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COVID-19 could be the most frequent occupational disease in Romania in 2020 2019冠状病毒病可能成为2020年罗马尼亚最常见的职业病
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0001
M. Oțelea, O. Arghir, Raluca Constantin, A. Rascu
Abstract The definition of COVID-19 as occupational disease follows the investigation of any other occupational disease caused by an infectious agent. The risk is not equal for all occupations and the occupational physician has to assess the working conditions to conclude a diagnosis of occupational COVID-19. In the pandemic context, employees face also other occupational hazards. The high level of work load and the scarce resources lead to stress, physical and mental exhaustion and irregular sleep. The protection measures, of undisputable benefit, increase the risk for contact dermatitis. There is a high probability for medium and possible long term effects of COVID-19, such as the post-traumatic stress disorder or the respiratory sequelae. These consequences need to be acknowledged and properly manged by the medical team taking care of the patient. This review presents the main characteristics of the occupational related disorders during and after the current pandemia.
在对其他由传染源引起的职业病进行调查后,将COVID-19定义为职业病。并非所有职业的风险都是相同的,职业医生必须评估工作条件,以得出职业性COVID-19的诊断。在大流行背景下,员工还面临其他职业危害。高水平的工作负荷和稀缺的资源导致压力,身心疲惫和不规律的睡眠。这些保护措施的好处毋庸置疑,但也增加了接触性皮炎的风险。COVID-19很有可能产生中期和可能的长期影响,如创伤后应激障碍或呼吸道后遗症。这些后果需要被照顾病人的医疗团队承认并妥善处理。本文综述了本次大流行期间和之后职业相关疾病的主要特征。
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引用次数: 0
A case of bilateral “double/multiple crush” entrapment syndrome of the upper limbs in a violinist 小提琴手双侧上肢“双/多重挤压”夹持综合征一例
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0007
Bogdan-Alexandru Barbu, C. Handra, Silviu Badoiu, S. Nica
Abstract Entrapment syndromes of the upper limb are common neuro-muscular-skeletal pathology in musician instrumentists. From this group of morbid entities, the most prevalent worldwide is carpal tunnel syndrome closely followed by the cubital tunnel syndrome and de Quervain stenosing tenosynovitis. Due to their distinctive etiopathogenic correlation with exposure to specific occupational factors linked to instrument interpretation and professional environment, these diseases raise a medical challenge and constitute a socioeconomic and professional burden with legal branchings and implications for individuals and society. These syndromes develop isolated or more often in various associations with each other in a clinical pattern that has been described under the model of “double crush” syndrome by Upton and McComas. From its inception in 1973 until the present time, this clinical model has been a point of interesting debate between various specialists worldwide. This model underlines an already lesioned neuron’s susceptibility and vulnerability for further neural damage at a different level from the initial lesion. The sophisticated clinical presentation of this “double or multiple crush” syndrome is due not only to overlapping symptomatology from each contributing neuro-muscular-skeletal pathology or lesional site but also to other local or systemic conditions such as trauma, diabetes, osteoarthritis, thyroid disease, obesity, etc. The occupational factors such as repetitive movements, strain and overload, vibrations, ergonomics, and others all contribute to the creation and progression of the morbid process. We cannot overstate the implications of understanding these complex relations and interdependencies between the factors mentioned above as they are essential not only for the diagnosis of these neuropathies but also for the treatment, rehabilitation, and occupational reinsertion of the patients. The studies support the fact that both lesional sites need to be medically addressed for an optimal outcome and resolution. We present the case of a female violinist with bilateral multiple neuro-muscular-skeletal pathologies of the upper limb treated previously invasively and conservatively over several years by various specialists without a satisfactory clinical resolution of the symptomatology or any professional and legal measures taken.
上肢夹持综合征是音乐家常见的神经-肌肉-骨骼病理。从这组病态实体中,世界范围内最常见的是腕管综合征,其次是肘管综合征和de Quervain狭窄性腱鞘炎。由于这些疾病与接触与仪器解释和专业环境相关的特定职业因素具有独特的致病相关性,因此这些疾病提出了医疗挑战,并构成了社会经济和专业负担,对个人和社会具有法律分支和影响。Upton和McComas在“双重挤压”综合征模型下描述了这些综合征的临床模式,这些综合征的发展是孤立的,或者更经常地相互关联。从1973年开始到现在,这种临床模式一直是世界各地专家之间有趣的争论点。该模型强调了已经受损的神经元在不同程度上对进一步神经损伤的易感性和脆弱性。这种“双重或多重挤压”综合征的复杂临床表现不仅是由于神经-肌肉-骨骼病理或病变部位的症状重叠,而且还与其他局部或全身性疾病如创伤、糖尿病、骨关节炎、甲状腺疾病、肥胖等有关。职业因素,如重复性运动,紧张和过载,振动,人体工程学等都有助于病态过程的产生和发展。我们不能夸大理解上述因素之间的复杂关系和相互依赖性的含义,因为它们不仅对这些神经病的诊断至关重要,而且对患者的治疗、康复和职业重新安置也至关重要。这些研究支持这样一个事实,即两个病变部位都需要进行医学处理,以获得最佳结果和解决方案。我们报告一名女小提琴手的病例,她患有双侧上肢多发性神经肌肉骨骼病变,经过不同专家多年的侵入性和保守治疗,但症状没有得到满意的临床解决,也没有采取任何专业和法律措施。
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引用次数: 0
Occupational Extrinsic Allergic Alveolitis in a poultry farmer 职业性外源性过敏性肺泡炎1例
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0010
Smărăndescu Raluca Andreea, M. Diaconu, C. Handra, A. Rascu
Abstract Hypersensitivity pneumonitis is a group of inflammatory interstitial lung diseases caused by hypersensitivity immune reactions to the inhalation of various antigens: fungal, bacterial, animal protein, or chemical sources, finely dispersed, with aerodynamic diameter <5μ, representing the respirable fraction. The national register for interstitial lung diseases records very few cases of hypersensitivity pneumonitis (extrinsec allergic alveolitis), a well defined occupational disease. Although not an eminently of occupational origin, the extrinsec allergic alveolitis can occur secondary to occupational exposure to organic substances (animal or insect proteins, bacteria, fungi) or inorganic (low molecular weight chemical compounds) and the occupational doctor is a key actor in the diagnosys. The disease has chronic evolution and exposure avoidance, as early as possible, has major prognostic influence. The occupational anamnesis remains the most important step and the occupational physician is the one in charge for monitoring and detection of the presence of respiratory symptoms in all employees with risk exposure. Next, we present the case of a farmer, without other comorbidities, who develops various respiratory and systemic diseases and manifestations due to repeated exposure to animal proteins and molds, in order to review the risk factors and the consequences of exposure in poultry farms.
超敏性肺炎是由于吸入各种抗原(真菌、细菌、动物蛋白或化学源)引起的超敏性免疫反应而引起的一组炎性间质性肺部疾病,其空气动力学直径<5μ,代表可吸入部分。国家间质性肺病登记记录很少有超敏性肺炎(外虫过敏性肺泡炎)的病例,这是一种明确的职业病。虽然不是一个明显的职业起源,但外虫过敏性肺泡炎可能继发于职业性暴露于有机物质(动物或昆虫蛋白质、细菌、真菌)或无机物质(低分子量化合物),职业医生是诊断的关键角色。本病有慢性演变,尽早避免暴露,对预后有重大影响。职业记忆仍然是最重要的步骤,职业医生负责监测和发现所有有风险暴露的员工是否存在呼吸道症状。接下来,我们将介绍一位没有其他合并症的农民的病例,他由于反复接触动物蛋白和霉菌而患上了各种呼吸系统疾病和表现,以便回顾家禽养殖场接触动物蛋白和霉菌的风险因素和后果。
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引用次数: 0
Lung function testing assessment by impulse oscillometry in chronic lung disease 脉冲振荡法评价慢性肺病患者的肺功能
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0006
R. Cîrjaliu, I. Arghir, E. Beitula, Ionel Odagiu, I. Ion, M. Nicolae, E. Danteș, O. Arghir
Abstract Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.
脉冲振荡测量法(Impulse oscillometry, IOS)是Dubois在50年前提出的强迫振荡技术的一种变体,它使我们能够测量潮汐呼吸时气道的电抗以及小气道和大气道的阻力。它对不能进行肺活量测定的受试者(如老人、儿童和神经系统疾病患者)的配合要求最低。IOS可以概述梗阻性气道疾病的诊断,区分小气道梗阻与大气道梗阻。在确定疾病的严重程度、恶化程度和评估治疗反应方面,它比肺活量测定法对周围气道疾病更敏感。其他应用包括移植排斥反应的早期评估,囊性纤维化,声带障碍,支气管扩张,过敏性肺炎,阻塞性睡眠呼吸暂停。
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引用次数: 0
The risks in nursing interventions offered by nurses with the purpose of preventing hospital-acquired pressure ulcers 以预防医院获得性压疮为目的的护士提供护理干预的风险
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0005
C. E. Dobre, Florin Cirstoiu, Mariana Zazu, D. Mazilu
Abstract The study was performed in seven medical units in Bucharest with the intention to offer a comprehensive analysis of the nurses’ current prevention practices for hospital-acquired pressure ulcers and also to determine: (1) the main risks that can negatively affect the prevention activities for this type of injury, and (2) if there is a correlation between the nurses’ knowledge and the clinical approach to the current hospital-acquired pressure ulcer prevention practices. The statistical analysis was based on data collected from 713 questionnaires from subjects who met the inclusion criteria of the study. The results showed that nurses considered protocols for hospital-acquired pressure ulcer prevention and its management to be important, but both were not always fully implemented into practice due to the lack of resources, time allocation and staff shortages. The regression analysis method we used was focused to assess the predictive capacity for the combined clinical knowledge and professional approaches to hospital-acquired pressure ulcer prevention and management. The conclusion was that a simultaneous improvement in the clinical approaches and professional knowledge on the topic of pressure-ulcer prevention and management may lead to an improvement of up to 6% of the practices in this field according to the results of the statistical analysis performed.
摘要:本研究在布加勒斯特的七个医疗单位进行,旨在全面分析护士目前对医院获得性压疮的预防做法,并确定:(1)可能对此类伤害的预防活动产生负面影响的主要风险,以及(2)护士的知识与目前医院获得性压疮预防做法的临床方法之间是否存在相关性。统计分析基于从符合研究纳入标准的受试者的713份问卷中收集的数据。结果显示,护士认为医院获得性压疮的预防和管理方案是重要的,但由于缺乏资源、时间分配和人员短缺,两者并不总是完全落实到实践中。我们采用回归分析方法,重点评估临床知识与专业方法相结合对医院获得性压疮预防和管理的预测能力。结论是,根据统计分析的结果,在预防和管理压力性溃疡方面,临床方法和专业知识的同时改进可能导致该领域的实践改进高达6%。
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引用次数: 1
Occupational medicine in Sibiu: the switch from historical diseases to the current and emergent ones 锡比乌职业医学:从历史疾病到当前和紧急疾病的转变
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0009
Mihaela Stoia
Abstract This study aimed to provide a brief historical overview of occupational medicine in Sibiu County combined with epidemiological evidence and trends in occupational diseases useful to design an agenda for future research and development of other components. Methods: to depict a model of circumstances, correlations, and trends, we applied to the local employee population a semi-structured narrative review method combined with the analysis of occupational diseases. The search strategy relied on literature and document review to create a timeline. We used a statistic chart histogram to highlight the most significant factors. Results: since 1950, concerning the industrial profile and the significant health effects on workers, we identified six stages of developing an occupational health network. The coverage was both for medical and hazard surveillance through a centralized system in the communist regime and recovery in the unique Sanatorium for occupational diseases established in the area. Occupational medicine private health services and the Faculty of Medicine from Sibiu appeared in the 1990s. Sibiu’s occupational disease model was a particular one in the 20th century, given the burden of lead poisoning from local industries. Infectious diseases in medical staff related to sporadic epidemics and the ongoing COVID-19 pandemic as an emergent professional risk pose new current challenges for occupational medicine. Conclusion: unique challenges increase the need for occupational epidemiologic research and the need for advances in other components of occupational health, but lessons from the past and traditional methods are well documented and still valuable.
摘要本研究旨在结合流行病学证据和职业病趋势,对锡必乌县职业医学的历史概况进行简要概述,为未来其他组成部分的研究和发展制定议程。方法:为了描述环境、相关性和趋势模型,我们将半结构化叙事回顾方法应用于当地员工群体,并结合职业病分析。搜索策略依赖于文献和文献回顾来创建一个时间轴。我们使用统计直方图来突出显示最重要的因素。结果:自1950年以来,关于工业概况和对工人的重大健康影响,我们确定了发展职业健康网络的六个阶段。覆盖范围包括通过共产主义政权的集中系统进行医疗和危害监测,以及在该地区建立的独特的职业病疗养院进行康复。20世纪90年代,锡比乌出现了职业医学、私人保健服务和医学院。考虑到当地工业铅中毒的负担,Sibiu的职业病模型在20世纪是一个特殊的模型。与散在流行和持续的COVID-19大流行相关的医务人员传染病作为一种紧急职业风险,对职业医学提出了新的挑战。结论:独特的挑战增加了对职业流行病学研究和在职业健康的其他组成部分取得进展的需要,但过去和传统方法的经验教训有充分的记录,仍然很有价值。
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引用次数: 1
The level of knowledge of family doctors on climate change 家庭医生对气候变化的认知水平
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0002
C. Croitoru, E. Ciobanu, V. Salaru
Abstract Currently, the question is no longer if the climate is changing because the magnitude and speed of climate change, but it is a fact confirmed by many teams of specialists. It has become a hotly debated topic for politicians, businessmen, environmentalists, society and media. We designed a pilot study using a questionnaire in order to identify the level of knowledge, skills and practices of family physicians regarding the impact of their work on the environment and climate change. The questionnaire included 42 items regarding socio-demographic data, doctors’ knowledge regarding climate change, global warming, heatwave, thermal stress, the activity performed by doctors during the heat wave and the information received by doctors about heatwave periods. The research results confirm the hypothesis that doctors have some knowledge about the phenomenon of climate change, but there are some gaps and misunderstandings of the cause and effect of the phenomenon, as well as the methods to combat them. There is a need for additional training and guidance of physicians on the relationship between climate change, global warming and population health.
目前,问题不再是气候是否因为气候变化的幅度和速度而发生变化,而是许多专家团队已经证实了这一事实。它已经成为政治家、商人、环保主义者、社会和媒体热议的话题。我们设计了一项使用问卷调查的试点研究,以确定家庭医生在其工作对环境和气候变化的影响方面的知识水平、技能和实践。问卷内容包括社会人口统计数据、医生对气候变化、全球变暖、热浪、热应激的认知、医生在热浪期间的活动、医生收到的热浪期信息等42个项目。研究结果证实了医生对气候变化现象有一定了解的假设,但对这一现象的因果关系以及应对方法存在一些差距和误解。有必要就气候变化、全球变暖和人口健康之间的关系对医生进行额外的培训和指导。
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引用次数: 0
Occupational exposure to inorganic lead and its compounds in Romania 罗马尼亚职业性接触无机铅及其化合物
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0004
M. Negru, V. Calotă, Lavinia Călugăreanu, D. Mates
Abstract Lead and its compounds are hazardous chemical agents; some lead compounds, are classified as carcinogens in humans. In Romania, the occupational exposure to inorganic lead and its compounds occurs in many sectors: production of lead, manufacture of batteries, manufacture of thermal ceramic products (terracotta), production of electric and electronic components, manufacture of articles of metal wire, production of dyes and additives for plastics, recovery of lead from waste batteries, waste collection and treatment of electrical and electronic equipment, etc. The binding occupational limit value for inorganic lead compounds established under the national regulations is 0.15 mg/m3 in the air (measured in relation to a reference period of eight hours, time-weighted average, TWA). The binding biological limit value is 70 μg Pb/100 ml blood. We have summarized lead occupational exposure data collected from the regional public health authorities in Romania, for the period 2011-2019. The concentrations of lead recorded in the workplaces air varied between “not detected” and 0.22 mg/m3. The lead concentrations in the blood had high values (over the alert value of 40 μg/100 ml blood) in several activities (production of lead, recovery-recycling of lead from waste batteries, manufacture of batteries, and manufacture of articles of metal wire) leading to the need of continuous surveillance of health status for the exposed workers.
铅及其化合物是一种危险的化学试剂;一些铅化合物被列为人类致癌物。在罗马尼亚,无机铅及其化合物的职业接触发生在许多部门:铅的生产、电池的制造、热陶瓷产品(赤陶土)的制造、电气和电子元件的生产、金属线制品的制造、塑料染料和添加剂的生产、从废电池中回收铅、电气和电子设备的废物收集和处理等。根据国家规定,空气中无机铅化合物的约束性职业极限值为0.15 mg/m3(参照8小时,时间加权平均值,TWA)。结合生物极限值为70 μg Pb/100 ml血。我们总结了2011-2019年期间从罗马尼亚地区公共卫生当局收集的铅职业暴露数据。工作场所空气中记录的铅浓度在“未检测到”和0.22毫克/立方米之间变化。血液中的铅浓度在若干活动(铅的生产、废电池中铅的回收和再循环、电池的制造和金属丝制品的制造)中有很高的值(超过40 μg/100毫升血的警戒值),因此需要对接触工人的健康状况进行持续监测。
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引用次数: 0
Caplan’s Syndrome (rheumatoid pneumoconiosis), a rare disease entity: case report 卡普兰综合征(类风湿性尘肺病),一种罕见疾病:1例报告
Pub Date : 2020-08-27 DOI: 10.2478/rjom-2020-0008
M. Diaconu, L. Moise, A. Rascu
Abstract Caplan’s syndrome, known as rheumatoid pneumoconiosis, was first described by Anthony Caplan in 1953, who identified a rare lung disorder found in coal mine workers with rheumatoid arthritis. Although Caplan’s syndrome was found in patients with a variety of pneumoconioses, it mostly affects individuals with long exposure to crystalline silica. We present a case of Caplan’s syndrome in a patient with advanced stage of rheumatoid arthritis and silicosis.
卡普兰综合征,又称类风湿尘肺病,于1953年由安东尼·卡普兰首次发现,他在患有类风湿关节炎的煤矿工人中发现了一种罕见的肺部疾病。尽管卡普兰综合征见于各种尘肺病患者,但它主要影响长期接触结晶二氧化硅的个体。我们提出一例卡普兰综合征的病人与晚期类风湿关节炎和矽肺。
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引用次数: 0
The “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study protocol “夜班工人昼夜节律紊乱引起的心电图改变”研究方案
Pub Date : 2019-12-01 DOI: 10.2478/rjom-2019-0002
M. Oțelea, A. Streinu-Cercel, D. Manolache, Andreea Mutu, Lavinia Călugăreanu, D. Mates, O. Săndulescu
Abstract In many large cohort studies, the night shift constitutes a risk factor for developing cardiovascular disease and diabetes in workers. Current screening tests for people working in night shift include fasting glycaemia and electrocardiography. In fact, there are few studies focused on the description of the electrocardiographic changes after the night shift. This article describes the protocol of the “ECG modifications induced by the disturbance of the circadian rhythm in night-shift workers (ECGNoct)” study, which was initiated by the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”. Nurses represent the target population. The protocol includes a full medical and occupational history, lifestyle habits (smoking, alcohol, nutrition), anthropometric and blood pressure measurements, blood tests (fasting glycemia, total cholesterol, triglycerides and high density lipoprotein cholesterol) and electrocardiogram recording. For nurses working in (night) shifts, we will record the electrocardiogram before and soon after the night shift. A cross sectional study will analyze the incidence of the metabolic syndrome criteria, the cardio-metabolic diseases and the electrocardiographic modifications and will compare the results between the group of nurses working and the group of nurse who do not. Based on these results, a longitudinal study will test the hypothesis that night shift increases the risk for cardio-metabolic diseases and that the electrocardiographic modifications precede the clinical symptoms. The results of the study will provide data on the association of night shifts and other non-occupational risk factors with the cardio-metabolic diseases in this specific population of healthcare workers that potentially will integrate into the occupational medicine policies.
在许多大型队列研究中,夜班是工人患心血管疾病和糖尿病的危险因素。目前夜班工作人员的筛查测试包括空腹血糖和心电图。事实上,很少有研究关注夜班后心电图变化的描述。本文描述了“夜班工人昼夜节律紊乱引起的心电图改变(ECGNoct)”研究的方案,该研究由国家传染病研究所“Matei balnu博士”教授发起。护士代表目标人群。该方案包括完整的医疗和职业史、生活习惯(吸烟、饮酒、营养)、人体测量和血压测量、血液测试(空腹血糖、总胆固醇、甘油三酯和高密度脂蛋白胆固醇)和心电图记录。对于夜班护士,我们会在夜班前和夜班后记录心电图。横断面研究将分析代谢综合征标准、心脏代谢疾病和心电图修改的发生率,并比较工作护士组和不工作护士组的结果。基于这些结果,一项纵向研究将检验夜班增加心血管代谢疾病风险的假设,以及心电图改变先于临床症状的假设。该研究的结果将提供夜班和其他非职业风险因素与这一特定人群的心脏代谢疾病的关联数据,这些数据可能会纳入职业医学政策。
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引用次数: 0
期刊
Romanian Journal of Occupational Medicine
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