well established. Nevertheless, much remains to be known about exposure thereto and the incidence and mortality from MPM. Objective: This systematic review aims to map the relationship between asbestos and MPM by studying the exposure to asbestos and the incidence and mortality of MPM. Methods: A systematic review was conducted relating asbestos and MPM. Exposure to asbestos, incidence, and mortality by MPM was reviewed. PubMed, Web of Science, Cochrane Library, RCAAP, DART-Europe, and the reference lists of included studies were searched, from January 1, 1960, to December 31, 2020. Methodological quality was checked, the risk of bias analysis was performed, a level of evidence grade was assigned, and descriptive data analysis was performed. Results: 3,484 unique citations were identified, which included seventeen observational studies that met inclusion criteria with a total of 1,104 patients. Heterogeneity is present between the included studies which range from a case series of 16 retrospective studies and 1 prospective study. Studies were mostly conducted in Europe, particularly in Italy (6), and were published between 1969 and 2020. The mean age of patients is approximately 66 years with a latency period between the first exposure and diagnosis of approximately 42 years. 14 studies present data regarding the occupational context and chrysotile and crocidolite are the most studied types of fibre. The incidence of cases occurred between the interval 1966 and 2014 and in 9 studies the mortality rate was 100% of patients. Conclusion: There is high evidence to support the relationships between asbestos and MPM. However, the relatively scant information provided by the studies reinforces the need for well-conducted research and implementation of National Mesothelioma Surveillance Centres at a global level.

Background: Assembly lines work is frequently associated to work-related upper limb musculoskeletal disorders. The related disability and absenteeism make it important to implement efficient health surveillance systems. The main objective of this study was to identify self-reported variables that can determine work-related upper limb musculoskeletal symptoms—discomfort/pain–during a 6-month follow-up. Methods: This was a prospective study with a 6-month follow-up period, performed in an assembly line. Upper limb musculoskeletal discomfort/pain was assessed through the presence of self-reported symptoms. Uni- and multivariate logistic regression analyses were used to evaluate which self-reported variables were associated to upper limb symptoms after 6 months at the present and to upper limbs symptoms in the past month. Results: Of the 200 workers at baseline, 145 replied to the survey after 6 months. For both outcomes, “having upper limb symptoms during the previous 6 months” and “education” were possible predictors. Conclusion: Our results suggest that having previous upper limb symptoms was related to its maintenance after 6 months, sustaining it as a specific determinant. It can be a hypothesis that this population had mainly workers with chronic symptoms, although our results give only limited support to self-reported indicators as determinants for upper limb symptoms. Nevertheless, the development of an efficient health surveillance system for high demanding jobs should implicate self-reported indicators, but also clinical and work conditions assessment should be accounted on the future. publishersversion published

This study followed assembly line workers during 7 months, comprising a 4-wk season holidays. The main purposes were to determine the potential effect of working time on the presence and intensity of upper limb musculoskeletal symptoms, as to verify the effect of 4 wk of job interruption in the upper limb musculoskeletal symptoms presence and intensity. Data was collected during 6 moments. Generalized estimating equations analyses were used. For the effect estimates, odds ratio with corresponding 95% confidence intervals were reported for each outcome/model. The upper limb musculoskeletal symptoms showed a significant increase (p=0.001), especially after the 4 wk off. In all data collection points there was a significant positive association between the upper limb musculoskeletal symptoms and general health status (p

Background: Despite the actual demographic trends and the global burden of cardiovascular diseases, there is little knowledge concerning the effects of retirement on this health outcome. Objective: We aimed to quantify the associations between retirement, and retirement age, with cardiovascular disease (heart disease and stroke) in the Portuguese population. Methods: We used data from the first Portuguese wave of the Survey of Health Ageing and Retirement in Europe. Logistic regression was applied to quantify the associations. The major risk factors for cardiovascular diseases and several features of retirement were considered as possible confounders or effect modifiers. Analysis was restricted to retirees in retirement process (retired for 5 years or less) and not retired because of illness. Results: An opposite direction of the association between retirement and heart disease was observed according to hypertension status, although not significant. Early retirement increased the odds of having a stroke, merely in individuals without heart disease (OR = 8.87; 95% CI 1.63-48.26). On the contrary, in individuals with heart disease, decreased the odds of having a stroke (OR = 0.08; 95% CI 0.01-0.68). Conclusions: Our findings suggest that retirement and retirement age may be beneficial or harmful, respectively, in the presence or absence of major risk factors for heart disease and stroke. We suggest that work-related stress affecting differently workers with and without these risk factors may eventually explain these findings. This paper used data from SHARE Wave 4 (DOI: 10.6103/SHARE.w4.710), see Borsch-Supan et al. ¨ for methodological details [14, 32, 33]. The SHARE data collection has been funded by the European Commission through FP5 (QLK6- CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006- 062193, COMPARE: CIT5-CT-2005-028857, SHA RELIFE: CIT4-CT-2006-028812), FP7 (SHARE PREP: GA N◦211909, SHARE-LEAP: GA N◦227822, SHARE M4: GA N◦261982, DASISH: GA N◦283646) and Horizon 2020 (SHARE DEV3: GA N◦676536, SHARE-COHESION: GA N◦870628, SERISS: GA N◦654221, SSHOC: GA N◦823782) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11, OGHA 04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org) info:eu-repo/semantics/publishedVersion

BACKGROUND Occupational physical demands are commonly assumed the cause of work-related Low Back Pain (LBP) and absenteeism. OBJECTIVES To analyse relationships between LBP at work, physical demands and absenteeism. METHODS Workers filled out a questionnaire on socio-demographic and work-related factors, general health, LBP (number of episodes in a 12-month period, pain severity and intensity), and occupational hazards related with physical demands. RESULTS 735 workers completed the questionnaire (male n = 359). A high proportion of workers n = 507 (69%), from different occupational backgrounds, reported at least one LBP episode in the previous 12-month period. The highest ratio of subjects with more than 6 episodes of LBP per year was found among public services employees (31.8%) and the lowest ratio among administrative workers (10.3%). The highest ratio of workers (39%) were classified as sedentary workers, 34% of workers having a low or moderate level of physical demands in their work, and 27% reported high levels of physical demands in their work. There was a 4 % absenteeism rate in a 12-month period, which was significantly higher in the group with physically demanding work. Those subjects with higher physical requirements at work have increased odds of having more than 3 episodes of LBP during the previous year (p

In the past years, several in vitro studies have addressed the pulmonary toxicity of multi-walled carbon nanotubes (MWCNT) and compared it with that caused by asbestos fibers, but their conclusions have been somewhat inconsistent and difficult to extrapolate to in vivo. Since cell coculture models were proposed to better represent the in vivo conditions than conventional monocultures, this work intended to compare the cytotoxicity and genotoxicity of MWCNT-7 (Mitsui-7) and crocidolite using A549 cells grown in a conventional monoculture or in coculture with THP-1 macrophages. Although a decrease in A549 viability was noted following exposure to a concentration range of MWCNT-7 and crocidolite, no viability change occurred in similarly exposed cocultures. Early events indicating epithelial to mesenchymal transition (EMT) were observed which could explain apoptosis resistance. The comet assay results were similar between the two models, being positive and negative for crocidolite and MWCNT-7, respectively. An increase in the micronucleus frequency was detected in the cocultured A549-treated cells with both materials, but not in the monoculture. On the other hand, exposure of A549 monocultures to MWCNT-7 induced a highly significant increase in nucleoplasmic bridges in which those were found embedded. Our overall results demonstrate that (i) both materials are cytotoxic and genotoxic, (ii) the presence of THP-1 macrophages upholds the viability of A549 cells and increases the aneugenic/clastogenic effects of both materials probably through EMT, and (iii) MWCNT-7 induces the formation of nucleoplasmic bridges in A549 cells. This research was supported by the Foundation for Science and Technology, Center for Toxicogenomics and Human Health (ToxOmics) under grant (UID/BIM/00009/2013) and by ToxApp4NanoCELFI (PTDC/SAU-PUB/32587/2017) through national funds (PIDDAC). info:eu-repo/semantics/publishedVersion

As with the SARS-CoV-1 outbreak in 2003–2004 and the MERS outbreak in 2012, there were early reports of frequent transmission to healthcare workers (HCW) in the SARS-CoV-2 pandemic. Our hospital center identified its first COVID-19 confirmed case on March 9, 2020, in a 6-day hospitalized patient. The first confirmed COVID-19 case in a HCW happened 3 days later, in a nurse with a probable epidemiological link related to the first confirmed patient. Our study’s first objective is to describe and characterize the impact of the first 3 months of the SARS-CoV-2 pandemic on the Centro Hospitalar Universitário Lisboa Norte (CHULN). Our second objective is to report the performance of the CHULN Occupational Health Department (OHD) and the impact of the pandemic on CHULN HCW and its adaptation across national, regional, and institutional epidemiological evolution. Over the first 3 months, 2,152 HCW were screened (which represent 29.8% of the total HCW population), grouped in 100 separate identifiable clusters, each one ranging from 2 to 98 HCW. The most prevalent profession screened were nurses (n = 800; 37.2%) followed by doctors (n = 634; 29.5%). The main source of potential infection and cluster generating screening procedures was co-worker related (n = 1,216; 56.5%). A patient source or a combined patient co-worker source was only accountable for 559 (26%) and 43 (2%) of cases, respectively. Our preliminary results demonstrate a lower infection rate among HCW than the ones commonly found in the literature. The main source of infection seemed to be co-worker related rather than patient related. New preventive strategies would have to be implemented in order to control SARS-CoV-2 spread.

Introduction: Health professionals who provide clinical care are exposed to patients potentially infected by the severe acute respiratory syndrome coronavirus 2 SARS-CoV-2), namely physicians and nurses;consequently, these professionals face higher risks of infection. Objectives: This study aimed to describe the prevalence of coronavirus disease 19 (COVID-19) cases among health professionals and the frequencies of risk factors and psychosocial risk. Methods: This is a cross-sectional study targeted at health professionals working in Portugal during the current COVID-19 pandemic. Data were obtained through a self-administered questionnaire available online at the websites of medical and nursing boards, among other sources. We performed a univariate analysis, calculating absolute and relative frequencies, and a bivariate analysis with a Pearson's chi-squared test. Results: We studied 4,212 health professionals, of which 36.7% (n = 1,514) worked in areas dedicated to the treatment of sick or suspected COVID-19 patients. Of these, 2.11% tested positive for SARS-CoV-2. Among all participants, 76.7% and 79.1% presented moderate to severe levels of fatigue and anxiety, respectively. Fatigue levels were significantly higher in professionals working in areas dedicated to the treatment of patients with COVID-19 (80.5% p = 0.01), but this difference was not observed regarding anxiety (79.5% p = 0.681). Conclusions: The percentage of health professionals who tested positive for SARS-CoV-2 was 2.11%. The reported high levels of fatigue and anxiety should determine a better protection of the health and safety of those who provide health care in the current pandemic. © 2021 Associacao Nacional de Medicina do Trabalho. All rights reserved.

This study aims to assess the airborne bioburden of rural and urban Portuguese Primary Health Care Centers (PHCC) using active and passive sampling methods and identify the potential differences in airborne microbiota between both environments. The highest total aerobic mesophilic bacterial load in indoor air were found in the Vaccination Room (448 CFU.m−3) in the Rural PHCC and in the Waiting Room (420 CFU.m−3) for Urban PHCC. The total coliforms contamination level in indoor air was detected only in the Cleaning Supplies Room (4 CFU.m−3) in the Urban PHCC. The most frequent bacteria genera identified was Micrococcus (21% Rural PHCC, 31% Urban PHCC). The surface samples showed a highest total aerobic mesophilic bacterial contamination in the Treatment Room (86 × 103 CFU.m−2) from the Rural PHCC and in the Front Office (200 × 103 CFU.m−2) from the Urban PHCC. The electrostatic dust cloth (EDC) samples showed a highest bacterial load in the Urban PHCC. Total aerobic mesophilic bacterial load in settled dust and in the Heating, Ventilating and Air Conditioning (HVAC) filter samples in the Urban PHCC (8 CFU.g−1 and 6 × 103 CFU.m−2) presented higher values compared with the Rural PHCC (1 CFU.g−1 and 2.5 × 103 CFU.m−2). Urban PHCC presented higher bacterial airborne contamination compared with the Rural PHCC for the majority of sampling sites, and when compared with the indoor air quality (IAQ) Portuguese legislation it was the Rural PHCC in two sampling places who did not comply with the established criteria.

Multi-walled carbon nanotubes (MWCNT) are engineered nanomaterials widely used in industrial and biomedical applications. Yet, MWCNT inhalation may induce pulmonary adverse effects, and the MWCNT-7 (Mitsui-7) has been classified as possibly carcinogenic to humans. However, its molecular mechanisms of action are poorly understood and there are no biomarkers of exposure for occupational monitoring. Several pulmonary diseases, including lung cancer, have been associated with alterations in microRNA expression that are used as biomarkers of disease progression, and differentially-expressed microRNAs (DE miRNAs) can also allow understanding the molecular effects induced by a toxicant. In this study, we identify DE miRNAs in A549 alveolar epithelial cells following 24 h exposure to MWCNT-7 or crocidolite, as well as their enriched cellular functional pathways. These indicate that both materials change cell survival, differentiation and proliferative properties under the influence of AMPK, FoxO, TGF-β and Hippo pathways, and their metabolic activity and cell-to-cell communication. In addition, MWCNT-7 affects the actin cytoskeleton, ubiquitin mediated proteolysis, and ECM-receptor interactions; crocidolite the PI3K-Akt and mTOR pathways, endocytosis, and central carbon metabolism. Since deregulation of these pathways may be related to carcinogenesis, an interaction network of DE miRNAs and corresponding target cancer-related genes was constructed, highlighting the carcinogenic potential of Mitsui-7. Highlights: Multi-walled carbon nanotubes (MWCNT) are nanomaterials widely used that may induce pulmonary adverse effects upon inhalation; A profile of differentially expressed (DE) miRNAs in A549 alveolar cells was identified following exposure to MWCNT-7 and crocidolite using NGS; Both materials change AMPK, FoxO, TGF-β and Hippo pathways, the cell metabolic activity and cell-to-cell communication; MWCNT-7 affects the actin cytoskeleton, ubiquitin mediated proteolysis, and ECM-receptor interactions; Crocidolite affects the PI3K-Akt and mTOR pathways, endocytosis, and central carbon metabolism; An interaction network of DE miRNAs and corresponding target cancer-related genes highlighted the carcinogenic potential of MWCNT-7, even at low dose and short-term exposure. This work was funded by FCT/MCTES, Project ToxApp4NanoCELFI (PTDC/SAU-PUB/32587/2017) through national funds (PIDDAC) and ToxOmics (UID/BIM/00009/2013). It is also a result of the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by FCT. info:eu-repo/semantics/publishedVersion

Introduction Asbestos, widely used for its important chemical and physical characteristics, are recognized in all their varieties as a human carcinogen by the International Agency for Research on Cancer (IARC) and as the leading cause of cancer associated with occupational exposure in industrialized countries. Despite being the most studied occupational hazard since 1965, it is the malignant pleural mesothelioma (MPM), the decisive aspect in the study of the exposure to asbestos. Objectives Make a state of the art of the relationships between asbestos and MPM in Portugal. Methodology A scoping review using the Joanna Briggs Institute (JBI) methodology was conducted using five information’s sources: Pubmed, Web of Science, The Cochrane Library, Scopus and Google Scholar and Open Access Scientific Repositories of Portugal and DART-Europe E-theses Portal to search also for gray literature. Data were collected between 1960-2019, with the keywords "Asbestos" and "Mesothelioma” and “Portugal”. Inclusion criteria were defined for types of participants, concept, context and types of studies. Results Of the 1453 studies reviewed 9 were included. The oldest study is from 1986. Five studies are about incidence and survival, two are case reports, one about exposure and mortality and one about treatment. To analyse incidence and mortality, four authors used hospital data and two the data from the southern regional cancer registry (ROR). In these studies, it is also presented the description of the population in terms of mean age, type of exposure, latency time, histological type and stage. Conclusion Portugal, such as other industrialized countries, used asbestos in a massive way, but despite this, few studies and data on the relationship between asbestos exposure and MPM are found. Dedicated studies are needed to objectively assess the true dimension of this potential problem in Portugal and characterise the different types of exposures related to MPM.

Background: Healthcare workers are exposed to many different occupational stressors, some of which are related to their working conditions. While the experience of stress seems to depend on individual perceptions, some characteristics of inpatient units might influence the occurrence of emotional exhaustion among nurses. Objective: The aim of the present study was to identify characteristics of inpatient units which might be associated with high levels of emotional exhaustion among healthcare workers, nurses in this case. Methods: We conducted the present cross-sectional, exploratory and descriptive study with 108 nurses (83.8% female; average age 33 years old) allocated to inpatients units (wards and intensive care) at a university hospital in Portugal. We administered the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) emotional exhaustion subscale and collected the following data relative to the units to which the participants were allocated: 1) mortality rate; 2) number of deceased patients; 3) shortage of nurses compared to national standards; 4) occupancy rate; 5) proportion of elderly patients (>65 years old). Results: We found a positive relationship between high levels of emotional exhaustion among nurses and very high number of deceased patients (p=0.012), high fatality rate (p=0.036) and high proportion of elderly patients (p=0.025). Conclusion: Very high number of deceased patients, high proportion of elderly patients and high fatality rate in inpatients units were associated with high levels of emotional exhaustion among nurses. These findings suggest that characterizing the objective conditions of inpatient units seems to be an important aspect to be considered in psychosocial risk management programs. info:eu-repo/semantics/publishedVersion

Centre for Toxicogenomics and Human Health (ToxOmics); Foundation for Science and Technology (UID/BIM/00009/2013)

Infections are among the most important occupational risks for healthcare workers. Some infections can be prevented through vaccination but, in other cases, there are no vaccines to prevent them, as happens with infections from antimicrobial-resistant organisms. Precautions related with transmission route and contact isolation or respiratory isolation are very important in order to protect healthcare workers and other patients. In this paper, the authors reviewed biological hazards for healthcare workers and described the procedures undertaken by an occupational health department (OHD) of a Portuguese hospital where vancomycin-resistant Staphylococcus aureus (VRSA) was isolated from a patient, for the first time in Europe. After the VRSA strain isolation, healthcare workers were instructed to adopt contact preventive measures. Nasal swabs were cultured weekly in 33 healthcare workers for several weeks until the patients’ culture changed to negative. In the meantime, OHD prepared actions to adopt in case of VRSA colonization or infection in healthcare workers.

Background Health care–associated infections (HCAIs) are preventable with adoption of recognized preventive measures. The first step is to identify patients at higher risk of HCAI. This study aimed to identify patient risk factors (RFs) present on admission and acquired during inpatient stay which could be associated with higher risk of acquiring HCAI. Methods A case-control study was conducted in adult patients admitted during 2011 who were hospitalized for >48 hours. Cases were patients with HCAIs. Controls were selected in a ratio of 3:1, case matched by the admission date. The likelihood of increased HCAI was determined through binary logistic regression. Results RFs identified as being the more relevant for HCAI were being a man (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7), being aged >50 years (OR, 2.9; 95% CI, 1.3-6.9), and having an insertion of a central venous line during hospital stay (OR, 12.4; 95% CI, 5.0-30.5). Conclusions RFs that showed statistical significance on admission were the patient's intrinsic factors, and RFs acquired during hospitalization were extrinsic RFs. When a set of RFs were present, the presence of a central venous line proved to be the more relevant one.

In the past years, several

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Introduction: Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational health prevention and surveillance strategies. Material and Methods: Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test and the Fisher’s exact test were used to calculate p values. Results: The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28 [78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it is possible to minimize workplace violence. Discussion: Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our study reflects the negative effects of threatening occupational stressors on mental health. Conclusion: Our results show that workplace violence is a relevant risk factor that significantly impacts workers’ health in a noxious manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined. Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir estratégias de prevenção e vigilância em saúde ocupacional. Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p. Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o incidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema. Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado reflete o efeito prejudicial da exposição a fontes de stress e ameaça. Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo. Palavras-chave: Fatores de Risco Profissionais; Prevenção; Saúde Ocupacional; Trabalhadores da Saúde; Violência no Local de trabalho. info:eu-repo/semantics/publishedVersion

Low back pain (LBP) is a common occupational health complaint and an important public health concern. Analyzing the association between physical demands at work and occupational outcomes can be useful for improving LBP prevention. In this study, workers filled out a questionnaire gathering data on socio-demographic and work-related characteristics, general health, LBP (episodes in the last 12 months, pain severity and intensity), and other occupational hazards related with physical demands (DMQ). 735 workers answered the questionnaire (male n = 359). They worked in different sectors. 507 (69%) reported LBP in the last year. The highest proportion of subjects with >6 episodes of LBP per year was found among public services (31.8%) and the lowest among administrative working in offices (10.3%). Most workers reported having sedentary-type work (39%), 34% a low/moderate physical intensity one, and 27% a highly physically demanding one. Results of logistic regression showed that, after adjusting for age, gender and sector: sedentary work (vs. high work intensity) was associated with a lower likelihood of having 3 to 6 LBP episodes per year (OR = 0.4; 95%CI 0.2–0.8), and >6 LBP episodes per year (OR = 0.5; 95%CI 0.3–0.9); low/moderate work intensity (vs. high work intensity) was also associated with a lower likelihood of having 3 to 6 LBP episodes per year (OR = 0.5; 95%CI 0.3–0.9) and >6 LBP episodes per year (OR = 0.6; 95%CI 0.3–1.0). Findings suggest that occupational high physical demands are associated with a higher likelihood of presenting LBP. For Occupational Health Services these results may contribute to design and assess better LBP prevention programs.

BACKGROUND: Hospital work-related musculoskeletal disorders (WRMSDs) symptoms are highly prevalent and nurses are considered the health care professional group more often affected by WRMSDs. OBJECTIVES: Understanding the effects of nursing tasks on WRMSDs symptoms. METHODS: Portuguese nurses answered to a modified Nordic Musculoskeletal symptoms Questionnaire. The increased likelihood of having WRMSDs symptoms was estimated from a daily working task schedule and the probability of suffering from lumbar WRMSDs symptoms intensity was also estimated. RESULTS:Hospital nurses studied (n = 1.396) were mainly females (75.8%), and most of them reported more than 1 symptom (88%). Low-back pain was the most prevalent complaint (60.9%). Tasks performed more than 10 times a day, such as invasive procedures (OR = 2.142); care of hygiene and patient comfort in bed (OR = 2.484); patient mobilization in bed (OR = 2.022); and patient feeding (OR = 2.186) had an effect on dorsal and lumbar symptoms ( p< 0.05). Those tasks involving invasive procedures were just the only ones producing symptoms simultaneously on every studied body part, such as lumbar, dorsal, wrist/hand and ankles/feet areas. CONCLUSIONS: Tasks with a greater effect on low-back pain intensity were patient bed feeding and patient hygiene and care. We found, when analysing simultaneously the effects of every task on the likelihood of having low-back symptoms, that involving invasive procedures were that only ones affecting simultaneously the presence of almost all WRMSDs symptoms studied.

INTRODUÇÃO: Realizou-se um estudo no setor de vigilância privada com vigilantes de transporte de valores (VTVA) diante da presença de queixas de saúde a uma organização sindical do setor. OBJETIVOS: Diagnosticar a situação de trabalho desses profissionais, do ponto de vista da saúde e segurança, caracterizando as condições de trabalho e as tarefas desses trabalhadores, identificando elementos da atividade de trabalho com influência em sua saúde e segurança e apontando os principais problemas de saúde autorreportados em três empresas que operam em Portugal. MÉTODOS: Efetivou-se um estudo exploratório, de natureza descritiva, recorrendo a um questionário dirigido a trabalhadores com três dimensões, de acordo com os objetivos no contexto da saúde e segurança do trabalho (SST). O questionário foi aplicado nas empresas pelos representantes do sindicato e sem qualquer participação das direções das empresas. RESULTADOS: A atividade desses funcionários apresenta exigências diversas, nomeadamente de concentração e precisão, carga física elevada, horários atípicos, exposição a situações emocionalmente fortes e ainda violência. Evidencia-se, por parte dos trabalhadores, influência negativa do trabalho em sua saúde e segurança, tanto no nível físico como no psicológico. CONCLUSÃO: Identifica-se uma importante variabilidade de condições e exigências do trabalho nas empresas observadas, que determina a necessidade de intervenção no contexto da SST, designadamente por meio de sensibilização sobre a legislação existente no sentido da prevenção das doenças ligadas ao trabalho e também dos acidentes de trabalho. info:eu-repo/semantics/publishedVersion

Cellulose nanofibrils (CNF) are manufactured nanofibres that hold impressive expectations in forest, food, pharmaceutical, and biomedical industries. CNF production and applications are leading to an increased human exposure and thereby it is of utmost importance to assess its safety to health. In this study, we screened the cytotoxic, immunotoxic and genotoxic effects of a CNF produced by TEMPO-mediated oxidation of an industrial bleached Eucalyptus globulus kraft pulp on a co-culture of lung epithelial alveolar (A549) cells and monocyte-derived macrophages (THP-1 cells). The results indicated that low CNF concentrations can stimulate A549 cells proliferation, whereas higher concentrations are moderately toxic. Moreover, no proinflammatory cytokine IL-1β was detected in the co-culture medium suggesting no immunotoxicity. Although CNF treatment did not induce sizable levels of DNA damage in A549 cells, it leaded to micronuclei formation at 1.5 and 3 μg/cm2. These findings suggest that this type of CNF is genotoxic through aneugenic or clastogenic mechanisms. Noteworthy, cell overgrowth and genotoxicity, which are events relevant for cell malignant transformation, were observed at low CNF concentration levels, which are more realistic and relevant for human exposure, e.g., in occupational settings. This research was co-funded through UID/BIM/00009/2013, Centre for Toxicogenomics and Human Health (ToxOmics), and SFRH/BDE/ 108095/2015, from the Foundation for Science and Technology, Portugal info:eu-repo/semantics/publishedVersion

Assembly lines are related to health risks and work-related musculoskeletal disorders (WMSD), particularly of the neck and upper limbs (WULMSD). The assessment of perceived musculoskeletal symptoms is essential to WULMSD prevention, but studies in this field are lacking. A cross sectional survey on assembly line workers (n=270) was performed. The objective of this study was to analyze the frequency and distribution of upper limb musculoskeletal symptoms in assembly line workers. Participants were predominantly men, with ages between 30 and 40 years. Neck and upper limbs pain/discomfort were the most reported symptoms (35.9%), with intensity predominantly moderate or severe. General Health Status and past musculoskeletal injury were the variables more related to the existence of musculoskeletal symptoms; longer working life in the same company, as under 5 years, were related to higher intensity of symptoms. An early identification of musculoskeletal symptoms and health surveillance over time is of most importance to develop WRULMSD prevention measures.

Background: Asbestos, the leading cause of cancer associated with occupational exposure in industrialized countries, was used on a large scale in the 1950s throughout Europe, namely in Portugal. Responsible for 107,000 annual deaths (WHO, 2014), the last consensus in 2015, mentions 34,000 mesothelioma deaths worlwide in 2013, a rare and difficult to diagnose cancer. Objectives: To evaluate the need for more in-depth studies on occupational exposure to asbestos and mesothelioma in Portugal. Methods: Systematic review, through the analysis of scientific articles, obtained in Pubmed between 2006-2016, with the keywords “Asbestos Portugal” and "Mesothelioma Portugal”. Data on deaths from mesothelioma between 2002-2014 were also obtained from the portuguese National Institute of Statistics (INE). Results: Only 6 articles presented inclusion criteria. One study estimated that in 1930-2003, 113,131 tons of asbestos were used in Portugal. Other study found that 1971-2000 had the highest value per kg/capita/year (1.06). In a recent study, 25% of 793 suspected construction materials contained asbestos. Regarding to mesothelioma in Portugal, we only found data of mortality rates. 1306 deaths were estimated between 1994-2010. Data obtained from INE indicates that, in the period from 2002 to 2014, occurred 199 deaths from mesothelioma, one of them in an individual under 24 years old. Conclusion: Portugal, such as other industrialized countries, used asbestos in a massive way, and despite the european ban, it can still be found in numerous buildings or equipments. So dedicated studies are needed to objectively assess the true dimension of this potential public health problem.

The widespread application of carbon nanotubes (CNT) on industrial, biomedical, and consumer products can represent an emerging respiratory occupational hazard. Particularly, their similarity with the fiber-like shape of asbestos have raised a strong concern about their carcinogenic potential. Several in vitro and in vivo studies have been supporting this view by pointing to immunotoxic, cytotoxic and genotoxic effects of some CNT that may conduct to pulmonary inflammation, fibrosis, and bronchioloalveolar hyperplasia in rodents. Recently, high throughput molecular methodologies have been applied to obtain more insightful information on CNT toxicity, through the identification of the affected biological and molecular pathways. Toxicogenomic approaches are expected to identify unique gene expression profiles that, besides providing mechanistic information and guiding new research, have also the potential to be used as biomarkers for biomonitoring purposes. In this review, the potential of genomic data analysis is illustrated by gene network and gene ontology enrichment analysis of a set of 41 differentially expressed genes selected from a literature search focused on studies of C57BL/6 mice exposed to the multiwalled CNT Mitsui-7. The majority of the biological processes annotated in the network are regulatory processes and the molecular functions are related to receptor-binding signalling. Accordingly, the network-annotated pathways are cell receptor-induced pathways. A single enriched molecular function and one biological process were identified. The relevance of specific epigenomic effects triggered by CNT exposure, for example, alteration of the miRNA expression profile is also discussed in light of its use as biomarkers in occupational health studies. Environ. Mol. Mutagen. 59:334-362, 2018. © 2018 Wiley Periodicals, Inc.

Visual demands, especially for near vision, are becoming increasingly more frequent at the workplace, and might cause visual fatigue or asthenopia. The tasks performed by ophthalmologists involve visual effort, raising interest in their study within the context of occupational health.To estimate the prevalence of visual complaints and its relationship to work demands among ophthalmologists at a university hospital in Lisbon.Occurrence of visual fatigue symptoms was assessed by means of a symptom questionnaire - College of Optometrists in Vision Development Quality of Life (COVD-QoL) - and through the identification of near points of accommodation and convergence. Schirmer's test was used to assess tear production. The results were analyzed by means of descriptive statistics, Spearman's coefficient and the Wilcoxon test for p0.05.Most among the 27 analyzed physicians reported visual fatigue (n=25), dry eyes and frequent blinking (n=27). Schirmer's test evidenced differences at the end of the working day and the near points of accommodation and convergence indicated occurrence of visual fatigue.The results showed significant differences between the beginning and the end of the working day among ophthalmologists, with occurrence of visual fatigue at the end of the working day. These findings point to the need to implement a health surveillance program to prevent occupational visual disorders.As exigências visuais, designadamente da visão ao perto, são cada vez mais frequentes no mundo do trabalho, podendo causar fadiga visual ou astenopia. Os médicos oftalmologistas exercem atividades que exigem esforço visual, o que determina o interesse no seu estudo pela saúde ocupacional.Identificar a prevalência das queixas visuais e a sua relação com as exigências do trabalho nos médicos oftalmologistas em um hospital universitário de Lisboa.Avaliou-se a ocorrência de sintomas de fadiga visual por meio de um questionário de sintomas - Inventário de Eficiência Visual (IEV) - e pela determinação dos pontos próximos de acomodação e de convergência. Utilizou-se o teste de Schirmer para a avaliação da secreção lacrimal. Os resultados foram analisados com o auxílio da estatística descritiva, do coeficiente de Spearman e do teste de Wilcoxon para p0,05.Dos 27 médicos respondentes, a maioria refere fadiga visual (n=25), assim como a presença de olhos secos e o piscar frequentemente (n=27). Os resultados do teste de Shirmer evidenciam diferenças no final do dia de trabalho e os pontos próximos de acomodação e convergência evidenciam a presença de fadiga visual.Os resultados revelaram diferenças significativas entre o início e o final do dia de atividade profissional dos médicos oftalmologistas, indiciando a existência de fadiga visual ao final do dia de trabalho. Tal situação determina a necessidade de implementar um programa de vigilância da saúde para prevenir alterações visuais de natureza profissional.

Contexto: A tendinite do manguito rotador (TMR) é frequente em operadores de caixa de supermercado devido às exigências do trabalho. É, de facto, frequente a realização de movimentos repetitivos de abdução e flexão dos membros superiores, muitas vezes em carga, que podem causar inflamação dos tecidos periarticulares do ombro, desencadeando sinais e sintomas de TMR. Objetivos: Conhecer a prevalência de TMR em operadores de caixa de supermercado por meio da avaliação de sintomas, sinais e ecografia. Métodos: Participaram 44 trabalhadores com idades entre 28 e 47 anos. Eles preencheram um questionário de queixas autorreferidas aos ombros e realizaram exame objetivo (manobras do arco doloroso, do conflito subacromial e abdução resistida do ombro) e ecografia de tecidos moles. Resultados: Identificaram-se queixas de dor no ombro em 26 operadores à direita (59,1%) e em 16 (36,4%) à esquerda. Ao exame objetivo, 15 e 11 trabalhadores (34,1% à direita e 25,0% à esquerda, respetivamente) apresentaram positividade nas três manobras. Na ultrassonografia foram encontradas alterações no ombro direito e esquerdo em 16 e 17 operadores (36,4 e 38,6%, respetivamente). Não foi encontrada concordância estatística entre as três abordagens. A “manobra de abdução resistida do ombro” revelou boa relação com as queixas de dor no ombro (χ2 Wald (1)=7,260; p=0,007). Obtiveram-se resultados semelhantes de associação entre essa manobra e a avaliação ecográfica (χ2 Wald (1)=6,854; p=0,009; ROC=0,714, sensibilidade 75%; especificidade 67,9%). Conclusões: Os resultados obtidos sugerem que a “manobra de abdução resistida do ombro” é preditiva de TMR na vigilância médica desses trabalhadores. Tal deverá ser verificado em futuros estudos, designadamente envolvendo amostras de maiores dimensões. info:eu-repo/semantics/publishedVersion

RESUMO - O diagnóstico de tuberculose latente (TL), designadamente em profissionais de saúde, tem sido efetuado ao longo dos anos através da prova de tuberculina (PT). Mais recentemente, surgiram os testes Interferon-ʎ Release Assays (IGRA) que, ao contrário da PT, não positivam com a vacina Bacillus Calmette-Guérin (BCG) nem com a maioria das micobactérias não tuberculosas. Na ausência de um gold standard para o diagnóstico de TL, o objetivo deste estudo consistiu em analisar a concordância entre as 2 técnicas de diagnóstico da TL, através da determinação do coeficiente Kappa e da taxa de concordância entre a PT e o teste IGRA em profissionais de saúde de um hospital central universitário português. Trata-se de um estudo transversal, retrospetivo, em que se efetuou a análise dos registos das PT e dos testes IGRA realizados em simultâneo (até 15 dias de intervalo) no serviço de saúde ocupacional, em 2010 e 2011 (n = 137). A grande maioria tinha efetuado BCG e 44,5% tinham efetuado 2 ou mais inoculações. O diâmetro médio da PT foi de 17,5 mm (DP 4,3). Apenas 2 profissionais apresentaram PT < 10 mm, sendo o teste IGRA negativo. Dos 135 participantes com PT positivo, apenas 53 (39,3%) apresentaram também o teste IGRA positivo. O nível de concordância entre a PT e o teste IGRA foi determinado através do coeficiente Kappa. Respetivamente, para um cut off da PT de 10, de 15 e de 20 mm, os níveis de concordância foram de 0,019 (p = 0,26), 0,19 (p = 0,001) e de 0,26 (p = 0,003). As taxas de concordância foram, respetivamente de 40, 54 e 65%. Verificou-se que a concordância entre os 2 métodos aumentou quando o cut off para a PT também aumentou. Contudo, seria expectável uma taxa de concordância mais elevada para cut off‘s de 15 mm e, sobretudo, de 20 mm, uma vez que a vacina BCG administrada na infância habitualmente induz respostas menores. É possível que a existência de mais do que uma inoculação de BCG na amostra estudada, especialmente depois da infância, possa ser responsável pela baixa concordância entre os 2 métodos, não se podendo também excluir a possibilidade de falsos negativos do teste IGRA. Na decisão de tratar TL, é necessário ter em consideração as limitações de ambos os testes e o seu nível de concordância, devendo ainda ser ponderados fatores individuais, ocupacionais e epidemiológicos. ABSTRACT - The diagnosis of latent tuberculosis infection (LTBI), namely in healthcare workers, has been done by tuberculin skin test (TST). Recently, Interferon-ʎ Release Assays (IGRA tests) have been introduced. Unlike TST, they do not turn positive after BCG vaccine or after most of non-tuberculous mycobacteria infections. In the absence of a gold standard for the diagnosis of LTB, the aim of this study was to analyze the correlation between the two LTB diagnostic techniques, by determining Kappa coefficient and concordance rate between TST and IGRA test, in healthcare workers of a Portuguese university hospital. We carried out a cross-sectional and retrospective study, and we analysed TST and IGRA tests records, that are performed simultaneously (up to 15 days apart) in Occupational Health Department, in 2010 and 2011 (n 137). Most of the sample did BCG and 44.5% did two or more inoculations. The average diameter of PT was 17.5 mm (SD 4.3). Only two subjects reported TST < 10 mm, both showing a negative IGRA test. Only 53 (39.3%) of the 135 participants with positive PT had a positive IGRA test too. The level of agreement between TST and the IGRA test was determined by Kappa coefficient. Respectively to a cut off for PT of 10 mm, 15 mm and 20 mm, the degree of agreement was 0.019 (p = 0.26), 0,19 (p = 0.001) and 0.26 (p = 0.003). Concordance rates were respectively 40%, 54% and 65%. It was found that the concordance between the two methods increased as the cut off for TST also increased. Nevertheless, a higher concordance rate would be expected with cut off of 15 mm, and particularly of 20 mm, since BCG vaccine administered in childhood usually induce smaller reactions. The existence of more than one BCG inoculation in the sample, especially after childhood, can be partly responsible for the low concordance between the two methods. Nevertheless, we cannot also exclude IGRA test’s false negatives. In the decision to treat LTB, it is necessary to take into account the limitations of both tests, their level of agreement and weighting individual, occupational and epidemiological factors. info:eu-repo/semantics/publishedVersion

Healthcare workers, namely registered nurses (RN), are frequently exposed to work-related musculoskeletal disorders (WRMSDs) risk factors. Identifying the symptoms of these disorders is one of the first epidemiological steps to managing them. This study aims to identify WRMSDs prevalence symptoms in Portuguese RN. During 8 months (2010-2011) the National Public Health School and the Portuguese Registered Nurses Board made a call to all RN to answer an online WRMSDs questionnaire. Respondents (n=2140) are mostly females (77.4%) and work mainly in hospitals (n=1396) and in primary healthcare centers (n=421). Results show high symptoms prevalence (last 12 months) in the lower back (60.6%), the upper back (44.5%), and the neck (48.6%). Nurses' activity, especially patient hygiene in bed, is a strong contributor (p>0.05) to pain in the upper back (OR=1.39 [1.09-1.80]) and lower back (OR=1.4 [1.08-1.84]). Patient holdup without mechanical support has the highest relationship (p>0.05) between work tasks and symptoms in the last 12 months in the upper back (OR=1.50 [1.19-1.90]). Prevalence rates of WRMSDs symptoms in Portuguese nurses are no different from other studies with Swedish, Italian and Greek nurses. Maybe changes in healthcare systems didn't change the way care is delivered and we must rethink how to prevent nurses WRMSDs.

Introduction: Chronic stress can influence immune response to vaccines. Healthcare workers are exposed to stressors and biological hazards, the health effects of which may be prevented through vaccination. Objectives: This study aims to evaluate the association between stress in nurses and: (1) insufficient response to influenza vaccine, assessed one month after vaccination (T1); (2) the drop in haemagglutination-inhibition (HAI) antibodies (ab) six months after vaccination (T6). Methods: A nested case–control study was carried out with 136 healthy hospital nurses. Individual interviews, the General Health Questionnaire (GHQ12) and Maslach Burnout Inventory (MBI-HSS) were applied in order to determine the presence of stress, using the triangulation method at the beginning of the study (T0). Influenza vaccine was administered and titres of HAI above each strain composing influenza vaccine before vaccination (T0), at T1 and T6 were assessed. Results: There was no statistically relevant (5%) relationship between stress and the insufficient immune response to the vaccine at T1. Nevertheless, there was an association between stress and the drop in HAI ab AH1 at T6, when we assessed stress by the triangulation method using an interview (p = 0.006), GHQ12 (p = 0.045) and combination of criteria (p = 0.001), even after multivariate analysis (respectively, p = 0.01, p < 0.05 and p = 0.002). The odds ratios were, respectively, 3.64, 2.73 and 5.22. Conclusions: The association we found, between chronic stress and the drop in HAI ab at T6, corroborates the hypothesis that stress can negatively influence immune response. Therefore, it seems reasonable to consider this issue when we implement vaccination programmes for healthcare workers. RESUMO - Introdução: O stresse crónico pode influenciar a resposta imunitária à vacinação. Os profissionais de saúde estão expostos a stressores de natureza profissional e ainda a agentes biológicos cujos efeitos poderão ser prevenidos pela vacinação. Objetivos: Estudar a associação entre a presença de stresse e (1) a “insuficiente” resposta imunitária à vacina contra a gripe, avaliada um mês após a vacinação (T1); (2) a redução dos títulos de anticorpos dirigidos às hemaglutininas (HAI) seis meses após a vacinação (T6). Métodos: Realizou-se um estudo caso-controlo incorporado num estudo de coortes com a participação de 136 enfermeiros hospitalares saudáveis. Realizaram-se entrevistas individuais e aplicaram-se os questionários The General Health Questionnaire (GHQ12) e Maslach Burnout Inventory (MBI-HSS) para determinação da presença de stresse crónico pelo método da triangulação, no início do estudo (T0). Foi administrada a vacina contra a gripe e determinou se os títulos de HAI dirigidos a cada estirpe componentes da vacina contra a gripe, antes da vacinação(T0), em T1 e em T6. Resultados: Não se encontrou associação significativa (5%) entre a presença de stress e a “insuficiente” resposta à vacina contra a gripe em T1. Contudo, encontrou-se uma associação entre a presença de stress e a diminuição do título de HAI dirigidos à estirpe A(H1N1) em T6 quando se avaliou a presença de stresse pelo método da triangulação usando a entrevista (p=0,006), o GHQ12 (p=0,045) e a combinação dos três critérios (p=0,001), que se manteve após análise multivariada (respetivamente p=0,01, p

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care–associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.

People vaccinated against influenza develop hemagglutination inhibition (HAI) antibodies (Ab) that bind to the virus and neutralize it. Ab titer levels are variable depending on factors insufficiently studied, and tend to decrease over time. In the present study, we analyzed antibodies responses before and after influenza vaccination in nurses working in a hospital, with the aim of: - identifying seroconversion rates to trivalent influenza vaccine one month after immunization; - evaluating if, six months after vaccination, influenza HAI Ab titer fall comparing to one-month post vaccination HAI Ab titer; - studying the association between the lack of HAI Ab response (seroconversion) assessed one month after immunization and: ◦ past influenza vaccinations, ◦ baseline (before vaccination) HAI Ab titer, ◦ baseline (before vaccination) HAI Ab titer ≥ 40 (considered as a protection titer). Hemagglutination inhibition reaction was used to assess specific HAI Ab titers against influenza A(H(1)N(1)), A(H(3)N(2)) and B virus strains included in the influenza vaccine and we used progressive dilutions of two times, starting on 1:10 until 1:20.480. Seroconversion rates, one month after vaccination, were 66.7% for A(H(1)N(1)) strain, 63.2% for A(H(3)N(2)) strain and 56.3% for B strain. The most immunogenic strain used in 2007/08 influenza vaccine was A(H(1)N(1)). Seroconversion rates after one month were negatively associated with past influenza vaccinations, baseline HAI Ab titers ≥ 40 and baseline HAI Ab titers. Six months after vaccination, 50% of participants showed a drop in HAI Ab titers to an half, for each of the considered strains, but they remain high enough to protect against the disease.

Quality standards, and subsequently benchmarking, based on patient outcome data are a rational means of assessing the quality of health care. However, variation in patients' baseline clinical risk precludes direct comparison of outcomes across operators, institutions and health care plans. In the years since the advent of interventional cardiology, there has been an enormous increase in the volume of activity and number of operators and centers performing percutaneous coronary intervention (PCI), together with considerable developments in the techniques, materials and adjunctive therapy associated with PCI. PCI outcomes depend on various factors, particularly patient characteristics and disease severity. The use of risk adjustment models to quantify differences in patient outcomes in interventional cardiology has been shown to provide a reliable and balanced comparison of performance and to lead to improvements in quality and safety in this area.The aim of this study was to develop a risk adjustment model for in-hospital major adverse cardiac and cerebrovascular events (MACCE) and for a single adverse event (in-hospital mortality) following PCI, using data from a national multicenter registry.This was a cohort study of all patients who underwent PCI in the centers that participate in the National Registry of Interventional Cardiology of the Portuguese Society of Cardiology between June 30, 2003 and June 30, 2006, in a total of 10,399 procedures.Factors associated with in-hospital MACCE included: age80 years; female gender; acute myocardial infarction; cardiogenic shock; renal failure; severely reduced ejection fraction; three or more diseased vessels; use of intra-aortic balloon pump; no stenting; and urgent/emergent PCI. The same variables were associated with the adverse event of in-hospital mortality. The area under the receiver operating characteristics (ROC) curve and the Hosmer-Lemeshow goodness-of-fit statistic, for both multivariate prediction models, were 0.83 and 0.69 (in-hospital MACCE) and 0.93 and 0.53 (in-hospital mortality), respectively, which indicates that these models have good discrimination and real clinical value and were well calibrated.A risk adjustment model for in-hospital MACCE and for in-hospital mortality after PCI was successfully developed using a large national multicenter registry. This is a powerful tool for quality assessment and represents a significant step towards credible and reliable comparison of results between providers.

R E S U M O - Introdução: As lesões musculoesqueléticas ligadas ao trabalho (LMELT) constituem um importante problema em todo o mundo, designadamente nos profissionais de saúde. Realizou-se um estudo nacional de caraterização da sintomatologia musculoesquelética ligada ao trabalho em enfermeiros portugueses na perspetiva da sua prevenção. Métodos: Os enfermeiros portugueses foram convidados a preencher um questionário em ambiente web com 4 dimensões: dados socio-demográficos, sintomas musculoesqueléticos em 15 zonas anatómicas, identificação das tarefas e sua relação com os sintomas e caracterização do estado de saúde. O estudo decorreu entre julho de 2010 e fevereiro de 2011 e contou com a colaboração da Ordem dos Enfermeiros. A análise estatística baseou-se em processos descritivos e em associações com o teste do 2 com um nível de significância de 5%. Resultados: Responderam ao questionário 2 140 enfermeiros (3,42% do total dos enfermeiros portugueses). Destacam-se as queixas localizadas à coluna vertebral (49% nos últimos 12 meses; 25% nos últimos 7 dias) e o absentismo relacionado (5,51%), igualmente nos últimos 12 meses. A intensidade dos sintomas é elevada (19% dos respondentes) assim como a sua frequência (em 33% é superior a 6 episódios diários). A relação entre as tarefas e as queixas é significativa (p < 0,05), entre outros, com: (i) a administração de medicamentos, o posicionamento mobilização e transferência do doente e os sintomas nos punhos e mãos ( 2 = 9,089; p = 0,028; 2 = 8,337; p = 0,040; 2 = 9,599; p = 0,022; 2 = 9,399; p = 0,024 respetivamente) e (ii) a higiene no leito e os sintomas localizados aos ombros, cotovelos e punhos/mãos ( 2 = 8,853; p = 0,031; 2 = 8,317; p = 0,040 e 2 = 9,599; p = 0,022, respetivamente). Discussão e conclusões: As LMELT em enfermeiros são, em grande parte, preveníveis e, por isso, não devem ser encaradas como «ossos do ofício». A intervenção sobre os locais, os processos, a organização temporal e os meios de trabalho pode prevenir as LMELT. O presente estudo, descritivo, revela uma elevada prevalência de sintomas de LMELT em enfermeiros portugueses. Tal indicia a necessidade premente de desenvolver programas de prevenção destas patologias em hospitais. A B S T R A C T - Introduction: Work-related musculoskeletal disorders (WRMSD) are a worldwide health problem, particularly in health care professionals. A nationwide study was done focused on the characterization of work-related musculoskeletal symptoms in Portuguese registered nurses (RN) in order to establish a baseline methodology to manage/prevent WRMSD. Methods: All Nurses (RN) were invited to complete, in web platform, a questionnaire of 4 different topics: (i) socio-demographic data, (ii) fifteen anatomic areas of musculoskeletal symptoms, (iii) tasks identification and its relation with symptoms and (iv) health status characterization. Statistical analysis was based on descriptive statistics and associations with the 2 test with a significance level of 5%. Results: A total of 2.140 RN answered the questionnaire (3.42% of all RN). Spine symptoms were among those most frequent symptoms (49% of RN referred in the last 12 months, 25% in the last 7 days) and their related work absence (5.51% of referrals). Other relevant indicators were symptoms intensity (19% were classified as high in the responding group) and symptoms frequency (33% of referrals were superior to 6 daily episodes). Associations between typical work tasks and complaints were found significant (p < 0.05) with (i) drug administration, positioning, mobilization and patient transfer and hand-fist symptoms ( 2 = 9.089; P = .028; 2 = 8.337; P = .040; 2 = 9.599; P = .022; 2 = 9.399; P = .024 respectively) and with (ii) bed hygiene and shoulder, elbow and hand-fist symptoms ( 2 = 8.853; P = .031; 8.317; P = .040; 9.599; P = .022 respectively). Discussion and conclusions: Work related musculoskeletal disorders in hospital nurses are most of times preventable, and they should not be commonly related to a normal work result. Workplace intervention in process, in temporal organization and in equipments could prevent WRMSD. Our descriptive study aims to evidence the elevated prevalence of WRMSD in RN and the certainty to develop occupational prevention programs in hospitals. info:eu-repo/semantics/publishedVersion