Atualização 2020 da Lista de Doenças Relacionadas ao Trabalho no Brasil

Resumo Objetivo: apresentar o processo de atualização de 2020 da Lista de Doenças Relacionadas ao Trabalho (LDRT) do Brasil. Métodos: entre 2019 e 2020, foi conduzido plano de trabalho em cinco etapas para produzir versão atualizada da LDRT. Resultados: na Etapa 1, a LDRT de 1999 foi comparada a outras listas internacionais e estrangeiras e foram consultados profissionais que fazem uso da lista brasileira. Na Etapa 2, organizou-se uma oficina de trabalho para discutir sobre a primeira versão da atualização. A Etapa 3 envolveu a análise das discussões da oficina de trabalho, a elaboração da segunda versão da atualização e a disponibilização para consulta pública. Na Etapa 4, após a análise das contribuições da consulta pública, elaborou-se a terceira versão, que foi encaminhada para análise governamental. A Etapa 5 consistiu na publicação da legislação com a atualização de 2020 da LDRT. Conclusão: a atualização da LDRT propiciou o aumento do número de códigos diagnósticos de 182 para 347. O capítulo com maior crescimento foi o relativo aos Transtornos Mentais e Comportamentais. Após intervalo de 21 anos, o processo amplamente participativo utilizado proporcionou a atualização, cumprindo a legislação sanitária nacional e contribuindo para o aprimoramento da integralidade na atenção à saúde dos trabalhadores.

Sentinel approach to detect emerging causes of work-related respiratory diseases

BACKGROUND

The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD).

AIMS

To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK.

METHODS

Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD.

RESULTS

A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses).

CONCLUSIONS

Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.

A scoping review to identify strategies that work to prevent four important occupational diseases

BACKGROUND

Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts.

METHODS

To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants.

RESULTS

We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity.

CONCLUSIONS

This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.

Limitations of periodical health examinations in detecting occupational chronic solvent encephalopathy

OBJECTIVES

Occupational diseases (ODs) are globally underdetected, and chronic solvent encephalopathy (CSE) is no exception. The aim was to study how the recommended policies and protocols were followed in occupational health services (OHS) periodical health examinations where symptomatic CSE cases have remained undetected.

METHODS

We retrospectively studied the medical records of occupational CSE cases (n=18) found in a screening project, which had not been detected in preceding OHS health examinations. We collected data from three sources: OHS units, the screening project and the Finnish Institute of Occupational Health. We analysed the health examinations conducted between symptom onset and the detection of CSE: regularity, content, use of recommended screening tools, exposure estimation and whether a physician was involved in the examinations, as recommended.

RESULTS

The mean duration of symptoms before OD identification was 7.3 years (range 3-13), and 36 health examinations had been conducted. Fifteen workers had attended these (1-9 times each) while suffering from CSE symptoms, and two before symptoms. Only one had not had access to OHS. The recommended symptom screening questionnaire, Euroquest, was used in five (14%) examinations, and previous solvent exposure inquired once. A physician was involved in 24 (67%) examinations, whereas the rest were carried out by a nurse.

CONCLUSIONS

Although health examinations are conducted, guidelines are not followed. This may be due to a lack of awareness concerning CSE, and may apply to other ODs. In addition to legislation and policies, OH professionals must be continuously educated to improve awareness, prevention and detection of ODs.

Big Data in occupational medicine: the convergence of -omics sciences, participatory research and e-health

Background:

New occupational hazards and risks are emerging in our progressively globalized society, in which ageing, migration, wild urbanization and rapid economic growth have led to unprecedented biological, chemical and physical exposures, linked to novel technologies, products and duty cycles. A focus shift from worker health to worker/citizen and community health is crucial. One of the major revolutions of the last decades is the computerization and digitization of the work process, the so-called “work 4.0”, and of the workplace.

Objectives:

To explore the roles and implications of Big Data in the new occupational medicine settings.

Methods:

Comprehensive literature search.

Results:

Big Data are characterized by volume, variety, veracity, velocity, and value. They come both from wet-lab techniques (“molecular Big Data”) and computational infrastructures, including databases, sensors and smart devices (“computational Big Data” and “digital Big Data”).

Conclusions:

In the light of novel hazards and thanks to new analytical approaches, molecular and digital underpinnings become extremely important in occupational medicine. Computational and digital tools can enable us to uncover new relationships between exposures and work-related diseases; to monitor the public reaction to novel risk factors associated to occupational diseases; to identify exposure-related changes in disease natural history; and to evaluate preventive workplace practices and legislative measures adopted for workplace health and safety.

The spectrosome of occupational health problems

Given the increased prevalence of cancer, respiratory diseases, and reproductive disorders, for which multifactorial origins are strongly suspected, the impact of the environment on the population represents a substantial public health challenge. Surveillance systems have become an essential public health decision-making tool. Networks have been constructed to facilitate the development of analyses of the multifactorial aspects of the relationships between occupational contexts and health. The aim of this study is to develop and present an approach for the optimal exploitation of observational databases to describe and improve the understanding of the (occupational) environment-health relationships, taking into account key multifactorial aspects. We have developed a spectral analysis (SA) approach that takes into account both the multi-exposure and dynamic natures of occupational health problems (OHPs) and related associations. The main results of this paper are to present the construction method of the "spectrum" and "spectrosome" of OHPs (range and structured list of occupational exposures) and describe the information contained therein with an illustrative example. The approach is illustrated using the case of non-Hodgkin lymphoma (NHL) from the French National Occupational Diseases Surveillance and Prevention Network database as a working example of an occupational disease. We found that the NHL spectrum includes 40 sets of occupational exposures characterized by important multi-exposures, especially solvent combinations or pesticide combinations, but also specific exposures such as polycyclic aromatic hydrocarbons, formaldehyde and ionizing radiation. These findings may be useful for surveillance and the assessment of occupational exposure related to health risks.