Magister Curationis - MCur / Background: Health care workers, more specifically, nursing students are at increased risk of occupational injury and exposure to blood borne pathogens. Compliance with universal precautions (UP) will minimise risk or transmission of HIV and HBV (Hepatitis B virus) according to the Department of Health of South Africa. Aim: The aim of this study was to investigate the knowledge and practice of universal precautions amongst nursing students and their fear of occupational exposure to blood borne pathogens. Rationale: The rationale for the study was to investigate what the studentss knowledge and practice of UP were, to see if this could be a possible contributing factor to occupational exposure. Research design: The study was a quantitative, cross sectional survey using a questionnaire that included one open ended question. Participants: The participants for the study were the undergraduate nursing students in year levels two to four (n = 253) who and were selected by means of stratified random sampling. Procedures: A questionnaire was administered to the participants by the researcher. Analysis of the data collected was done through statistical package for social sciences (SPSS 16.0) and content analysis. Results: The researcher established that there is indeed a lack of knowledge regarding UP and that the students’ self reported practice of UP is poor. No statistically significant correlation between knowledge and practice of UP were found. There is underreporting of occupational exposures to staff at the School of Nursing. The majority of students reported a moderate to severe fear for occupational exposures and contributing factors raised by them are reality in the clinical facilities. / South Africa

Orientador: Adriano Fregonesi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T20:23:11Z (GMT). No. of bitstreams: 1 Borges_ClaudioFerreira_D.pdf: 1990683 bytes, checksum: 1a75e1725e18e65f74c600f93224b4bb (MD5) Previous issue date: 2015 / Resumo: Objetivo: Foi realizada uma pesquisa de âmbito nacional com urologistas brasileiros a fim de estudar seu comportamento frente à exposição à radiação e ao uso de equipamentos de proteção e monitoramento. Material e Métodos: Um questionário com 13 perguntas foi enviado por e-mail para urologistas brasileiros; as questões abordavam temas como características demográficas, a exposição à radiação, bem como a utilização de dispositivos de proteção e dosímetros. As razões pelas quais esses dispositivos não foram utilizados também foram investigadas. Resultados: Um total de 332 questionários foi preenchido completamente e analisado; a idade média dos entrevistados foi de 43,3 ± 10,8 anos. Aventais de chumbo e protetores de tireoide são utilizados em cada procedimento por 84,4% e 53,89% dos entrevistados, respectivamente. Óculos de proteção nunca são utilizados por 72,12% dos entrevistados. Urologistas mais velhos são mais propensos a não usar proteção adequada. Dos urologistas que responderam, 76,42% nunca usam dosímetros. Conclusão: Este estudo mostra uma utilização insatisfatória dos dispositivos de proteção contra radiação e dosímetros, revelando uma baixa adesão ao ALARA (as low as reasonably achievable) entre urologistas brasileiros / Abstract: Purpose: We performed a nationwide survey of Brazilian urologists to study behaviors toward radiation exposure and the use of protective and monitoring equipment. Material and Methods: A 13-question e-mail questionnaire was sent to Brazilian urologists; the questions addressed demographic characteristics, radiation exposure, and the utilization of shielding devices and dosimeters. The reasons why these devices were not used were also investigated. Results: A total of 332 completed questionnaires were analyzed; the median age of the respondents was 43.3 ± 10.8 years. Lead aprons and thyroid protection are utilized in every procedure by 84.4% and 53.89% of respondents, respectively. Protective eyeglasses are never used by 72.12% of the respondents. Older urologists were more likely not to use adequate protection. Of the urologists who responded, 76.42% never use dosimeters. Conclusion: This study shows an unsatisfactory utilization of radiation-shielding devices and dosimeters, revealing a low compliance to the ALARA (as low as reasonably achievable) principle among Brazilian urologists / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Orientadores: Vera Lúcia da Silveira Nantes Button, Marcelo Baptista de Freitas / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação / Made available in DSpace on 2018-08-28T09:42:26Z (GMT). No. of bitstreams: 1 Malthez_AnnaLuizaMetidieriCruz_D.pdf: 4070699 bytes, checksum: 5b502eb8b2975aac6052df7ad659d32a (MD5) Previous issue date: 2015 / Resumo: Neste estudo foi desenvolvido um dosímetro (monitor individual) para monitoração externa de indivíduos ocupacionalmente expostos à radiação (raios X e gama) que faz o uso simultâneo das técnicas de termoluminescência (TL) e luminescência opticamente estimulada (OSL - Optically Stimulated Luminescence), combinado às diferentes características dosimétricas de detectores já utilizados com a técnica TL na rotina dos Serviços de Monitoração Individual Externa (SMIEs) no Brasil (LiF:Mg,Ti ¿ TLD100, CaF2:natural, CaSO4:Dy - IPEN) e detectores utilizados com a técnica OSL, ainda pouco explorados na monitoração individual (BeO ¿ Thermalox 995) e recentemente autorizados a serem utilizados com a técnica OSL no país (Al2O3:C - Luxel). Para o desenvolvimento do monitor, diversas características intrínsecas e dosimétricas dos detectores empregando as técnicas TL e OSL em três diferentes equipamentos leitores foram avaliadas. Testes de desempenho foram aplicados ao monitor desenvolvido, conforme critérios estabelecidos no país e no exterior (CASEC e IEC, respectivamente). Os resultados obtidos demonstram que as respostas TL e OSL dos detectores dependem fortemente da configuração do leitor utilizado, da técnica empregada (TL ou OSL) e do tipo de sinal avaliado, no caso da técnica OSL (OSL total ou inicial). Assim é fundamental uma análise prévia de características intrínsecas do material, como comprimento de onda principal da emissão luminescente, tipo (inicial ou total) e magnitude (doses baixa, moderada ou alta) do sinal que será avaliado para a escolha adequada dos parâmetros do leitor (filtros, máscaras, potência, entre outros) empregando as duas técnicas. Os resultados obtidos com a técnica OSL reforçam seu uso na monitoração individual no Brasil, uma vez que estavam em acordo com a técnica TL, amplamente empregada pelos SMIEs nacionais. Além da determinação de dose individual, normalmente empregada na monitoração de trabalhadores, o dosímetro desenvolvido permite também estimar doses acumuladas ao longo do tempo, empregando a técnica OSL nos detectores de Al2O3:C ou BeO, sendo que no caso deste último, a dose única (ou individual) também pode ser determinada com a técnica TL aplicada simultaneamente no mesmo detector. Após a avaliação das respostas em energia dos detectores, um algoritmo foi desenvolvido, testado e validado para avaliar fatores de correção com respeito à energia, baseado na razão entre as respostas de um par de detectores TL e OSL. Os resultados demonstraram que as diferentes razões entre os sinais provenientes do par, permitem avaliar de forma precisa a qualidade da radiação à qual o par de detectores foi exposto. O monitor desenvolvido possui três configurações diferentes de pares de detectores, Al2O3:C/LiF:Mg,Ti, Al2O3:C/BeO e CaSO4:Dy/BeO. Ele apresenta como principais vantagens, em relação aos dosímetros já existentes em uso comercialmente, a possibilidade de poder inferir informações sobre a dose e qualidade da radiação (energia efetiva) sem a utilização de filtros e com diminuição das incertezas associadas, avaliar doses acumuladas ao longo do tempo com o mesmo dosímetro e combinar todas as características dos detectores associadas às técnicas TL e OSL, simultaneamente em um mesmo dosímetro. Os resultados dos testes de desempenho do monitor apresentaram conformidade com os critérios nacionais e internacionais estabelecidos, e contribuíram para que os critérios nacionais utilizados para a técnica TL possam ser estendidos para a técnica OSL / Abstract: In this study a dosimeter (personal monitor) for external monitoring of individuals occupationally exposed to radiation (X and gamma rays) was developed using simultaneously thermoluminescent (TL) and optically stimulated luminescence (OSL) techniques. Intrinsic characteristics of detectors already used with TL technique in External Individual Monitoring Services routine in Brazil (LiF:Mg,Ti ¿ TLD 100, CaF2:natural and CaSO4:Dy ¿ IPEN) were combined to detectors used with OSL technique, one less explored (BeO ¿ Thermalox 995), and other recently approved (Al2O3:C - Luxel) to be used in individual monitoring in the country (Al2O3:C - Luxel). During the monitor development, several intrinsic and dosimetric characteristics of detectors were evaluated employing TL and OSL techniques in three different reader equipments. Performance tests were applied to the developed monitor according to national and international established criteria (CASEC and IEC, respectively). The obtained results showed that the responses of TL and OSL detectors are strongly dependent on reader configuration, employed technique (TL and OSL) and, in the particular case of OSL technique, also the signal (total or initial OSL). Therefore, a previous analysis of the intrinsic characteristics of the material, as the main wavelength of the luminescent emission, the signal type (initial or total) and dose magnitude (low, moderate or high) must to be made in order to select the reader configuration (filters, power, and others) used with each technique. The results obtained with OSL technique reinforce its use in Brazil, as they were in agreement with TL technique, which is already largely used by national EIMS. In addition to the assess of individual dose, usually employed in workers monitoring, the developed dosimeter allows evaluating accumulated dose over time using OSL technique with Al2O3:C or BeO detectors, and single or individual doses can be evaluated applying TL technique simultaneously applied in the same detector. After the evaluation of the energy response of detectors, an algorithm was developed, tested and validated to assess correction factors with respect to energy, based on the ratio of the responses of a pair of TL and OSL detectors. The results confirm that the different ratios between signals from a detector pair allow to evaluate more accurately the radiation quality to that the pair of detectors were exposed. The monitor was developed with three different arrangements of pairs of detectors, Al2O3:C/LiF:Mg,Ti, Al2O3:C/BeO and CaSO4:Dy/BeO. It presents as main advantages, compared to existing commercial dosimeters in use, the possibility to infer information on the dosage and quality of radiation (effective energy) without the use of filters and reducing associated uncertainties, to assess cumulative doses over time with the same dosimeter, and to combine all features of the detectors associated with TL and OSL techniques, simultaneously, in the same dosimeter. The results of the performance tests of the developed monitor were in accordance to national and international criteria, and contributed to that the national criteria, used for TL technique, can also be extended to the OSL technique / Doutorado / Engenharia Biomedica / Doutora em Engenharia Elétrica

Contexte. La population agricole française, dans son ensemble, présente un plus faible risque de Cancer BronchoPulmonaire (CBP) par rapport à la population générale. Ce constat, retrouvé au niveau international, s’explique au moins en partie par un tabagisme plus faible notamment chez les plus âgés et chez les femmes ; un effet « protecteur » des endotoxines est également suspecté. Néanmoins le milieu professionnel agricole peut exposer à de nombreux cancérogènes pulmonaires avérés ou suspectés ; malgré cela, à l’exception de certains secteurs d’élevage, il n’existe que très peu de données sur les associations entre expositions ou situations de travail précises en milieu agricole et le risque de CBP. Objectifs. Le premier objectif de ce travail de thèse était d’étudier les associations, au sein de la cohorte AGRICAN (AGRIculture et CANcer), entre (1) CBP et exposition aux activités et tâches de cultures ; (2) CBP et utilisation de pesticides arsenicaux et herbicides dinitroanilines, et de mettre à profit le nombre important de sujets inclus et de cas de CBP pour réaliser ces analyses par sous-type histologique. Le deuxième objectif était d’initier un projet de métrologie de divers aérocontaminants en milieu professionnel agricole. Méthodes. Les analyses ont été menées en utilisant les données de l’étudeAGRICAN et de la matrice culture-exposition aux pesticides PESTIMAT. Nous avons utilisé un modèle de Cox, ajusté sur le sexe, le tabagisme, les élevages bovin et équin. Le projet métrologique AirExpA s’est limité à la Normandie, avec mesures personnelles des poussières totales (en temps réel), endotoxines et 38 mycotoxines (en cumulé), en élevage bovin, lors des foins et des moissons de blé/orge et pois fourrager/féverole. Résultats et discussion. Nous avons retrouvé une association inverse entre l’activité de culture de maïs et le risque de CBP, une association positive entre adénocarcinomes et viticulture, ainsi qu’entre carcinomes à petites cellules et culture de pois fourragers/féveroles. Les éléments de plausibilité d’un lien entre ces secteurs d’activité et le risque de CBP sont encore des hypothèses : la culture de maïs, par le stockage du grain, pourrait exposer aux endotoxines ; à l’inverse, la récolte de pois fourragers a été décrite comme empoussiérante, mais cet élément doit être confirmé par une caractérisation des poussières. Nous n’avons pas retrouvé d’association entre utilisation de pesticides arsenicaux, ni de dinitroanilines, et risque de CBP ; cependant les analyses stratifiées sur le sexe et le statut tabagique, montraient des associations positives chez les non-fumeurs et chez les femmes (en particulier pour les adénocarcinomes). Enfin, le projet AirExpA a permis de documenter un gradient d’exposition aux poussières et endotoxines en fonction de différentes tâches en élevage bovin, et une exposition plus modérée mais réelle, aux endotoxines, lors des activités de culture. Les analyses de mycotoxines sont toutes revenues inférieures aux limites de quantification. L’analyse des pics d’exposition, l’étude d’autres aérocontaminants et d’autres secteurs agricoles, sont des perspectives de ce projet. Conclusion. Notre travail soulève de nouvelles questions de recherche quant à des associations possibles entre certaines expositions professionnelles en milieu agricole (cultures et tâches, utilisation de certains pesticides) et risque de CBP, et contribue à une meilleure connaissance des expositions professionnelles des agriculteurs aux aérocontaminants. / Background. Farmers are at lower risk of lung cancer, compared to the general population, at least partly because of a reduced rate of smoking among the elderly and women. A “protective” effect of endotoxins has also been hypothesized. Even though some of the occupational exposures occurring during farming-related activities are well-known or suspected lung carcinogens, there is scarce data in the literature, about the associations between specific occupational exposures or tasks in farming, and the risk of lung cancer. Objectives.The first aim was to analyse, in the AGRICAN cohort, the associations between lung cancer and (1) occupational exposure to various crops and related tasks; (2) arsenical pesticides and dinitroaniline herbicides use in farming. We also aimed at stratifying our analysis by histological subtypes of lung cancer. The second aim was to initiate a metrological project, to assess farmers’ occupational exposure to various airborne pollutants, in relation with the risk of lung cancer. Methods. We used the data from the French AGRIculture and CANcer cohort (AGRICAN) and from the PESTIcide MATrix project (PESTIMAT), to assess the associations between occupational farming exposures and lung cancer. A Cox model was performed, with adjustment on gender, smoking intensity, cattle and horses breeding. Our metrological project AirExpA was first launched in Normandy and focused on a few exposures – total dusts in real-time ; endotoxins and 38 mycotoxins, cumulative – in cattle breeding, wheat/barley and peas harvesting, and haymaking. Results and discussion. We reported a negative association between lung cancer and corn growing, and positive associations between (1) vineyard growing and adenocarcinoma; (2) peas growing and small cell lung cancer. Corn growing, especially grain handling, might expose to significant levels of endotoxins, thus explaining the inverse association. Peas growing, especially harvesting, is reportedly a dusty task; the AirExpA project will enable us to better characterize the dusts. We found no association between arsenicals use and lung cancer, nor with dinitroaniline herbicides use. However, stratifying on gender and smoking status showed positive associations among women and never-smokers, especially for adenocarcinomas. The AirExpA project showed dust and endotoxins exposure gradients in cattle breeding, depending on the task, and a mild but real exposure to endotoxins in various tasks in crop growing. All samples for mycotoxins were below the limit of quantification. Analysing exposure peaks, extending the project to other breedings/crops and air pollutants are among the perspectives. Conclusion. Our results raise new research questions about possible associations between occupational agricultural exposures and lung cancer, and contribute to a better knowledge and understanding of farmers’ occupational exposure to air pollutants.

En épidémiologie de la santé au travail, la non prise en compte du genre dans les études peut contribuer à maintenir dans l'invisibilité certaines questions propres à la santé des femmes, telles les risques cancérogènes qu'elles peuvent encourir en milieu professionnel. L’objectif de cette thèse est d'analyser la manière dont les biais liés au genre affectent différentes étapes du processus de production des connaissances épidémiologiques sur les cancers d'origine professionnelle.Le premier biais notable est le nombre limité d’études s’intéressant à l’étiologie des cancers d’origine professionnelle chez les femmes. À travers une revue systématique d’études observationnelles (n= 243) indexées sur PubMed et portant sur le cancer du poumon, nous montrons que les risques cancérogènes restent largement sous-étudiés chez les femmes comparées aux hommes. Dans un deuxième temps, à partir de l’enquête Giscop93, nous avons réalisé une comparaison à l’échelle du poste de travail (n= 7 702) entre une évaluation de l’exposition aux solvants chlorés effectuée par un comité d’expert·e·s et une évaluation effectuée par la matrice emplois-expositions en population générale Matgéné. Nos résultats suggèrent des désaccords (dans les indices d’exposition produits) entre les deux outils, qui varient notamment selon le degré de féminisation du métier évalué. Dans un troisième temps, nous montrons à partir de l’enquête cas-témoins ICARE (cas, n= 2 926 dont 22% de femmes, témoins, n= 3 555 dont 22% de femmes) que le odds ratio de cancer du poumon associé à l’exposition aux solvants chlorés diffère selon le sexe et la catégorie socioprofessionnelle.Cet ensemble de travaux nous a mené à des propositions de pratiques de recherche et de nouvelles méthodes d’analyse et de contrôle des biais de genre dans les études en épidémiologie de la santé au travail. / In occupational epidemiology, failure to take gender into account in the analyses may contribute to conceal certain issues specific to women's health, such as the carcinogenic risks they may incur in the workplace. The aim of this thesis is to analyze how gender-related biases affect different stages of the process of producing epidemiological knowledge on occupational cancers, in particular in the definition of the scope of investigation, the exposure assessment and the statistical modelling.The first significant bias is the limited number of studies assessing the etiology of occupational cancers in women. Through a systematic review of observational studies (n = 243) indexed on PubMed for lung cancer, we show that carcinogenic risks remain largely under-studied in women as compared to men. Secondly, based on the Giscop93 study, we have compared, at the job level (n= 7 702), an assessment of occupational exposure to chlorinated solvents made by an expert panel to an evaluation performed by a general population job-exposure matrix Matgéné. Our results suggest some disagreements (in the exposure indices assigned) between the two methods, notably according to the degree of feminization of the job evaluated. Thirdly, based on the ICARE case-control study (cases, n = 2 926 (22% were women), controls, n = 3 555 (22% were women)), we show that the odds ratio of lung cancer associated with exposure to chlorinated solvents is modified by sex and occupational category.This body of work has led us to proposals for research practices and new methods for the analysis and control of gender bias in occupational epidemiology studies.

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SAMMANFATTNING Bakgrund En del av företagssköterskans arbetsuppgifter är att arbeta förebyggande och se olika typer av problematik som finns hos arbetstagare och arbetsgivare. Omvårdnad av människan ska stå i fokus och rikta sig mot arbetslivet där en säker och god omvårdnad ges (SOU 2011:63). Vibrationsexponering av händer och åtföljande effekter utgör ett betydande arbetsmedicinskt problem där kyrkvaktmästare utgör en exponerad yrkesgrupp. Syfte Syftet med studien var att kartlägga besvär i händer och armar hos kyrkvaktmästare och deras kunskaper kring riskerna med vibrationsexponering. Metod 50 kyrkvaktmästare besvarande två enkäter, en om symtom och en om arbetsmiljö vid vibrationsexponering av handhållna verktyg och dess risker och skador. Resultatet presenterades som deskriptiva data. Resultat Köldkänsla 40 %, vita fingrar 38 % och kramp 38 % var de vanligaste symtomen. Symtom var vanligare bland dem som arbetat minst 10 år i vibrations exponerade arbete. De hade lite kunskap om riskerna med arbetet. Ingen av kyrkvaktmästarna hade blivit erbjuden medicinsk kontoroll enligt Arbetsmiljöverkets föreskrifter. Slutsats Symtom var vanligt förekommande, om medicinska kontroller hade utförts skulle symtomen förmodligen ha upptäcks i ett tidigare skede och inneburit att deras lidande kunde ha minskat. Den medicinska kontrollen hade även inneburit att arbetsgivaren tagit sitt arbetsmiljöansvar för att minimera vibrationsexponeringen (AFS 2005:15). En viktig del i företagssköterskans preventiva arbete är att informera arbetsgivaren om dennes ansvar vid vibrations exponerade arbete och arbetstagarna om riskerna. Nyckelord: hand- arm vibration, riskfaktorer, yrkessjukdomar, yrkesmässig exponering, kyrkvaktmästare / ABSTRACT Background Part of the company nurse's work is to work proactively and identify different types of problems among workers and employers. Nursing of man should be the focus and target the workplace where a safe and good nursing care is provided (SOU 2011:63). Vibration exposure of hands and concomitant effects represent a significant work related problem with care takers from an exposed profession. Aim The aim of the study was to identify hand and arm symptoms in vibration exposure with care takers and their knowledge of the risks associated with vibration exposure. Method Fifty care takers answered two questionnaires, one about symptoms and one about the work environment and vibration exposure of the hand-held tools and its risks and injuries. The results were presented as descriptive data. Results Sensation of cold (40%), white fingers (38%) and cramp (38%) were the most common symptoms. Symptoms were more common among those who had worked at least ten (10) years in vibration exposed work. They had little knowledge of the risks associated with vibration exposure. None of the care takers had been offered medical examination according to the regulation. Conclusion Symptoms were common among care takers; if medical examinations had been carried out the symptoms would probably have been detected at an earlier stage and meant that their suffering could have been reduced. The medical examinations had also meant that the employer would have taken the safety responsibilities to minimize vibration exposure (AFS 2005:15). An important part of the job of the company nurse is to inform the employer of his responsibility for vibration exposure and the workers about the risks. Keywords: hand-arm vibration, risk factors, occupational diseases, occupational exposure, care takers.