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Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, Murgia N, Naidoo RN, Reynolds CJ, Sigsgaard T, Torén K, Vinnikov D, Redlich CA. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2020; 199:1312-1334. [PMID: 31149852 PMCID: PMC6543721 DOI: 10.1164/rccm.201904-0717st] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.
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Uden L, Barber E, Ford N, Cooke GS. Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infect Dis 2017; 4:ofx137. [PMID: 28875155 PMCID: PMC5575844 DOI: 10.1093/ofid/ofx137] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/24/2017] [Indexed: 01/25/2023] Open
Abstract
Background Tuberculosis (TB) remains a major challenge to global health. Healthcare workers (HCWs) appear to be at increased risk of TB compared with the general population, despite efforts to scale up infection control and reduce nosocomial TB transmission. This review aims to provide an updated estimate of the occupational risk of latent TB infection (LTBI) and active TB among HCWs compared with the general population. Methods A systematic review was performed to identify studies published over the last 10 years reporting TB prevalence or incidence among HCWs and a control group. Pooled effect estimates were calculated to determine the risk of infection. Results Twenty-one studies met the inclusion criteria, providing data on 30961 HCWs across 16 countries. Prevalence of LTBI among HCWs was 37%, and mean incidence rate of active TB was 97/100000 per year. Compared with the general population, the risk of LTBI was greater for HCWs (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.61–3.20), and the incidence rate ratio for active TB was 2.94 (95% CI, 1.67–5.19). Comparing tuberculin skin test and interferon-gamma release assay, OR for LTBI was found to be 1.72 and 5.61, respectively. Conclusions The overall risk of both LTBI and TB to HCWs continues to be significantly higher than that of the general population, consistent with previous findings. This study highlights the continuing need for improvements in infection control and HCW screening programs.
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Affiliation(s)
- Lydia Uden
- Division of Infectious Diseases, Imperial College London
| | - Ella Barber
- Division of Infectious Diseases, Imperial College London.,Manson Unit, Médecins Sans Frontières, London, UK; and
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Graham S Cooke
- Division of Infectious Diseases, Imperial College London
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Pazin-Filho A, de Almeida E, Cirilo LP, Lourençato FM, Baptista LM, Pintyá JP, Capeli RD, Silva SMPFD, Wolf CM, Dinardi MM, Scarpelini S, Damasceno MC. Impact of long-stay beds on the performance of a tertiary hospital in emergencies. Rev Saude Publica 2016; 49:S0034-89102015000100266. [PMID: 26603353 PMCID: PMC4650935 DOI: 10.1590/s0034-8910.2015049006078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/28/2015] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.
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Affiliation(s)
- Antonio Pazin-Filho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Edna de Almeida
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Leni Peres Cirilo
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | - Lisandra Maria Baptista
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José Paulo Pintyá
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Ronaldo Dias Capeli
- Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil
| | | | - Claudia Maria Wolf
- Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil
| | - Marcelo Marcos Dinardi
- Departamento Regional de Saúde XIII, Secretaria de Saúde do Estado de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sandro Scarpelini
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT, Menegueti MG. Selfishness among healthcare workers and nosocomial infections: a causal relationship? Rev Soc Bras Med Trop 2015; 47:407-8. [PMID: 25229277 DOI: 10.1590/0037-8682-0191-2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 01/14/2023] Open
Affiliation(s)
- Fernando Bellissimo-Rodrigues
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Mayra Gonçalves Menegueti
- Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Fernandes LH, Alvarenga CW, Santos LLD, Pazin Filho A. The need to improve health care in prisons. Rev Saude Publica 2014; 48:275-83. [PMID: 24897049 PMCID: PMC4206137 DOI: 10.1590/s0034-8910.2014048004934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze physical structure, working conditions of health professionals and
outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female
prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A
self-applied instrument was developed to collect quantitative data on the
characteristics of health care structure, equipment and personnel in
prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and
Chi-square or Fisher’s tests were used to compare categorical and continuous
variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging.
With respect to the teams, it was observed that a large majority were in
conditions close to those proposed by the Bipartite Commission 2013 but
without improvement being reflected in the indicators. With respect to the
process, more than 60.0% of prisons located in small towns do not have the
structural conditions to ensure secondary or tertiary health care for the
continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and
monitoring future actions for the continuous improvement of healthcare
processes.
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Affiliation(s)
- Luiz Henrique Fernandes
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Carlos Willie Alvarenga
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Luciane Loures dos Santos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Antonio Pazin Filho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Bellissimo-Rodrigues F, Passos ADC, Ruffino-Netto A. Latent tuberculosis: the snake inside the egg. Rev Soc Bras Med Trop 2014; 46:667-8. [PMID: 24474005 DOI: 10.1590/0037-8682-0170-2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/21/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fernando Bellissimo-Rodrigues
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP
| | - Afonso Dinis Costa Passos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP
| | - Antônio Ruffino-Netto
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP
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Adolfi Júnior MS, Pallini FM, Pessotti H, Wolf CM, Patelli HT, Capeli RD, Poli-Neto OB, Neves FF, Scarpelini S, Marques PMDA, Pazin-Filho A. Emergency medical coordination using a web platform: a pilot study. Rev Saude Publica 2011; 44:1063-71. [PMID: 21107504 DOI: 10.1590/s0034-89102010000600011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/26/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe a management system for emergency medical coordination based on the worldwide web of computers. METHODS The emergency coordination system was developed according to an evolving software model for prototype development. Communication between users and the system was implemented by means of web technologies. The system was developed on a personal homepage and the database was developed using MySQL. The prototype was based on the medical coordination process of the Thirteenth Regional Healthcare Division of the State of São Paulo (Southeastern Brazil) and was applied to 26 municipalities within this regional division, for four consecutive weeks in September 2009. The system made it possible to document requests in chronological order, without allowing editing of data already entered, and ensured hierarchical confidential access to the information for each participant in the system. RESULTS The system presented 100% availability, reliability and integrity of information. A total of 1,046 requests were made to the system, of which 703 (68%) were completed. The solicitants already presented 98% adherence to the system in the first week of application, while adherence among service providers gradually increased (37% in the fourth week). The municipalities closest to Ribeirão Preto that did not have high-complexity providers were the ones that most used the system. CONCLUSIONS Medical coordination of emergency requests through the worldwide web of computers was shown to be feasible and reliable, and it enabled transparency within the process and direct access to information for managers. It allowed indicators to be constructed in order to monitor and improve the process, from the perspective of creating semi-automated coordination and advances in system organization.
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Affiliation(s)
- Mário Sérgio Adolfi Júnior
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Conde MB, Melo FAFD, Marques AMC, Cardoso NC, Pinheiro VGF, Dalcin PDTR, Machado Junior A, Lemos ACM, Netto AR, Durovni B, Sant'Anna CC, Lima D, Capone D, Barreira D, Matos ED, Mello FCDQ, David FC, Marsico G, Afiune JB, Silva JRLE, Jamal LF, Telles MADS, Hirata MH, Dalcolmo MP, Rabahi MF, Cailleaux-Cesar M, Palaci M, Morrone N, Guerra RL, Dietze R, Miranda SSD, Cavalcante SC, Nogueira SA, Nonato TSG, Martire T, Galesi VMN, Dettoni VDV. III Brazilian Thoracic Association Guidelines on tuberculosis. J Bras Pneumol 2010; 35:1018-48. [PMID: 19918635 DOI: 10.1590/s1806-37132009001000011] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/25/2009] [Indexed: 11/21/2022] Open
Abstract
New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.
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