RESUMEN
AIMS: Interventional cardiologists are amongst the most intensive radiation users within medicine. To assess the implications of this usage, the "Women In Innovation" Group (WIN) created a web-based survey called "WIN for Safety" distributed through the European Association of Percutaneous Coronary Intervention (EAPCI) to all catheterisation laboratory healthcare professionals, enquiring about radiation protection measures, compliance with monitoring, health (orthopaedic issues), radiation-associated problems (cataracts and cancer) and restrictions imposed upon the pregnant female. METHODS AND RESULTS: In total, there were 615 participants: 72.8% were interventional cardiologists. Most (73.5%) of them were male and 63.3% were aged 31-50 years. A radiation collar badge was used by the majority (64.4%) and the most frequently utilised protective measure was the thyroid shield (87.2%). Potential illnesses related to radiation exposure included 19.5% orthopaedic problems (back/neck/hip pain), 5.5% varicose veins, 2.4% blood count problems and 2.0% cataracts. Notably, an association between orthopaedic problems and years of exposure was found (p=0.001). Overall, only 2.2% had ever been diagnosed with a cancer, with a trend for more females to be affected (4.4% vs. 1.8%; p=0.067). Finally, 62.1% have restrictions imposed upon the pregnant female in the working environment. CONCLUSIONS: Awareness of radiation in the field of interventional cardiology is essential. The main risk is orthopaedic problems and measures should be taken for prevention. Cancer has not been demonstrated to be a direct consequence; however, we should remain vigilant and monitor individuals.
Asunto(s)
Enfermedades Profesionales/etiología , Exposición Profesional , Salud Laboral , Intervención Coronaria Percutánea/efectos adversos , Dosis de Radiación , Traumatismos por Radiación/etiología , Radiografía Intervencional/efectos adversos , Adulto , Actitud del Personal de Salud , Concienciación , Distribución de Chi-Cuadrado , Relación Dosis-Respuesta en la Radiación , Femenino , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Internet , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/prevención & control , Exposición Profesional/prevención & control , Exposición Profesional/normas , Salud Laboral/normas , Intervención Coronaria Percutánea/normas , Guías de Práctica Clínica como Asunto , Embarazo , Traumatismos por Radiación/prevención & control , Protección Radiológica , Radiografía Intervencional/normas , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
OBJECTIVES: To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control. DESIGN: Secondary data analysis from a randomized two-by-two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. SETTING: Eleven Veterans Affairs Medical Centers. PARTICIPANTS: Ninety-nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care. MEASUREMENTS: Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission. RESULTS: Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care. CONCLUSION: Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.
Asunto(s)
Analgésicos/uso terapéutico , Neoplasias/complicaciones , Manejo del Dolor , Dolor/tratamiento farmacológico , Dolor/etiología , Anciano , Consultores , HumanosRESUMEN
Currently, there is a need to reduce the occupational exposure of health care workers to anticancer drugs. Environmental contamination by anticancer drugs and subsequent exposure of health care workers are associated with vaporization of anticancer drugs. Furthermore, carcinomatous unpleasant odor is an additional problem to vaporized anticancer drugs in the field of clinical cancer therapy. We attempted to degrade vaporized anticancer drug and unpleasant odor using a photocatalyst. Cyclophosphamide or unpleasant odors (ammonia, formaldehyde, isovaleric acid, and butyric acid) were vaporized by heating in a closed chamber. Plates of photocatalyst coated with titanium dioxide were placed into the chamber and irradiated by light source. Vaporized cyclophosphamide in the chamber was recovered by bubbling the internal air through acetone and derivatized by trifluoroacetic anhydride for analysis by gas chromatographic-mass spectrometric assay. Vaporized odors were determined using a gas-detector tube, which changed color depending on the concentration. Following activation of the photocatalyst by a light source, the residual amounts of anticancer drug and unpleasant odor components were significantly decreased compared with when the photocatalyst was not activated without a light source. These results indicate that the photocatalysts can accelerate the degradation of vaporized anticancer drugs and odor components. Air-cleaning equipment using a photocatalyst is expected to be useful in improving the QOL of cancer patients experiencing carcinomatous unpleasant odor, and in reducing occupational exposure of health care workers to anticancer drugs.
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Antineoplásicos , Contaminación Ambiental/prevención & control , Luz , Odorantes , Ciclofosfamida/análisis , Exposición Profesional/prevención & control , Fotoquímica , Titanio , VolatilizaciónRESUMEN
Most antitumour therapies damage tumour cell DNA either directly or indirectly. Without repair, damage can result in genetic instability and eventually cancer. The strong association between the lack of DNA damage repair, mutations and cancer is dramatically demonstrated by a number of cancer-prone human syndromes, such as xeroderma pigmentosum, ataxia-telangiectasia and Fanconi anemia. Notably, DNA damage responses, and particularly DNA repair, influence the outcome of therapy. Because DNA repair normally excises lethal DNA lesions, it is intuitive that efficient repair will contribute to intrinsic drug resistance. Unexpectedly, a paradoxical relationship between DNA mismatch repair and drug sensitivity has been revealed by model studies in cell lines. This suggests that connections between DNA repair mechanism efficiency and tumour therapy might be more complex. Here, we review the evidence for the contribution of carcinogenic properties of several drugs as well as of alterations in specific mechanisms involved in drug-induced DNA damage response and repair in the pathogenesis of therapy-related cancers.
Asunto(s)
Antineoplásicos/efectos adversos , Daño del ADN , Reparación del ADN , Leucemia/tratamiento farmacológico , Neoplasias Primarias Secundarias/inducido químicamente , Humanos , Exposición ProfesionalRESUMEN
BACKGROUND: In view of the evidence of cytotoxicity of chemotherapic antineoplastic drugs (AD), current guidelines recommend the evaluation of the health risks of hospital personnel exposed to these compounds. Biological monitoring is the main tool to evaluate all possible drug intake and measure workers' real risk. OBJECTIVES: The aim of this study was to assess occupational exposure toAD in a large hospital in Northern Italy in order to verify the effectiveness of the structural and procedural improvements carried out over the last decade. METHODS: Three biological monitoring campaigns were performed using LC-MS/MS analysis of cyclophosphamide (CP) and metotrexate (MTX) as biomarkers of internal dose in the urine of hospital workers. In the first two campaigns, 50 and 81 workers respectively were monitored during AD preparation operations. The last campaign, concerning AD administration activity, was performed after a centralized preparation unit had been set up. Two environmental monitoring campaigns were carried out as well, to complete AD exposure assessment. RESULTS: During the first monitoring campaign we found positive urinary samples in all the wards studied (total positivity 36%), whereas in the second campaign 11% of the samples were positive and four departments showed negative results in all urine samples. The last campaign showed all urinary CP and MTX levels below the detection limit of the analytical method CONCLUSION: Exposure of oncology ward nurses considerably decreased due to the centralization of AD preparation operations together with training and education of workers. The last biological monitoring results were reassuring; nevertheless, surface contamination still occurred and safety measures should be further improved in order to achieve the lowest reasonably possible contamination levels.
Asunto(s)
Antineoplásicos/orina , Ciclofosfamida/orina , Monitoreo del Ambiente , Promoción de la Salud/estadística & datos numéricos , Metotrexato/orina , Exposición Profesional/análisis , Personal de Hospital , Adulto , Antineoplásicos/farmacocinética , Ciclofosfamida/farmacocinética , Femenino , Humanos , Exposición por Inhalación/análisis , Exposición por Inhalación/prevención & control , Italia , Masculino , Metotrexato/farmacocinética , Persona de Mediana Edad , Personal de Enfermería en Hospital , Exposición Profesional/prevención & control , Servicio de Oncología en Hospital/estadística & datos numéricos , Habitaciones de Pacientes/estadística & datos numéricos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Equipos de Seguridad/estadística & datos numéricos , Medición de Riesgo , Absorción Cutánea , Adulto JovenRESUMEN
BACKGROUND: Physical activity has been identified as protective factor for invasive breast cancer risk, whereas comparable studies on in situ carcinoma are rare. METHODS: The study included data from 283,827 women of the multinational European Prospective Investigation into C7ancer and Nutrition (EPIC)-cohort study. Detailed information on different types of physical activity conducted during the prior year, such as occupational, recreational, and household activity, as well as on important cofactors, was assessed at baseline. Adjusted HRs for in situ breast cancer were estimated by Cox proportional hazards models. RESULTS: During a median follow-up period of 11.7 years, 1,059 incidents of breast carcinoma in situ were identified. In crude and adjusted multivariable models, no associations were found for occupational, household, and recreational physical activity. Furthermore, total physical activity was not associated with risk of in situ breast cancer. Comparing moderately inactive, moderately active, and active participants with inactive study participants resulted in adjusted HRs of 0.99 [95% confidence interval (CI), 0.83-1.19], 0.99 (95% CI, 0.82-1.20), and 1.07 (95% CI, 0.81-1.40), respectively (P value of trend test: 0.788). No inverse associations were found in any substrata defined by age at diagnosis or body mass index (BMI) status. CONCLUSIONS: In this large prospective study, we did not find any evidence of an association between physical activity and in situ breast cancer risk. If not by chance, the contrast between our results for carcinoma in situ and the recognized inverse association for invasive breast cancer suggests that physical activity may have stronger effects on proliferation and late stage carcinogenesis.
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Neoplasias de la Mama/epidemiología , Carcinoma in Situ/epidemiología , Actividad Motora , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/prevención & control , Carcinoma in Situ/prevención & control , Estudios de Cohortes , Europa (Continente)/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care.
Asunto(s)
Atención Integral de Salud , Prestación Integrada de Atención de Salud/métodos , Neoplasias/terapia , Cuidados Paliativos/métodos , Agotamiento Profesional , Competencia Clínica , Atención Integral de Salud/métodos , Educación Médica Continua , Empatía/fisiología , Desamparo Adquirido , HumanosRESUMEN
Sinonasal cancers are rare and are often associated with occupational exposure that should be researched. Their diagnosis is often delayed. Carcinomas are the most common histological variety. The aim of the present report is to review the main scientific literature about sinonasal cancer to identify their clinicopathological features, and their main causes and treatment modalities. The treatment of these tumors is surgical, usually followed by radiotherapy.
Asunto(s)
Cavidad Nasal , Neoplasias Nasales , Enfermedades Raras , Adenocarcinoma/etiología , Adenocarcinoma/patología , Adenocarcinoma/terapia , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Cavidad Nasal/patología , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/etiología , Neoplasias Nasales/patología , Neoplasias Nasales/terapia , Exposición Profesional/efectos adversos , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/etiología , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/terapia , Enfermedades Raras/diagnóstico , Enfermedades Raras/etiología , Enfermedades Raras/patología , Enfermedades Raras/terapia , Factores de RiesgoRESUMEN
BACKGROUND: Asbestos is an industrial mineral that can cause diseases such as asbestosis, lung cancer, and mesothelioma. Asbestos consumption in China has increased steadily since the 1960s and is currently at half a million tonnes per year. Work conditions in the asbestos-related industries are poor and exposure levels frequently exceed the occupational exposure limit. OBJECTIVE: To provide an updated overview on asbestos production and consumption in China and discuss what is known about the resulting burden of asbestos-related diseases. FINDINGS: China is the world's top chrysotile consumer and second largest producer. Over a million people may be occupationally exposed, yet reliable disease statistics are unavailable and the national burden of asbestos-related disease (ARD) is not well known. Nevertheless, ARD prevalence, incidence, and mortality are expected to be high and will increase for many decades due to the volume of asbestos consumed historically, and a long latency period. CONCLUSIONS: Government policies to prevent ARD have been implemented but more actions are necessary to ensure compliance and ultimately, the complete elimination of asbestos to prevent a heavy future disease burden.
Asunto(s)
Amianto/toxicidad , Asbestosis/epidemiología , Neoplasias Pulmonares/epidemiología , Mesotelioma/epidemiología , Exposición Profesional , Asbestosis/etiología , Asbestosis/mortalidad , Asbestosis/prevención & control , China/epidemiología , Humanos , Incidencia , Industrias , Neoplasias Pulmonares/inducido químicamente , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/prevención & control , Mesotelioma/etiología , Mesotelioma/mortalidad , Mesotelioma/prevención & control , PrevalenciaRESUMEN
Chronic exposure to UV light is the most important etiological factor for the occurrence of malignant skin tumors. Light-skinned persons who for professional reasons or in leisure activities are exposed to sunlight without sun protection for long periods of time are particularly at risk. This article gives a summary of the histopathology of malignant skin tumors caused by UV light.
Asunto(s)
Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/patología , Enfermedades Profesionales/etiología , Enfermedades Profesionales/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/etiología , Rayos Ultravioleta/efectos adversos , Humanos , Exposición Profesional/efectos adversos , Piel/patología , Neoplasias Cutáneas/prevención & controlRESUMEN
La incidencia más alta de hepatitis A y B ocurre en adultos. Antes de la disponibilidad de la vacuna frente a la hepatitis B la infección por VHB era la enfermedad profesional más frecuente entre personas expuestas a la sangre. Tras la vacunación rutinaria de los trabajadores ha pasado a ser un evento raro en estos colectivos. La hepatitis A es la hepatitis viral más frecuente en España y también es uno de los riesgos más frecuentes en viajeros internacionales. La vacuna frente a la hepatitis B ha sido la primera vacuna producida por tecnología de DNA recombinante, y es también la primera vacuna con efectividad probada en la prevención de un cáncer. Ambas vacunas inactivas son seguras, altamente inmunógenas y efectivas en la prevención de la enfermedad. Adicionalmente, las personas vacunadas permanecen protegidas a largo plazo. La disponibilidad de una vacuna combinada optimiza la vacunación de trabajadores que necesitan protección frente a ambos virus (AU)
The highest incidence of hepatitis A and B are among adults. Before hepatitis B vaccination HBV infection was recognized as a common occupational hazard among persons exposed to blood. After routine hepatitis B vaccination of workers, HBV infection is a rare event in these populations. Hepatitis A is the most frequent viral hepatitis in Spain and it's one of the most frequent risk of international travelers too. Hepatitis B vaccine has been the first one which has proven effectiveness in prevention of a cancer. Both inactivated vaccines are safety and highly immunogenic and vaccines effectiveness has been proved. In addition, vaccinated people remain protected against infection in the long term. The availability of a combination vaccine optimizes the vaccination of workers who need protection against both viruses (AU)
Asunto(s)
Humanos , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/prevención & control , Hepatitis B/prevención & control , Vacunas Combinadas/administración & dosificación , Salud LaboralRESUMEN
NIOSH has updated its latest list of antineoplastic and other hazardous drugs in health care settings.
Asunto(s)
Antineoplásicos/toxicidad , Sustancias Peligrosas/toxicidad , Sector de Atención de Salud/normas , Exposición Profesional/prevención & control , Salud Laboral , Administración de la Seguridad , Humanos , National Institute for Occupational Safety and Health, U.S. , Estados UnidosRESUMEN
Four influential papers that have appeared recently in the main psychiatric journals from Russia are summarized. The first paper examines socio-demographic profile and clinical manifestations and data of people with mental disorders attending the private psychiatric clinics. It was seen that about 50% of private mental health settings' patients had never consulted a public psychiatric service before seeking help at private psychiatric clinics. Private mental health services have proven their effectiveness in the treatment of non-psychotic disorders and intervention in early onset psychoses. The second paper describes neuropsychological and evolutionary approaches in understanding the comorbidity between depressive and anxiety disorders. It suggests that if anxiety disorder manifests as the first diagnosis, it is more likely that the person will have depression than vice versa. The next article concludes that there is a specific vulnerability of different groups of somatically ill patients to particular mental disorders: cancer is mainly associated with dissociative disorders and asthenia; patients with cardiac disorders are more likely to have comorbid anxiety disorders, hypochondriasis and severe depression. Patients with dermatological illnesses are more likely to have obsessive-compulsive disorder, delusional disorder and mild depression. The last paper discusses some social-psychological and neuro-immunological parameters of people with "dangerous" professions. Using mathematical method, the authors created a model that can decrease the negative influence of work-related extreme factors.
Asunto(s)
Psiquiatría/métodos , Psiquiatría/tendencias , Agotamiento Profesional/diagnóstico , Agotamiento Profesional/etiología , Agotamiento Profesional/psicología , Humanos , Trastornos Mentales/terapia , Publicaciones Periódicas como Asunto , Federación de RusiaRESUMEN
Skin cancer induced by occupational UV-irradiation is not an official occupational disease number in the appendix of the German ordinance on occupational diseases (Berufskrankheitenverordnung (BKV) but can be recognized as a "virtually" occupational disease according to § 9 (2) of the 7th book of the German Social Code (SGB VII). Epidemiological studies have demonstrated a positive, statistically significant and relevant association between occupational UV-irradiation and the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK). Outdoor workers have on average a 100% higher risk to develop SCC compared to the general population. Therefore, the prerequisites for a new occupational disease are fulfilled and SCC and AK should be reported as an occupational disease if an additional 40% occupationally-related UV-irradiation is documented and the clinical criteria are typical for work- related skin cancer. Epidemiologic evidence also indicates a significant association between work-related UV-irradiation and basal cell carcinoma (BCC) risk: however the results are less consistent and the association is weaker than with SCC. There is an urgent need for further studies in outdoor workers on BCC and lentigo maligna melanoma.
Asunto(s)
Neoplasias Inducidas por Radiación/epidemiología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Exposición Profesional/estadística & datos numéricos , Neoplasias Cutáneas/epidemiología , Rayos Ultravioleta , Adulto , Anciano , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/prevención & control , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: The effects of magnetic field exposure on cancer risks remains unclear. AIMS: To examine cancer incidence among a cohort of UK electricity generation and transmission workers. METHODS: Cancer morbidity experienced by a cohort of 81 842 employees of the former Central Electricity Generating Board of England and Wales was investigated for the period 1973-2008. All employees had worked for at least 6 months with some employment between 1973 and 1982. Standardized registration ratios (SRRs) were calculated on the basis of national rates. RESULTS: Overall cancer morbidity was slightly below expectation in males and females. Significant excesses were found in male workers for mesothelioma (Observed [Obs] 504, SRR 331), skin cancer (non-melanoma) (Obs 3187, SRR 107) and prostate cancer (Obs 2684, SRR 107) and in female workers for cancer of the small intestine (Obs 10, SRR 306) and nasal cancer (Obs 9, SRR 474). Brain cancers were close to expectation in males and below expectation in females. Leukaemia incidence (all types) was slightly below expectation in males and females. More detailed analyses showed import ant contrasts for mesothelioma and leukaemia. CONCLUSIONS: The clear occupational excess of mesothelioma was not matched by a corresponding excess of lung cancer, and the level of asbestos-induced lung cancer in this industry must be low. Leukaemia risks declined with period from hire; confident interpretation of this finding is not possible. The excesses of cancers of the nasal cavities and small intestine are probably not occupational, though the excess of skin cancer may be due to outdoor work.
Asunto(s)
Electricidad/efectos adversos , Melanoma/epidemiología , Mesotelioma/epidemiología , Neoplasias/epidemiología , Enfermedades Profesionales/epidemiología , Exposición Profesional/estadística & datos numéricos , Centrales Eléctricas , Femenino , Humanos , Incidencia , Masculino , Neoplasias/etiología , Enfermedades Profesionales/etiología , Exposición Profesional/prevención & control , Sistema de Registros , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
In various areas of professional activity, exposure of skin to ultraviolet radiation coming from artificial sources may occur. These UV rays differ from the solar UV radiation due to their intensity and spectrum. We review current developments with the introduction of statutory exposure limit values for jobs with UV radiation from artificial sources, a selection of relevant activities with artificial UV exposure and an overview of the occurrence of skin disorders and dermatologically relevant skin diseases caused by these specific occupational exposures. The latter is relevant for medical advice in occupational dermatology and occupational medicine. On the basis of existing studies on welders and studies regarding occupations with "open flames" (using the example of the glassblower) it is evident that so far no reliable data exist regarding the chronic photodamage or the occurrence of UV-typical skin cancers, but instead clear evidence exists regarding the regular occurrence of acute light damage in these occupations.
Asunto(s)
Iluminación/estadística & datos numéricos , Neoplasias Inducidas por Radiación/epidemiología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Neoplasias Cutáneas/epidemiología , Rayos Ultravioleta , Soldadura/estadística & datos numéricos , Alemania/epidemiología , Humanos , Incidencia , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Exposición Profesional/estadística & datos numéricos , Prevalencia , Factores de RiesgoRESUMEN
UV-light induced skin cancer is being more and more accepted in Germany as an occupational disease for several jobs with increased UV-light exposure. Over the past 100 years sunscreens with filters against UVB- and UVA-light have been developed. Another development is the use of antioxidants such as vitamin E, vitamin C and herbal agents for additional photoprotection. The evidence supporting these products in their topical and systemic formulation is very variable. The recent changes in the recognition of UV-induced skin cancers as occupational diseases increases the need for preventive strategies which are supported by appropriate clinical studies.
Asunto(s)
Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Exposición Profesional/efectos adversos , Protectores contra Radiación/uso terapéutico , Radiodermatitis/etiología , Radiodermatitis/prevención & control , Rayos Ultravioleta/efectos adversos , Antioxidantes/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Alemania/epidemiología , Humanos , Prevalencia , Factores de Riesgo , Protectores Solares/uso terapéuticoRESUMEN
PURPOSE: The results of a study to help identify the best glove protection for health care professionals frequently exposed to cytotoxic agents are reported. METHODS: The permeation of 17 cytotoxic drugs through different glove materials and glove combinations was studied under the conditions of simulated dynamic contact (e.g., friction, stretching), a temperature of 37 °C (normal body temperature), different exposure times (30 and 60 minutes), and a 15-minute pretreatment with 70% alcohol or isopropyl alcohol. For 6 drugs, permeability was further evaluated at a temperature of 43 °C with different double-gloving combinations in order to assess the risk of health care worker exposure during the administration of hyperthermic intraperitoneal chemotherapy (HIPEC). All evaluated glove products were provided by one manufacturer. Analytical measurements were performed in triplicate using chromatographic and spectrometric techniques. RESULTS: None of the gloves exhibited permeation exceeding European standard EN 374-3 (1000 ng/cm(2)·min) or American standard ASTM F739-07 (100 ng/cm(2)·min); for a few drugs, glove permeation exceeded ASTM D6978-05 (10 ng/cm(2)·min). The highest permeation rates (66.5 and 36.3 ng/cm(2)·min) were observed with two natural rubber latex products exposed for 60 minutes to carmustine. None of the evaluated double-gloving combinations displayed any detected permeation at 43 °C, confirming that they can be used safely during HIPEC. CONCLUSION: Gloves evaluated with a dynamic permeation testing device at 37 °C after pretreatment with alcohol or isopropyl alcohol showed permeation rates by selected cytotoxic drugs of <100 ng/cm(2)·min after 30 or 60 minutes of drug exposure. Undergloves alone and glove-glove and glove-underglove combinations showed no detectable permeation in tests performed at 43 °C.
