In order to investigate the etiology of and evaluate interventions for work-related back injuries, researchers need efficient, accurate occupational exposure assessment methods suitable for large samples. The chapters in this thesis examine critical decisions using electromyography (EMG): How should exposure be measured? For what duration? Who should be measured, and how many times? Low-back EMG, or muscle activity data, was collected during 138 full-shift field measurements over 30 different job titles at 50 different worksites in 5 heavy industries: forestry, transportation, wood products, construction, and warehousing. Observations and self-reports of posture, manual materials handling (MMH), and driving exposures were collected concurrently. 1) Variability of EMG calibration measurements was investigated on right/left sides, multiple trials, 4 positions, and pre/post-shift. Position accounts for the majority of explained variability; there is little to gain by measuring multiple trials or pre- and post-shift, but measuring both sides and multiple positions is worthwhile. 2) Observation and self-report data were easier to collect and cheaper than the EMG direct measure. Costs and successful field performance need to be weighed against the added data detail when making choices about exposure assessment techniques for epidemiological studies. 3) Observed and self-reported exposures were used to predict EMG exposure metrics using mixed multiple linear regression models. Regression models using observed variables predicted 43-50% of the variability in the EMG metrics, while self-reported variables predicted 21%-36%. The observation exposure model provides a low-cost alternative to direct measurement. The self-reported exposure model should be considered with more caution. 4) Full-shift EMG data was resampled for 4, 2, and 1 hour, and for 10 and 2 minute durations to determine the optimal sampling duration. Bias was consistently low, but shorter durations had higher absolute error, percentage error, and limits of agreement. Durations of 4 and 2 hours may be acceptable but those less than 1 hour had large errors. 5) Components of EMG variance were calculated between- and within-subject, and between- industry, company, job, and post hoc grouping. Resolution, contrast, and exposure-response relationship attenuation were calculated for each grouping scheme. The post hoc scheme had the highest contrast and lowest resolution. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Firefighters and asphalt pavers are exposed to polycyclic aromatic hydrocarbons (PAHs) during various work activities. The purpose of this study was to evaluate urinary PAH levels and compare these bio-monitoring levels among firefighters, asphalt pavers, and non-occupationally exposed individuals. The National Institute of Standards and Technology (NIST) urinary PAH levels were used for non-occupationally exposed controls. When compared to the NIST standard for smokers and non-smokers, firefighters demonstrated statistically significant differences in urinary concentration differences for the following metabolites: 2-OH-fluorene, 3-OH-fluorene and 1-OH-pyrene, which were lower in firefighters than the NIST mean for smokers. 1-OH-phenanthrene, 2-OH-phenanthrene and 3-OH-phenanthrene were higher among world trade center exposed firefighters than the NIST mean for smokers. When firefighters were compared to the NIST non-smoker standard, firefighters demonstrated elevated levels in all tested PAH biomarkers due to a mixture of smokers and non-smokers in the firefighter cohort. Asphalt workers had statistically significant higher urinary concentration elevations in 2-OH-fluorene, 1-OH-phenanthrene and 3-OH-phenanthrene as compared to the NIST smoker mean. When asphalt pavers were compared to the NIST non-smoker mean, asphalt pavers had statistically significant increases in all tested PAH biomarkers, with the exception of 2-OH-phenanthrene. While firefighters did not demonstrate a substantial change in urinary PAH metabolite levels compared to control populations of smokers and non-smokers, asphalt pavers experienced concentrations that were in some cases increased by orders of magnitude compared to NIST controls. Future research may be needed to evaluate any potential health risk posted to occupational exposed asphalt pavers.

Les tumeurs germinales du testicule (TGT) représentent le cancer le plus fréquent chez les hommes Européens âgés de 15 et 39 ans. L'incidence a doublé dans la plupart des pays Européens depuis 30 ans. Cette augmentation rapide, les variations géographiques d'incidence et les études chez les populations migrantes suggèrent un rôle des facteurs environnementaux dans le développement des TGT. Cette thèse propose de contribuer à l'amélioration des connaissances concernant l'évolution du TGT en clarifiant l'impact des expositions environnementales et professionnelles, notamment pendant la période prénatale. Les objectifs principaux sont de: 1. Prédire l'incidence du TGT jusqu'en 2025 en estimant la part d'augmentation due aux changements démographiques afin d'obtenir une estimation de l'augmentation due aux risques. 2. Faire un bilan de l'état des connaissances sur l'association entre les expositions environnementales et professionnelles et le développement du TGT dans une revue systématique de littérature 3. Investiguer l'association entre l'exposition parentale professionnelle aux pesticides en période prénatale et le TGT parmi la descendance Les résultats montrent que l'incidence du TGT continue d'augmenter, mettant en avant un fort impact environnemental dans l'évolution du TGT. Néanmoins, la revue de littérature ne permettait pas d'identifier de facteurs de risque environnementaux avérés, mais montrait un manque d'études investiguant les expositions prénatales sur le risque de TGT. L'étude NORD-TEST menée sur les données de registre de quatre pays nordiques est l'étude la plus puissante à ce jour et ne montre aucune association entre l'exposition parentale professionnelle aux pesticides en période prénatale et le TGT / Testicular germ cell tumours (TGCT) are the most common cancer diagnosed among young European men aged between 15 and 39 years. TGCT incidence rates have doubled in most European countries over the last 30 years. This rapid increase in incidence, the geographical variations and the studies in migrant populations suggest a role of environmental factors in TGCT aetiology. This thesis aims to contribute to the knowledge of TGCT evolution by studying the impact of environmental and occupational exposures, especially during the prenatal period. The objectives are: 1. To estimate the proportion of the increased incidence due to overall changes in risk patterns compared to the proportion due to demographic changes, by predicting the future testicular cancer trends in Europe 2. To summarize and evaluate the current knowledge on environmental and occupational exposures related to TGCT risk by means of a systematic literature review 3. To investigate the association between the prenatal parental occupational exposure to pesticides and TGCT risk in the offspring. The results show that the TGCT incidence continues to increase, supporting an environmental impact on TGCT evolution. From the epidemiological literature to date no specific environmental risk factors emerge; however, there have clearly been a lack of studies investigating prenatal exposures on TGCT risk. The NORD-TEST study, based on registry data from four Nordic countries, is the largest study to date. No association was found between parental occupational exposure to pesticides during prenatal period and TGCT risk

A constante exposição à poluição do ar continua acometendo a saúde das populações, resultando num aumento da morbidade e mortalidade decorrente de problemas respiratórios e cardiovasculares. O estudo é transversal, com o objetivo de avaliar as modificações na pressão arterial sistêmica, e pressão de pulso, em indivíduos do gênero masculino, jovens, expostos à poluição do tráfego no município de Santo André, região metropolitana da Grande São Paulo - Brasil. Os níveis horários diários de poluentes do ar obtidos junto a Companhia de Tecnologia de Saneamento Ambiental do Estado de São Paulo (CETESB), as informações sobre temperatura e precipitação foram obtidas junto ao Instituto Nacional de Meteorologia (INMET). Foi realizada a análise descritiva de todas as variáveis do estudo. Foi utilizado o modelo de equação linear, tendo como variáveis dependentes a pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão de pulso (PP), os poluentes do ar como vaiáveis independentes, e como variáveis de controle a temperatura mínima, precipitação, período de trabalho e período do dia. Foram analisados 19 agentes de tráfego do município de Santo André. A média de idade do grupo estudado foi de 42,8 (dp = 5,2) anos, variando entre 32 e 51 anos. Quanto ao IMC, temos que a média do grupo estudado foi de 25,2 (dp = 2,8), variando entre 19,2 e 29,4. Observa-se que para cada aumento de um interquartil no nível de PM10 (34g/m3) a PAS aumenta em 1,35 mmHg (IC95%: 0,40; 2,30), a PAD horária aumenta em 1,35 mmHg (IC95%: 0,57; 2,13), e a PP horária aumenta em 1,35 mmHg (IC95%: 0,40; 2,30) na hora de exposição. Os agentes de tráfego no município de Santo André apresentaram aumento da PAS, PAD e PP com a exposição ao PM10 e do O3. Os agentes de tráfego apresentaram aumentos nos níveis da pressão arterial e pressão de pulso com a exposição a poluição do ar em Santo André / The constant exposition to air pollution continues to cause the populations health problems, and its result an increase of morbidity and mortality by respiratory and cardiovascular diseases. This is a cross-sectional study which aims to assess the modifications in the systemic blood pressure and the pulse pressure in young male individuals, exposed to the traffic pollution in Santo André city, metropolitan region of the Greater São Paulo in Brazil. The hourly daily levels of air pollutants were obtained from the Technology Institute for the Environment and Sanitation of São Paulo State (CETESB), the information by temperature and precipitation was obtained from the National Meteorology Office (INMET). There has been carried out a descriptive analysis of all variables of the study. The linear equation model has been used, having as dependent variables the systolic blood pressure (SBP), the diastolic blood pressure (DBP) and the pulse pressure (PP), the air pollutants as independent variables, and as control variables the minimum temperature, precipitation, working period and day time. A number of 19 traffic agents in Santo André city have been analysed. The average age of the studied group was of 42.8 (sd = 5.2) years old, ranging from 32 to 51 years old. Concerning the BMI, we have got the information that the average of the studied group was of 25.2 (sd = 2.8), ranging from 19.2 to 29.4. It is observed that for an interquartile range increased in PM10 (34g/m3), the SBP increases in 1.35 mmHg (CI95%: 0.40; 2.30), the DBP increases in 1.35 mmHg (CI95%: 0.57; 2.13), and the PP increases in 1.35 mmHg (CI95%: 0.40; 2.30) at the exposure time. The traffic agents in Santo André city presented increase of SBP, DBP and PP with the exposure to PM10 and to O3. The traffic agents from Santo André presented higher arterial blood pressure and pulse pressure levels associated with the air pollution exposure in Santo André city

Objetivo: Determinar la asociación entre el nivel de conocimientos y actitudes sobre accidentes ocupacionales en prácticas clínicas de alumnos de odontología de una clínica universitaria de Lima - Perú. Materiales y Métodos: Se evaluaron a 156 alumnos de la carrera de Odontología. El nivel de conocimientos y actitudes fueron evaluados mediante una encuesta adaptada de 24 preguntas. Además a ello, se evaluaron otras variables como el tipo de exposición, material punzocortante, especialidad clínica, entre otros, mediante un cuestionario de autoreporte adaptado. Ambas encuestas fueron revisadas y aprobadas por expertos en la materia. Se calcularon proporciones para las variables cualitativas y medidas de tendencia central (mediana) para la variable edad. De la misma manera se usaron: la Prueba de Chi-Cuadrado y Umann Whitney, para la asociación de variables. Resultados: El 78,2% de los participantes tuvo conocimiento alto frente al manejo de accidentes ocupacionales; de la misma manera, 72,4% manifestó actitud positiva. No se encontró asociación estadísticamente significativa (p>0,05) entre las variables conocimientos y actitud. Por otro lado, el 69,1% de los alumnos sufrió al menos un accidente ocupacional durante sus prácticas clínicas, en su mayoría causado por un material punzocortante, predominando el explorador con 65,1%. Conclusiones: No se encontró asociación entre las variables conocimiento y actitud, sin embargo, una gran cantidad de alumnos sufre este tipo de exposiciones, por lo que se recomienda una educación más efectiva sobre prevención y manejo de accidentes ocupacionales. / Objective: To determine the association between the level of knowledge, and attitude towards post exposure management of occupational accidents in the clinical practice of dental students at a university clinic in Lima - Peru. Materials and Methods: 156 dentistry students were evaluated. The students’ level of knowledge and attitude to post exposure management of occupational accidents were evaluated through an adapted survey of 24 questions. In addition, information on occupational accidents such as the type of exposure, involvement of sharp materials, and type of procedure was gathered via a self-reported questionnaire. Both surveys were reviewed and approved by subject matter experts. Absolute frequencies were calculated for the qualitative variables and central tendency measures (median) were calculated for quantitative variables. The Chi-Square test and Mann-Whitney U test were used to test for statistical significance in the association of variables. Results: 78,2% of the participants had a high knowledge of occupational accident management; and 72,4% demonstrated a positive attitude towards accident management. No statistically significant association (p> 0.05) was found between knowledge and attitude. 69,1% of the students suffered at least one occupational accident during their clinical practice and most involved sharp materials. The explorer was involved in 65,1% of exposures. Conclusions: No association was found between knowledge and attitude towards accident management. However, a great number of students have suffered from occupational accidents resulting in hazardous exposure, so a more effective education on prevention and management of occupational accidents is recommended. / Tesis

Problemställning och syfte: Bromerade flamskyddsmedel (BFR) används i många varor och produkter. Polybromerade difenyletrar (PBDEs) är en av dessa och deras kemiska struktur liknar den i miljögiftet PCB och kan på samma sätt lagras upp i miljön samt skada människor och djur. På arbetsplatser där BFR förekommer riskerar medarbetarna att exponeras. I den här studien har olika BFR undersökts i samband med servicearbete på flygplan. Målet har varit att jämföra förekomsten i damm och luft, samt blod (serum) med resultat från tidi­gare studier. Metod: Damm- och luftprovtagning har genomförts vid olika faser av service­arbetet. Proverna har analyserats med avseende på olika typer av BRF. Dess­utom har medarbetarnas upptag av BRF via blodprov (serum) undersökts. Resultat: Undersökningen har visat att samtliga former av PBDE samt övriga BFR förekommer i höga koncentrationer i damm och luft i flygplanen, men med ojämn fördelning. Analyserna av serum visade att flygmekanikerna har förhöjda nivåer jämfört med svensk allmänhet och jämförbar nivå med högexponerade yrkesgrupper. Medarbetarnas ålder, år i yrke och arbetad tid i flygplan den senaste månaden uppvisade inget samband i förhållande till PBDE i serum. Slutsats: Koncentrationerna av BFR i damm och luft är högre än i de flesta andra miljöer och koncentrationerna i serum är högre än de flesta referens­gruppers. För att minska risken för exponering behöver insatserna för att mini­mera dammet via städning förbättras. Dessutom bör informationen gällande hygien och användning av personlig skyddsutrustning repeteras för medarbe­tarna. Samtliga yrkeshygieniska åtgärder bör fastställas och hanteras i det systematiska arbetsmiljöarbetet via rutiner och handlingsplaner. / Presentation and aim: Brominated flame retardants (BFRs) are used in many materials and products. Polybrominated diphenyl ethers (PBDEs) are the most well known and because of their structures, similar to that of PCB, they have been proposed to possibly affect health and environment. Occupational exposure has been an issue for years and this study investigated BRF in aircraft mainte­nance. The aim of this study was to assess the presence and levels of BRFs in dust, air and blood (serum) and compare the results with different references. Method: Dust and air were sampled in different phases of the work with the air­craft and analysis of a spectrum of BFR was performed. In addition, serum from employees was sampled and analyzed for the presence of PBDEs. Result: PBDEs and other BFRs were found in dust and air samples at high con­centrations. Serum concentrations in the technicians were slightly higher to those observed in the general Swedish population and in the same magnitude as some highly exposed occupational references. Years of work, age or time spent in the aircraft before giving blood seems not to have an impact on the level of BFRs in serum. Conclusion: This study shows high concentrations of BFR in dust and air in the aircraft and the concentrations of PBDEs in serum were high compared to most reference groups. To minimize the risk for exposure, it is important to focus on industrial hygiene improvements to minimize the amount of dust in working areas. The personal hygiene and use of personal safety equipment can also be improved and the routines should be described and included in the appropriate documentation regarding work environment.

Problématique. Le tabagisme est le facteur de risque le plus important de cancer du poumon, cependant, d'autres facteurs comme les combinaisons de prédispositions génétiques, d'expositions environnementales et d'autres facteurs liés au mode de vie peuvent également contribuer au risque. Cette étude vise à déterminer les associations entre les expositions professionnelles courantes et le risque de cancer du poumon. Méthodes. Une étude cas-cohorte nichée dans l'étude CARTaGENE a été utilisée. Les cas comprenaient tous les participants avec un diagnostic incident de cancer du poumon de 2009 à 2016 (n= 147). Au départ, une sous-cohorte de 1 032 individus a été échantillonnée. La matrice d'exposition professionnelle du Canada (CANJEM) a été utilisée pour déterminer les expositions professionnelles de l’emploi occupé le plus longtemps par les participants. Vingt-huit agents avec ≥ 5 cas exposés ont été retenus pour les analyses. Différents modèles de régression logistique multivariée avec des estimateurs de variance robuste ont été utilisés pour estimer les ratios des côtes (RC) et les intervalles de confiance (IC) à 95% pour les associations entre chaque agent et le risque de cancer du poumon tout en contrôlant pour les facteurs de risque établis. Résultats. Un risque accru de cancer du poumon a été observé chez les personnes exposées aux cendres (RC = 4.42; IC 95%: 1.75-11.15), au sulfate de calcium (RC = 4.13; IC 95%: 1.20-14.20), au chlorure d'hydrogène (RC = 3.79; 95% IC: 1.07-13.41), au formaldéhyde (RC = 3.73; IC 95%: 1.51-9.19), aux fumées de cuisson (RC = 2.92; IC 95%: 1.33-6.42), aux alcanes (RC = 4.33; IC 95%: 1.41-13.29), aux aldéhydes aliphatiques (RC = 3.94; IC 95%: 1.41-10.98) et aux agents de nettoyage (RC = 2.60; IC 95%: 1.50-4.52). Une diminution de l'incidence du cancer du poumon a été observée chez les participants exposés au monoxyde de carbone (RC = 0.29; IC 95%: 0.12-0.74) et aux hydrocarbures aromatiques polycycliques de pétrole (RC = 0.18; IC 95%: 0.05-0.60). Conclusion. Nos résultats soutiennent le rôle de plusieurs agents professionnels, pour lesquels nous avons des connaissances limitées, dans la contribution au risque de cancer du poumon. / Background. Smoking is the strongest risk factor for lung cancer; however, other factors like the combinations of genetic predisposition, environmental exposures, and other lifestyle factors may also contribute to risk. This study aims to determine associations between prevalent occupational exposures and lung cancer risk. Methods. A case-cohort design was nested within the CARTaGENE study. Cases included all participants with an incident diagnosis of lung cancer from 2009-2016 (n=147). A sub-cohort of 1,032 individuals was sampled at baseline. The Canadian Job Exposure Matrix was used to determine occupational exposures in participants’ longest-held job. Twenty-eight agents with ≥5 exposed cases were retained for analysis. Separate multivariable logistic regression models with robust variance estimators were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between each agent and lung cancer risk while controlling for established risk factors. Results. Increased lung cancer risk was found among those exposed to ashes (OR=4.42; 95% CI: 1.75-11.15), calcium sulfate (OR=4.13; 95% CI: 1.20-14.20), hydrogen chloride (OR=3.79; 95% CI: 1.07-13.41), formaldehyde (OR=3.73; 95% CI: 1.51-9.19), cooking fumes (OR=2.92; 95% CI: 1.33-6.42), alkanes (OR=4.33; 95% CI:1.41-13.29), aliphatic aldehydes (OR=3.94; 95% CI: 1.41-10.98), and cleaning agents (OR=2.60; 95% CI: 1.50-4.52). A decrease in lung cancer incidence was found among participants exposed to carbon monoxide (OR=0.29; 95% CI:0.12-0.74) and polycyclic aromatic hydrocarbons from petroleum (OR=0.18; 95% CI: 0.05-0.60). Conclusion. Our findings support the role of several occupational agents, for which we have limited knowledge, in contributing to lung cancer risk.

Thèse en cotutelle internationale (Université Paris-Saclay) / Thesis completed under international cotutelle (Université Paris-Saclay) / CONTEXTE : Des résultats issus d'études sur les migrants suggèrent que les facteurs de risque environnementaux peuvent jouer un rôle dans la pathogenèse du cancer du sein, de l'ovaire et du poumon. Néanmoins, le rôle de ces facteurs dans l’étiologie de ces cancers reste mal connu. Les facteurs de risque professionnels chez les femmes ont été relativement peu étudiés malgré la proportion importante de la main-d'œuvre féminine à travers le monde. Peu d'études ont en effet examiné les professions fréquentes chez les femmes et les risques professionnels liés aux cancers féminins. OBJECTIFS : Etudier les associations entre 1) la profession, les expositions professionnelles et le cancer de l'ovaire, 2) les expositions professionnelles et le cancer du sein, et 3) la profession, les expositions professionnelles et le cancer du poumon. METHODES : Les données de trois études cas-témoins réalisées en population générale chez des femmes au Canada et en France qui disposaient d’informations sur l'historique professionnel ont été utilisées : l'étude PROVAQ sur le cancer de l'ovaire (491 cas, 897 témoins), l'étude CECILE sur le cancer du sein (1 206 cas, 1 294 témoins) et l'étude WELCA sur le cancer du poumon (731 cas, 751 témoins). Dans ces trois études, un hygiéniste industriel a codé la profession de chaque emploi de chaque participante. Les codes de profession ont été croisés avec une matrice emplois-expositions canadienne afin d’estimer les expositions professionnelles aux agents les plus répandus. La relation entre l'exposition à chacun des agents et le risque de cancer a été évaluée : 29 agents pour le cancer de l'ovaire, 49 agents pour le cancer du sein et 41 agents pour le cancer du poumon. Pour les cancers de l'ovaire et du poumon, les risques associés aux professions les plus fréquemment rencontrées ont également été étudiés. Les associations avec le risque de cancer pour les professions et les expositions professionnelles ont été estimées par régression logistique et en ajustant pour des facteurs de confusion, identifiés à l'aide de graphes acycliques dirigés. RESULTATS : Des risques accrus de cancer de l'ovaire ont été suggérés pour les professions dans le domaine de la comptabilité, de la vente, de la coiffure et de la couture, ainsi que pour les expositions aux agents chimiques utilisés dans les métiers de la coiffure. Pour le cancer du sein, les expositions professionnelles aux poussières de fibres textiles, aux solvants organiques, aux hydrocarbures aromatiques polycycliques, aux poussières de plastique et aux fumées de pyrolyse, étaient associées à des augmentations du risque. Les odds ratios différaient selon les sous-types de cancer du sein et en fonction du statut ménopausique pour certains agents. Pour le cancer du poumon, des odds ratios élevés ont été observés dans les métiers de l'enseignement, les professions libérales, chez les cols-blancs, la vente et les services. Des associations étaient également observées avec de nombreuses expositions professionnelles, en cohérence avec des études antérieures chez les femmes, telles que les fumées de cuisson, le formaldéhyde, les solvants organiques, les hydrocarbures aromatiques polycycliques, les métaux et les peintures/vernis. Les risques de cancer du poumon pour certains agents semblaient différer selon le statut tabagique. CONCLUSIONS : Certaines professions et expositions professionnelles peuvent être associées à des risques accrus de cancer de l'ovaire, du sein et du poumon chez les femmes. Du fait de la nature exploratoire du travail, d'autres recherches chez des femmes en population générale doivent être menées afin de confirmer ces résultats. Des études portant sur des échantillons plus importants et l’évaluation des expositions par experts, permettant d’utiliser des méthodes statiques avancées, pourraient être utiles pour identifier le rôle spécifique de certaines expositions professionnelles dans le risque de cancer. / BACKGROUND: Evidence from migrant studies suggests that environmental risk factors may play a role in the pathogenesis of breast, ovarian, and lung cancers, yet the etiology of these cancers remains poorly understood. Women account for a significant proportion of the labour force worldwide, yet research on occupational hazards of female workers is limited. Few studies have examined occupations common to women and occupational risks in relation to female cancers. OBJECTIVES: The specific objectives of the thesis were: 1) to study the association between occupation, occupational exposures and ovarian cancer, 2) to study the association between occupational exposures and breast cancer, and 3) to study the association between occupation, occupational exposures and lung cancer in women. METHODS: Data from three population-based case-control studies on women in Canada and France that collected occupational history information was used to achieve the objectives: the PROVAQ study on ovarian cancer (491 cases, 897 controls), the CECILE study on breast cancer (1,206 cases, 1,294 controls), and the WELCA study on lung cancer (731 cases, 751 controls). In all three studies, an industrial hygienist coded the occupation of each participant’s job. Job codes were linked to the Canadian job-exposure matrix, thereby generating exposure estimates for many agents. The relationship between exposure to each of the most prevalent agents and cancer risk was assessed, specifically 29 agents for ovarian cancer, 49 agents for breast cancer, and 41 agents for lung cancer. For ovarian and lung cancers, prevalent occupations were additionally examined by comparing participants employed in an occupation for <10 years and ≥10 years vs. never employed in the occupation. Associations with cancer risk for occupations and occupational exposures were estimated using logistic regression and adjusting for minimally sufficient confounder sets, identified using directed acyclic graphs. RESULTS: Excess ovarian cancer risks were suggested for accountancy, sales, hairdressing, and sewing occupations, and for occupational exposure to agents linked to hairdressing-related occupations. Interpretations of results for single agents were limited due to multiple correlated exposures. For breast cancer, occupational exposure to agents, particularly textile fibre dusts, organic solvents, polycyclic aromatic hydrocarbons, plastic dusts and pyrolysis fumes, were potentially associated with increased risks. Relative risks were suggested to differ among breast cancer subtypes and according to menopausal status for some agents. For lung cancer, elevated odds ratios were observed for teaching, professional, white-collar, sales, and service occupations, and for numerous occupational exposures, some of which were consistent with previous studies in women, such as cooking fumes, formaldehyde, organic solvents, polycyclic aromatic hydrocarbons, metals, and paints/varnishes. Lung cancer risks for some agents were suggested to differ by smoking status. CONCLUSIONS: Certain occupations and occupational exposures may be associated with excess ovarian, breast, and lung cancer risks in women. As many odds ratios observed were imprecise, further population-based research on women is warranted to replicate findings. Studies with larger sample sizes and expert assessment information that can perform more advanced statistical methods accounting for multiple exposures may be useful in disentangling the effects of correlated agents in the estimation of cancer risk.

En cirugía abierta, piel y el tejido se cortan lograr tener proximidad a un órgano o estructura, extirpar la lesión y mantener intacta a través de una barrera protectora. Los guantes pueden reducir el peligro de exhibición del personal de la salud durante la cirugía abierta a microorganismos patógenos, como el virus de la inmunodeficiencia humana (VIH) y los virus de la hepatitis, que pacientes portadores pueden transmitir a los trabajadores de la salud. Sin embargo, las perforaciones en los guantes son bastante comunes. El propósito de este análisis secundario es verificar si da seguridad el uso de dos guantes al equipo médico durante varios procedimientos quirúrgicos. El método utilizado es la enfermería basada en la evidencia; la pregunta de investigación fue: ¿es efectivo el uso del doble guante para el equipo médico en quirófano? Se buscó información en las siguientes bases de datos: Biblioteca Virtual en Salud, PUBMED y ELSEIVER, se encontraron 359 artículos de revistas, donde solo 13 fueron escogidos, todos estos artículos fueron remitidos a Gálvez. Toro Finalmente, el artículo fue seleccionado y analizado utilizando las guías PRISMA, por tratarse de un tipo de estudio científico. Para cuestiones clínicas, verificar que usar dos guantes tiene mayor efectividad que uno solo, siempre dependiendo de la especialidad y el tiempo de la cirugía. / In open surgery, skin and tissue are cut to achieve proximity to an organ or structure, excising the lesion and keeping it intact through a protective barrier. Gloves can reduce the danger of exposure of healthcare personnel during open surgery to pathogenic microorganisms, such as the human immunodeficiency virus (HIV) and hepatitis viruses, which patient carriers can transmit to healthcare workers. However, glove perforations are quite common. The purpose of this secondary analysis is to verify whether it is safe for the medical team to wear two gloves during various surgical procedures. The method used is evidence-based nursing; The research question was: is the use of double gloves effective for the medical team in the operating room? Information was searched in the following databases: Virtual Health Library, PUBMED and ELSEIVER, 359 journal articles were found, where only 13 were chosen, all these articles were sent to Gálvez. Bull Finally, the article was selected and analyzed using the PRISMA guidelines, as it is a type of scientific study. For clinical issues, verify that using two gloves is more effective than one, always depending on the specialty and the time of surgery.

Bakgrund: Kirurgisk rök förekommer dagligen i operationsmiljön och utgör hälsorisker för alla i rummet. Skyddsaspekter innefattar specialbyggda ventilationssystem, rökevakueringssystem, personlig skyddsutrustning, riktlinjer, utbildning och rutiner. Operationssjuksköterskors medvetenhet samt attityder kring risker samt skyddsaspekter är bristande. Studier med svenska operationssjuksköterskors perspektiv är begränsade. Syfte: Att undersöka operationssjuksköterskors medvetenhet och attityder kring hälsorisker samt riskhantering i samband med arbete som involverar kirurgisk rök. Metod: Studien genomfördes som en explorativ kvalitativ studie med en induktiv ansats. Fyra semistrukturerade fokusgruppsintervjuer genomfördes med totalt 12 deltagare från fyra olika sjukhus i södra Sverige. Resultat: Hos operationssjuksköterskorna fanns det en medvetenhet om hälsorisker samt riskhantering men med uttryckta kunskapsluckor. Detta speglades av attityder såsom förnekelse, likgiltighet, oro och ambivalens hos operationssjuksköterskorna. Kunskapsluckor innefattade bland annat saknad kännedom om skriftliga rutiner, risker för patienten, munskyddens ineffektivitet och sambandet mellan lukt och kirurgisk rök. Det uttrycktes då behov om ett större ansvarstagande och initiativ från nyckelpersoner hos operationssjuksköterskorna, andra professioner i operationssalen, arbetsgivare, produktleverantörer samt utbildningssamordnare på universiteten. Slutsats: En symbiosliknande relation mellan operationssjuksköterskornas medvetenhet, attityd och kunskap identifierades. Operationssjuksköterskornas medvetenhet och uttryckta kunskaper inom ämnet var beroende av deras attityd i vissa avseenden och vice versa. Det fanns en tydlig lucka i deras kunskaper och brist i motivation samtidigt som det fanns en vilja och intresse om att kunskaperna ska säkerställas och utvecklas genom kollektivt arbete. Studien visar att rutiner bär mycket vikt för hur väl riskhanteringar följs. Mer forskning och samarbete mellan olika parter behövs för säkerställandet av hälsa för alla i operationsrummet. / Background: Surgical smoke occurs daily in the operating theatre and poses health risks for everyone involved. Safety aspects include ventilation systems, smoke evacuation systems, personal protective equipment, guidelines, and education. Studies with the perspective of Swedish operating theatre nurses’ awareness and attitudes regarding risks and protection aspects are limited. Aim: To examine operating theatre nurses' awareness and attitudes towards health risks and risk management related to work involving surgical smoke. Method: The study was conducted as an exploratory qualitative study with an inductive approach. This was done through four semi-structured focus group interviews with a total of 12 participants from four different hospitals in southern Sweden. Results: There was an awareness of health risks and risk management, but with expressed gaps in knowledge. This was reflected by attitudes such as denial, indifference, concern, and ambivalence. Knowledge gaps included written routines, risks for the patient, the ineffectiveness of surgical masks and the connection between odor and surgical smoke. There was a need for responsibility from key personnel in the surgical nursing profession, other professions in the operating theatre, employers, product suppliers and coordinators at the universities. Conclusion: A relationship between surgical nurses' awareness, attitude and knowledge was identified. The surgical nurses' awareness and expressed knowledge was dependent on their attitudes in certain aspects and vice versa. The study shows that routines carry a lot of weight for how well risk management is followed. Further studies and collaboration between different parties is needed to ensure the health of everyone in the operating theatre.