Treaty Occupationay Toxicology
Publisher: Biblioteca24 horas
Published: 2010
Place of publication: Brazil
Language: eng
Format: Paperback
Number of pages: 498
Description: medical books
Table of contents: title: The world today is in a full search process for maximum yield and maximum cost. Such a goal is; title: due to the fact that the demand by developing and underdeveloped countries, the pursuit of global economic control by the developed countries. Of course, that interest is related to the well being of humankind, since the state has the primary goal, the society. To achieve these goals, countries have to have an essential factor, technology.; title: This factor brings positive economic benefits, since there is an investment in the binomial - Man Machine. However, it is necessary to consider that this factor may contribute to a result contrary to that expected by the state, because there will be a direct influence on the working environment of man.; title: Therefore, it is necessary something that will protect human labor, then there is the concept of security.; title: In 1700, was published in Italy, a book whose author was a doctor named Bernardino Ramazzini,; title: which had repercussions throughout the world due to its importance. In this work, Ramazzini describes fifty different professions and diseases related to them. It introduced a new concept by Ramazzini, "What is your occupation?". Today we might interpret this question as follows: "Say what your job, to say the risks that you are subject." For this important work, Bernardino Ramazzini was known as the "Father of Medicine of Labor."; title: At the time of publication of this book, professional activities were still handmade, being carried; title: out by small numbers of workers and, consequently, cases of occupational diseases were few, or little interest has arisen regarding the problems cited in the work of Ramazzini.; title: In the eighteenth century, then there is almost a century later, in England, the Industrial; title: Revolution, a mo0vimento that would change the entire design in relation to work performed, and; title: accidents and occupational diseases stemmed from them. The first factories were located close to; title: watercourses, because the machines were driven by hydraulic power, owing to its location, it had a shortage of workers. With the advent of steam power, factories could be located in large cities where the manpower was achieved more easily.; title: The manufacturing operations become simplified by machinery introduced in production. The; title: tasks to be performed by the worker were repetitive, which led to an increasing number of accidents. Coupled with the fact mentioned above, there was no criterion for the recruitment of skilled labor, where men, women and even children were selected without any initial examination as to the health and physical development or other human factors. The demand for manpower was so unscrupulous that these children were purchased from destitute parents, coming to be accepted by a retarded child group for each of twelve; title: healthy children. The number of accidents increased dramatically, where the death of children was often caused by poorly designed machines, which offered no security.; title: As production was first, there were limits on hours of work, and gas burners used for nighttime.; title: In the work environment were caused by poor noise machines, high temperatures, due to lack of; title: ventilation, poor lighting, etc.. those factors that contributed to the high number of accidents, because until the work orders in production were not heard by the employee due to the high noise level. In the process of’ ‘working man's activity logs, so by means of work, processing the work object, desired from the beginning. This process is void in the product. Your product is a value in use, a natural material adapted to human needs through processing the form. The work is united with his goal, worked.; title: Before all the work is a process between man and nature, a process in which man, by her own actions,mediates, regulates and controls your metabolism with nature. He faces the same natural materials as a natural force. He sets in motion natural forces belonging to his physicality, arms and legs, head and hands in order to appropriate the natural material in a form useful for your own life. By working through this movement, on the Nature external to it and modify it, modify it, while his own nature. He develops the powers it dormant and may subject the game of his forces to his own domain .. . We assume the job in a way that belongs exclusively to man. A spider conducts operations that resemble those of the weaver, and the bee ashamed over a human architect to build the combs of their beehives. But what distinguishes, in; title: advance, the worst architect from the best of bees is that he built the comb on his head, before you build it in wax. At the end of the working process, you get a result that already existed at the beginning of this work in the imagination .. . He not only performs a transformation of the natural form of matter, held at the same time, the natural matter, seuobjetivo, he knows he determines the law as to the nature and mode of his activity and which has to subordinate his will. And this subordination is not an isolated act. Besides the efforts of agencies that work is required the will directed to an end, which manifests as attention throughout the course of work .. . The simple elements of the work process are activities geared to one end or the work itself, its object and its means. ''(Marx, Capital, I, 1 section III, chap. V); title: This treatise is dedicated to the teaching and dissemination of information that constitutes the; title: formation of knowledge of occupational diseases, only through security measures and effective; title: enforcement of the PPE (personal protective equipment) and regular occupational medical examinations is that we can reduce the numbers accidents and chronic diseases caused by occupational poisoning.; title: Contents; title: PREFACE; title: THE VALUE OF LABOR; title: ACKNOWLEDGEMENTS 1; title: DEDICATION; title: INTRODUCTION; title: OATH OF AREA MEDICAL; title: HISTORY AND CONCEPTS OF TOXICOLOGY; title: CONCEPT OF TOXICOLOGY; title: CHAPTER 1 - Poisoning; title: CHAPTER 2 - OCCUPATIONAL DISEASES; title: CHAPTER 3 - MAIN occupational dermatitis; title: REFERENCES; title: ANNEXE; title: CHAPTER 4 - LEGAL SUPPORT; title: CHAPTER 5 - GENERAL OCCUPATIONAL TUMORS; title: CHAPTER 6 - THE ILLNESS OF WORKERS AND ITS; title: RELATION TO WORK; title: 136; title: CHAPTER 7 - BASIS FOR CONTROL TECHNIQUES; title: OF RISK FACTORS AND TO IMPROVE; title: OF ENVIRONMENTAL AND WORKING CONDITIONS 139; title: CHAPTER 8 - IDENTIFICATION AND CONTROL OF; title: RISK FACTORS IN THE PERSPECTIVE OF HYGIENE; title: LABOR AND ERGONOMICS; title: CHAPTER 9 - 5.1 DIAGNOSIS OF A DISEASE; title: RELATED TO WORK AND REMOVAL OF WORK; title: CHAPTER 10 - RELATED DISEASES; title: LABOR INFECTIOUS DISEASES RELATED WORK; title: CHAPTER 11 - WORK-RELATED DISEASES; title: PROCEDURES MANUAL FOR HEALTH SERVICES; title: CHAPTER 12 - Neoplasm (tumor) WORK-RELATED; title: CHAPTER 13 - Blood and blood forming organs; title: RELATED WORK 244; title: CHAPTER 14 - Aplastic ANEMIA TREATMENT AND; title: OTHER CONDUITS; title: 263; title: CHAPTER 15 - DISEASES ENDOCRINE, NUTRITIONAL; title: AND METABOLIC WORK-RELATED; title: 279; title: CHAPTER 16 - MENTAL DISORDERS AND; title: BEHAVIOUR RELATED WORK; title: 292; title: CHAPTER 17 - PREVENTION; title: REFERENCES; title: TABLES; title: INTRODUCTION; title: Since the ancient Greco-Roman, work was already seen as a factor generating and modifying the; title: conditions of living, getting sick and dying men. Works of Hippocrates, Pliny, Galen and others called attention to the importance of the environment, seasonality, type of job and social position in determining the production of disease. With the social reality of those times, when nations were enslaving other nations subdued in war, these reports were unlikely to have the stamp of social protest. De Re Metallica, the work of Georg Bauer (Georgius Agricola), 1556, refers to lung disease in miners, with interesting description of symptoms now attributed to silicosis, asthma and Agricultural called miners. Already Paracelsus, in l567, it also describes diseases of miners in the region of Bohemia and mercury poisoning. And in 1700, the extraordinary work; title: of Bernardino Ramazzini, a doctor who worked in the region of Modena in Italy, and with an impressive vision clinic for that time where there were no major propaedeutic, describes diseases occurring in over fifty occupations. In his book From Morbis Artificum Diatriba can find, besides the sharpness of the comments, a subtle criticism of manners. Because of the importance of his work, received from posterity the title of father of Occupational Medicine. Ramazzini, in anticipation of some basic concepts of Social Medicine, emphasized the importance of studying the relationship between the health status of a given population and their living conditions, which were, he said, depending on the social situation (Rosen, 1994). And actually, if you look in the background the political and social panorama of contemporary Europe, we find the view accepted by many Ramazzini, adding the idea that social life and everything that she was referring (as working conditions and health) should be at the service of the State, setting up; title: there as one of elements of a doctrinal system, which was later called mercantilism or cameralism.; title: Returning to the references of diseases related to work, remember Morgan in the Treaty of Pathology, 1761 apud MENDES (1980) observed and emphasized the occupation item, the reporting of all cases reported. PERCIVAL POTT, in 1776, and made the first detailed references to scrotal cancer in chimney sweeps, which actually was formed in March as the initial studies of the relationship between cancer andwork (cited in Mendes, 1994).; title: In 1700, Ramazzini later c the "Father of Occupational Medicine", published his work, "De; title: Morbis Artificum Diatriba" a series of work-related diseases. With progress, new industrial processes have emerged and with them came new duties or occupations. It has become increasingly imperative to the existence of services that take care of health and welfare of workers. Adverse environmental conditions of work have favored the emergence of occupational diseases and the occurrence of accidents whose consequences are widely known. Across Europe, mainly in Germany but also in France and England, extends the doctrine of Medicine of the State, based ideologues such as Petty says, "... A healthy population is synonymous with opulence and power." He lived the concern with the growing urbanization, with issues of food for the people, sanitation, major epidemics (Foucault, 1987). The medicine is beginning to become collective, urban, social (Mendes, 1994). And it is precisely here that a new fact arises that would modify an entire global economic system, with consequences for social and health of European populations: the INDUSTRIAL REVOLUTION. Historically, the second makes clear; title: ROSEN (1994), one of the factors responsible for the development of the modern world and the; title: organization and actions of modern public health was the rise of an industrial economy that, for most authors, has its distinctive period between 1760 and 1850. Still living a feudal model of the Middle Ages, but with a growing movement of urbanization, industrialization of modern Britain starts, and the plants have settled mainly in urban areas. The craftsmanship, where the man was holding the whole process gives rise to an industrial process with profound social changes.; title: INDUSTRIAL REVOLUTION with a new situation arises: the work indoors, sometimes confined; title: to what was called factories. The rural exodus, urban issues of sanitation and poverty were joined by another big problem: the poor working conditions (and environment) by changing the pattern of illness among workers who have suffered accidents and diseases in developing industrial areas, such as , European typhus (then called fever of plants). The majority of the workforce were women and children who suffered abuse by various agents, arising from the process and / or work environment. In 1831, C. Thackrar Turner, an English physician, in his book "The effects of arts, crafts and professions and the civil state and the life habits the heath and longevity," revealed the deplorable living and working in Leeds, England. Concern about the strength Working with economic losses prompted the intervention of governments in the factories. And we got to the early nineteenth century with the presence of doctors in factories (an emblematic example of Dr. Robert Baker, England, quoted by MENDES, 1980) and emergence of the first public health laws that strongly addressed the issue of health workers (Factory Act, 1833, for example). The Occupational Medicine had its first milestone there. In the late nineteenth century was perceived a new era: the knowledge of scientific medicine, based on germ theory, amounted; title: to recognition of the concepts of social medicine, where issues such as housing, sanitation, and others come in as co- determining factors in the genesis of the disease process. The model of medical services within the company has spread to several countries in Europe and other continents, along with the industrialization process, and assumed an important role in controlling the workforce through increased productivity and regulation of absenteeism ( MENDES & DIAS, 1991). We arrived at the beginning of the twentieth century with the world around with big changes. The Marxist ideology, socialism and communism, in opposition to capitalism and the First World War, the result of imperialism still inherited from the past century. All these facts, as he explains (HOBSBAWUN, 1995), produced deep changes in political and social landscape of the world. The process of industrialization and increasing urbanization have changed the landscape of the capital-labor ratio. The emerging trade union movement began to express the social control that the workforce needed. At the same time, new technologies, to incorporate new work processes, generated risks culminating in work accidents and occupational diseases. As we know, the end of last century and the beginning of this, were marked by great inventions, and the incorporation of this new collection of science and technology was not without damage. The dynamics of capital-labor ratio has changed, while keeping the final binomial: exploiter and exploited, capitalist and worker. The Occupational Medicine found that in the early; title: twentieth century, has the perspective of medicine of the body, individual and organic, structured under the figure of the doctor's work as agent and, through empirical instruments, acted on its object, man worker with a clinical-therapeutic approach, in which at most is analyzing the microenvironment of work and the action of certain pathogenic agents (DIAS, 1994; Tambellini, 1993).; title: This model also proved to be insufficient by scientific reductionism and conceptual. The working; title: man had his demands Biological yes, but also psychological and social, in this aspect, the industrial; title: revolution came to bring that Leavell & Clark (1976) mental illness at worker.; title: In the early twentieth century, with the expansion and consolidation of the model began with the; title: industrial revolution and the transnationalization of the economy, the need for measures and common parameters, such as regulation and organization of the work, which standardize the countries producing goods industrialized. So it is, that was created the International Labour Organisation in 1919. This organization has already recognized, in their first meetings, the existence of occupational diseases. In turn, the capitalist model created transformed the relations between man and nature, among human beings, with work and with society. Came the scientific organization of work, Taylorism and Fordism, converting the worker subject to object, and assisted by modern theories of Directors, which had as purpose, although not exclusive, productivity. And therefore, the conquest of the market. The sciences have evolved in turn, setting up new fields of knowledge, especially pure and applied chemistry, engineering, social sciences and the incorporation of the dimension of psychoanalysis. Developed the first; title: concepts of Industrial Hygiene, Ergonomics and strengthened to Engineering Safety. Similarly, in the field of Public Health, Schools began to be created, such as John Hopkins, of Pittsburgh, with an emphasis on preventive medicine as prominent figures who had Leavell & Clark. All this has set a new model based on multidisciplinary and multiprofessional, Occupational Health, who was born under the aegis of Public Health with a much broader view than the original model of Occupational Medicine. It  should be noted that this has not disappeared, but was expanded by adding up the body of knowledge to knowledge embedded in other disciplines and other professions. Thus:; title: "The Occupational Health occurs mostly in large companies, with mapping of multi-and; title: interdisciplinary, with the organization of multi-professional teams gradually, and the emphasis on; title: industrial hygiene, reflecting the historical origins of medical services and the prominence of the industry in industrialized. "(Mendes, 1991).; title: The Occupational Health going to give a rational response, scientific, health problems for certain; title: processes and work environments and through the Toxicology and parameters established as tolerance limits, it was attempted to quantify the response or resistance of the working man to factors occupational risk. Even today, in major industrialized countries, the model is hegemonic Occupational Health, as an effective protective legislation for workers and the environment is combined with equally efficient action from the regulatory authorities (the example we have the Occupational Safety Health Administration on- OSHA and National Institute for Occupational Health and Safety, NIOSH, the United States of America).; title: But even then, by virtue of the social movements of the 60s, where he discussed the model of society since even the intrinsic meaning of work, he felt the need for greater participation of workers and society as a whole, the discussion the major issues pertaining to the area. In Europe, where they swarmed renewal; title: movements broke out in Italy of the 70s, a movement of workers demanding greater participation in matters of health and safety, which resulted in changes to legislation such as the involvement of unions in monitoring environments work, the right to information (risks, environmental commitment, technological changes) and, finally, significant improvement in conditions and labor relations. This was the Italian labor movement. And changes in legislation on health and safety of workers kept happening in several countries, and the movement that began in Italy, arrived in Latin America, where political and social turmoil and the thirst for change led to germinate, based on health reform and democratizing the struggles that virtually all the countries of Central and South America is waging this context that the subject area Occupational Health was set up and framed in a context of profound changes in work processes that began in the 70s, and whose hallmark was a transnationalization of the economies where industries have; title: moved to the Third World, especially those for causing damage to health or the environment, like; title: pesticides, asbestos and lead. Also the automation to computerization, outsourcing, when deciding remarkable transformations in the organization and work process, their impact on workers and their health. The Occupational Health also emerged as a new approach to protection of men and women, in light of the pressure of capital. The works of Laurell & Noriega-incorporated markedly this thread strength and influence of researchers and; title: health workers throughout Latin America will help to determine the object of the worker, as the study of health-disease process of human groups from the perspective of the work. Was delineated a field under construction within the Public Health and the theoretical and methodological assumptions that Tambellini (1993) and MENDES (1994) expressed as a break with the hegemonic conception of establishing a causal link between the disease and a specific agent and avoid the extreme opposite of social determinism unique. Hence the theoretical conceptual Tambellini (1985) "Occupational Health is the area of knowledge and application technique that gives an account of understanding the multiple factors that affect the health of workers and their families, regardless of the sources they come from, the consequences of action of these factors on this population (diseases) and the varied ways of acting on these conditions ... "; title: From all that can be seen from these and other authors trying to draw an outline history and theory; title: to the field worker's health, it is clear the role of the worker himself as a social actor, dynamic, suffering and responding to the pressures of capital, and developing it own mechanisms of social control to a new time and form of organization of the work process. In summary, by Occupational Health is defined as a set of theoretical practices developed by interdisciplinary and interagency actors situated in different places and different social bonded by a common vision (MINAYO-GOMEZ & Thedim, 1997). It is noted that the Occupational Health was consolidated in Latin America revisiting its own model, which comes 90 years to more pragmatic and less ideological, paradigmatic questioning some guidelines that delineated their practice more intense in the early '80s.; title: 2. The second issue health-labor in Brazil; title: In the short history of Brazil, only five centuries, the way it structured and economically the; title: country has also determined the type of relationship with work. The mineral extraction for which the knowledge and subsequent occupation of the Brazilian interior, the feudal agrarian model, the large estates of the planters and later of the colonels, the exploitation of native Indians, enslaved and sometimes also the years of black slavery, determined that - similarly to what happened in ancient times of ancient Egypt, Greece and Rome - the legwork was devoid of value attribute, and any disease processes that involve, as occupational diseases and work accidents, trivialized all the minor granted to labor deprived of any rights of citizenship.; title: With the abolition of slavery at the end of last century and the arrival of European immigrants; title: earlier this century, Brazil begins his first major outbreak Industrial nearly one hundred years of delay. The great inventions of the late nineteenth century, the industrial revolution steam engine and textile industry, besides political, social and economical world, their impact on Brazil republic. The medicine then showed natural concern with major epidemics as well, playing the French social model of medicine, special care cemeteries, slaughterhouses, hospitals, prisons and factories. MENDES (1980) cites studies on the subject like MENDONÇA in 1850 who wrote "Of the snuff and cigar factories." And the model of industrial development in no way differed from that lived in England many years ago, primitive plants, with no minimum standards of hygiene, employing cheap labor, women and children in poor working conditions.; title: And we got to the early twentieth century, with profound changes in the labor-capital relations in; title: the country, and indeed, in any form of organization and systematization of the work process,; title: emphasizing the liberal movements of organizing workers, such as unions, basic socialist. To regulate the growth and to maintain the principle of power that amalgamates the Brazils, growing state control, similar to European mercantilism. Thereafter, in the early twentieth century, we now have two references: the; title: external influences, doctrinal, coming from Europe and the United States, and internally, the echo of the; title: political and profound social changes in the country. Earlier this century, doctors of the National School; title: of Medicine, Red Beach, protesting against the reality of the factories in Brazil. At the Congress of the; title: young Republic of Brazil, there is the proposal in 1904, which grant social security benefits to workers; title: injured at work, a constant, then the federal capital to Rio de Janeiro. (Mendes, 1980) Thereafter, with the; title: greatest influence of North American medicine and public health schools such as Johns Hopkins, the; title: teaching of hygiene at work came to be included in courses for health workers and later in medical; title: courses in Brazil. Contradictorily. was in a period of totalitarian government (a dictatorship of the Estado; title: Novo), emerged the Consolidation of Labor Laws - CLT, which grouped and systematized labor laws,; title: representing remarkable progress of the legal point of view. It was also a period marked by growth and; title: affirmation of the union movement in Brazil. Updates of the Law of Work Accidents ensued; title: (FALEIROS, 1992).The technical and scientific development of Occupational Medicine, mainly in Rio de; title: Janeiro and Sao Paulo passed by the existence of entities like the SESP Services (Public Health; title: Specialist) and SESI (Social Service of Industry). The Schools of Preventive Medicine, of American; title: influence, did incorporate multiprofessional and interdisciplinary approach to the original model of; title: Occupational Medicine, which also began in Brazil, contextualizing a broader area, the Occupational; title: Health. Also in medical training, disciplines such as Occupational Medicine were included in the; title: curricula of most medical schools in the country. It was created by the Brazilian Association of; title: Occupational Medicine (ABMT), headquartered in Rio de Janeiro. Professionals such as Daphnes de; title: Soto, Talita Tudor, Bernardo Bedrikow and Diogo Pupo Nogueira, among others, were prominent figures; title: in the Occupational Health at the time. Proliferating medical services companies, asserting itself as the; title: labor market also interesting for the country's doctors, especially those with training in Public Health; title: (health workers) or in Preventive Medicine.; title: The 60 met Brazil in a new political crisis that culminated in the military coup of March 31, 1964.; title: Brazil, also the former dictatorship of the Estado Novo, with Vargas, the decades between 30 to 50,; title: started to live a restricted period of democratic freedoms at the same time that - keeping the logic of; title: totalitarianism - the government tried to disciplinary the question of work, applying laws and reforms.; title: Social Security Institutes of unified categories, not just to organize the policy of social benefits, but also; title: to weaken the union movement. The Labor Department also consolidated its shares, intervening; title: decisively in security and occupational health. In general, acatávamos technical recommendations of the; title: International Labour Organisation (ILO) and later the Joint ILO / WHO Committee and tuned it in our; title: legislation. The jingoism of the beginning of military government, gave rise to attitudes such as the; title: nationalization of insurance of occupational accidents in 1966, the revival of old slogans like "oil is ours"; title: campaign for 200 miles (sovereignty of the coast). It was the third great industrial boom in the country,; title: was the "Brazilian miracle", with the start of construction of pharaonic works, such as Trans, Rio-Niteroi; title: bridge, football stadiums, dams, etc.. financed with internal and external indebtedness. The rapid pace of; title: such works transformed the fields into battlefields, where workers were dying every day. In 1968 the; title: world was true revolution of values, with the backdrop of the ideological and political dualism: x; title: capitalism socialism. The tension of the Cold War, the threat of atomic holocaust, the failure of wars like; title: Vietnam, but a real revolution in habits (ecological and peace movements, etc..) Probably had its heyday; title: in 1968, and movements democratizing and libertarians have spread across Europe (Hobsbawm, 1995).; title: Brazil, a country of young population markedly in that period, was influenced by such movements, and; title: had its own history of suffering and revolt against the military dictatorship years in determining a period; title: known as the year of lead or terror. The 70s came to meet the country dealing with such conflicts,; title: political instability own periods of exception. The alternative to reducing accidents at work found by the; title: military regime in the early '70s, due to the high rates of accidents, was the legal requirement for; title: companies to hire skilled professionals (occupational physicians, nurses or nursing assistants labor,; title: engineers and safety experts), thus creating Specialized Services in Safety Engineering and Occupational; title: Medicine - SESMTs-sized according to the degree of risk and the number of employees of companies; title: (Bonciani, 1994). The creation of such services was already recommended by the ILO since 1959, but; title: was emphasized in Brazil in 70 years. It was a technical model tied to the business sector. Brazil's; title: government was concerned exclusively with workplace accidents, or by the economic repercussions; title: (severe damage to public) or by the emphasis in all media: "Brazil, the world champion of workplace; title: accidents." Little or no attention was given to the said illnesses. It is interesting to reproduce from a; title: discourse of Arnaldo Prieto, Minister of Labour, in 1976, and also mentioned by Bonciani (1994):; title: "For this, we turn our attention to 1974, when the total of occupational injuries reached a figure of; title: 1. 796. 761, with an average of 5. 891 accidents per working day, and that resulted in 3 total. 764 deaths; title: and 65. 373 permanently disabled (...) causing losses of eight (8) billion cruises. "; title: There was need for intervention measures, therefore. The academic level, the School of Public; title: Health at USP (Universidade de Sao Paulo) created the Department of Environmental Health, which; title: housed an area of Occupational Health. By that time, many medical courses had also this area in their; title: curricula. To prepare technical expertise in required number, the government established the Jorge Duprat; title: Figueiredo Foundation for Occupational Health and Safety - FUNDACENTRO Agency of the Ministry of; title: Labor also affect the search. Graduate courses in Occupational Health and Safety Engineering have; title: spread from north to south, usually in partnership with universities. Also on the legal profession,; title: Government has extended and modified in Chapter V of the Labor Code, which deals with medicine and; title: occupational safety, to create the Regulatory Norms (BRASIL. Ministry of Labour. Ordinance 3. 214) in; title: June 1978, adopting quantitative assessment of environmental risks and limits of tolerance within the; title: scope of Occupational Health, keeping the social security legislation, accident, with characteristics of a; title: medicalized practice, and on an individual level, considering only insured workers, or formerly engaged; title: in the labor market (MENDES & DIAS, 1991) .; title: At the end of the 70 appeared in Brazil, two movements in the health field, with different elements; title: within an early process of democratization of the country and of great importance. The first is called the; title: Health Movement, which, based on the principles of the Conference of Alma-Ata (1978) and in its own; title: internal struggle for citizenship rights in Brazil, including the access to health, conceived the Brazilian; title: Health Reform Proposal seeking comprehensive care and overcoming the dichotomous model -; title: preventive medicine, curative medicine (AUGUSTO, 1995).; title: The second movement is the Trade Union Movement, which did not by chance began at ABC,; title: from the great strikes of 1978 in the automobile, and that spread through much of the country from there.; title: (LACAZ, 1994). With the reorganization of the union movement, was introduced into the health issue on; title: the agendas for discussion and claims, following at least there, the Italian workers' model from the 60s; title: and 70s. In 1978, the Commission was established Inter-Health, Labor and that eventually became the; title: Inter Department of Studies and Research in Health and Work Environments-DIESAT, which would; title: support the important role trade unions in discussing health issues and work, trying to overcome welfare,; title: inheritance of the Estado Novo (LACAZ, 1994). In parallel, several unions have structured specific; title: boards, for the treatment of health concerns of workers. The union has added technical aspect that also; title: were active in the health reform process in Brazil, others from academia, especially preventive medicine; title: departments of universities (Tambellini, 1993). The unions, as the Central Unica dos Trabalhadores; title: (CUT) to create the INSS had an important role in the so-called social control of the health issue at work.; title: Was then launched one of the pillars of this new area, the Occupational Health, coming to fill a gap left; title: by the previous models, of Occupational Medicine classical eda Occupational Health, who proved; title: insufficient as well put MENDES & DAY (1991), because: Occupational Health, who proved to be; title: insufficient, as well put MENDES & DAY (1991), because:; title: a. are grounded in the mechanism;; title: b. not perform a true interdisciplinary, towards the integration of knowledge in favor of the; title: employee;; title: c. the training of human resources, knowledge production and intervention technology, do; title: not keep pace of transformation of work processes.; title: This new area, the Occupational Health, took the flags: the right to know, refusal to work in; title: situations of risk, health is not exchangeable for cash, including health and environmental clauses in; title: collective bargaining agreements, the actions of completeness occupational health, recognition of the; title: knowledge workers' participation in the management of health services, consensual validation,; title: homogenous groups of risk, incorporation of epidemiology as a tool for recognition of risk and harm to; title: health and the environment (ODDONE, 1986). International agencies have also influenced the genesis of; title: Occupational Health: the Pan American Sanitary Shop (PAHO) launched the document "Program of; title: Action for Health of Workers" in 1983, and the Joint ILO / WHO launched the Convention 161 and; title: Recommendation 171 (Service Health). Brazil, living in the said period for reopening or redemocratization,; title: saw in Public Health, a new model with values from the health reform and nuclei of; title: preventive medicine, the Occupational Health Program. The Occupational Health Program, which began to be created in several Brazilian states, from the early 80s, had his real moment of ideological creation with the VIII National Health Conference in 1986, an event that marked the philosophical principles SUS. So much so, that was convened for that same year the First National Conference on Occupational Health, which, by bringing an unprecedented, trade unionists, experts in the field of health and related fields, universities and community in general, successfully launched the foundations for a new path. The constitutional reform of 1988, defining citizenship rights as health and work, marked a move already in the New Republic said in a moment of political transition to democracy, to confirm the role of the State; title: accountable for decent health care for workers and people in general.; title: In 1990 Brazil enacted the Organic Law of Health, 8. 080, which constituted the reference came; title: from the NHS and, indeed, not as a government initiative, but as a reflection of the struggles for reform health, which had the marks to VIII National Health Conference and the First National Conference on Occupational Health. In addition to setting goals and principles of the SUS, such as decentralization, universality, comprehensiveness and prioritization of services, Law 8. 080 decisively addresses the issue; title: of health worker in its Article 6 conceptualizing it as:; title: "... A set of activities that is intended, through epidemiological monitoring and health surveillance,; title: promotion and protection of health workers, and seeks the recovery and rehabilitation of workers; title: subjected to the risks and problems arising in working conditions ".; title: In 1991, the Ministry of Health, through its Division of Health Protection of Workers (DIPSAT),; title: the new area created from the National Secretariat of Health Surveillance, promoted the National Seminar on Occupational Health, bringing together all the states of Federation, represented mostly by engineers or managers, Occupational Health Program, which was extensively discussed the operationalization of the; title: Act 8. 080 and the reality of regional programs. As a product of that seminar, I was scheduled the; title: National Seminar on the injured worker, to be held in November 1991. In 1991, the Ministry of Welfare; title: has published the new Costing and Benefits Act (8. 212 and 8. 213) with some significant advances in the security issue, such as stability to the injured worker.; title: An important achievement during the first half of the nineties was the establishment of the; title: Interministerial Commission on Occupational Health, whose report of November 1993 contained the; title: principles of joint action from government agencies for the health of the worker. Progressed in the; title: country the actions of environmental intervention aimed at protecting the health of the worker. Until 1993, were 161 Programs Occupational Health organized or being organized in Brazil (Dias, 1994). This vitality could be found in the Second National Conference on Occupational Health held in March 1994, preceded by a pre-conference in nearly all Brazilian states and had about a thousand delegates, civil servants, representatives of trade unions, professional associations , technical advisors and academic organizations (AUGUSTO, 1995). Paracelsus - Swiss physician and alchemist (1493-1541) "All substances are poisons, there is nothing that is not poison. Only the right dose differentiates a poison from a remedy. "Paracelsus (1493-1541) Bernardino Ramazzini (10/3/1633 to 5/11/1714) was an Italian doctor. Ramazzini was a forerunner in the use of a derivative of quinine to treat malaria. But his most important contribution to medicine was; title: the work on occupational diseases called The Morbis Artificum Diatriba (Diseases of Labour) which; title: related health risks caused by chemicals, dust, metals and other agents encountered by workers in occupations. This was one of the pioneering work and the basis of occupational medicine, which played a  role in its development. He worked as a teacher dena University of Padua from 1700 until his death.; title: OATH OF AREA MEDICAL; title: Hippocrates, the Greek physician, 460-377th. C; title: INTEREST:; title: Consider also my teachers to my parents.; title: To teach this art, generously, to my and their children, considering them equal to my brothers, and; title: those who have committed to pursue it, subject to this oath, and no; title: other in contrary.; title: Apply the treatment to the benefit of patients according to my ability to consciousness, preventing them from any harm, even in order for anyone; Never practice methods that cause abortion;Preserve the dignity of my life and my art; Log in private so only the patients for their benefit without corrupting the morals, nor do they; title: cause harm or damage; Secrecy of whatever I see, hear or come to know the practice of medicine or elsewhere, should not be disclosed, given the discretion as a duty; Keeping that commitment to the limit of my strength. If I fulfill this oath and violating in any way, let me enjoy my life and my art, enjoying eternity,; title: fame and honor among men.; title: If I transgress and perjure is otherwise my fate.; title: II-free translation from Greek by Dr. Amilcare Carletti.; title: I swear and promise that the practice of medicine, will always be faithful to the demands of honor,; title: the principles of science and duties.; title: Give my free professional care to the poor and not require my ever higher salaries to my work.; title: Admitted to the intimacy of home, my eyes do not see what goes on there, my language will be; title: changed to know the secrets entrusted to me, and my profession does not serve to corrupt the morals, nor to encourage the crime, nor will practice methods causing abortion.; title: I will deal with the same equal footing, rich and poor.; title: SANTA BECOME MY LIFE AND MY ART. I promise to keep this oath to the extreme limits of; title: my strength and my life. If this does not meet my commitment, that is my fame and my destination; title: negligible compared to men.; title: HISTORY AND CONCEPTS OF TOXICOLOGY; title: In ancient China, there are reports of Emperor Shen Nung, who lived around 5000 a. C. (Also; title: known as Emperor Yan, "the divine farmer" for having introduced the advent of agriculture in ancient China, and also as the father of Chinese medicine since tested about 365 herbs and possibly died due to toxic doses thereof) and was responsible for composing a treatise on herbs that in turn was being updated by future generations, which explains the deep knowledge of Chinese people with regard to medicinal herbs. Following the saga of toxicological knowledge, appear around 1500 a. C., the Ebers Papyrus, one of the oldest preserved documents with toxicological information to the present day. In 1862, in Luxor, the papyrus was purchased by Edwin Smith, American adventurer who lived in the city of Cairo, and; title: remained with the paper until 1869, when he put up for sale. In 1872 the papyrus was purchased by the Egyptologist Georg Moritz Ebers novelist, hence the name coming Ebers Papyrus. Papyrus is a; title: comprehensive report of the medical history of ancient Egypt. In it are given as knowledge of the human body, structure and cardiac and vascular healing substances prescriptions for various ailments caused by toxic agents of animal origin when both vegetable and mineral. After 100 years, in Sumer (1400 BC), texts related to a mythological figure called Gula, were associated with charms, spells and poisoning, showing that the toxicology, again, as elsewhere, was linked with magic and power. In line with developments, Homer describes the use of poison on arrows in their world-famous works "The Odyssey" and "The Iliad." Socrates is sentenced to die by drinking hemlock bitter (with great power plant alkaloid toxic) and his nemesis. After 100 years, in Sumer (1400 BC), texts related to a mythological figure called Gula, were associated with encntos, spells and poisoning, showing that the toxicology, again, as elsewhere, it is on core and power . In line with developments, Homer describes the use of poison on arrows in their world-famous works "The Odyssey" and "The Iliad." Socrates is sentenced to die by drinking hemlock bitter (with great power plant alkaloid toxic) and his nemesis already demonstrating a good understanding of the mechanism of toxic action, the famous Greek philosopher said that after sucking the liquid remains no longer feel up to walking legs because thereby accelerate the effect of the drug. Also Alexander the Great, one of the great conquerors of antiquity and the king of Macedon (a pupil of Aristotle, Plato's pupil, a disciple of Socrates) died from poisoning.; title: Numerous other historical figures such as legendary Mithridates IV, Cleopatra, the components of; title: the Borgia family, Leonardo da Vinci, Paracelsus, Catherine de Medici, J. Mateu B. Orfila has; title: compulsory service in any text on the history of Toxicology, represented by the importance in the; title: evolution of this science, each with its own unique contribution.; title: When Paracelsius postulated that the difference between healing and poisoning is the dose,; title: established some theoretical toxicology as a scientific discipline, where there was a subsequent universal convergence. With that, was a new conceptual domain, breaking with common sense, leaving aside the "magic potions" people of his time. It was a split within the then-current empirical knowledge of civilization. But it was only in the nineteenth century that toxicology was configured as modern science, and within all the transformations that gave overwhelming your life and think of Europe at that time, especially with the ways that the development of chemistry was opening. Toxicology not limited to the findings of toxic effects. He also sought to discover and understand the mechanisms of action of toxic substances. No longer just a descriptive and analytical science and has acquired an experimental nature (Moraes, 1991). Thus, absorbed a recent approach that is preventing, through its application for recognition, identification and quantification of risks.; title: Brazil; title: Obviously the question toxicológicaé also known in Brazil for several centuries. Since the Indians,; title: who have exhibited this type of information until the black slave, who brought their ancestral knowledge of relevant practices and religions of their land, and Portuguese, with the knowledge of the European season. From the standpoint of Toxicology configured here as a matter of study, research and teaching, we can say that it emerges strongly in the year 1950. In 1976 takes place in the city of Manaus, the name, the first technical event - scientific toxicology registered in Brazil.; title: In 1977, in the seaside city of Guaruja, Sao Paulo, is the First Brazilian Congress of Toxicology,; title: which discussions remain only in memory of the brave survivors who have it participated.; title: After 15 successive editions of congress, since that first in Guaruja, Brazil toxicology grew, and; title: today is represented by a broad, multidisciplinary and multi-family toxicologists. House mater of our toxicology, the Society of Toxicology (SBTox, www. Sbtox. Com. Br) has organized several conferences and all these other events, fulfilling its role to disseminate and assert that science among us, prompting the Brazilian population and the authority of the country for the most important facts related to it. Among others, we must also emphasize here the existence and cooperation of institutions and organizations such as the Brazilian Society of Ecotoxicologiae Analyst Group of Pesticide Residue.; title: CONCEPT OF TOXICOLOGY; title: It's part of physiology that studies the body osefeitossobre pathogenic chemical agents.; title: FOOD, MEDICINE, POISON; title: All substances are poisons; there is nothing that is not poison.; title: Only the right dose differentiates a poison from a remedy. "Paracelsus (1493-1541). Fonz-Diacon,; title: in its toxicology, offers the following definition:" poison "is a defined chemical substance, introduced into the body, acts, until the toxic dose in proportion to the mass and cause disorders, which may cause death. "Sydney Smith said that" it is almost impossible to define the word poison, because certain substances hazardous to life. in certain circumstances, prove to be innocuous in others, and how many things can be absorbed, arrive to take place hazardous to health, taken in excess "; title: DIVISION OF TOXICOLOGY; title: Paying attention to the studies of the toxicology of harmful substances is divided into:; title: I-prophylactic; title: II-Industrial; title: III clinical; title: IV-Forensics; title: V-analytical; title: I-TOXICOLOGY PROPHYLACTIC; title: Nocivosdo study of the chemical environment in general. Identifies toxic, its origins and; title: quantities. Propose precise and hygienic measures necessary to control health; title: Avoiding large-scale poisoning of the population. Prophylactic Toxicology intended to maintain; title: the safety limits for humans exposed to the action of several chemical agents dispersed in the; title: environment.; title: II-INDUSTRIAL TOXICOLOGY; title: Aspects are considered:; title: a) Chemicals: producing new products that are intended for therapy, medication, should be isolated; title: and synthesized;; title: b) Hygienic, for the middle saneamneto for insecticidal, fungicidal, estéticacomo cosmetics, the; title: comforts of home (paints, bleaches, detergents, adhesives, etc.);; title: c) Surgical, as antiseptics, etc. Example of the latter can be remembered in relation to the; title: pharmaceutical industry, following the dramatic effects of thalidomide were by regaining their care.; title: III-CLINICAL TOXICOLOGY; title: Through the study of symptoms and clinical signs that harmful effects of chemicals produced in; title: the human body to diagnose clinical toxicology demand and guide appropriate therapy. It is; title: recommended, always, that any form of intoxication or poisoning has special clinical attention, even in patients with severe intoxication that was not followed by death.; title: The parallel is always present in the light of industrial economic race: the launch of new; title: chemicals in the pharmaceutical market new toxic cause.; title: The iatrogenic poisoning.; title: IV-FORENSIC TOXICOLOGY; title: It is significant value to the satisfaction of justice, either by clinical workup, such as by chemical; title: analysis, it is able to identify the poisons of any species and guide the dictates persecuted. The importance of studying Forensic Toxicology from the need to establish, in cases of death by poisoning, if it were from suicide, accident or crime. The forensic toxicology has expanded in recent years as its field of action, which is practically freed of legal medicine, constituting part of the discipline. Programs in Forensic Toxicological matter is studied very superficially, aiming only to provide some more knowledge needed by coroners and lawyers.; title: CHAPTER 1; title: Poisoning; title: Poisoning is the act or effect of intoxicants. Poison is poison. It is the intordução of toxic; title: substance in the body. Depending on the type of toxicology expertise can be considered in several ways. Interest in the present case the professionals, since the object of occupational medicine. Can be matched in special circumstances food caused not only by toxic foods, plants or animals, for chemical additives for the narcotics and drugs and by drugs.; title: The formal diagnosis in intoxicated person must meet the following: a) history, b) clinical; title: examination, c) laboratory tests and clinical toxicológiconecessários.O physical examination (clinical) should be thorough and very careful attention to the verification of the pupils, of fever, blood pressure, pulse, heart rate, skin, oral abnormalities, neurological disorders, etc. The clinical history should raise with details of family members or third parties, and events that occurred before involving the patient with intoxication. In cases of occupational intoxication due to stress the importance of detailing the activities; title: carried out and highlight the possibility of continuous exposure and intermittent or permanent; title: employment to the chemical contaminant. Are frequent symptoms of some types of poisoning:; title: a) Ocular changes: mydriasis (dilated pupils), atropininc poisoning by belladonna plant, solvents,; title: tobacco, depressants, etc.), miosis (pupils contracted), (organophosphate poisoning, opiate; title: b) anomalies mouth: dry mouth (poisoning atropine, belladonna plant, etc.), hypersalivation; title: (pesticides, heavy metals), gingival (heavy metals);; title: c) neurological disorders: a coma (poisoning by alcohol, barbiturates, opiates, tranquilizers,; title: salicylates, organic solvents, cyanide, antihistamines), seizures (organochlorine pesticides,; title: organophosphates, strychnine, aminophylline, etc.), tremors and muscle jerking (insecticides; title: organophosphates, nicotine), paralysis (heavy metal poisoning), headaches (carbon monoxide poisoning,; title: nitrite, nitrate), d) urinary disorders: Urinary retention (atropininc poisoning), hematuria (anticoagulants),; title: anuria (toxic disturbances that determine .; title: PENETRATION IN THE BODY; title: Penetration (from the Latin "penetration") lies in the act of penetrating ouefeito.; title: The velocity and absorption depend on the route of penetration. but also the effects, neutralization and elimination of possible toxic tóxico.Os (or poisons) and the drugs can be delivered orally, gastric, rectal, inhalation, dermal, subcutaneous, intramuscular, intraperitoneal, intravenous, intraartrial, intraosseous and intrathecal . The most common are the oral and gastrointestinal. The drug can be absorbed at the oral mucosa or swallowed, the level of gastric and intestinal mucosa. So you can act the poison needs to reach the arterial system and its effects will manifest capilar.Aí. The hair system is the; title: field of action of poisons (Fonz-Deacon), so that quick açãodo poison depends on the path more or less that has to do to reach the capillary system, as well as the obstacles in its path.; title: TOXICITY; title: Is the ability of chemical agent have harmful effects to the body humano.E always measured in; title: relation to other agents and varies among species and within the same biological espécie.O coefficient (toxicity) is the toxic dose per kilogram dose Animal.as is considered fatal one that can eliminate 100% of the same species, the average fatal dose is one that is able to kill 50% of those animals.; title: It is produced by the toxic effects:; title: a) desired exacerbated, as bleeding consequent to the use of anticoagulants.; title: b) a number of points as bronchial asthma consequences of the use of salicylates lethal (cardiac; title: arrest consequent to the use of anesthetic).; title: The lower the average fatal dose is considered the more toxic the penetrating agent. For human; title: toxicity is rated:; title: a) extremely toxic. ...........1mg/Kg Or less;; title: b) highly toxic:. .................. 10 to 50 mg / kg; title: c) moderately toxic:. ........... 50 to 100 mg / kg; title: d) slightly toxic:. .................... 0, 5th 5 g / kg; title: Poison ENDEMIC; title: Are those produced by natural means in the presence of toxic environment. The main ones are: a); title: chronic regional endemic hidroarsenismo, which occurs in regions of Córdoba, San Luis, Santiago del Estero;; title: b) hidrofluorose that occurs in the south of Buenos Aires and the pampas.; title: SOCIAL Poisoning; title: Are those that have profound social consequences for the inconvenience psicomorais people.The; title: in producing what can be said of addiction and poisoning anticoncepcionais.Elas cause euphoria,; title: tolerance, habit, symptoms of dependence and withdrawal symptoms and can be considered; title: toxicomanígena.; title: The euphoria estadofalso consist of well-being with demonstrations hilariantes.O habit in need of; title: a progressive increase in doses to achieve the same effect (some even lethal doses). Tolerance reduces the capacity developed the habit of tolerating doses considered noxious or psychic dependence letais.A is an uncontrollable desire claiming droga.A physical dependence is a state that is characterized by the appearance of physical symptoms when the drug is discontinued. Abstinence is summarized in the syndrome characterized by a set of symptoms and signs opposite to those produced by the drug.; title: GENETIC Poisoning; title: Are those relating to enzyme changes were transmitted by inheritance or idiosyncratic. The action; title: of a chemical on the organism is followed by metabolism or by storage. The termination of the effect occurs with the complete elimination. The metabolic result can give a product in more or less toxic.; title: Thus, when an enzyme catalyzes a reaction that makes a very active chemical agent other less; title: active, lack of this enzyme causes the toxicity of the chemical agent is greater and more prolonged. It is known that genetic characteristics are transmitted through the genes I study these problems is to affect pharmacogenetics.; title: Poison Iatrogeny; title: Paradoxically are those which arise as a result of drug use, the higher dose, summation, synergism,; title: or else by hypersensitivity error indication, or the method of application, giving rise to the emergence of the desired effects and exacerbation of colaterais.A responsibility is assigned doctors, paramedics and the communities affected persons and they do not consider the recommendations therapies. Also included are those prescribed by traditional healers, or infusions, poultices, enemas, prepared by the lay person or bystanders, but for therapeutic purposes.; title: Can (iatrogenic poisoning) produce:; title: a) defects (thalidomide, selenium); title: b) neuropsychiatric disturbances (seizures and parkinsonism; corticosteroids neuritis, arsenic and; title: antimony; Kernícteros; vitamin K in newborn infants, encephalopathy); title: d) metabolic disorders (gout secondary, mustard, radioactive phosphorus, TEM-tri-ethylenemethenamine,; title: demineralization, cortisone long);; title: Grow day by day the numbers of iatrogenic poisoning, shock allergic to penicillin or certain; title: anesthetics. There is no doubt that the pharmaceutical industry today presents new "weapons" therapeutic elementary values, which were responsible for the elimination of many diseases, particularly infectious, but those same "weapons" are thrown in the trade without needed care and increase the "therapeutic risk"; title: by the lack of oversight in sales.; title: Food poisoning; title: Are those that occur by ingestion of contaminated food. Contamination can take place by:; title: a) chemicals, metals, pesticides, preservatives, artificial coloring, antioxidant of grease, oil etc..; title: b) chemicals in the food itself: fungi, mollusks, fish, peas, cassava,; title: c) bacteria: staphylococcus, salmonella, proteus, enterococci, clostidium botulinum (due to; title: presentade disease germ itself and its toxins, which is why it is called food poisoning of toxins. Such bacteria are excellent culture media in the jerked beef, bacon, No ham, sausage on in sausages, in salad, mayonnaise, eggs, cream, candies and ice creams. The fish, shrimp, oysters, mussels have rapid decomposition that promote and facilitate bacterial growth.; title: Receive the special designation mycetes intoxication by fungos.são most venomous species:; title: Amanita phalloides, verna and Vitrolick; amanita muscarinic and panthere, glyromitaesculento. It features food poisoning in a short period of time between food and symptoms, so that the presence of the pathogen in the body thus favors.; title: DEFENCE ORGANISATION; title: The path of the poison is not done freely, without obstacles. The body tends to defend itself, the; title: extent of their forces. The first obstacle is that the poison is in the viscera fígado.Esta enjoys the property of their tissues fixed in certain foreign elements in the form of organic compounds.; title: Minimal doses of lead may well be arrested, after being eliminated by bile. Only large doses of; title: lead can cause death rapidamnete, crossing the barrier liver. The liver can also modify chemical Anatur; title: certain alkaloids and mitigate them toxidez.Os bones also cooperate in the defense orgânica.O arsenic,; title: mercury salts, absorbed in large doses, can reach the capillary system and determine the death in small; title: doses; title: The body's defense in explaining why certain poisons, highly toxic when absorbed by the blood; title: directly, bypassing the liver, do not exert any harmful effects when they enter via the gastrointestinal; title: tract.; title: The snake's venom, for example, deadly when it enters directly into the circulation after the bite,; title: can be absorbed by sucking the wound, without any danger.; title: The lungs also act defensively in favor of a gas economia.Quando is ingested into dissolution,; title: before reaching the capillary system, it must go through pulmões.Ora, effecting the lungs, gas exchange; title: between the organism and the environment: gas exhaled carbon dioxide and oxygen is fixed, the venous; title: blood, dark, it is arterial blood, red radiance.; title: The lungs, eliminating, at least in part the toxic, gaseous, volatile, such as carbon monoxide,; title: hydrogen sulphide, chloroform, alcohol, ether.; title: The leukocytes also take part in organic defense (phagocytic action).; title: BESREDKA demonstrated that when introducing under the skin of an animal, a small amount of; title: a compound soluble or insoluble arsenic (arsenious anhydride, trissulfureto arsenic), it produces a; title: hypercellularity, which maketh the body of these toxic through a variety of fagocitiose.O arsenic mineral; title: is disaggregated and transformed into organic arsenic, much less toxic, which is later eliminated by the; title: kidneys.; title: Finally, the body defends itself by vomiting and diarréia.Em general, toxic substances have strong; title: emetic properties, so that most of the poison can be rejected by vomiting before absorçãotenha been; title: sufficient to cause death. Evacuations Alvin befallen the ingestion of certain toxins, expel the body's still; title: a part of the venom.; title: Thefactors INFLUENCE ON THE ACTION OF POISONS; title: The division of a state of toxic influence favorably on his absorção.O arsenious anhydride, for; title: example, administered in powder form, will act less quickly than in solution because the first case the; title: poison will be absorbed only in proportion to their slow dissolution in body fluids, while the second; title: hypothesis is immediately absorbed.; title: Foods that are eaten while the toxic substance, can facilitate or retard their bodies absorção.Os; title: acids facilitate the absorption of phosphorus by dissolving it and allowing it to penetrate the bloodstream,; title: rather it will slow the absorption of a poison also fearful, arsenious anhydride.; title: The state of emptiness or fullness of the stomach also has an influence on the uptake of venenos.Se; title: the stomach is empty at the time of ingestion of toxic, although not diluted in the mass food will soon; title: absorvido.No otherwise it will be slower absorbed and more easily found in the liver or rejected by the; title: bile and urine.; title: However, its action will cianuretode potassium maximum in the case of repletion of the stomach is; title: that the potassium cyanide is toxic, giving off hydrogen cyanide under the influence of hydrochloric acid; title: in gastric juice that is secreted when the stomach contains food.; title: The body weakened by the disease less resistant to the action of poisons in a state of saúde.Certas; title: people are more sensitive to even a poison than others, this is called susceptibility particular idiosyncrasy.; title: Finally, the age also influences on atividadedos poisons: a child succumbs to the ingestion of a few; title: drops of laudanum, while an adult may absorb several ounces without drawbacks should also be; title: sérios.Ocostume assinalado.Permite body to resist the action of a massive dose that would this is deadly; title: without treinamento.Chama to that fact Mithridates, Mithridates word derived from the king of antiquity,; title: who, fearful of being poisoned, became accustomed the action of poisons.; title: MODES OF ACTION. EXPLANATORY THEORIES; title: The toxic substances act on the body very variable in its intensity, speed and mode ação.Alguns; title: poisons kill quickly acting on major organ systems, blood system, nervous muscular.Outros act slowly,; title: serving many vezessobre the glandular system .; title: REMOVAL OF POISONS; title: In what way are eliminated poisons in our body? Some pass through the body and are eliminated; title: without any change in its chemical makeup. Most alkaloids (strychnine, morphine, brucine, nicotine) are; title: rejected by the urine, though nothing has changed in their molecular structure (in the poisoning, the; title: alkaloids being always absorbed in excess, not only that this excess is not modified in the urine).; title: The carbon monoxide, hydrogen cyanide, chloroform, ether etc.. Are still in the same case. Other; title: bodies, in contrast, are modified during their passage through the body and form rejeitadossob; title: diferente.Alguns are reduced, the bromates bromureto pass to the state of the state of the iodates iodureto,; title: but more often than not, they are oxidized to expense of oxygen sangue.Os sulphides, sulphites,; title: thiosulphate become sulfates etc. extensions.Some times the toxic nature of change by a double; title: decomposition, which occurs in the stomach between the elements of gastric juice and veneno.Assim,; title: small amounts of lead acetate give rise to insoluble lead chloride, the contact of acid gastric juice; title: clorídricodo, and acetic acid inofensivo.Tenham sofridomodificação or not, drugs are eliminated more or; title: less slowly in the body, which always tends to get rid of foreign elements .; title: ROUTE OF ELIMINATION; title: The routes of elimination of toxic substances, or products resulting therefrom, are the devices of; title: secretion or excretion, such as the liver (the bile), kidneys (in urine), the various glands of the economy; title: (sweat, saliva, mucous membranes the skin) and finally to the gaseous substances (carbon monoxide,; title: hydrogen sulfide, alcohol, etc.), the lungs.; title: But the substances eliminated by the salivary glands are partially reabsorbed with the bolus;; title: eliminated by the bile partly pass faeces, but can be reabsorbed in the intestine fortunate that the great; title: route of elimination is the kidney.; title: Only the study of each particular venenoé allowing explicit reference to the duration of your; title: elimination period.; title: SPECIES DEVENENOS; title: The three kingdoms of nature can provide toxic substances so that we have mineral poisons; title: (Copper sulphate, lead acetate), vegetable poisons (strychnine, morphine), which are more formidable; title: poisons animals, discovered the end of last century, almost simultaneously, the Italian and French; title: SELMA ARMAND GAUTIER (leucomaínas and ptomaine) . The leucomaínas organs are produced; title: during pathological conditions, and ptomaine stem from rotting organic matter.; title: GASES OF ROOMS:; title: The carbon monoxide is odorless substance, colorless, density equal to 0.96, with a blue flame; title: burning, and very toxic to the human body. Their usual sources are fumes from burning coal, the braziers,; title: fires and explosions. Between us is almost always as the original source of the gas street. The common; title: gas that we use in kitchens, is from the calcination of coal and presents a complex composition in which; title: we can distinguish hydrogen, methane, carbon monoxide, nitrogen, acetylene.; title: The carbon monoxide poisoning as superagudaseriam reported cases of sudden and massive; title: inhalation. The victim is only three to four breaths and is immediately attacked the tremors, dizziness,; title: loses consciousness and dies. The common thread, however, is the acute form, in which the patient has headache, hallucinations, tinnitus, scintillating scotoma, impotence, muscle, nausea, vomiting, convulsions and coma coma.O can last hours or days, and the more fatal will be the prognosis the longer its duration. If the individual is restored, has many times, confusional state, delirium, neuritis, paralysis, hyperesthesia, neuralgia, xanthopsia, blindness, tinnitus, dizziness, edema and trophic skin disturbances,aspiration pneumonia, etc..; title: Besides the two preceding forms, there is still a chronic form of poisoning oxicarbonada, usually; title: professional (cooks, firemen, etc.). The patient complains psychic disturbances with intellectual torpor, loss of desire, insomnia, etc.; motor as asthenia; sensitive as rheumatic pain, epistaxis, nausea, vomiting.; title: Poison Iatrogeny; title: Paradoxically are those which arise as a result of drug use, the higher dose, summation, synergism,; title: or else by hypersensitivity error indication, or the method of application, giving rise to the onset of exacerbation of the desired effects and side effects. The responsibility is assigned to doctors, paramedics and affected people themselves and they do not consider treatment recommendations. Also included are those prescribed by traditional healers, or infusions, poultices, enemas, prepared by the lay person or bystanders, but for therapeutic purposes.; title: Can (iatrogenic poisoning) produce:; title: a) defects (thalidomide, selenium); title: b) neuropsychiatric disturbances (seizures and parkinsonism; corticosteroids neuritis, arsenic and; title: antimony; Kernícteros; vitamin K in newborn infants, encephalopathy); title: ENVIRONMENTAL Poisoning; title: Are those that occur in the environment (air, water, soil). In big cities is that most occur, since in; title: these focus industries, the cars polluting and contaminating the etc.All ambiente.Veja the case of; title: Cubatao, considered the most polluted city in the country; title: Losses are known organisms that cause air pollution to man; a) death, b) chronic diseases; title: (bronchitis, emphysema, asthma). c) recurrent episodes of morbidity (decrease in vital capacity), d) minor; title: disorders and functional reduction (discomfort, respiratory infections);; title: e) psychological effects (reduced visibility, odor, irritation, trachea and nose). The pollution by; title: sulfur dioxide, one of the most common pollutant, produces the following effects;; title: a) The effects of concentration are: I-health effects, especially increased risk of diseases affecting; title: the respiratory system; II-corrosion surfaces metálicase their effects on certain types of stone and painted; title: surfaces; III-effects on life plants because of the influence on photosynthesis and other vital.; title: b) Effects of acid deposition because of the rain water and they are: I-effect on lakes and rios.II; title: and effect on soil; title: Occupational poisoning; title: Are those of the person from exposure to chemicals in the exercise of their activities. These are the areas that matter most to infortunistica. Are presented for acute onset and crônicas.Têm increased nowadays due to the rising number of chemical agents and / or toxic that a worker has contact.; title: Intoxication may be defined as professional occupational disease or work (and the acute; title: recognition as an accident within the meaning of the term by some medical experts).; title: The occupational medicine or occupational has devoted more attention especially after the; title: "package" of March 1986 Decree-Law No: 2284 1986, by recent numbers of new jobs in industries and commerce in general. The pulmonary diseases are the most common chronic and acute poisoning today.; title: May be related:; title: a) mineral pneumoconiosis (caused by silicates) (kaolin, talc, mica, and asbestos), for coal, for; title: iron, graphite, tin (estanose) barium sulphate (baritose) for aluminum, beryllium by, for nickel; cadmium;; title: by vanadium by selenium, tellurium by at tungsten; title: b) pneumoconiosis caused by organic cotton, sisal, jute, bagasse, etc..; title: c) occupational diseases caused by soluble gases and aerosols, ammonia, chlorine, nitrous oxide; title: (fertilizer), etc..; title: d) Special mention needs to pesticides, smoking, rodents, herbicides, insecticides, fungicides,; title: repellents, since they provoke often victims both in handling the preparation, the work itself, as in; title: spraying and / or use.; title: Cancer is produced by professional:; title: a) tar, tars and oils, arsenic, x-rays (the skin);; title: b) benzidine, aniline, diphenylamine, auramine, xenilamina, betanaftamina (bladder);; title: e) benzene, radiation (leukemia); title: f) radioactive substances (bone cancer); title: DISEASE OF WORK:; title: a) Any so-called occupational diseases inherent in certain industries and related act in the Ministry; title: of Labour.; title: The degenerative disease is not inherent in either age group, resulting from special conditions or; title: exceptional in that work executed, provided, directly related to the activities performed, causing reduced capacity for work that would justify the granting of disability benefits under the Act.; title: OCCUPATIONAL TUMORS; title: Tumors may arise from occupational exposure to the carcinogenic action or result of trauma in the; title: etiology of skin coat tumors, one should not disregard the existence of conominantes causes, such as individual constitution, lifestyle habits, especially as regards to chronic poisoning, such as alcoholism, the maintenance of poor nutrition and rest.; title: CARCINOGENIC CHEMICAL AGENTS; title: Exposure: Arsenic, Chromium, Coal, aromatic amines, nickel, oil and heavy metals.; title: CHAPTER 2; title: OCCUPATIONAL DISEASES; title: Data from 1991 estimated at 100,000 the number of mining assets and reported about 400 000; title: workers involved in mining activities. In the manufacturing industry to the IBGE, in 1996, estimated at 8, 5 million workers in activity, with about 43% of potentially exposed to dust. In the same year, the estimate was in the construction of 4, 5 million workers. The agricultural sector, in turn, had 16, 7 million workers exposed to organic dust mainly. Recent data for estimation of exposure to silica in Brazil indicate that for the period 1999 to 2000, about 1,815,953 workers with formal jobs were exposed to silica for more than 30% of your journey involves exposure to asbestos work. about 20 000 workers employed in mineral extraction and processing (mining of asbestos, asbestos-cement products, friction materials, specialty papers, seals and gaskets and textile products). This number dropped in the last four years due to market loss and replacement of asbestos in some industrial products. However, it is estimated that another 250 thousand - 300 thousand workers are exposed inadvertently in the sectors of construction and mechanical maintenance. The extraction of coal currently employs (2004-2005) three thousand - four thousand miners. It is an activity that has floating numbers, depending on energy policy, demand and price of coal.; title: Epidemiological data from several countries show that the risk of pneumoconiosis is still a; title: problem worldwide both in developed countries as in developing, although in the working conditions and job insecurity and environmental control of individual exposure, lead to a greater risk.; title: In the 90s, for example, have reported outbreaks (clusters) of silicosis in countries like France,; title: Italy, Netherlands, USA, Canada and Finland, although mortality from silicosis in these countries have fallen dramatically in recent decades. In countries like South Africa, in the same decade, the estimated incidence of silicosis among miners was 20 to 30%. At this high rate is associated with the high risk of tuberculosis and the high prevalence of infection HIV.Da Similarly, researchers in countries like China, India and Brazil have published results from studies with high prevalence of silicosis, showing the existence of the problem and the need for improvement in diagnosis and control exposição.Os epidemiological data on pneumoconiosis in Brazil are scarce and refer to some of these areas of activities in situations focais.Os data are available about the occurrence of silicosis, for example give a partial idea of the risk related to this pneumoconiose.A larger national sample of silicosis is in the mining of underground gold of Minas Gerais, where there have been about four thousand cases. Other studies have; title: investigated important in the ceramic industry. Some cross-sectional descriptive studies published so far; title: give a frequency of silicosis ranging from 3, 5% in the quarrying sector (exploration and production of; title: granite gravel) to 23, 6% in the sector of shipbuilding operations (blasting sand). With regard to exposure; title: to asbestos or asbestos, the few published studies show a prevalence of 5, 8% of asbestosis in asbestoscement; title: industry (manufacturing of roofing and water tanks) and the occurrence of 74 cases of asbestosis; title: (8, 9%) , and 246 cases of pleural plaques (29, 7%) in selected population of former workers of that sector; title: of the asbestos industry. In coal mining in Brazil, restricted to the South, there are over 2,000 diagnosed; title: cases of PTC. The point prevalence of PTC in mining assets in the 80's was 5, and 6% probability of; title: occurrence was estimated at 20% after 15 years working underground. Series of clinical cases and other; title: cases of pneumoconiosis have been described over the years, warning of possible occurrence of diseases; title: related to exposure and iron oxide, phosphate rock, talc, abrasives, hard metals, beryllium and sericite.; title: 1.4 PATHOGENESIS AND PATHOPHYSIOLOGY; title: For the occurrence of pneumoconiosis is necessary that the particulate material to be inhaled and; title: reach the lower airways, in concentrations high enough to overcome the clearance mechanisms: the; title: mucociliary transport, lymphatic transport (known as clearance) and phagocytosis by alveolar; title: macrophages. Mucociliary transport is predominantly provided by the mucociliary system up (80%); title: through the ciliary system from the terminal bronchioles.; title: About 20% of the pulmonary transport is carried by the lymphatic system, which receives or free; title: particles phagocytosed by alveolar macrophages. Pneumoconiosis is a disease by inhaling dust,; title: substances that the body can fight with his little immune defense mechanisms and / or leukocytes, unlike; title: what happens with microorganisms that can be phagocytosed, digested or destroyed by the action of; title: antibodies and immune cells through lysosomal enzymes and other mechanisms. To be effective in; title: reaching the lower respiratory tract the particles should have a median aerodynamic diameter less than; title: 10μm, because above this size are retained in the upper airways. The respirable fraction (<5μm) are more likely to be deposited in the lower respiratory tract (respiratory and terminal bronchioles and alveoli), and initiate the inflammatory process that is perpetuated by the chronic inhalation and / or quantity that exceeds the defenses, may lead to lung changes. Particles with diameters of 5 to 10μm, although to a lesser extent, also afford to be deposited in these regions and produce disease.; title: The pulmonary reactions to inorganic dust deposition in the lung will depend on physicochemical; title: characteristics of the aerosol (eg, smaller particles and freshly fractured silica fibers thinner and longer in the case of asbestos, are more harmful) dose (which depends, among others, concentration in inhaled air, the volume per minute and duration of exposure), presence of other dusts, previous pulmonary disease, which can be modulated by immunologic factors individual and in many cases by smoking.; title: Non-fibrogenic pneumoconioses:; title: characterized, the histopathologic point of view, by type of macular lesion interstitial; title: peribronchiolar deposition of particles phagocytosed or not, with no or slight degree of structural; title: disorder, and mild inflammatory infiltrate around, with none or mild fibroblast proliferation and fibrosis. Dependent on the knowledge of the kind of dust inhaled, pneumoconiosis and siderosis leads specific name (Fe), baritose (Ba), estanose (Sn), in order etc.Tendo histopathological pattern formation and deposition of stains isolated, without producing fibrosis, respiratory dysfunction is virtually absent and the clinical course is considered benign when compared to the possible evolution of fibrogenic pneumoconioses. Despite the absence of fibrosis, the radiation pattern of change is quite similar to silicosis, micronodular or reticulonodular opacities with diffuse. The radiopacity is due to the presence of  metal / mineral deposits in the interstitium; title: In some cases, as in baritose and in some rare cases of siderosis, the possibility of regression of the; title: radiological picture from the elimination of deposits through the clearance macrophage-linfático.Em other; title: cases, however, depending on the dose of inhalation duration of exposure is prolonged and the particles; title: are very fine (<1μm) deposited dust can cause a tissue reaction with production of various degrees of; title: fibrosis. Fibrogenic pneumoconioses: As the term says are the pulmonary reactions to inhalation of; title: particulate matter that leads to interstitial fibrosis of the lung parenchyma. The following are briefly; title: discussed the mechanisms involved in the development of major diseases covered in this manual.; title: •Silicosis and asbestosis: the processes of installation and development of silicosis and asbestosis; title: are similar, although the first results in a focal interstitial fibrosis, which begins with the formation of; title: granulomas concentric deposition of collagen, and the second with the proliferation of collagen in the; title: interstitium, without the presence of inflammatory cells relevant to defense, which was not well; title: understood yet. Inhaled particles (silica or asbestos) in contact with water and within alveolar; title: macrophages after being engulfed induce the formation of reactive oxygen species (ROS) and nitrogen; title: (RNS) which stimulate (through the activation of nuclear transcription factors) cytokine production by; title: macrophages, responsible for attracting to the region alveolar inflammatory cells (lymphocytes, mast; title: cells, neutrophils), which in turn release more cytokines and ROS and RNA. This process eventually; title: induce an alveolitis with lesion of type I pneumocytes, proliferation of type II pneumocytes and; title: fibroblasts, passage of particles into the interstitium and stimulating the proliferation of interstitial; title: fibroblasts to initiating fibrogenesis. If inhalation of particles has been great, or persist in time, the; title: inflammatory process with cellular damage, proliferation, apoptosis, and fibrogenesis, there is still; title: installing the diffuse and progressive fibrosis of the lung parenchyma.; title: •Hypersensitivity pneumonitis:; title: is characterized by acute episodes of mononuclear cell infiltration and accumulation of fluid in the; title: airspaces and interstitium, a few hours after contact with antigen. In this process, macrophages play an; title: important role, in contact with inhaled antigen, release cytokines that attract inflammatory cells giving; title: rise to inflammation, which may manifest clinically with fever, cough, dyspnea, headache, myalgia, these; title: symptoms were of short duration ( 1 to 3 days) and that resolve spontaneously. Repeated exposure to antigen, leading to recurrent exudative pneumonia, may evolve into a chronic form of the disease with; title: non-necrotizing granuloma, bronchiolitis obliterans and diffuse interstitial fibrosis. The mechanisms; title: involved in its phase of activity usually responds to corticosteroid treatment.; title: •Hard metal pneumoconiosis:; title: the mechanism of disease involves an inflammatory reaction triggered by the alloy, which is; title: manifested by cellular and humoral immune mechanisms, presenting pictures of subacute alveolitis or insidiously progressing to interstitial fibrosis with the presence of bizarre giant cells occupying the alveolar spaces and interstitium, coexisting phases of desquamative interstitial pneumonia and chronic; title: fibrosis.; title: •Coal workers' pneumoconiosis (PTC):; title: workers' pneumoconiosis in coal dust deposition triggers an inflammatory process initially; title: orchestrated by alveolar macrophages, with lower intensity than those generated by silica particles, but; title: sufficient to cause injury to the alveolar epithelium. As a result, until the passage of particles into the; title: interstitium and begins the formation of accumulations of coal and macrophages with engulfed particles,; title: around the respiratory bronchioles, with the presence of reticulin fibers and deposition of small amounts; title: of collagen.; title: These injuries, known as coal macule, measuring about 1 to 6mm. Intralobular are little or not; title: visible on radiographs and usually accompanied by focal emphysema adjacent to areas of the macula.; title: With progression of the disease, resulting from inhalation or continued even after the cessation of; title: exposure, may develop in larger nodules of about 7 to 20mm, with presence of macrophages with; title: pigment inside them, presence of reticulin and increased amounts collagen. With chronic exposure, the; title: nodules may coalesce giving rise to the form of progressive massive fibrosis (PMF). The PMF is usually; title: bilateral, predominantly upper lobe, middle lobe and superior segments of lower lobes. They are usually; title: asymmetrical, sometimes showing characteristics of malignant tumor, which may cavitate, with the; title: patient expectorating blackened material, known as melanoptise. The lesions are distinguished by the; title: FMP by silica present, histologically, higher reticulin / collagen, large amount of coal dust, dense arrays; title: of reticulin and collagen and absence of silicotic nodules. The FMP evolves more frequently with; title: dyspnea, mixed respiratory disorder, pulmonary hypertension and cor pulmonale.; title: •Berylliosis or chronic beryllium disease:; title: is a granulomatous pulmonary disease, whose evolution can lead to chronic interstitial fibrosis of; title: lung parenchyma, resulting; title: of immune response to beryllium inhalation. Presents three important features: 1) can be triggered; title: by low doses or short exposure (<1 year) 2) manifests itself after a long latency period (usually> 10 years; title: after start of exposure) even though the; title: individual away from exposure for several years, and 3) less than 5% of exposed individuals; title: develop the disease, probably due to greater genetic susceptibility. It is indistinguishable; title: of sarcoidosis and, unlike other pneumoconiosis, can be treated with corticosteroids.; title: •Mixed dust:; title: mineral dust aerosols are mixed with low silica content, such as mica, sericite, kaolin and others.; title: They can produce pictures of nodular fibrosis, different classical silicosis. In some recent studies, these; title: nodules proved to be starring on histopathology (known as "Medusa head injury), with progression to; title: diffuse fibrosis from them, giving a radiological reticulo-nodular. Occasionally, they occur with; title: pneumoconiosis PMF. Importantly, the type of change might not be homogeneous parenchymal full; title: extent of the lung. It is not uncommon prevalence of pneumoconiosis nodules (eg, nodules or silicotic; title: nodules in mixed dust) in the upper lobes and the prevalence of interstitial fibrosis at the bases of the; title: same lung in cases of exposure to dust of silica with restricted content. The histological diagnosis will; title: depend on the predominant changes found that, in short, is a reflection of the area of lung sampled. In; title: coal may also occur in rheumatoid pneumoconiosis or Caplan's syndrome. Affected patients have; title: circulating rheumatoid factor and pulmonary nodules with central eosinophilic, granular and necrotic,; title: with fragments of collagen, elastin calcification and sometimes cavitation. Exposure to silica is also; title: associated with an increased incidence of other autoimmune diseases such as scleroderma and renal; title: glomerular disease. Pneumoconiosis is studied within the chapter of interstitial lung disease. The common; title: characteristic of this group of diseases is the functional constraint for interstitial fibrosis and the; title: consequent reduction of the expansion of the parenchyma, associated with barriers to gas exchange. In; title: general, there was constraint functional only in cases advanced pneumoconiosis.; title: The decrease in gas exchange occurs earlier in pneumoconiosis; title: that cause diffuse fibrosis, since the nodular fibrosis (eg, silicosis) preserves areas of normal; title: parenchyma between the nodules, sufficient to maintain a normal function of gas exchange, until the later; title: stages of the disease, when much of parenchyma; title: fibróticas.A areas are replaced by deposition of mineral dust in large and small airways, can; title: generate tables of chronic bronchitis, for direct aggression to the epithelium; title: bronchial airflow limitation and / or emphysema, for unbalanced relations protease / antiprotease.; title: These effects are independent of the presence of pneumoconiosis and functionally similar to obstructive; title: disease caused by tobacco and air pollution. The persistent inflammation around the airways can lead to the formation of localized areas of centrilobular emphysema by excessive release of proteolytic enzymes, explaining the changes and development of obstructive frames chronic airflow limitation (CAL) in exposed susceptible. It can not, however, rule out a possible synergistic effect of smoking and inhalation of inorganic dust, in the development process more aggressive tissue. In practice, the more functional; title: defect observed in workers exposed to mineral dust is the airway obstruction.; title: 3 METHODOLOGY; title: This protocol was drafted from a model suggested by the Technical Department of Occupational; title: Health, Ministry of Health The method used has been drafted as a reference point the experience of; title: physicians invited to participate through discussion of form and content of the document and presentation; title: of texts. These professionals have extensive experience in clinical care of workers with suspicion, or; title: patients with pneumoconiosis at different levels of resolution, and also academic experience, through; title: scientific publications, theses, texts and public holdings, being nationally recognized by his peers.; title: During the work we used the following sources:; title: • Texts published by the authors of the protocol.; title: • Texts from other authors published today in books, manuals and / or scientific articles.; title: • Books and publications of international organizations such as WHO and ILO.; title: • Brazilian legislation in force.; title: In formulating these recommendations were taken into account recent evidence regarding; title: knowledge of the various pneumoconioses and research methods applicable. However, it should be noted,these recommendations are subject to change depending on the evolution of knowledge of their own illnesses and research methods. The flow of protocol development is outlined as follows:; title: 4. 1 Definitions, occupational hazards and diagnostic methods; title: 4.1.1 Pneumoconiosis non-fibrogenic; title: Definition: lung disease caused by exposure to fibrogenic dusts with low potential, also known as; title: pneumoconiosis due to dust inert.; title: Examples: siderosis, baritose, estanose, pneumoconiosis coal plant, phosphate rock.; title: Occupations at risk:; title: electric arc welders, workers exposed to charcoal (production, storage and industrial use), workers; title: of phosphate rock mining and bagging of barium and tin.; title: Diagnostic methods:; title: • History of occupational exposure to dust not fibrogenic.; title: • History of clinical symptoms with absent or with symptoms that are generally preceded by; title: radiological findings.; title: • Chest plain radiography interpreted in accordance with; title: 2000 ILO criteria.; title: Key features:; title: characterized by the accumulation of macrophages laden with particles arranged in macula,; title: associated with reticulin fibers and collagen fibers and few expressed by small nodular opacities,; title: associated or not with reticular, diffuse and bilateral. They usually occur after long-term occupational; title: exposures. Respiratory symptoms are often lacking, and the dyspnea is the main one. Generally, diagnosis; title: is an incidental finding or a periodic review.; title: Differential Diagnosis: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis,; title: histoplasmosis, other fungal infections, diffuse bronchiolitis.; title: 4.1.2 Pneumoconiosis fibrogenic; title: 4.1.2.1 Silicose1; title: • Chronic Silicosis; title: Definition: pneumoconiosis caused by inhalation of free crystalline silica that manifests itself; title: after long-term exposure, usually more than ten years, characterized by progressive fibrosis of the lung; title: parenchyma.; title: Occupations at risk:; title: mining industry: surface and underground mining.; title: • Processing of minerals, stone cutting, crushing, grinding, lapping.; title: • Manufacturing industry: ceramics, foundries that use sand in the process; glass.; title: • Abrasives, marble, granite cutting and polishing;; title: cosmetics.; title: • Construction industry: tunnel boring, sanding walls, laying floors, cut stone.; title: • Mixed Activities: prosthetic; diggers of wells; artists; sand blasting operations.; title: Diagnostic methods:; title: • History of occupational exposure to dust containing free crystalline silica.; title: • History of clinical symptoms with absent or with symptoms that are generally preceded by; title: radiological findings.; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: Key features: characterized by a reaction focal collagen deposition organized in concentric; title: nodules of collagen fibers associated with the presence of bodies birefringent to polarized light.; title: Does not usually cause symptoms in the early stages and even moderate.; title: The dyspnea is the main symptom and physical examination, most often, does not show; title: significant changes in unit respiratório.Expressa were radiologically by nodular opacities; title: that begin in the upper parts.; title: Differential Diagnosis: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis, histoplasmosis,; title: other fungal infections, bronchiolitis diffuse.; title: •Accelerated silicosis or subacute; title: Definition: form of silicosis arising from occupational exposure to respirable dust with high; title: concentrations of crystalline silica, manifesting between five and ten years following initial exposure.; title: Occupations at risk:; title: well diggers, stonecutters, and all; title: other occupations at risk for exposure to silica in which there may be an intense exposure.; title: Diagnostic methods:; title: • occupational history of intense exposure to silica.; title: • Clinical history with respiratory symptoms earlier and limiting.; title: • Chest plain radiography interpreted according to the criteria of the ILO.; title: Key features: characterized by fibrotic nodules present, and often areas with focal lesions of acute; title: silicosis. Present respiratory symptoms, particularly dyspnea; title: and cough. The radiological changes are rapid progression and is associated to an increased risk of; title: comorbidities, especially tuberculosis and autoimmune diseases.; title: Differential Diagnosis: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis, histoplasmosis,; title: other fungal infections, diffuse bronchiolitis.; title: •Acute silicosis; title: Definition: A form of silicosis that occurs due to exposure to large quantities of dust from; title: freshly fractured silica, characterized by diffuse alveolar damage and exudation of eosinophilic; title: material in lipoprotein airspace and interstitial inflammation. Usually manifests itself after a few; title: months or years of exposure.; title: Occupations at risk: operations with sand blasting, grinding; title: stone.; title: Diagnostic methods:; title: • occupational history of intense exposure to silica dust; title: for a short time.; title: • Clinical history with dyspnea rapidly progressiva.Radiografia simple chest interpreted according; title: to the criteria of the ILO.; title: Key features: diffuse lung disease, quick installation, with respiratory symptoms and; title: constitutional present, characterized by a anatomopatolgicamente material deposition proteinaceous; title: intra-alveolar without interstitial fibrosis. It is a rare disease, occurring in situations of massive; title: exposure to silica for periods ranging from a few weeks to four or five years, evolving; title: rapidly to a lethal outcome (usually within one year of diagnosis).; title: Differential Diagnosis: Pulmonary alveolar proteinosis syndrome, adult respiratory distress,; title: pulmonary edema.; title: 4.1.2.2 coal workers' pneumoconiosis; title: Definition:; title: pneumoconiosis caused by inhalation of coal, its accumulation in the lungs and tissue reaction.; title: Occupations at risk:; title: miners mining front, detonators, transport and storage of coal in confined spaces.; title: Diagnostic methods:; title: • History of occupational exposure to dust generated in mining operations, transportation and; title: storage of coal.; title: • Clinical history with respiratory variable, tending to asymptomatic in mild and moderate.; title: • Chest plain radiography interpreted in accordance with; title: 2000 ILO criteria.; title: Key features:; title: characterized by formation of pigmented macules with peribronchiolar and perivascular reticulin; title: deposits, sometimes associated with focal collagen organized in reaction to; title: form stellate nodules associated with the presence of bodies birefringent to polarized light. Does; title: not usually cause symptoms in the early stages of the disease and intermediate. Occasionally, workers; title: affected; title: develop progressive massive fibrosis.; title: Differential Diagnosis:; title: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis, histoplasmosis, other fungal infections,; title: diffuse bronchiolitis.; title: 4.1.2.3 Pneumoconiosis in mixed dust; title: Definition:; title: pneumoconiosis caused by exposure to mineral dust; title: with low content of crystalline silica, as in exposure the dust of mica, kaolin, sericite, marble, in; title: processes with use of; title: abrasives in foundries and in some cases the ceramic industry.; title: Occupations at risk:; title: workers in mining and processing; title: silicates, such as mining, milling and use of mica, kaolin, sericite, feldspar, potters, deburring.; title: Diagnostic methods:; title: • Occupational history of intense exposure to dust with a high content of silicates.; title: • Clinical history with respiratory variable, tending to asymptomatic in mild and moderate.; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: Key features:; title: reaction is characterized by focal collagen organized in stellate nodules and diffuse interstitial; title: fibrosis associated with the presence of bodies birefringent to polarized light. Usually occur after longterm; title: occupational exposures.; title: Differential Diagnosis:; title: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis, histoplasmosis, other fungal infections,; title: diffuse bronchiolitis.; title: 4.1.2.4 Asbestos-related Diseases; title: • Asbestosis; title: Definition:; title: pneumoconiosis consequent to inhalation exposure to dust containing asbestos fibers.; title: Occupations at risk:; title: workers in mining and processing of asbestos (manufacture of asbestos-cement products, friction; title: materials, fireproof fabrics with asbestos gaskets and seals, special paper and cardboard) and consumption; title: of products containing asbestos.; title: Diagnostic methods:; title: • History of occupational exposure to dust with asbestos fibers.; title: • Clinical history with respiratory variable.; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: • High-resolution computed tomography.; title: Key features:; title: characterized by diffuse interstitial fibrosis in lung inflated, away from areas of tumor or other; title: lesion associated with the presence of two or more asbestos bodies per cross sectional area of 1cm2; title: When not found to be the counting of asbestos fibers, which should be in the range expected for; title: asbestosis accordingto the reference laboratory for analysis under way. Exertional dyspnea and dry cough; title: that may progress to dyspnea at rest, hypoxemia and cor pulmonale. The radiological changes are; title: characterized by the presence of irregular opacities predominating in the lower fields,; title: and often associated with pleural plaques.; title: Differential Diagnosis:; title: emphysema, usual interstitial pneumonia, collagen diseases, lymphangitis carcinomatosis.; title: • Pleural disease by asbestos; title: Definition:; title: fibrosis of the parietal pleura and / or visceral as a consequence of exposure to dust with asbestos; title: fibers.; title: The asbestos-related pleural abnormalities can present as circumscribed pleural thickening; title: (pleural plaques) or diffuse, with or without calcifications, pleural effusions, rounded atelectasis and; title: streaks pleuroparenchymal fibrosis.; title: Occupations at risk:; title: workers in mining and processing of asbestos (manufacture of asbestos-cement products, friction; title: materials, fireproof fabrics with asbestos, gaskets and seals, special paper and cardboard) and; title: consumption of products containing asbestos.; title: Diagnostic methods:; title: • History of occupational exposure to dust with asbestos fibers.; title: • Clinical history with respiratory poor.; title: Pleural plaques are usually asymptomatic. The diffuse pleural thickening, when moderate or; title: extensive courses with symptoms of functional constraint - dyspnea. Pleural effusion may be; title: asymptomatic or present with symptoms of chest pain, fever, dyspnea on exertion. • Chest plain; title: radiography interpreted according to the criteria of the ILO in 2000.; title: • High-resolution computed tomography.; title: Key features:; title: The circumscribed pleural thickening or pleural plaques are focal areas of irregular fibrosis, almost; title: devoid of vessels and cells, as well as signs of inflammatory reactions that occur primarily in the parietal; title: pleura, and are more often seen in regions posterior lateral chest wall and also in the diaphragm and; title: mediastinal regions.; title: It is the most common disease caused by inhaling asbestos fibers. The diffuse pleural thickening; title: is a disease that affects the pleural, does not present a specific format, varies in width between 1mm and; title: 1cm or more, is usually bilateral and frequently is associated with fibrotic bands that enter the; title: parenchyma. It is less specific exposure to asbestos and may appear as a sequela of an inflammatory; title: reaction; title: caused by other diseases. Pleural thickening may extend to areas of interlobar and interlobular; title: septa, usually consequent pleural effusion, causing a twisting of the area of lung parenchyma, which is; title: coiled and showing atelectasis, leading to a round image, known as rounded atelectasis. Pleural effusion; title: by asbestos can occur at any time of the exhibition and presents; title: characteristics of exudate. It is often bloody, with presence of leukocytes, mesothelial cells and; title: eosinophils. It is usually asymptomatic but may present with pleuritic pain and fever. It can last several; title: months, be unilateral or bilateral and appeal.; title: Differential Diagnosis:; title: pleural plaques alone, particularly diaphragmatic plaques are highly suggestive of exposure to; title: asbestos. Wall panels are the main differential diagnoses subpleural fat, shadows muscle and rib fracture.; title: The diffuse pleural thickening can have other causes, such as a sequela of tuberculosis, surgery, chest; title: trauma or drug reaction. The differential diagnosis of pleural effusion is important to remember; title: tuberculosis pleural effusion and neoplastic diseases.; title: 4.1.2.5 Pneumoconiosis in abrasive; title: Definition:; title: in this protocol is defined as the pneumoconiosis caused by inhalation exposure to dust abrasives:; title: aluminum oxide or corundum (Al2O3) and silicon carbide or carborundum (SiC).; title: Occupations at risk:; title: workers in the production of abrasives, in finishing operations in foundries and metal plants in; title: general, sharpening tools milling and grinding of scrap.; title: Diagnostic methods:; title: • Occupational history of intense exposure to dust containing alumina or carborundum, as well as; title: dust derived from the material being worked.; title: • Clinical history with respiratory variable, tending to asymptomatic in mild and moderate.; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: Key features:; title: shows similar characteristics to those of mixed dust pneumoconiosis.; title: Differential Diagnosis:; title: miliary tuberculosis, sarcoidosis, paracoccidioidomycosis, histoplasmosis, other fungal infections,; title: diffuse bronchiolitis.; title: Pneumoconiosis 4.1.2.6 for hard metals; title: Definition:; title: pneumoconiosis caused by exposure to dust from metal alloys composed of tungsten and other; title: heavy metals such as titanium, tantalum, niobium and vanadium on the property associated with the; title: cobalt binder.; title: Occupations at risk:; title: workers in the production of tools and pieces of hard metals in sharpening tools made of alloys; title: and other Widia, special wheels and dentures.; title: Diagnostic methods:; title: • History of occupational exposure to dust containing alloys; title: hard metals.; title: • Clinical history started with progressive dyspnea after a certain exposure time (variable from; title: months to years).; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: • High-resolution computed tomography of; title: thorax.; title: • bronchoalveolar lavage differential cell counts for research.; title: • Discussion of need for biopsy.; title: Key features:; title: characterized by a desquamative interstitial pneumonia with giant cells. Coexists with symptoms; title: of fatigue, dyspnea, early, cough dryness, pain, chest tightness and other constitutional symptoms. With; title: progression of the disease may appear fever and weight loss. In general, the symptoms appear after a; title: period of "sensitization" variable from months to years.; title: Differential Diagnosis:; title: emphysema, usual interstitial pneumonia, asbestosis.; title: 4.1.2.7 Pulmonary by beryllium; title: Definition:; title: lung disease caused by inhalation of fumes or dusts of beryllium salts.; title: Occupations at risk:; title: workers in the aerospace industry, nuclear power industry, manufacturing and use of special; title: grinding wheels and special alloys in dental prosthetics.; title: Diagnostic methods:; title: • History of occupational exposure to dust containing beryllium.; title: • Clinical history started with progressive dyspnea after a certain exposure time (variable from; title: months to years).; title: • Chest plain radiography interpreted in accordance with; title: 2000 ILO criteria.; title: • CT scan of chest high-resolution.; title: • bronchoalveolar lavage differential cell counts for research.; title: • Discussion of need for biopsy.; title: Key features:; title: characterized by manifest itself in two forms: a table of acute irritation of the tracheobronchial tree; title: and may lead to chemical pneumonitis, with consequent hypoxia and secondary fibrosis and chronic; title: disorder characterized by granulomatous pulmonary and systemic involvement secondary to chronic; title: exposure to low doses, Call for Pulmonary Disease Beryllium or BDP. The lag time is on average 10 to; title: 15 years and may occur years after exposure has ceased. The DPB is associated alveolitis characterized; title: by accumulation of lymphocytes and macrophages within alveoli and interstice adjacent to granuloma; title: formation not DRINKS, sarcoid like, suggesting the pathophysiological mechanism involving immune; title: response by delayed-type hypersensitivity. The main symptoms are chest pain, cough, fatigue, weight loss; title: and arthralgia, which may present with adenopathy, skin lesions, hepatosplenomegaly and clubbing.; title: Differential Diagnosis:; title: Sarcoidosis, tuberculosis, paracoccidioidomycosis, histoplasmosis.; title: Hypersensitivity pneumonitis; title: Definition:; title: The hypersensitivity pneumonitis (HP) is not a pneumoconiosis itself. Also known as extrinsic; title: allergic alveolitis, is a group of lung diseases resulting from sensitization by inhalation exposures to; title: applicants of antigenic particles derived from organic matter and some chemicals (eg, phthalic anhydride; title: and toluene diisocyanate, TDI), both in; title: workplace and in others.; title: Occupations at risk:; title: workers in animal husbandry, transport processes, loading, unloading and storing agricultural,; title: handling and other chemicals.; title: Diagnostic methods:; title: • History of occupational exposure to organic dusts with allergenic potential. • Clinical history; title: started with progressive dyspnea after a certain exposure time (variable from months to years).; title: • Chest plain radiography interpreted according to the criteria of the ILO in 2000.; title: • High-resolution computed tomography of; title: thorax.; title: The temporal relationship between exposure and suspected clínicosão framework of fundamental; title: importance to establish a "causal link" as in pneumoconiosis, which are diseases of large períodode; title: induction (latency). Activities outside the workplace, comohobbies should also be listed. There is a; title: "aprendizadoformal" in occupational history - we need to acknowledge that simplesindagação of; title: "profession" is insufficient and uninformative regarding the respiratory risk exposures. So the curiosity of; title: the professional who investigates a suspected case study and practical experiences are basic ingredients to; title: get good data. Occasionally it is necessary that the place of; title: work to be played for a correct understanding of the exhibition.; title: 4.2.2 Questionnaire on respiratory symptoms; title: The questionnaires on respiratory symptoms are commonly used in evaluation of groups, but can; title: be used in individual assessments as an additional tool in history.; title: The main advantage of the questionnaire is to standardize information and the possibility of; title: gradation of symptoms. To be a useful tool it must obey the principles of validity and reliability; title: (repeatability). In practice, two questionnaires are used: the questionnaire; title: chronic bronchitis and the Medical Research Council questionnaire on respiratory symptoms of the; title: American Thoracic Society. The latter can be completed by the interviewee. Both investigate the cough,; title: phlegm, dyspnea, wheezing and smoking.; title: 4.2.3 Imaging methods; title: The reference method for the analysis of conventional radiographs of the chest is the Radiological; title: Classification of the ILO, whose latest release is 2000. It allows X-rays are interpreted and encoded in a; title: standardized way, by using standard comparative radiographs and appropriate log sheets. The radiological; title: changes; title: are summarized with information about the patient's identification and radiography, quality of the; title: plate, changes in lung parenchyma, pleural changes and symbols, which denote changes associated or not; title: with pneumoconiosis.; title: A roadmap on Radiological Classification of the ILO is at Annex B. A hint of Radiological Leaf; title: Reading is at Annex C. The frequency of radiographs is dictated by labor laws. It is necessary for the; title: professional who plays the examinations has; title: specific training and appropriate to do so, since a diagnosis of occupational lung disease is; title: accompanied by procedures and legal consequences that affect the life of patients. The radiological; title: changes of pneumoconiosis are more frequent:; title: Exposure to silica dust and that presents with nodular opacities:; title: images are the expression of the accumulation of dust-laden macrophages (macules) in; title: pneumoconiosis caused by dust or no fibrogenic fibrotic nodules, as in silicosis.; title: Are micronodular opacities, types p, q, r, usually starting in the upper third; title: of both lungs. In advanced cases, there may be images of calcified mediastinal lymph nodes,; title: known in English as eggshell (symbol s), distortion of intrathoracic structures; title: (symboldi)conglomeration of nodules (symbol ax). In fibrogenic pneumoconioses,; title: radiological changes may progress independent of continued exposure. The progression of lesions; title: can lead to large opacities, classified as A, B or C, according to; title: ILO criteria.; title: Exposures to asbestos:; title: plaques and diffuse pleural thickening are better visualized in the lower halves of the side walls of; title: the chest radiographs in posteroanterior earlier. The radiological appearance depends on the location and; title: density of the plates can be viewed tangentially as one or more opacities forming a sharp interface of the; title: wall with pulmonary parenchymal opacities or how that overlaps with the parenchyma, without the; title: appearance of an anatomical structure intraparenchymal.; title: The oblique projections can help the visualization. The plates need to be differentiated from; title: extrapleural fat (especially in obese patients). In case of unilateral thickening, you should make the; title: differential diagnosis of reactions with rib fractures and muscle shadows.; title: When viewed from the front (face on), chest X-ray, they can simulate pulmonary nodules (if; title: single) or pulmonary fibrosis (for multiple and small), which may hinder a proper reading of amendments; title: to the lung parenchyma. Calcifications in a thickening allow facilitation in identification.; title: Radiology of asbestosis is characterized by the presence of small irregular opacities, types s, t, u,; title: usually bilateral and commonly involving the lower lobes. Are also occasionally noted parenchymal; title: bands (symbol bp) and septal lines (symbolkl). With the progression of fibrosis, there may be signs; title: of reduced volume and honeycombing. Other symbols are common radiological thickening of the; title: horizontal scission (pi) the lack of cardiac contours (ih) and diaphragmatic (id). Once these changes; title: are described in specific, the presence of pleural plaques are associated with strong evidence of; title: exposure to asbestos. Currently, high-resolution computed tomography (HRCT) has been used with; title: greater consistency in the investigation of suspected cases.; title: HRCT is superior to conventional radiography in detecting lesions pleuropulmonary caused by; title: exposure to asbestos, but until now, that course with pneumoconiosis in nodular opacities such as; title: silicosis, for example, there is no consistent evidence in the literature, sufficient to be considered as a; title: method of choice in diagnosing early stages of the disease.; title: The technique recommended for HRCT is described in Annex D. The tests should be done in the; title: prone position, to eliminate the gravitational effect at the bases of the initiation site of fibrotic changes; title: caused by asbestos. The cost of TCARs is still prohibitive for the examination of his appointment as; title: medical control periódico.As tomographic present in pneumoconiosis are summarized below:; title: In patients exposed to silica, coal dust and other evolving with nodular opacities: presence of; title: nodules and also along the axial interstitium including fissures. In cases of silicosis, the disease onset; title: usually affects the posterior portions of the upper lobes. With the evolution of the process, you may notice; title: conglomeration of injury, usually in the upper lobes.; title: In patients exposed to asbestos: pleural plaques are seen on HRCT in the parietal, diaphragmatic; title: and mediastinal structure as a radiological density similar to muscle, defined as thickening, with or; title: without calcifications. When the diaphragm reaches the pleural thickening due to the cutting plane of the; title: CT scan, your view on HRCT can be impaired when it is not calcified. HRCT allows to differentiate; title: between the thickening of intrapulmonary lesions and extrapleural fat. The CT changes associated with; title: asbestosis are:; title: 1. Intralobular interstitial thickening.; title: 2. Interlobular septal thickening.; title: 3. Subpleural lines 1 to 10 cm, parallel to the pleura, which are usually with septal lines.; title: 4. Parenchymal bands from 2 to 5cm, touching the pleural surface.; title: 5. Frosted glass, changes that persist when changing the patient position, corresponding; title: histologically to thickening of the alveolar walls and interlobular septal involvement. Possibly reflect; title: alveolitis.; title: 6. Lobular disarray subpleural.; title: 7. Bronchiolectasis or traction bronchiectasis.; title: 8. Honeycombing, cystic spaces small, smaller than 1 cm in diameter, with slight wall thickening.; title: 4.2.4 Lung Biopsy; title: Occasionally, exhaustion of noninvasive diagnostic methods, lung biopsy may be indicated in the; title: following situations:; title: 1. Radiological abnormalities consistent with exposure, but:; title: • occupational history with uncharacteristic or absent;; title: • with a history of exposure to dust or other unknown agents;; title: • insufficient exposure to cause changes; title: observed;; title: • radiological appearance inconsistent with the type of exposure reported.; title: 2. In cases of litigation, after disagreement between at least two players due to; title: familiarizados/credenciados5 radiological interpretation of the International Classification of Radiographs; title: of Pneumoconiosis ILO. In these cases, we recommend the implementation of abnormality, also; title: interpreted by an experienced professional in the method, before the definition of lung biopsy. A lung; title: biopsy should be performed in-service trained and performed by a pathologist with expertise.; title: 4.2.5 Functional tests; title: The pulmonary function tests are essential in the investigation of occupational respiratory diseases; title: that affect the airways, as well as the establishment of disability in patients with pneumoconiosis. In; title: contrast to occupational asthma, pulmonary function tests are not applicable in the diagnosis of; title: pneumoconiosis. Spirometry is the most commonplace of functional evaluation. It takes a fast, easy and; title: low cost. In occupational terms, the main indications are 1. Evaluation of workers with respiratory; title: symptoms.; title: 2. Evaluation of respiratory dysfunction and disability.; title: 3. Longitudinal follow up of workers exposed to respiratory hazards.; title: Its usefulness in individual assessments (clinical) of workers seeking medical attention for; title: respiratory problems is similar to routine clinical practice. Standardization of spirometry, the items; title: relating to equipment, technique and technical quality control and interpretation, shall meet the criteria of; title: the Brazilian Consensus on Spirometry. In occupational terms the "healthy worker effect" is clearly; title: present in certain economic sectors. This is a phenomenon of selection that concentrates workers with; title: physical skills necessary to perform certain functions, for example, underground mining. In general,; title: workers with altered pulmonary function or respiratory symptoms tend not to remain in office; title: high physical demand. Therefore, it is common to find normal spirometry groups exposed to; title: respiratory hazards, and even in patients with pneumoconiosis. Some situations require greater; title: sophistication in the exploration of pulmonary function, especially the assessment of respiratory; title: dysfunction and disability compensation for purposes of social security and civil remedies. The study of; title: diffusion of carbon monoxide (CO) and assessment of exercise capacity distinguished by its ability to; title: better assess the complaints of dyspnea, not always expressed by spirometric changes. These methods are; title: usually available in reference services in pulmonology.; title: 4.3 Diagnosis of pneumoconiosis; title: The diagnosis of pneumoconiosis and pleural abnormalities by asbestos based on the triad: a.; title: Consistent work history.; title: b. Latency compatible.; title: c. Changes compatible image. Changes are considered compatible image:; title: • Chest radiograph with radiological findings ≥ 1 / 0 (radiological characteristics are described in; title: subsection 4.2.3 and Annex B) and / or the presence of pleural abnormalities.; title: • High-resolution computed tomography with changes consistent with exposure above. In cases of; title: exposure to silica dust and mixed dust from coal, as well as some non-fibrogenic dusts the typical consist; title: of centrilobular nodules of varying density and profusion, and nodules along the axial interstitium of the; title: lung. CT changes are considered definitive of fibrosis by asbestos exposure: the presence of; title: bronchiolectasis or traction bronchiectasis and honeycombing. If these changes are not present, there must; title: be at least three types of changes (1-6), described in subsection 4.2.3, in more than one level of court and; title: bilateral. Cases of unilateral changes consistent with fibrosis are rare, and deserves further evaluation.; title: The diagnosis of a case of pneumoconiosis and / or by asbestos pleural disease therefore requires the; title: integration of occupational history, exposure time and latency and compatible radiological findings; title: according to the criteria of the International Classification of Radiographs of Pneumoconiose/2000 ILO.; title: The interpretation of chest radiography should be performed by a medical professional before undergoing; title: a qualification / training. For confirmation of the radiological abnormalities compatible, it is essential; title: that, beyond training, the reader; title: has at its disposal a set of standard radiographs of the ILO, in order to make comparative; title: radiological readings and classify the radiographs according to criteria established in relation to highresolution; title: computed tomography of the chest, considering the cost of the examination, shall be made at a; title: place that is guaranteed good quality radiographs and training of professional; title: responsible for interpreting the images obtidas7.As indications of biopsy are summarized in; title: subsection 4.2.4. It must be ensured that the interpretation of results is made by pathology services and; title: reference by experienced pathologists in the reading of slides with suspected pneumoconiosis.; title: A ranking of the diagnosis takes into account the resolution capacity of the health system. It is; title: possible that in certain places, the final diagnosis can be done in Primary Care Units. When there are no; title: possibilities of obtaining good quality radiological and trained readers, the patient should be referred to a; title: reference unit secondary or tertiary.; title: 4.4 Treatment; title: For all pneumoconioses mandatory expulsion is no indication that exposure to causou.Tratamento; title: medication is indicated only in pneumoconiosis with pathogenesis-related hypersensitivity response, such; title: as the lung by cobalt, the lung and the beryllium hypersensitivity pneumonitis. In these cases, in addition; title: to binding and final removal from exposure, the glucocorticoid is indicada.Nos not fibrogenic; title: pneumoconiosis cases, removal may eventually produce a reduction in the intensity of radiographic; title: opacities.; title: the settled, and spray mist of water at the point of production of dust. Two classical measures in; title: this type of control are located exhaustion, which should be installed against the flow of inhaled worker in; title: his job, and general ventilation of the environment as a whole. Other basic measures of industrial hygiene; title: are the total or partial enclosure of dust-producing process, with external operation, trying to isolate; title: polluting processes, and changes in layout. Replacing matérias-primas/produtos preventive measures are; title: of great importance, as the use of other abrasive sand blasting operations and the use of alternative fibers; title: in asbestos-cement products, friction materials and others. Substitutes should have a known toxicity; title: profile in order not to incur the replacement of certain other similar risks. The industrial fumes to the; title: outside should be subjected to processes that minimize or eliminate its impact on the environment and the; title: neighborhood. The individual respiratory protection should be used in operations where respiratory; title: protection measures for collective are insufficient to control inhalation exposure. The use of respirators; title: must fit the type of aerosol generated and be part of a Respiratory Protection Program. Respirators must; title: be of good quality, efficiency, show good adaptation to the face of the worker, to have periodic; title: maintenance, cleaning and replacement filters when needed. Wash contaminated clothing containing dust; title: must be made by the company to avoid the risk of contamination of their educational familiares.Ações are; title: of fundamental importance in primary and secondary prevention of pneumoconiosis. It is not uncommon; title: ignorance of risk in work environments with risk of exposure to inhaled dust. Information on risks; title: involved in different processes must be priorities, both for employers and employees. Prevention; title: programs within companies have a greater chance of success with the active participation of the involved; title: segments. Based on principles of screening, the medical control seeks to identify the disease in its latent; title: state, when some kind of intervention can halt, reverse or slow the onset and progression of abnormal; title: physiological conditions. The application of standard routines, such as respiratory symptoms; title: questionnaire, physical examination, radiographs and spirometry journals are intended to identify such; title: cases. The medical control, in that sense, despite being called "secondary" serves as a privileged source of; title: information feeding the control "primary" industrial hygiene, indicating the need for changes in the; title: productive process, collective protection, such as enclosure, exhaust ventilation and use of personal; title: protective equipment, in the most specific exception. The types of exams and its frequency should be; title: based on literature and clinical common sense. The current issue of NR-7 CLT brought important changes; title: that allow more freedom in developing prevention programs, encouraging epidemiologic methods.; title: The largest annual basis or to perform chest X-rays in environments at risk for inhaled dust,; title: contained in several national and international standards, can not be scientifically grounded, as is known,; title: for example, the average latency for the appearance of certain pneumoconioses such as silicosis and; title: asbestosis. Even; title: in the case of fibrogenic dust, the proposal to hold annual chest X-rays only make sense for early; title: detection of cases after years of exposure, except in cases demonstrating atypical clinical course,; title: especially in suspected acute or subacute silicosis. However, for labor, firms that fall in the risk of; title: exposure to mineral dust should comply with instructions contained in NR7. Also in relation to secondary; title: prevention, we must remember the increased risk of tuberculosis in individuals exposed to silica, even if; title: they are removed from exposure, as well as the increased risk of lung cancer in workers exposed to; title: asbestos and silica.; title: Data that lead to suspicion silicotuberculosis is a rapid progression of lesions, cavitations,; title: conglomerates and large opacities besides the constitutional symptoms such as asthenia, weight loss and; title: persistent low fever. In 1996, the International Agency for Research on Cancer (IARC) has classified; title: silica as Group I, ie, a substance described as carcinogenic to humans. There is an excess risk in silicaexposed,; title: predominantly in chronic silicosis. Individuals exposed to asbestos pleural or parenchymal; title: involvement without the higher risk of developing cancer compared with unexposed, constituting a risk; title: group and should be subject to monitoring.; title: The presence of pleural thickening and / or abestos and is associated with an increased risk for; title: cancer, probably reflecting a greater burden of exposure, although there is no safe tolerance limits for; title: carcinogens. The presence of pleural thickening and / or asbestosis is associated with a higher risk,; title: probably reflecting a greater burden of exposure, although there is evidence on the existence of safe; title: tolerance limits for carcinogens.; title: 4.6 Conduct in patients with pneumoconiosis; title: Diagnosed cases should be treated as "sentinel case" and should be duly notified and trigger; title: actions integrated surveillance, with the objective of detecting other cases not yet diagnosed within the; title: environment generating the disease, and adoption of preventive measures and protection to exposed; title: workers, as described in item 4.4.; title: As a general rule, workers with pneumoconiosis should be removed from exposure that caused the; title: illness, because continued exposure leads to a worsening of the condition. However, it is recommended; title: that professionals responsible for directing has common sense in judging whether the activity and the; title: conditions which caused the disease persists at the time of establishing the practice. It is possible that; title: exposure does not, by process change or total effectiveness of preventive measures. Pneumoconiosis is; title: notifiable diseases in the National Health System, regardless of their working ties. Workers in the formal; title: market also mean, by notification in the Work Accident Communication (CAT), which is a document of; title: the Ministry of Welfare and Social Security. The CAT can be issued by the company by the union or any; title: nprofissional health involved in the process of investigation. With this document, the affected worker; title: shall undergo a medical assessment by Social Security to evaluate the "causal" and "disability", the; title: criteria used in judging the right to social security benefit. A "failure" is differentiated from; title: "dysfunction," according to the settings below:; title: Dysfunction: is the reduction of respiratory function and are usually assessed by pulmonary; title: function tests during rest and exercise and questionnaires assessing symptoms, particularly dyspnea. Task; title: is primarily medical.; title: Disability: is the overall effect of the dysfunction in the patient's life expressed by the inability to; title: adequately perform a task at work or in daily life due to malfunction. Failure is not only related to; title: medical conditions, but involves more complex factors such as age, sex, anthropometry, education,; title: psychological status, socioeconomic status and type of energy requirement of the occupation, becoming a; title: medical administrative assignment. The diagnosis of pneumoconiosis needs to be accompanied by an; title: inability to work or need for change of function; title: so that the worker is entitled to social security benefit. However, even without dysfunction, the; title: occurrence of disease is sufficient to queo employee filed a lawsuit for injury at common law. Workers; title: suffering from pneumoconiosis, and removal procedures of exposure, notification and pension; title: administration, when the law (formal workers) should be monitored regularly by clinical and imaging,; title: and, where possible, functional assessment by spirometry biennials. It should also be guaranteed the; title: attendance and conduct of examinations; title: Additional whenever the situation of the patient so desired (appearance of symptoms, episodes of; title: decompensation, association with other diseases). Occupational Lung Diseases; title: DERMATOSES; title: The occupational dermatitis represent considerable portion of disease professionals. Its; title: prevalence is difficult and complex evaluation. Many of these dermatoses is not enough statistics and; title: even the knowledge of experts. Many are self-treatment, others are treated in the ambulatory of the; title: company. Some come to the clinician and the specialist doctors in the consortia that provide assistance; title: under an agreement with the National Social Security Institute (INSS). Only a small share of these; title: dermatoses comes to specialized services. Skin diseases caused by physical, chemical and biological; title: agents from occupational exposure and working conditions are responsible for the discomfort, pain,; title: itching, burning, and other psychosomatic reactions which generate even loss of job. These conditions are; title: inherent in the work organization that seeks to achieve the goals of high productivity and product quality,; title: with the sizing of workers and material resources provided by companies without the criterion of quality; title: of work life is indeed taken into account. The organization of work, without considering the human factor; title: and its limits, is structured in different hierarchical levels, with the characteristic inflexibility and highintensity; title: work rate, pressure for productivity and inability to control by workers. One of the steps; title: required for this process is knowledge of real situation of workers, regardless of their insertion; title: labor market. Taking responsibility for comprehensive health care worker, the NHS must to be a; title: rich and comprehensive source of information and as executor of interventions to prevent at all levels; title: of health care. The data obtained through records of attendance, once formatted and computerized, will be; title: instrumental in the short term, give a more real to the health of workers in our country That effort now; title: developed that can generate knowledge levels aimed at mobilizing resources to interact with the factors; title: causing diseases in workers; to minimize them as much as possible and neutralize them completely.; title: SCOPE; title: 2.1 Disease or condition; title: It's all change in the mucous membranes, skin and its annexes, which directly or indirectly caused,; title: conditioned, maintained or exacerbated by agents present in an occupation or in the workplace (ILO,; title: 2001).; title: 2.1.1 Causes of occupational dermatitis; title: Two main groups of factors can be listed as conditioners; title: of occupational dermatitis:; title: •indirect causes or predisposing factors;; title: •direct causes, are composed of biological, physical, chemical, existing environmental and; title: laughed acts directly on the seed coat, either causing or exacerbating preexisting dermatosis; title: (BIRMINGHAM, 1998).; title: 2.1.2 Indirect causes or predisposing factors; title: •Age:; title: •Young workers are less experienced, more affected by costumamser act with less caution in; title: manipulaçãode chemicals potentially perigosospara skin. On the other hand, the integument is not yet; title: adapted to contatante to produce the espessamentoda stratum corneum (Hardening) tolerance or; title: adaptation to the agent. (LAMMINTAUSTA; Maibach, 1990).; title: •Gender:; title: •men and women are equally affects the. However, women have greater impairment in hands and; title: may be followed less severe and more rapid remission (PATIL; Maibach, 1994; Meding, 2000). Women,; title: in general, have better outcomes in their acne (Nethercott;; title: Holness, 1993).; title: •Ethnicity:; title: •people of the yellow race and the black race are more protected against the action of sunlight that; title: people were white, black with responses in keloids more often than whites. There are racial differences in; title: the penetration of chemical agents and other substânciasna skin. Several studies have shown that the; title: black race has agents penetration lower than Caucasians and that the stratum corneum of the black race; title: has a greater number of layers and spontaneous peeling of this layer is two and a half times greater than in; title: white and yellow (Berardesca; Maibach, 1988).; title: •Climate:; title: •temperature and humidity (HOSO et al, 2000) influenciamo appearance of skin lesions such as; title: pyoderma, fungal infections, miliaria. The outdoor work is often subject to the action of sunlight, insect; title: bites, contact with plants, exposure to rain and wind, bemcomo agents for various potentially dangerous; title: skin.; title: •Morbid history and concomitant dermatoses:; title: •patients with atopic dermatitis or atopic diathesis are more susceptible to the action of irritants,; title: especially alkaline, and can develop contact dermatitis caused by irritants and do not tolerate well the; title: humidity and high temperature environments; activity in patients with dermatitis (nummular eczema,; title: eczema irritative, dermato Plant, psoriasis, lichen planus, etc.). are more likely to develop acne or; title: occupational acne had worsened in their working environment, specific protective are neglected.; title: •Working conditions:; title: •The work in standing position, in susceptible workers may lead to the onset of stasis dermatitis,; title: varicose veins or aggravate existing ones.; title: •Presence of vapors, gases and dust above the limits of tolerance may be a predisposing factor, as; title: well as the lack of lighting, proper ventilation and adequate toilets and showers clean and close to; title: workplaces.; title: •Failure to use adequate protection or incorrect use or the use of Personal Protective Equipment; title: (PPE) of poor quality and a failure by the standards of worker health and safety standard for the activity; title: they perform, may play important role in the onset of occupational dermatitis.; title: 2.1.3 Direct causes; title: Biological, physical and chemical. May cause occupational dermatitis or act as triggering factors,; title: or aggravating competitors. The most common biological agents: bacteria, fungi, yeasts, viruses and; title: insects.; title: •Physical agents. The main ones are: non-ionizing radiation, heat, cold, electricity.; title: •Chemical agents. The main ones are:; title: 1. Irritants →cement, solvents, cutting oils, detergents, acids and alkalis.; title: 2. Alérgenosaditivos rubber, nickel, chromium and; title: cobalt as contaminants in the cement, resins, used in topical treatment of dermatoses.; title: 2.2 Admission, diagnosis, treatment and prevention; title: Admission will be structured from the proper forms that include objective data of the worker. The; title: employee, after completing a form, should be examined in the appropriate location with adequate light.; title: This procedure is described in Annex B. Diagnosis or diagnosis following procedures which, if done; title: consistently will lead to hit rates for the possible causative agents and occupational link.; title: 2.2.1 Diagnosis: how to identify cases of dermatoses; title: occupational; title: For the diagnosis and establishment of appropriate conduct of occupational skin diseases,; title: suspected or confirmed, it is important to consider; title: the following: Clinical picture, history of occupational exposure, observing; title: correlation between the onset of symptoms and the onset of exposure, as well as the location of; title: lesions in areas in contact with the suspected agents. Improvement with the removal and worsens with the; title: return to work. this positive skin patch, where a contact dermatitis caused by sensitization.; title: Table 1 - Diagnosis of contact dermatitis:; title: allergic and irritant.; title: The clinical picture is compatible with contact dermatitis? Occurs in the workplace exposure to; title: irritants or potentially allergenic? Nexus exists between the onset of acne and period of exposure?; title: (Concordance anamnestic); title: The lesions are located in areas in contact with the suspected agents?; title: (Concordance topographic); title: There are better with spacing and / or worsened by the return to the same; title: activity? You can delete the non-occupational exposure as a causal factor.; title: It is possible through the patch tests to identify the likely agent; title: causal?; title: Note: five of these positive alternatives, are strongly suspected occupational dermatosis. The; title: diagnosis of occupational dermatitis (Fisher, 2001; BIRMINGHAM,; title: 1998) is done with relative ease, except in some borderline cases where it becomes difficult to do; title: so. Some aspects are very important to obtain an accurate diagnosis. Among them we quote:; title: 1. patient identification;; title: 2. interview;; title: 3. physical examination;; title: 4. diagnosis;; title: 5. differential diagnosis;; title: 6. exams;; title: 7. visit to the workplace;; title: b) occupational Anamnesis; title: The occupational history, as occurs in all specialties; title: Medical, is an important tool for diagnosis. A good occupational history will lead us to the; title: possible etiologic agent. For this it is necessary to have proper form and a prepared script, where the data; title: required to be reported.; title: Personal history. Atopy, or family, previous skin disease.; title: Personal or family history of asthma, rhinitis, atopic dermatitis. These pathologies, have specific; title: meanings making the skin of these patients more susceptible to attack by various agents.; title: c) Physical Exam; title: Physical examination is of paramount importance to assess the type, location and extent of injuries; title: presented seated. Note: If necessary, refer to Appendix B - Examination dermatológico.Toda the skin; title: should be examined by noting, if possible, a puppet drawn on paper itself, the location of the lesions. In; title: dermatology, occupational injuries occur more frequently in the hands, forearms, arms, neck, face and; title: legs. However, in some cases, all skin can be achieved.; title: If possible, can be idealized form suitable for being recorded their findings on physical; title: examination. This contains data that can guide treatment and prevention of further recurrences.; title: To record:; title: Detailed Description of injuries: injuries noted on the doll.; title: Location Symmetry Color Form; title: There is impotence of the affected area? () Yes () No; title: Figure 1 - Report on the design areas with dermatoses; title: d) Diagnostic hypothesis; title: When formulating the HD becomes important to check whether there is a causal relationship.; title: This dermatitis are occupational dermatitis more freqüentes.Estima that, together, the allergic; title: contact dermatitis and irritant contact dermatitis represent about 90% of cases of occupational dermatitis.; title: Although in most cases do not produce pictures as serious, are often responsible; title: by discomfort, itching, wounds, trauma, aesthetic and functional changes that affect the social life; title: and work.; title: 2.2.2 Differential Diagnosis; title: Considerations:; title: Many workers with skin diseases are referred to serviçosespecializados with the primary diagnosis; title: of occupational dermatosis, although many of them correspond to non-occupational skin processes. In this; title: situation, if necessary, one should resort to the expert who must establish the correct diagnosis of acne.; title: Non-contact dermatitis, occupational allergic or irritant may mimic allergic dermatitis and irritant; title: occupational contact. It is a true contact dermatitis. However, a good history can show us that it is not of; title: occupational etiology and therefore has no causal link. One can also infer that an occupational contact; title: dermatitis may be aggravated by activities of the weekend, such as reform of the residence, repairs, and; title: other paintings. Other skin conditions can often raise doubts about the causal relationship, such as; title: psoriasis, herpes simplex and herpes zoster, idiopathic vesicular reactions by the presence of ringworm on; title: the feet mícides (Dyshidrosis eczema), nummular eczema and skin reactions to drugs, etc.. If in doubt,; title: refer the affected worker to a specialist.; title: 2.3 Investigations: histopathology, patch tests and other; title: 2.3.1 Laboratory tests; title: Are rarely requested.; title: 2.3.2 Histopathology; title: Preferably, it should be requested by the specialist. Patch tests are required in cases of suspected; title: allergic contact dermatitis.; title: 2.3.3 Test of contact - concept; title: It is done in a biotest with the back of the patient contatantes a battery of allergens known as the; title: standard battery and more suspected allergens handled, and those used to treat acne. The contact test is a; title: method for studying allergic to well established rules and fundamentals. Through the test Contact; title: Dermatitis, irritative can differentiate Contact (DIC) of Allergic Contact Dermatitis (ACD). Based on test; title: results, we can guide the patient to avoid further contact (s) agent (s) complained (s) with skin and; title: institute appropriate preventive measures when new contacts are imperative (FISHER, IRMA; title: KIHLMAN, 1989; AMERICAN CONTACT DERMATITIS SOCIETY, 1994).; title: The contact test with allergens should be prepared in good quality and provenance. The mixture of; title: the allergen with the vehicle should be as homogeneous as possible and obey the appropriate technology.; title: The tests should have high quality and has good sensitivity and specificity (FISHER; Maibach, 1990).; title: The sensitivity of the test is directly related to its ability to identify whether the patient introduced by; title: contact allergy. Specificity is the ability of the test has to discriminate a true allergic reaction to another; title: non-allergic. Precision or accuracy is the sum of sensitivity and specificity.; title: Low sensitivity of the test can express a false negative.; title: Low test specificity can express a false positive.; title: Relevance: we say that the allergen from a positive test has significance when it is related to acne.; title: We took the accused in allergen testing and courses to cure acne or insignificant improvement of the; title: clinical (Podmore, BURROWS, BINGHAM,; title: 1984).; title: Table 1 - Interpretation of the contact test:; title: • Mono awareness: a positive allergen is responsible for Allergic Contact Dermatitis (ACD). Your; title: total withdrawal leads to healing of acne.; title: • Poly awareness: multiple positive allergens, the withdrawal of all leads to a cure or significant; title: improvement.; title: • Poly awareness: Several positive allergens, the withdrawal of all does not cure or improvement; title: of clinical status. In this case check:; title: a) There are no other allergens tested and were not detected by occupational history?; title: b) factitious dermatitis, dermatitis artefacta, self-injury. The worker knows ways of keeping your; title: acne active, to prevent their dismissal or loss of benefits.; title: c) worker can eventually run away from temporary jobs (beak) to improve the income and activity; title: in that contact sensitizers or irritants that impede good deed for the proposed treatment.; title: Contact test with standard battery and suspects; title: The contact test should always be done with a standard that will apply to all suspects with; title: Allergic Contact Dermatitis (ACD). Using standard tables of concentration by a study group of contact; title: dermatitis of the Brazilian Society of Dermatology. Besides the standard, test substances referred the; title: patient by means of anamnesis, which must be well prepared and thorough. The suspected allergens,; title: obtained by previous history should be tested with standard battery.; title: All precautions must be taken when testing substances of unknown composition. The test should; title: be offered whenever there is suspicion or evidence that it is an Allergic Contact Dermatitis (ACD). The; title: test should be performed by previously trained staff and its reading and interpretation done by; title: professional; title: Note: The physician involved in health care worker should know the work environment of each; title: activity. For this we suggest that it has at least one or two days per month to meet the workplace in order; title: to better understand the hardships that a worker may suffer in that specific activity. During these visits he; title: must become aware of chemicals that are present in the activities and especially their potential for; title: aggression to the skin. Obtaining data of substances through its technical details is important to know; title: more accurate data. Maintain good links with local services related to worker health.; title: 2.4 Visits to the workplace; title: Inspection of the workplace can provide us important data about the conditions under which work; title: is performed. Potentially irritating agents or allergens can be identified and how they reach the skin of the; title: worker.; title: 2.5 Information provided by the employer; title: With the information obtained, the doctor will get significant subsidies that will help you; title: characterize the "causal" in difficult cases.; title: 2.6 Criteria for removal; title: We suggest the criteria adopted by the AMA - Work-Related Diseases. Procedures Manual for the; title: Health Services 2001.; title: -Staging, indicators and parameters for removal of the workers of their jobs.; title: •Grade or Level 1; title: Signs and symptoms of skin disease are present, even intermittently. There is no restriction or; title: limitation of performance for only a few activities of daily living, although exposure to certain chemicals; title: or physical agents can increase the temporary limitation. No treatment is required or intermittent; title: treatment.; title: •Grade or Level 2; title: Signs and symptoms of skin disease are present, even intermittently. There is some limitation of; title: performance for activities of daily living. Intermittent or continuous treatment may be required.; title: •Grade or Level 3; title: Signs and symptoms of skin disease are present, even intermittently. There is limitation of the; title: performance of many activities of daily living. Intermittent or continuous treatment may be required.; title: •Degree or Level 4; title: Signs and symptoms of skin disease are constantly present. There is limitation of the performance; title: of many activities of daily living that may include intermittent confinement within the home or another; title: home. Intermittent or continuous treatment may be required.; title: •Degree or Level Five; title: Signs and symptoms of skin disease are constantly present. There is limitation of the performance; title: of most activities of daily living that may include occasional or constant confinement indoors and another; title: domicílio.Tratamento intermittent or constant may be required.; title: CHAPTER 3; title: MAIN occupational dermatitis; title: 3.1 irritant contact dermatitis (ICD) ICD - 10 L24; title: Unlike allergic contact dermatitis, it is not necessary prior sensitization. The pathophysiology; title: ofirritant contact dermatitis does not require the involvement of immunological mechanisms. Thus, it can; title: appear on all workers exposed to skin irritants, depending on its concentration and exposure time and; title: frequency of contact with the irritant. Frequent contact with water, soaps and detergents to promote; title: irritation.; title: The clinical picture varies according to the irritant and may appear in the form of dermatitis; title: indistinguishable of acute allergic contact dermatitis, ulcerations to deep red inchemical burns.; title: Thechronic irritant dermatitis is more frequent than acute or accidental. Repeated assaults by low-grade; title: irritant, occur over time. In these cases, skin dryness and cracks are often the first signs that evolve into; title: erythema, scaling, papules, vesicles and gradual thickening of the skin. Theirritant contact dermatitis can; title: be readily diagnosed by clinical and occupational histories. Patch testing or patch test are not indicated for; title: diagnosis. But chronic ICDs do not respond well to treatment may take the test to investigate contact; title: sensitization to the drug sometimes used.; title: 3.1.1 Irritant Contact Dermatitis strong (DICF); title: •Etiopathogenesis; title: Strong irritants are chemicals that produce, when in contact with skin, severe inflammatory; title: lesions, the first contact. The severity of injury depends on the toxicity of contact time and concentration; title: of chemical agent. The cement for being abrasive and highly alkaline hygroscopic, produces, under; title: special conditions when contact with skin, shallow and deep ulcerations. The contact time of the mass or; title: cement grout more pressure and friction exerted by the shoe and / or clothing against the tegument are; title: important factors in the onset of these lesions. The fall of cement, cement grout or concrete, or cement; title: dust (ONUB; Essiet, 1986), in quantity, inside the boot or shoe, the more friction and pressure that occur; title: in the area of skin contact with the cement will initially produce intense erythema, ulceration later,; title: ulceration and necrosis in the affected area. Hannuksela (1976) described deep ulcerations in the patellar; title: region, about 12 hours after exposure, in the seven workers who were working on their knees in contact; title: with wet cement. The alkalinity and oxidizing power of knowledge are important factors in the genesis of; title: these ulcerated lesions. The friction and pressure are factors conditioning, because lesions occur with; title: greater severity on sites where these factors exist, the more accumulation of the mass of cement or; title: concrete.; title: •Clinical Presentation; title: Hours after falling mass of cement in their boots or shoes, there is erythema with itching, burning,; title: burning. The next day, it may be remarked in an active phase lesions, ulcerated, or necrotic, depending; title: solely on contact time and alkalinity; title: cement or concrete.; title: - Key clinical features of the main contact dermatitis; title: Irritant contact dermatitis (ICD). Dry skin on contact area. Desquamation with or without; title: erythema. Can evolve with cracks and bleeds. It is important to emphasize that the irritation process will; title: depend on the causative agent (see below the classification of irritants as ICD 10).; title: Strong contact irritant dermatitis (DIFC). Surge ulceration in the contact area with subsequent; title: necrosis. Stinging, burning pain and symptoms are present. Contact with acids, strong alkalis are the main; title: agents responsible. Another important player is the falling mass of cement or concrete into boots, shoes or; title: gloves. Allergic Contact Dermatitis (ACD) presence of erythema, swelling, blisters and prurido.Ao; title: become chronic, there is a serous crusting sometimes with secondary infection occurs sometimes; title: lichenification (skin thickening). Note: itching, along with other clinical findings, it is a good indicator of; title: Allergic Contact Dermatitis (ACD).; title: Table 4 - Major irritant contact dermatitis and their respective agents; title: Irritant contact dermatitis due to detergents (L24.0); title: Irritant contact dermatitis due to oils and fats (L24.1); title: Irritant contact dermatitis due to solvents: ketones, cyclohexane, chlorine compounds, esters,; title: glycol, hydrocarbons (L24.2); title: Irritant contact dermatitis due to cosmetics (L24.3); title: Irritant contact dermatitis due to drugs in contact with skin (L24.4); title: Irritant contact dermatitis due to other chemicals: arsenic, beryllium, bromine, chrome, cement,; title: fluorine, phosphorus, pesticides; title: (L24.5); title: Irritant contact dermatitis due to food in contact with the skin (L24.6); title: Irritant contact dermatitis due to plants except food (L24.7); title: Irritant contact dermatitis due to other chemicals, dyes (L24.8); title: 3.2 Allergic contact dermatitis (ACD) ICD - 10 L23; title: CVD manifest as acute or chronic eczema. In the acute phase, are accompanied often by intense; title: itching, and in the chronic forms of skin thickening (lichenification), peeling and cracking. Classified as; title: allergens, for having presented a positive patch tests, demonstrated approximately five thousand; title: substances (DE GROOT, 1994). Table 5. ACD corresponds to an immunological reaction of type IV.; title: Contacting the substance is able to penetrate the skin and stimulate the body's immune system to produce; title: T cells that release various cytokines,; title: causing an inflammatory reaction. The DAC results from eczematous skin reaction, immunemediated; title: T cell with antigen-specific delayed response to an antigen hapten in contact with skin. Move; title: away from contact with the allergen, there may be remission of the picture, but the hypersensitivity; title: remains latent and reexposições again unleash lo.O incubation period, after the initial exposure,; title: can vary from fiveto 21 days. In sensitized workers, re-exposed to contact with a sensitizing agent, it is; title: anticipated the appearance of eczema in a period of one to three days and his disappearance from two to; title: three weeks, after termination of exposure.; title: Table 5 - Major causative agents of Allergic Contact Dermatitis (ACD) ICD - 10; title: Allergic contact dermatitis due to metals (L23.0); title: Allergic contact dermatitis due to adhesives (L23.1); title: Allergic contact dermatitis due to cosmetics (Manufacturing / handling) (L23.2); title: Allergic contact dermatitis due to drugs in contact with the skin (L23.3); title: Allergic contact dermatitis due to dyes (L23.4); title: Allergic contact dermatitis due to other chemicals (L23.5); title: Allergic contact dermatitis due to food in contact with the skin (manufacturing / handling) (L23.6); title: Allergic contact dermatitis due to plants (excluding plants used as food) (L23.7); title: Allergic contact dermatitis due to other agents (external cause specified) (L23.8).; title: Characteristics of chronic conditions:; title: The chronic conditions are characterized by thickened skin, with cracks, and may exacerbate; title: the reexposições the antigen. The diagnosis and characterization as a work related disease are made based; title: on clinical and occupational history and clinical examination. The identification of allergenic substances; title: (for diagnostic purposes and to prevent new contacts and re-exposure) can be aided by patch tests or patch; title: tests.; title: 3.2.1. Treatment and other approaches; title: 3.2.1.1 Topical; title: •Astringents; title: In the stage of vesicles and oozing is indicated for use tampons or immersion of the feet and hands; title: in a normal saline solution, boric acid or potassium permanganate. The lesions are usually dry in three; title: days.; title: •Emollients; title: Referred to recover the function of the skin, reduce dryness and itching. Vaseline can be used, cold; title: cream, cream Lanette. Add urea only when the skin is full, otherwise; title: itching and burning may occur. Targeting warm bath, not with mild soap and loofah.; title: •Topical Corticosteroids; title: The choice of concentration, power and vehicle depends on several factors: type, stage and; title: location of the eczema, and the age of the patient.; title: Creams or lotions: for exudative lesions.; title: Cream, lotion or gel, or hairy areas for flexor.; title: Ointment: For dry lesions and the use of adverse crônicas.EfeitosCorticosteroids: Skin atrophy,; title: telangiectasia, purple streaks.; title: If there is recurrence by suspending the treatment, especially when using highly potent steroids; title: and abruptly interrupt their use; title: •spread or secondary infection: bacterial, fungal;; title: •perioral dermatitis, acne rosacea - when used on the face;; title: •sensitization to the actual formula or corticosteroids;; title: •Systemic use: adrenal axis suppression - cushingoid manifestations.; title: 3.2.1.2 Systemic treatment; title: If there is secondary infection may be extensive used antibiotics such as erythromycin,; title: cephalosporin, tetracycline, and antifungals: fluconazole, ketoconazole, terbinafine, itraconazole.; title: •Antihistamines to relieve itching, hydroxyzine, loratadine, cetirizine.; title: •Systemic steroids, given in the acute phase of severe exacerbations.; title: •Treatment with psoralen and UVA (PUVA). This treatment is for patients with chronic,; title: widespread; title: - Must be performed in specialized centers.; title: •Cyclosporine: the immunosuppressive action, has dose-dependent toxicity and may be used only; title: under supervision of a physician experienced in the use of this drug.; title: To summarize:; title: - Care hygienic places to prevent secondary infection.; title: - Topical Treatment: steroids and / or antibiotics,; title: emollients, moisturizers.; title: - Systemic treatment:; title: - Systemic antihistamines. In more extensive cases, one must employ systemic corticoidoterapia.; title: Removal from exposure is essential.; title: - In case of secondary infection uses: topical antibiotic, or systemic, depending on the extent of the; title: injuries.; title: Despite the unwieldy, the chronically resulting from occupational eczema respond well to; title: appropriate therapy. If this does not occur, you should check one of the following:; title: 1.trabalhador remains in contact with irritants and sensitizers;; title: 2. areas of integument remain due to eczematous excoriation produced by rubbing;; title: 3. self-injury may be occurring (artefacta dermatitis) or the important contribution of emotional; title: factors in the maintenance of acne.; title: 3.3 contact dermatitis with photosensitivity; title: 3.3.1 Dermatitis caused by ultraviolet radiation: ICD - 10 L56; title: The photodermatoses, also called photodermatitis or lucid, comprise a large number of abnormal; title: reactions of the skin caused by ultraviolet light or visible spectrum of light. Two tables are the most; title: important polar: phototoxicity and photoallergy. Workers in many occupational activities can be exposed; title: by four or more hours at peak times and be affected if they neglect adequate protection. Table 6.; title: The phototoxic reactions (phototoxicity) result from chemically induced reactivity to ultraviolet; title: light and / or radiation, on a non-immune. The phototoxic reactions, by what is known so far, occur; title: within a logic of dose-response, and the intensity of reaction proportional to the concentration of the; title: chemical and the amount of radiation in certain wavelength.; title: Table 6 - Occupations most affected by the action of ultraviolet light; title: •Farmers.; title: •Fresh produce.; title: •Fishermen.; title: •Sailors.; title: •Gardeners.; title: •Workers in road maintenance.; title: •Construction workers.; title: •Relays.; title: •Lifeguards.; title: •Workers in deepwater fields.; title: •Workers in maintenance services outside.; title: •Telephone, electricity and others who work in foreign services.; title: •Buoys-Frias.; title: •Welders (arc welding).; title: •With arc welders.; title: •Operators with ultraviolet germicidal agents.; title: •Laser ultraviolet and others.; title: 3.3.2 Clinical picture and diagnosis; title: Phototoxic reactions are manifested by an immediate sensation of burning, redness, swelling,; title: blistering and sometimes blisters. The burning sensation is more pronounced than those observed in; title: ordinary sunburn, but is relieved in the shade. Late erythema and edema may appear after a few hours to; title: one to two days after exposure. In more severe cases blisters may appear.; title: A localized hyperpigmentation can be observed after the reaction, and in some cases it may be the; title: only manifestation. The intensity of the disease depend on the amount of radiation, skin type, the site of; title: exposure and concentration of the substance. Lesions of phototoxic reactions are confined to areas of skin; title: exposed to light, typically in one or more areas of the face, tips of ears, the "V" neckline, neck, back of; title: the neck, extensor surfaces of forearms and back of hands. The presence in other areas will depend on the; title: worker's clothing. Photoallergic reactions are usually characterized by eczematous lesions, occurring in; title: erythema, edema, infiltration, and vesiculation in; title: more severe cases, blisters. The lesions may extend beyond the exposed areas, aggravating the; title: areas previously observed cobertas.Pode be a mild widespread dermatitis. To the extent that reduces; title: dermatitis, pigmentary changes and skin thickening may become prominent.; title: Some patients react to extremely small amounts of light energy. The impairment charge of; title: photoallergy wave lie in the range of long-wave ultraviolet (UVA). A serious complication of; title: photoallergy is the development of a persistent reaction to light. The disease is characterized by extreme; title: photosensitivity that persists despite the removal of all contact with the photoallergen. You may get an; title: extension of the action spectrum of light, which causes small exposures to UV radiation trigger; title: photosensitivity.; title: Photoallergic reactions (photoallergy) are differentiated from phototoxic reactions the nature of; title: immune response that occurs only in individuals who were previously sensitized by simultaneous; title: exposure to photosensitizing substances and radiation properly. The photoallergy seems to involve; title: biological processes similar to those of allergic contact dermatitis, except by ultraviolet radiation, the; title: conversion of the hapten in complete allergen.; title: The diagnosis of photodermatoses often suggested for the distribution and character of skin; title: lesions. The frames require photoallergy for confirmation, a more thorough investigation that includes; title: photopatch test (Phototest), which must be performed by a specialist (dermatologist) familiar with the; title: technique.; title: Table 7 - fotossensibibilidade reactions caused by various agents; title: 1) For systemic action:; title: a) antiarrhythmic agents, amiodarone, methyldopa, propranolol, quinidine;; title: b) antibiotics: tetracycline, dimetilclortetraciclina, nalidixic acid;; title: c) oral antidiabetic sulfonamide;; title: d) non-steroidal anti-inflammatory, piroxicam, benoxiprofen,; title: acetylsalicylic acid (ASA), phenylbutazone and oxifenilbutazona, ibuprofen;; title: e) antineoplastic agents (methotrexate, vinblastine, 5.fluorouracil);; title: f) derivatives of quinine - chloroquine;; title: g) diuretics - thiazide, chlorothiazide, furosemide;; title: h) retinoids, isotretinoin, etretinate.; title: 2) For topical:; title: a) antifungals: griseofulvin, ketoconazole;; title: b) dyes: acridine, eosin, methylene blue, toluidine blue, 35 blue, fluorescein and rose bengal,; title: difeniletileno (stilbene), neutral red;; title: c) petroleum, coal tar, creosote, pixe, benzo (α) pyrene, anthracene, phenanthrene, fluorantreno,β-; title: methylanthracenes;; title: d) Phytophotodermatitis: furocoumarins, psoralen, the family of Umbelliferae - celery,; title: parsley, carrot, (Compositae)Chrysanthemum, sunflower.; title: Plants of the families of Moraceae (Fig, jackfruit, breadfruit) and Rutaceae (Citrus fruits in; title: general);; title: e) fragrances: methylcoumarin, musk ambrette;; title: f) sunscreens: PABA and glyceryl-PABA, oxybenzone, Parsol, Eusolex, benzophenones;; title: g) halogenated topics: tribromosalicilianilida (TBS), triclorocarbanilida (TCC), n-butyl; title: 4.clorosaliciliamida, hexachlorophene;.; title: h) Other: cyclamate, cadmium, riboflavin, sulfonamides.; title: 3.4 ulcerations; title: 3.4.1 Chronic ulcer of skin not elsewhere classified ICD - 10 L98.4; title: Skin contact with strong acids or alkalis can cause skin ulceration in the short term (acute ulcer) or; title: long term (chronic ulcer). Chromium and its compounds, such as chromic acid, the chromate sodium or; title: potassium and ammonium dichromate, among others, are irritating chemicals capable of producing; title: chronic skin ulcers of occupational origin. It is rarely an isolated finding, but may be an early; title: manifestation of exposure. The effect of chromium can cause irritation, and chronic ulcers of the skin, irritant contact dermatitis, irritation and ulceration of the nasal mucosa, leading to perforation of the nasal septum, especially in workers exposed to chromic acid mist in electroplating. Tables of allergic contact dermatitis are also common.; title: The long-term effects include cancer of the nasal and lung cancer. Other irritants in animal or; title: vegetable origin, such as proteolytic enzymes and infection, can produce charts of chronic skin ulceration.; title: 3.4.2 Epidemiology - risk factors of occupational nature known; title: In workers occupationally exposed to chromium and its compounds or enzymes of animal,; title: vegetable or bacterial infection, the diagnosis of skin ulcer chromium associated with the work, history occupational and medical and anatomical location; excluded other non-occupational causes.; title: 3.4.3 Clinical picture and diagnosis; title: The ulcers caused by exposure to chromium develop, usually in damp areas, such as nasal mucosa,; title: or skin areas in which there were previous injuries such as abrasion or break in continuity due to injuries.; title: Ulcers may appear on the junction of the phalanges of the finger (or outer surface of extension), the most salient points in or near the fingernails, among other locations. Have from 2 to 4mm in diameter, with raised borders and clearly marked with the bottom; title: excavated. They are very sensitive and painful and may be covered by a crust. A secondary bacterial infection is common. The evolution is slow and can leave scarring. The continuity of exposure can lead to the formation of a halo around the necrotic ulcer with growing size. In the process of chroming exposure; title: to chromic acid mist can cause severe damage to workers' health.; title: Table 8 - Shares of hexavalent chromium on the integument, mucosasvias upper; title: Periungual lesions.; title: Ulcers in previously injured in the integument.; title: Ulceration and perforation of the nasal septum.; title: Brown tongue and teeth.; title: Rhinitis and asthma attacks.; title: Cancer of the bronchi (bronchogenic carcinoma).; title: Other irritants produce ulceration without distinguishing clinical features the diagnosis is made; title: based on clinical characteristics and history of exposure to chromium or other irritating agent. When the causative agent is chrome, should be investigated other harmful effects such as ulcers, nasal septum perforation, cancer of the nasal septum and chronic effects on the lung.; title: 3.4.4 Treatment and other behaviors; title: According recommends Ali (1995), the treatment of ulcers caused by chrome should include:; title: a) the cessation of exposure to harmful agents;; title: b) cleaning of ulceration using saline 0 9% or a; title: ascorbic acid solution prepared by dissolving a tablet of 1 g of effervescent vitamin C in 10ml of; title: distilled water or saline. The solution should be kept in dark bottle and renewed semanalmente.Deve to make a dressing with cotton wool soaked in the solution, leavingabout an hour and afterwards, use a healer. Repeat the procedure for five days, keeping the healer to cure.; title: In cases of irritation or nasal septum perforation, using cotton soaked in this solution for about an; title: hour with the patient lying for five days. Use saline nasal use several times a day during the treatment.; title: The return to the same desktop, after healing of ulceration or perforation of the septum, can cause; title: recurrence.; title: CHAPTER 16; title: MENTAL DISORDERS AND BEHAVIOUR RELATED WORK; title: (Group V of ICD-10); title: 10.1 INTRODUCTION *; title: According to WHO estimates, the minor mental disorders affect about 30% of workers employed,; title: and severe mental illness, about 50-10%. In Brazil, the INSS data on granting social benefits of sickness, incapacity for work exceeding 15 days and permanent disability, permanent disability for work, show that mental disorders, especially the chronic alcoholism, ranks third among the causes of these occurrences; title: (Medina, 1986).; title: In our society, work is a mediator of social integration, both for its economic value (subsistence),; title: due to the cultural (symbolic) and therefore of fundamental importance in subjectivity, in the way of life and, therefore, health physical and mental health of people. The contribution of labor to changes in the mental health of people takes place from a wide range of aspects: from off factors such as exposure to certain toxic agent, to the articulation of complex factors related to work organization, as the division and division of tasks, policies, people management and organizational hierarchical structure. The mental disorders; title: and behavior related to work result, therefore, not isolated factors, but the work contexts in; title: interaction with the body and the psychic apparatus of the workers. The actions involved in the act of working can achieve the body of workers, producing biological damage and dysfunction, but also psychological reactions to work situations pathogenic, and may trigger psychopathological processes specifically related to conditions of work performed by the worker.; title: Due to the prominent place that work occupies in people's lives and a source of livelihood security; title: and social position, lack of work or even the threat of job loss cause suffering psíquicoG by threatening the livelihoods and material life of worker and his family. At the same time undermines the subjective; title: value that the person is assigned, generating feelings of capital loss, anguish,insecurity, hopelessness and despair, featuring paintings of anxiety and depression.; title: The current world economic scenario, in which the conditions of job insecurity, underemployment; title: and the segmentation of the labor market are increasing, reflected in the internal processes of production restructuring, downsizing of staff, technological resources, impacting the mental health workers.; title: The work covers also a key place in the dynamics of affective investment of pessoas.Condições; title: favor of free use of the skills of workers and the control of labor by workers have been identified as key requirements for the job can provide pleasure, wellbeing and health, failing to cause disease. On the other; title: hand, the work lacks meaning, without social support, unrecognized or that would constitute a source of threat to physical and / or psychological, can trigger psychological distress.; title: Various situations as a failure, an accident at work, a position change (rise or fall) in the hierarchy; title: often determine various psychopathological, since the so-called adjustment disorders or reactions to estresseguntil severe and incapacitating depressions, varying according to characteristics of the context of the situation and the mood of the individual to respond to them.; title: The process of communication within the work environment, shaped by organizational culture is; title: also an important factor in determining mental health. Environments that prevent spontaneous; title: communication, expressions of dissatisfaction, employees' suggestions regarding the organization or the; title: work performed will lead to tension and therefore pain and mental disorders. Often, the suffering and dissatisfaction of worker forward not only by the disease, but the rates of absenteeism, and interpersonal conflicts extratrabalho. Factors related to time and pace of work are very important in determining the suffering psíquicogwork-related. Long work hours with few breaks for rest and / or meals short,; title: uncomfortable places, night shifts, alternating turns or shifts starting early in the morning, intense; title: rhythms and monotonous; worker's submission to the rhythm of the machines , under which it has no control, pressure from supervisors or bosses for more speed and productivity cause often of anxiety, chronic fatigue and sleep disturbances. The levels of attention and concentration required to perform the tasks, combined with the level of pressure exerted by the organization of work, can create tension, fatigue and burnout or burn-out (Translated into Portuguese as burnout syndrome or burnout).; title: Studies have shown that some heavy metals and solvents may have direct toxic action on the; title: nervous system, causing mental and behavioral changes, manifested by irritability, nervousness,; title: restlessness, impaired memory and cognition, initially not very specific, and Finally, with a chronic; title: course, often disabling and irreversible.; title: Work accidents may have mental consequences when, for example, affect the central nervous; title: system, as in traumatic brain injury with concussion and / or injury. The experience of work accidents involving risk to life or limb threatening workers determine sometimes typical psychopathological, psychological syndromes characterized as post-traumatic. Sometimes, there are syndromes related to dysfunction or brain injury, superimposed on psychiatric symptoms, yet blending in to the deterioration of the social network due to changes in the economic landscape of work, exacerbating psychiatric disorders.; title: Work contexts individuals have been associated with specific psychopathological, which are; title: assigned specific terminology. Seligmann-Silva proposes a characterization for some clinical cases have already been observed. One example is the burn-out, syndrome characterized by emotional exhaustion, depersonalization and self-deprecation. Initially related professions to provide care and assistance to people, especially in economically critical situations and need, the designation has been extended to other professions that involve high emotional investment and personal, in which the work focuses on human problems of high determination and complexities beyond the reach of the worker, such as pain, suffering,; title: injustice, poverty (Seligmann-Silva, 1995).; title: Another example is the post-traumatic syndromes that refer to experiences of trauma in the; title: workplace in recent times become more frequent, for example, the large number of armed robberies of bank branches with their hostages.; title: The prevention of mental disorders and behavior related to work based on the procedures for; title: monitoring of health hazards and environments and working conditions. Uses medical knowledgeclinical,; title: epidemiological, occupational hygiene, toxicology, ergonomics, psychology, among other; title: disciplines,; title: enhances the perception of workers about their work and health and is based on technical standards; title: and regulations involving:; title: •reconnaissance activities and workplaces where there are chemicals, physical agents, and / or; title: biological risk factors arising from work organization potentially cause disease;; title: •identifying problems or potential harm to health arising from exposure to identified risk factors;; title: •identifying and proposing measures to be taken to eliminate or control exposure to risk factors; title: and for protection of workers;; title: •education and information to workers and employers.; title: The health surveillance of workers should consider the multiple factors involved in determining; title: the mental and behavioral disorders related to work. In some cases, they are chemical in nature, in others,; title: intrinsically related to the organization and management of work or lack of work and in many cases result; title: from a synergistic action of these factors.; title: Upon confirmation of the diagnosis and establish its relationship to work, following the procedures; title: described in Chapter 2, the health services responsible for health care worker should implement the; title: following actions:; title: •assessing the need for removal (temporary or permanent) worker exposure, sector of employment; title: or work as a whole;; title: LIST OF MENTAL DISORDERS AND BEHAVIOUR RELATED TO WORK IN; title: ACCORDANCE WITH THE ORDINANCE / MS No. 1.339/1999; title: •Dementia in other diseases classified elsewhere (F02.8); title: •Delirium, not superimposed on dementia, as described (F05.0); title: •Mild cognitive impairment (F06.7); title: •Organic personality disorder (F07.0); title: •Organic mental disorder or symptomatic NS (F09. -); title: •Chronic alcoholism (work related) (F10.2); title: •Depressive episodes (F32. -); title: •State of posttraumatic stress disorder (F43.1); title: •Neurasthenia (includes fatigue syndrome) (F48.0); title: •Other specified neurotic disorders (including professional neurosis) (F48.8); title: •Disorder of sleep-wake cycle due to non-organic factors (F51.2 Nonorganic); title: •Feeling of being finished (syndrome burn-out g, the burnout syndrome) (Z73.0); title: 10.3.1 OTHER DEMENTIA IN SPECIFIC DISEASES CLASSIFIED; title: OTHER PLACES IN ICD-10 F02.8; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Dementia is conceptualized as a syndrome, usually progressive, chronic disease due to a brain,; title: acquired character, which occur several shortcomings of higher cortical functions, including:; title: memory, thinking, orientation, comprehension, calculation, learning capacity, language and trial.; title: Consciousness is not affected and cognitive impairments are accompanied and occasionally; title: preceded by deterioration; title: emotional control, social conduct or motivation (Bertolote, 1997). May be associated with several; title: diseases that primarily or secondarily affecting the brain, among them, epilepsy, alcoholism,; title: hepatolenticular degeneration, acquired hypothyroidism, lupus erythematosus, trypanosomiasis,; title: poisoning, HIV disease, disease Huntington g's DiseaseParkinson g, the occurrence of multiple; title: infarctions, other ischemic cerebrovascular disease and cerebral contusions repeated, like those suffered; title: by boxers.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Dementia due to drugs and toxins (including dementia due to chronic alcoholism) are 10 to 20% of; title: cases ofdementia in general. Head injuries account for 1-5% of cases. No data are available showing the; title: percentages concerning the contribution of work or occupation.; title: Frames dementia have been found traumatic brain injury (TBI) and the effects of occupational; title: exposure to toxic chemicals following:; title: •asphyxiating substances: carbon monoxide (CO), hydrogen sulfide (H ² S);; title: •carbon sulfide;; title: •heavy metals (Manganese, mercury, lead and arsenic);; title: •organometallic derivatives (Organotin and tetraethyl lead).; title: In workers exposed to these neurotoxic chemicals, the diagnosis of dementia; title: work-related, other causes non-occupational, must be set in Group I of the; title: Classification Schilling,that work plays the role of necessary cause.; title: CLINICAL AND DIAGNOSTIC; title: Diagnostic criteria:; title: •impairment or disability manifested by cognitive decline (higher cortical), such as learning; title: ability, memory, attention, concentration, language, level of intelligence, problem-solving ability, insight; title: and appropriate social behavior;; title: •impairment or incapacity for personal activities of daily living.; title: A decline in cognitive abilities is essential for the diagnosis of dementia. Interference in the; title: performance of social roles within the family, workplace and other spheres of life should not be used as; title: the sole diagnostic criterion or guideline. However, these can serve as indicators of diagnostic; title: researchdementia and, once diagnosed as a useful indicator of severity.; title: TREATMENT AND OTHER CONDUITS; title: The approach of dementia patients is characterized by supportive care:; title: •medical indication for withdrawal of the worker exposure to toxic agent;; title: •enable patient access to the benefits of the SAT;; title: •emotional support for patients and their families;; title: •Symptomatic drug treatment: Benzodiazepines for anxiety and insomnia, antidepressants; title: for depression, antipsychotics for delirium, hallucinations and disruptive behavior;; title: •management of the work situation: orientation of managers and colleagues about the relationship; title: of; title: mental health problem the patient with the work, seeking collaboration and support for the; title: investigation of other cases in the workplace where the patient / worker comes.; title: CHAPTER 17; title: PREVENTION; title: The prevention of work-related dementia basically consists in monitoring environments, working; title: conditions and the effects or health hazards, as described in the introduction to this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker, the social aspects and intervention in the workplace.; title: In the presence of a chemical risk factor, the environmental control measures aimed at the; title: elimination or reduction of exposure levels, through:; title: •entrapment and isolation procedures of work sectors, if possible using hermetically sealed; title: systems;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of exposed workers and; title: exposure time;; title: •measures of general cleaning of work environments and facilities for personal hygiene, resources; title: for bathing, washing hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other things:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •individual psychosocial factors;; title: •working relationships between colleagues and managers; title: •and collective protection measures implemented by individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion involving changes in work organization. Practices that promote health and; title: healthy work environments should include actions for education and prevention of drug abuse, especially; title: alcohol.; title: The prevention of major accidents with the potential to cause traumatic brain injury should be; title: systematically through management practices and adequate safety measures, with the participation of; title: workers.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate.; title: DELIRIUM, superimposed on the dementia-NOT AS DESCRIBED ICD-10 F05.0; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Delirium is a syndrome characterized by decreased level of consciousness, with disturbance of; title: orientation (in time and space) and attention (and hipovigilância hipotenacidade) associated with global impairment of cognitive functions. Changes may occur in mood (irritability), perception (illusions and / or visual hallucinations especially) of thought (delusional ideation) and behavior (reactions of fear and agitation). The patient usually presents a characteristic inversion of the sleep-wake schedule with daytime sleepiness and restless sleep. Can be accompanied by neurological symptoms such as tremor, asterixis, nystagmus, incoordination and urinary incontinence. Generally, delirium has a sudden onset (within hours or days), a short course and floating and rapid improvement once the causative factor is identified and corrected. The delirium may occur in the course of a dementia may progress to dementia, to full recovery for morte.Apresenta different levels of severity, from mild to very severe.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Frames delirium have been found between the effects of occupational exposure to the following; title: toxic chemicals or conditions:; title: •asphyxiating substances: carbon monoxide (CO), hydrogen disulfide (H2S);; title: •carbon sulfide;; title: heavy metals (manganese, mercury, lead and arsenic);; title: •organometallic derivatives (Organotin and tetraethyl lead);; title: •traumatic brain injury (TBI).; title: Should be ruled out a pre-existing dementia, established or evolving. The delirium may be due to a; title: general medical condition such as that experienced by some patients during periods of hospitalization. 15 to 25% of patients in wards of internal medicine and 30% of patients in surgical wards and intensive care cardiac units have delirium poisoning with substance - and should be checked for specific drug involved or abstinence from substance - or due to multiple etiologies.; title: In workers exposed to these neurotoxic chemicals, the diagnosis of work-related delirium,; title: excluded other non-occupational causes, can be classified in Group I of the Classification of Schilling in; title: that work plays the role of necessary cause.; title: 3 CLINICAL AND DIAGNOSTIC; title: With regard to staff related to work, must be observed the following diagnostic criteria:; title: decreased level of consciousness - reflected by reduced clarity of awareness about the; title: environment, with reduced capacity to focus, focus, maintain or shift attention. It is the fundamental aspect of the diagnostic criteria for delirium;; title: •changes in cognition, such as memory deficit, disorientation, language disturbance or disturbance; title: in the development of a perception that is not explained by a preexisting dementia, established or; title: evolving;; title: •disturbance that develops over a short period of time (hours to days), with a tendency to; title: fluctuation throughout the day;; title: •there is evidence from history, physical examination or laboratory findings that the disturbance is; title: a direct or indirect, associated with a work situation.; title: 4 TREATMENT AND OTHER CONDUITS; title: Thedelirium, as acute or subacute, characterized as a medical emergency, and the first goal of; title: treatment is to control the condition or factor that is causing it. In the case of occupational exposure to; title: toxic agents in the central nervous system, the removal of the patient / employee desktop is the first action to be taken. Provide physical support (to avoid accidents: patients may be hurt due to disorientation and psychomotor), sensory and environmental control (level of stimulation from the environment: less or more, hold references known to the people calm and patient and family around) .; title: The symptomatic pharmacological treatment is necessary in cases where there is insomnia, and; title: psychotic symptoms such as hallucinations, delusions and agitation. The drug of choice is haloperidol in the initial dose ranging from 2 to 10 mg (depending on weight, age and physical condition of the patient) intramuscularly, repeated at the end of an hour if the patient remains agitated. The oral dose must be 1, 5 times higher than the parenteral to maintain the same therapeutic effect. The effective daily dose of haloperidol may vary from 5 to 50 mg, according to the severity of delirium. Insomnia can be treated with benzodiazepines of short half-life, such as lorazepam. The use of anticonvulsants is indicated in cases where there is concurrent seizures.; title: 5 PREVENTION; title: The prevention of delirium,non-overlapping dementia-related work, consists in monitoring; title: environments, working conditions and the effects or health hazards, as described in the introduction to; title: this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The environmental control measures aimed at eliminating or reducing exposure to chemicals; title: involved in the genesis of the disease, through:; title: •entrapment and isolation procedures of work sectors, if possible using systems hermetically; title: sealed;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of exposed workers and; title: exposure time;; title: •measures of general cleaning of work environments, personal care, resources for bathing, washing; title: hands, arms, face, clothing exchange;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other things:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •individual and collective strategies adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion involving changes in work organization. Promotion practices; title: health and healthy work environments should include measures of education and prevention of; title: drug abuse, especially alcohol.; title: Suspected or confirmed disease compared with the work must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through the instruments themselves, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate; title: Mild cognitive impairment ICD-10 F06.7; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Mild cognitive impairment characterized by alterations of memory, orientation, learning ability; title: and reduced ability to concentrate on tasks longer periods.; title: The patient complains of intense feeling of mental fatigue when mental tasks and new learning is; title: perceived subjectively as difficult, although objectively able to do it well. These symptoms may manifest; title: themselves preceding or succeeding frames of various infections (including HIV) or physical disorders,; title: both cerebral and systemic, with no direct evidence of brain impairment.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Frames mild cognitive impairment have been found between the effects of occupational exposure; title: to; title: following toxic chemicals and physical agents:; title: •Methyl bromide;; title: •Lead and its toxic compounds;; title: •manganese and its toxic compounds;; title: •mercury and its toxic compounds;; title: •carbon sulfide;; title: •toluene aromatic solvents and other neurotoxic;; title: •Trichloroethylene, tetrachlorethylene, trichloroethane halogenated organic solvents and other; title: neurotoxic;; title: •other neurotoxic solvents;; title: •high noise levels.; title: In workers exposed to these neurotoxic chemicals, among others, the diagnosis of mild cognitive; title: impairment related to work, excluded other non-occupational causes, can be classified in Group I of the; title: Classification of Schilling in that work plays the role of a necessary cause.; title: CLINICAL AND DIAGNOSTIC; title: The main symptom is a decline in cognitive performance, including complaints of memory; title: impairment, learning difficulties or concentration. Psychological testing objectives can be useful but; title: should be interpreted with caution, given its specificity and confusion with other causes related to living; title: conditions.; title: The differential diagnosis with post-encephalitic syndromes and posttraumatic can be done from; title: the etiology and symptoms of lower amplitude, generally lighter and of shorter duration.; title: TREATMENT AND OTHER CONDUITS; title: The diagnosis of mild cognitive impairment indicates the existence of injuries to the normal; title: physiology of the cerebral cortex. Whereas the cause of the injury (toxic agent), in the case of mild; title: cognitive impairment related to work, is in the workplace, the main therapeutic measure is the removal of; title: the patient's work.; title: A thorough evaluation of the stage of cognitive functions should be undertaken by a specialist.; title: Conductions medical, psychological and social aspects of the case include the pharmacological; title: treatment and symptomatic: Benzodiazepines for insomnia and anxiety, antidepressants for depression.; title: Psychotic symptoms in cases of mild cognitive impairment are rare. Depending on the degree of; title: dysfunction and / or injury, one can evaluate the usefulness of neuropsychological rehabilitation of; title: patients and rehabilitation professionals.; title: The control measures and medical surveillance in relation to other workers exposed to toxic agent; title: in the same work environment are critical in preventing further cases.; title: PREVENTION; title: The prevention of mild cognitive impairment related to work consists in monitoring environments,; title: working conditions and the effects or health hazards, as described in the introduction to this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The environmental control measures aimed at the elimination or reduction of exposure to the; title: chemicals involved in the genesis of the disease, through:; title: •entrapment and isolation procedures of work sectors, if possible using hermetically sealed; title: systems;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of exposed workers and; title: exposure time;; title: •measures of general cleaning of work environments, personal care, resources for bathing, washing; title: hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other things:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion involving changes in work organization. Practices that promote health and; title: healthy work environments should include actions for education and prevention of drug abuse, especially; title: alcohol.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: ORGANIC PERSONALITY DISORDER ICD-10 F07.0; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Organic personality disorder is conceptualized as a change in personality and behavior that appears; title: as a residual or concomitant disorder of an illness, injury or brain dysfunction. It is characterized by a; title: significant change in habitual patterns of premorbid behavior, particularly as regards the expression of; title: emotions, needs and impulses. Cognitive function may be compromised in a particular way or even; title: exclusively in the areas of planning and anticipation of the likely social consequences pessoaise, as in call; title: frontal lobe syndrome, which can occur not only associated with frontal lobe lesions,; title: but also the lesions of other brain areas circumscribed.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Frames Organic personality disorder have been found between the effects of occupational; title: exposure to toxic chemicals following:; title: •Methyl bromide;; title: •Lead or its toxic compounds;; title: •manganese and its toxic compounds;; title: •mercury and its toxic compounds;; title: •carbon sulfide;; title: •toluene aromatic solvents and other neurotoxic;; title: •Trichloroethylene, tetrachlorethylene, trichloroethane halogenated organic solvents and other; title: neurotoxic;; title: •other neurotoxic solvents.; title: In workers exposed to these neurotoxic chemicals, among others, the diagnosis of organic; title: personality disorder, other causes non-occupational, can be classified in Group I of the Classification of; title: Schilling in that work plays the role of a necessary cause.; title: 3 CLINICAL AND DIAGNOSTIC; title: In addition to a well-defined history or other evidence of disease or brain dysfunction, a definitive; title: diagnosis requires the presence of two or more of the following:; title: •consistently reduced ability to persevere in activities with particular purposes,; title: especially those involving longer periods of time and delayed gratification;; title: •altered emotional behavior, characterized by emotional lability, joy superficial and unmotivated; title: (Euphoria, inappropriate jocularity) and easy change to irritability, rapid bursts of anger and; title: aggression or apathy;; title: •expression of needs and impulses without considering consequences or social conventions (theft,; title: inappropriate sexual overtures, eating voraciously, or show disregard for personal hygiene);; title: •cognitive disturbances in the form of suspicion, paranoid ideation and / or preoccupation with a; title: single theme, usually abstract (eg religion, right and wrong);; title: •remarkable change of speed and flow of language production with aspects such as; title: circumstantiality, prolixity, viscosity and hypergraphia;; title: •sexual behavior change.; title: TREATMENT AND OTHER CONDUITS; title: As the organic personality disorder related to working sequela of brain injury or dysfunction, the; title: treatment aims at the social rehabilitation, or reduce the harm caused by personal behavior and social; title: change.; title: Pharmacological treatment is symptomatic: Benzodiazepines for insomnia and anxiety, depression; title: and antidepressants to antipsychotics for disruptive behavior. It can be shown using carbamazepine to; title: control impulsiveness.; title: Usually there is an indication of disability retirement and rehabilitation measures aimed at the; title: patient's socialization in the family and community.; title: PREVENTION; title: The prevention of organic personality disorder related to working consists in monitoring; title: environments, working conditions and the effects or health hazards, as described in the introduction to; title: this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The environmental control measures aimed at the elimination or reduction of exposure to; title: chemicals involved in the genesis of the disease, through:; title: •entrapment and isolation procedures of work sectors, if possible using hermetically sealed; title: systems;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of workers exposed; title: and the exposure time;; title: •measures of general cleaning of work environments, personal care, resources for bathing, washing; title: hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity in order to know the factors that may contribute to the illness, such as:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •defense strategies, individual and collective, adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion involving changes in work organization. Practices promotion; title: health and healthy work environments should include measures of education and prevention of; title: drug abuse, especially alcohol.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union; title: MENTAL DISORDER OR ORGANIC SYMPTOMATIC NON-SPECIFIED ICD-10 F09 .-; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: This term covers a range of mental disorders grouped by having in common a demonstrable; title: etiology in cerebral disease, brain damage or other damage that leads to a dysfunction that may be; title: primary,; title: as in illness, injury or damage that affects the brain directly and selectively, or secondary, as in; title: systemic diseases in which the brain is one of the multiple organs involved.; title: This group of the dementia in Alzheimer's disease g,vascular dementia,syndrome; title: amnésicagorganic (Not induced by alcohol or drugs) and several other organic disorders; title: (hallucinosis, state; title: catatonic, delusional mood, anxiety), the post-encephalitis syndrome and post-traumatic, including; title: also theorganic psychosis and psychotic symptoms.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Frames organic or symptomatic mental disorder have been found between the effects of exposure; title: occupational toxic chemicals to the following:; title: •Methyl bromide;; title: •Lead and its toxic compounds;; title: •manganese and its toxic compounds;; title: •mercury and its toxic compounds;; title: •carbon sulfide;; title: •toluene aromatic solvents and other neurotoxic;; title: •Trichloroethylene, tetrachlorethylene, trichloroethane and other solvents Halogenated organic; title: neurotoxic;; title: •other neurotoxic solvents.; title: In workers exposed to these neurotoxic chemicals, among others, the diagnosis of organic mental; title: disorder or symptom, other causes non-occupational, can be classified in Group I of the Classification of; title: Schilling in that work plays the role of a necessary cause.; title: 3 CLINICAL AND DIAGNOSTIC; title: The clinical picture is characterized by evidence of disease, injury or brain dysfunction or a; title: systemic physical illness, known to be associated with one of syndromes:; title: •a temporal relationship (weeks or few months) between the development of the underlying; title: disease and the onset of mental syndrome;; title: •recovery from mental disorders after the removal or improvement of the underlying presumed; title: cause;; title: •absence of evidence to suggest an alternative cause of mental syndrome, for example, a strong; title: family history or estressegprecipitant.; title: 4 TREATMENT AND OTHER CONDUITS; title: Pharmacological treatment: Benzodiazepines for insomnia and anxiety, depression and; title: antidepressants to antipsychotics for disruptive behavior. It can be shown using carbamazepine to control; title: impulsiveness. Generally, there is an indication of permanent disability, with rehabilitation measures; title: addressing himself more to the patient's socialization in the family and community.; title: 5 PREVENTION; title: The prevention of organic or symptomatic mental disorder unspecified work-related consists in; title: monitoring environments, working conditions and the effects or health hazards, as described in the; title: introduction to this chapter. Requires an integrated, coordinated care across sectors and surveillance, it is; title: desirable that the service is done by a multidisciplinary team, with an interdisciplinary approach, able to; title: deal and support the suffering psíquicogthe worker and the social aspects and intervention in the; title: workplace.; title: The environmental control measures aimed at the elimination or reduction of exposure to the; title: chemicals involved in the genesis of the disease, through:; title: •entrapment and isolation procedures of work sectors, if possible using systems; title: hermetically sealed;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of workers exposed; title: and the exposure time;; title: •measures of general cleaning of work environments, personal care, resources for bathing, washing; title: hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other things:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion which involve changes in work organization. Practices that promote; title: health and healthy work environments should include actions for education and prevention of drug abuse,; title: especially alcohol.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (Epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union; title: CHRONIC ALCOHOLISM RELATED TO WORK ICD-10 F10.2; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Alcoholism refers to a chronic manner and continued to use alcohol, characterized by lack of; title: regular intake or a pattern of alcohol consumption with frequent episodes of intoxication, and; title: preoccupation with alcohol and their use despite adverse consequences of this behavior for life and health; title: of the user. According to WHO, alcohol dependence syndrome is a work-related problems. The American; title: Society of Addiction in 1990 found the alcoholism as a chronic disease that has its primary development; title: and manifestations influenced by genetic factors, psychosocial and environmental factors, often; title: progressive and fatal. The disruption of control of alcohol be characterized by continuous or periodic and; title: distortions of thought, characteristically denial, that is, the alcoholic drinker tends not to recognize that; title: alcohol abuse causes.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: The work is considered one of Psychosocial Risk Factors for chronic alcoholism. The collective; title: consumption of alcoholic beverages associated with employment situations may be due todefensivag; title: practice as a means to ensure inclusion in the group. It can also be a way to achieve one's own work, due; title: to the pharmacological effects of alcohol own: soothing, euphoric, stimulating, relaxing, sleep inducing,; title: anesthetic and antiseptic. However, these situations are not sufficient to characterize the pathological use; title: of alcohol.; title: A higher frequency of cases (individual) alcoholism has been observed in certain occupations,; title: especially those that are characterized as being socially discredited and even rejection of some; title: determinants, such as those involving contact with corpses, garbage or waste in general, seizing and; title: killing of dogs, activities in which tension is constant and high, as in dangerous work situations (public; title: transport, banking establishments, construction), high density of mental activity (government offices,; title: banking institutions and commercial), monotonous work, which generates boredom, work on which the; title: person works in isolation from human society (red); work situations that involve prolonged separation; title: from home (Frequent travel, offshore, mining areas).; title: The relations of chronic alcoholism the work can be classified by ICD-10, using the following; title: codes: "factors influencing health status: (...) potential health hazards related to socioeconomic and; title: psychosocial circumstances (Z55-Z65 section of CID -10) or the following "additional factors related to; title: the causes of morbidity and mortality classified elsewhere (Y90-Y98 section of ICD-10; title: The treatment strategies chronic alcoholism include:; title: PSYCHOTHERAPY: The patient usually has an ambivalent relationship with the therapy; title: sessions and can lose and make a drinking relapse. The therapist must deal with the abuse of; title: alcohol as a psychic defense, be prepared to be tested several times and can not hide behind the lack; title: of motivation when the patient relapses are threatening. Depression, often associated; title: withalcoholism; title: chronic, can be conducted through the support role of the therapist may be indicated the addition; title: of antidepressant medication. In addition to the experiences of individual psychotherapy, there are; title: experiences of group psychotherapy that can be quite interesting, especially in services; title: Public health care worker;; title: PHARMACOLOGICAL TREATMENT: both anti-anxiety drugs such as antidepressants are; title: indicated for the treatment of symptoms of anxiety and depression in patients with disorders related to; title: alcohol abuse;; title: MUTUAL HELP GROUPS: Alcoholics Anonymous (AA) / Groups for Families of Alcoholics; title: Anonymous (Al-Anon) - the AA groups are voluntary mutual help hundreds of thousands of people with; title: disorders related to alcohol. Founded in the United States (U.S.) in 1935 by two men alcoholics, is; title: widespread throughout the world and exists in Brazil. Although often patients seek to create objections in; title: the AA, when seeking often become enthusiastic participants, which improves the prognosis by; title: increasing adherence to treatment and social support of patients. The service which the employee serves; title: alcohol dependence should deliver this type of referral;; title: RESOURCE CENTERS OF ATTENTION DAILY after a hospitalization due to alcohol; title: dependence, the return home and community, including work, requires measures of emotional support,; title: guidance and psychosocial rehabilitation phase that may be provided by mental health services, like day; title: care centers.; title: 5 PREVENTION; title: Prevention actions alcoholism they merely hold courses and lectures for the purpose of attempting; title: to transmit scientific knowledge and advice about the harmful actions of alcohol in the body are often; title: harmless.; title: Generally, only positive results reaching programs that identify, and work situations of everyday; title: life, aspects organizacionaisgand environmental risk related to alcohol, trying to implement actions to; title: transform them, for example:; title: •supervisory practices and leading directly into the worker's dignity and role are considered with; title: special attention in work situations socially discredited;; title: •provision of adequate facilities, availability of showers and equipment for personal hygiene; title: (including sufficient clothing trade);; title: •developing strategies to reduce exposure to situations of threats, aggression and anger as popular; title: with the participation of the workers themselves in developing such strategies;; title: •availability of breaks in pleasant and comfortable, to relieve tension;; title: •availability of means of communication and interaction with others during the workday in work; title: situations in isolation;; title: •reduction and control of noise and vibration in the workplace (workers often use alcohol as a; title: hypnotic after working in noisy environments with vibration).; title: The classic example is that of bus drivers.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: ICD-10 Depressive Episodes F32 .-; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: The depressive episodes characterized by sad mood, loss of interest and pleasure in daily activities,; title: being a common feeling of fatigue increased. The patient may complain of difficulty concentrating, may; title: have low self-esteem and confidence, hopelessness, thoughts of guilt and worthlessness, bleak and; title: pessimistic visions of the future, ideas or suicidal acts. Sleep is often disrupted, usually terminal; title: insomnia. The patient complains of decreased appetite, weight loss usually sensitive. Symptoms of; title: anxiety are very common. Anxiety tends to be typically more intense in the morning. Changes in; title: psychomotor retardation can range from agitation. There may be a slowness of thought. The depressive; title: episodes should be classified in the mild, moderate, severe without psychotic symptoms, severe with; title: psychotic symptoms.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: The ratio of depressive episodes the work can be subtle. The successive disappointments in work; title: situations frustrating losses accumulated over the years of work, the excessive demands for increased; title: performance at work, generated by excessive competition, resulting in constant threat of losing one which; title: the employee is in the hierarchy the company's actual loss, loss of job and dismissal may provide more or; title: less severe depressions or protracted. The unemployment situation has long been associated with; title: development of depressive episodes Several studies in different countries. Some controlled comparative; title: studies have shown a higher prevalence of depression in typists, computer operators, typists,; title: lawyers, special educators and consultants.; title: Depressive episodes are also associated with occupational exposure to the following substances; title: Toxic chemical:; title: •Methyl bromide;; title: •Lead and its toxic compounds;; title: •manganese and its toxic compounds;; title: •mercury and its toxic compounds;; title: •carbon sulfide;; title: •toluene aromatic solvents and other neurotoxic;; title: •Trichloroethylene, tetrachlorethylene, trichloroethane halogenated organic solvents and other; title: neurotoxic;; title: •other neurotoxic solvents.; title: In workers exposed to these neurotoxic chemicals, among others, the diagnosis of; title: depressive episodes, excluded other non-occupational causes, can be classified in Group I of; title: Schilling classification, in which work plays the role of necessary cause. Depressive symptoms in; title: these cases usually is not the primary condition and is usually associated with organic mental disorders; title: induced by these substances, such as dementia, delirium, mild cognitive disorder, organic personality; title: disorder, organic mental disorder or symptomatic unspecified as described in items. So whenever you get; title: a depressive syndrome characterized and there is a history of occupational exposure to toxic substances; title: should be investigated; title: the coexistence of an organic mental disorder, or indicative of cerebral dysfunction or injury.; title: 3 CLINICAL AND DIAGNOSTIC; title: The diagnosis of depressive episode requires the presence of at least five of the following; title: symptoms for a period of at least two weeks, and one of the characteristic symptoms is sad mood or; title: diminished interest or pleasure, plus:; title: •marked loss of interest or pleasure in activities that are normally pleasurable;; title: •decreased or increased appetite with weight gain or loss (5% or more of body weight in the last; title: month);; title: •insomnia or hypersomnia;; title: •psychomotor agitation or retardation;; title: •fatigue or loss of energy;; title: •feelings of hopelessness, excessive or inappropriate guilt;; title: •diminished ability to think and to concentrate or indecisiveness;; title: •recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without; title: a specific plan or a suicide attempt or a plan specific suicide.; title: 4 TREATMENT AND OTHER CONDUITS; title: The limitation of available therapeutic resources depends on the severity and specificity of each; title: case, however, is consensus that treatment of psychiatry depressive episodes involves:; title: PSYCHOTHERAPY: is indicated even when they are prescribed psychiatric drugs, because the; title: treatment of depressive episode tends to extend for a period of at least six months, in which the patient is; title: frail and in need of emotional support;; title: PHARMACOLOGICAL TREATMENT: the prescription of antidepressants is indicated; title: depending on the severity of depression. Currently, there are a variety of antidepressant drugs and; title: regimens; title: possible dose. The prescription should be accompanied by an expert, at least in referral system.; title: Are often indicated Benzodiazepines to control anxiety symptoms; title: and insomnia early in treatment because the therapeutic effect of antidepressants begins on average; title: after two weeks of use;; title: PSYCHOSOCIAL INTERVENTIONS: one of the central features of depressive episode is; title: discouragement for everyday activities in which the work is included: "a life loses its color and nothing; title: has value."; title: So sometimes the ability to work is very damaged, preventing the subject of occupational meet; title: their commitments. Often, absences from work are not justified, the first manifestation perceived by; title: relatives or colleagues, bosses or employers. When the depressive episode isrelated to working conditions; title: this compromise may be earlier and more evident, since the affective factors involved in depression are at; title: work, for example, the loss of a post of leadership or other sudden change in the hierarchy of an; title: organization.; title: It is very important that the physician or psychiatrist, along with the health team responsible for; title: the patient are able to:; title: •carefully evaluate the indication of absenteeism through sick leave.; title: Should involve the patient in that decision, seeking help both away from work if necessary for; title: treatment, and to return to the occupation when recovered;; title: •justify each of its recommendations to the organization where the patient works, social security; title: and health system, seeking to ensure respect for the clinical situation of the worker;; title: •help patients cope with the difficulties involved in a process of withdrawal and return to work, for; title: example, the threat of dismissal after the return to work.; title: Often depressive episodes are moments in the life of the subjects in which major changes take; title: place and where the work is usually involved. This implies often that the subject change positions or jobs; title: or even jobs. Right there, social support is crucial for treatment and to ensure the quality of life. This; title: support is implemented to guarantee the right to; title: treatment, access to health services, social security and recognition of the suffering. Clinicians and; title: health services can not offer such guarantees, but should trigger these rights and involve organizations; title: and patients;; title: •guide the patient's relatives, and co-workers, bosses, leaders and managers on how to deal with; title: the situation of the patient's illness, especially as regards the time required for the subject to resume their; title: work capacity. Special attention should be given to the implementation of decisions, opinions, certificates; title: and issue of CAT, in recognition social (including health insurance and Social Security) from an ailment; title: which, if not physical injury has provable way, is characterized by excessive anxiety compromising the; title: ability to work accurately.; title: 5 PREVENTION; title: The prevention of depressive episodes related to work basically consists in monitoring; title: environments, working conditions and the effects or health hazards, as described in the introduction to; title: this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The environmental control measures aimed at eliminating or reducing exposure to chemicals; title: involved in the genesis of the disease, through:; title: •entrapment and isolation procedures of work sectors, if possible, using hermetically sealed; title: systems;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient;; title: •systematic monitoring of ambient air concentrations;; title: •adopting forms of work organization that allow reducing the number of exposed workers and; title: exposure time;; title: •measures of general cleaning of work environments, personal care, resources for bathing, washing; title: hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other factors:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Sadness and joy are the affection. So, are present in all human relationships, including; title: relationships at work and with work. We feel sad when frustrated in our aspirations, but especially when; title: we lose someone or something that is very dear to us. The sadness he feels at the loss can characterize a; title: state of mourning that is normal or may evolve into a depression (melancholy). The depressive episode; title: related to work characterized by loss of socializing at work: job loss, loss of rank, frustration of; title: expectations related to work and career, noting that the inclusion at work is a fundamental human; title: dimension in our society. The prevention of depression related to work is therefore also ethical. It; title: depends on the economic order and justice in labor relations at both the macro and micro. The classic; title: example of the relationship between depression and economic order is the long-term unemployment.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors;; title: •accompany the return of the worker to work, whether in the same activity with modifications or; title: restrictions, either to another activity, which is important to ensure that there is progression, recurrence.; title: STATE OF POST-TRAUMATIC STRESS ICD-10 F43.1; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Thestate of post-traumatic stress characterized as a late response and / or protracted to a stressful; title: event or situation (short or long term) of exceptionally threatening or catastrophic nature. And,; title: admittedly, would cause extreme distress to any person. Examples: natural disasters or man made, serious; title: accidents, witnessing a violent death or being subjected to torture, rape, terrorism or any other crime. The; title: patient experienced, witnessed or was confronted with an event or events that involved death or threat of; title: death, serious injury or threat of physical integrity to self or others.; title: Predisposing factors such as personality traits or previous history of neurotic illness may lower the; title: threshold for the development of the syndrome or aggravate its course, but are neither necessary nor; title: sufficient to explain its occurrence.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: The estimated prevalence of disorder, posttraumatic stress in the general population is 1-3%. In; title: risk groups (eg, fighters), prevalence rates vary from 5 to 75%. Not available epidemiological data related; title: to occupations and professions events that pose a risk to sufficiently menacing to trigger the disorder.; title: There are studies restricted to small groups and case reports. The risk of developing disorder,; title: posttraumatic stress related to work seems to be related to hazardous work involving responsibility for; title: human lives, at risk of major accidents, such as work systems in rail, underground and aerial, the work of; title: firefighters, etc.. It is more common in adults and children, but can occur at any age due to the nature of; title: the situations that trigger. The disorder affects more single, divorced, widowed or socially or; title: economically disadvantaged persons.; title: According to ICD-10, the relationship between disorder, posttraumatic stress Chronic work can be; title: linked to "factors influencing health status: (...) potential health hazards.; title: socioeconomic and psychosocial circumstances (Z55-Z65 section) or to "additional factors related; title: to the causes of morbidity and mortality classified elsewhere (Y90-Y98 section):; title: •other physical and mental difficulties related to work: reaction after work accident serious or; title: catastrophic assault on or after work (Z56.6);; title: •circumstance relating to working conditions (Y96).; title: In workers who suffered the situations described in the concept of the disease in work; title: circumstances, the diagnosis of disorder, posttraumatic stress, other causes non-occupational, can be; title: classified in Group I of the Classification of Schilling in that work plays the role of a necessary cause.; title: 3 CLINICAL AND DIAGNOSTIC; title: The typical picture of state of post-traumatic stress includes revivals of repeated episodes of; title: trauma, which bind to a clear knowledge or dreams (nightmares). The patient presents with a persistent; title: feeling of numbness or emotional blunting, decreased involvement or reaction to the world around him,; title: rejecting the activities and situations reminiscent of the episode traumático.Usualmente, there is a state of; title: autonomic arousal with increased hypervigilance, reactions exacerbated incentives and insomnia. They; title: may also present themselves anxious and depressive symptoms and suicidal ideation. The abuse of; title: alcohol and other drugs can be a complicating factor. May occur and dramatic episodes of acute fear,; title: panic or aggression, triggered by stimuli that evoke a memory and / or sudden revival of trauma or of the; title: original reaction him.; title: The onset follows the trauma with a latency period that can range from a few weeks; title: to months (rarely exceeds 6 months). The course is fluctuating but recovery can be expected in; title: most cases. In a small proportion of patients, the chronic condition can progress for many years,; title: becoming a permanent change of personality.; title: The diagnosis of state of post-traumatic stress can be done in patients with tables; title: start until six months after an event or period * traumatic stress characterized by:; title: •stressful event or situation (short or long term) of exceptionally threatening or catastrophic nature,; title: which the patient was exposed in a work situation or work-related;; title: •recollections or revivals of persistent and recurrent stressor in pictures; title: thoughts, perceptions or memories vivid and / or nightmares and / or acting or feeling as if the; title: traumatic event were happening again (including the feeling of reliving the experience, illusions,; title: hallucinations and dissociative episodes of flashback, including those that occur on awakening or when; title: intoxicated) and / or distress at exposure to internal or external cues that resemble or symbolize an aspect; title: of the traumatic event and / or physiological reaction or exacerbated the internal evidence; title: outside that symbolize or resemble an aspect of the traumatic event);; title: •persistent attitude to avoid circumstances similar or related stressor event (not present before the; title: trauma) as indicated by:; title: -efforts to avoid thoughts, feelings or conversations associated with trauma;; title: -efforts to avoid activities, places or people that bring reminders of the trauma;; title: -inability to recall, either partially or completely, some important aspects of the period of exposure; title: to the stressor;; title: -significantly diminished interest or participation in significant activities;; title: -feelings of detachment or estrangement from others;; title: -emotional distance (eg, inability to have loving feelings);; title: -sense of future short (for example, no longer expects to have a career, marriage, children, a; title: normal life expectancy); -persistent symptoms of exaggerated alertness;; title: -difficulty falling asleep or staying asleep;; title: -irritability or outbursts of anger;; title: -difficulty concentrating;; title: -hypervigilance;; title: -exaggerated response to fear.; title: You can make a probable diagnosis if the latency between the event and the onset of symptoms; title: is greater than 6 months. The literature reports that; title: Latency can be a week or 30 years.; title: 4 TREATMENT AND OTHER CONDUITS; title: The treatment of disorder, posttraumatic stress involves:; title: Psychotherapy: individual therapy is always indicated. In the acute phase may follow the model of; title: crisis intervention with support, guidance and development of instruments to deal with the traumatic; title: event. In the chronic phase, psychotherapy aims to let the patient speak freely, letting you recall the; title: traumatic event and, when possible, get to work rebuilding the future. Group psychotherapy may also be; title: effective in preparing the trauma, especially in the chronic phase. Psychotherapy of a family can offer; title: direct support to family members and patient;; title: PHARMACOLOGICAL TREATMENT: tricyclic antidepressants, especially imipramine and; title: amitriptyline, have a proven action in the treatment of state of post-traumatic stress. The dosage is the; title: same as the treatment of depressive disorders, and the minimum duration of a therapeutic trial should be; title: eight weeks.; title: Patients who respond well should stay the course of the antidepressant for a minimum period of; title: one year before attempting removal. The use of antipsychotics such as haloperidol, should be avoided; title: except in short periods to control severe aggressiveness or agitation;; title: PSYCHOSOCIAL INTERVENTIONS: the state of post-traumatic stress related to work usually; title: refers to a traumatic event characterized as a work accident. Psychosocial interventions are the; title: recognition of the relationship of clinical work, the host of the suffering of workers in the workplace and; title: for the guidance and referrals appropriate to the situation. Often, the development of stress disorder,; title: posttraumaticthan away from work for treatment, implies a vocational rehabilitation project, since the; title: sequels, especially the persistent phobic pictures, can prevent the return to their previous jobs. The host of; title: desire for change, commitment and efforts of the healthcare team, to the patient to resume a productive; title: life, are essential for future reconstruction of the affected worker.; title: 5 PREVENTION; title: The prevention of state of post-traumatic stress related to work involves a complex network of; title: measures for accident prevention, safety and promotion of conditions at work, including work; title: organizational conditions that respect the subjectivity of workers. Requires an integrated, coordinated; title: care across sectors and surveillance, it is desirable that the service is done by a multidisciplinary team,; title: with an interdisciplinary approach, able to deal and support the suffering psíquicogthe worker and the; title: social aspects and intervention in the workplace.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other factors:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the decline in health information systems (epidemiological, health and / or health; title: worker), through the instruments themselves, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT for Social Security; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: Neurasthenia (Includes Fatigue Syndrome) ICD-10 F48.0 1 DEFINITION OF DISEASE -; title: DESCRIPTION; title: The most striking feature of fatigue syndrome-related work *is the presence of constant fatigue,; title: accumulated over months or years of work situations where there is no opportunity to obtain necessary; title: and sufficient rest. Fatigue is reported by the patient as being constant, like waking up tired, both; title: physically and mentally, featuring a general fatigue. Other important events include: poor sleep quality,; title: difficulty to deepen sleep, frequent awakenings during the night, especially initial insomnia, difficulty; title: falling asleep or unable to head off ", irritability or lack of patience and discouragement.; title: Other symptoms that may be part of the syndrome are: headaches, muscle pain (usually in the; title: muscles most used at work), loss of appetite and general malaise. This is generally a chronic condition.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: Complaints of fatigue are extremely common among employed workers. Risk factors of; title: occupational nature that seem to contribute to the emergence of a pathological situation of fatigue are:; title: accelerated pace of work without breaks or pauses without proper conditions for rest and relaxation, long; title: working hours (excessive overtime, commuting from home to work and home from work too long, double; title: shifts to supplement the family income) and working hours in shifts.; title: Fatigue seems related to the pathological interaction of several of these factors together, over; title: months or years.; title: These demonstrations have also been associated with occupational exposure to certain chemicals,; title: including:; title: •Methyl bromide;; title: •Lead and its toxic compounds;; title: •manganese and its toxic compounds;; title: •mercury and its toxic compounds;; title: •carbon sulfide;; title: •toluene aromatic solvents and other neurotoxic;; title: •Trichloroethylene, tetrachlorethylene, trichloroethane halogenated organic solvents and other; title: neurotoxic;; title: •other neurotoxic solvents.; title: In workers exposed to work situations described above, the diagnosis of fatigue syndrome; title: can be included in Group I of the Classification of Schilling, ie, the work acts as a necessary cause.; title: CLINICAL AND DIAGNOSTIC; title: The diagnosis of related fatigue syndrome trabalhogis made from the occupational history and; title: history of a job well done. One must ask about the duration of working hours, working conditions, rest; title: during the journey, the pace of work, conditions of the labor process (presence of noise and other; title: offenders), work pressure, conditions living and housing, to evaluate the conditions of rest and recreation; title: worker. Do not forget that fatigue syndrome-related work can be found in unemployed workers, it may; title: have been acquired during previous work.; title: Definitive diagnosis is based on the following criteria:; title: •persistent and distressing complaints of increased fatigue after mental effort or persistent; title: complaints; title: and overwhelming body of weakness and exhaustion after minimal physical exertion;; title: •at least two of the following: muscle soreness, dizziness, tension headaches,; title: sleep disturbance, inability to relax, irritability, dyspepsia;; title: •patient is unable to recover through rest, relaxation or entertainment;; title: •duration of the disorder at least three months.; title: The differential diagnosis of fatigue syndrome-related work is based on history and should; title: be done with:; title: •fatigue syndrome postviral (G93.9);; title: •post-encephalitic syndrome (F07.1);; title: •postconcussion syndrome (F07.2);; title: •mood disorders (F30 and F39-);; title: •Panic disorder (F41.0);; title: •generalized anxiety disorder (F41.1).; title: 4 TREATMENT AND OTHER CONDUITS; title: It may be advisable to prescribe anxiolytics / hypnotics (benzodiazepines), aiming to control or; title: moderate the most prominent symptoms such as insomnia and irritability, considering always the risk of; title: development of tolerance and dependence of these psychotropic drugs. You should aim to objective; title: changes in working conditions (work organization) and subjective to which a sick worker is subject. The; title: psychotherapy in order to address the subjective changes in relation to work, can be useful.; title: 5 PREVENTION; title: The prevention of fatigue syndrome-related work consists in monitoring environments, working; title: conditions and the effects or health hazards, as described in the introduction to this chapter.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The environmental control measures aimed at the elimination or reduction of risk factors; title: responsible for the genesis of the disease, present at work, through:; title: •entrapment and isolation procedures of work sectors, if possible using hermetically sealed; title: systems, where exposure to chemicals and noise, for example;; title: •hygiene standards and strict security, including exhaust ventilation systems adequate and; title: efficient; mechanization of processes in order to relieve the physical load of work;; title: •systematic monitoring of concentrations of harmful agents in ambient air;; title: •adopting forms of work organization to allow diversification of tasks, reducing the isolation of; title: workers and reduce the cognitive demands arising from pressures for productivity, excessive control,; title: among others;; title: •measures of general cleaning of work environments, comfort and personal hygiene for workers,; title: resources for bathing, washing hands, arms, face and exchange of clothing;; title: •provision by the employer of personal protective equipment appropriate in order to complement; title: measures of collective protection.; title: The interventions needed to improve working conditions based on ergonomic analysis of actual; title: work or activity, emphasis is, among other factors:; title: •content of tasks, and operational methods of employment;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •and collective protection measures implemented by individual companies; •individual and; title: collective strategies adopted by the workers.; title: Employee participation and managerial levels of awareness are essential to the implementation of; title: corrective measures and health promotion involving changes in the organization of trabalhoque correct; title: the causes of overwork (excessive speed, lack of breaks, etc.). And enable the psychosocial rehabilitation; title: and / or professional employee.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT for Social Security; title: as described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: The occurrence of an event of related fatigue syndrome trabalhogshould be considered as a; title: sentinel event, directing the investigation of workplace interventions and psychosocial support the group; title: of workers came from where the stricken;; title: Other specified neurotic disorders (including Neurosis Pro) CID-10 F48.8; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: The group Other specified neurotic disorders includes mixed disorders of conduct, beliefs and; title: emotions who have a close association with a particular culture. According to ICD-10, occupational; title: neurosis, which includes the writer's cramp, * Is included in this group.; title: The category professional neurosis is defined by Aubert (1993) as "a persistent psychogenic; title: illness, in which symptoms are a symbolic expression of psychic conflict, whose development is tied to a; title: particular situation or professional organization."; title: The professional neurosis presents three clinical forms:; title: NEUROSIS CURRENT WORK: traumatic neurosis, related to a current trauma;; title: Psychoneurosis PROFESSIONAL when a given work situation works as a trigger, reactivating; title: infantile conflicts that remained in the unconscious;; title: NEUROSIS IN EXCELLENCE: developed from certain situations that lead to organizational; title: processes of fatigue; title: (Burn-out *) People who invest heavily in their efforts and ideals given activity.; title: The category professional neurosis includes work-related psychiatric disorders, in which; title: subjective aspects and personal characteristics, combined with the organizational conditions of work,; title: determine psychological distress *.; title: Generally, they are paintings of chronic evolution that tend to define as a pattern of behavior.; title: The organization of work plays a decisive role in the development of these patterns of behavior, to; title: encourage and exploit these personal characteristics.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: According to ICD-10 (Z65 and Z55-section), the relationship of the tables in the group bunched; title: neurosis professional conceptualized as above, with the work can be linked to socioeconomic; title: circumstances and psychosocial; title: including:; title: •problems related to employment and unemployment (Z56. -);; title: •unemployment (Z56.0);; title: •changing jobs (Z56.1);; title: •threat of job loss (Z56.2);; title: •pace of drudgery (Z56.3);; title: •poor adjustment to work (difficult working conditions) (Z56.5);; title: •other physical and mental difficulties related to work (Z56.6).; title: Thus, there is epidemiological evidence of excess prevalence of these disorders in certain; title: occupational groups, their occurrence can be classified as work related disease, the Group II of the; title: Schilling classification, in which the work can be considered as a risk factor in the whole risk factors; title: associated with multifactorial etiology of the disease.; title: At the current stage of knowledge, this is an epidemiological link, the probabilistic nature,; title: especially when information about working conditions, properly investigated, are consistent with the; title: epidemiological evidence available.; title: In some cases, the circumstances under which the work is done could cause or contribute to; title: disease recurrence, leading to situate it in Group III of the Classification of Schilling.; title: 3 CLINICAL AND DIAGNOSTIC; title: The so-called cultural disorders have several features, but two aspects stand out:; title: •are not easily slotted into the categories of psychiatric classifications established and; title: used internationally;; title: •were first described in a population or area in particular cultural and subsequently associated with; title: them.; title: Calls neuroses professionals have been classified in this group of disorders, because there have; title: been no diagnostic criteria established in another classification. The symptoms are nonspecific: fatigue,; title: listlessness, irritability, sleep disturbances (insomnia or excessive sleepiness, etc.).; title: It is often the inability for work that appears as the first symptom indicating the presence of a; title: professional neurosis: the person who formerly worked well prepared and with dedication can no longer; title: work, feels tired but can not explain the exact reasons. Medical history, including occupational history; title: and physical examination did not reveal somatic determinants for the frame.; title: The diagnosis is established based on the complaints mentioned in the history of work and analysis; title: of the situation current work. For example, in neurosis of excellence personal values characterized by; title: high standards are crucial to articulate with the organizational culture where excellence is imperative.; title: 4 TREATMENT AND OTHER CONDUITS; title: When symptoms commit the lives of workers, individual psychotherapy is the best treatment for; title: professional neurosis. It is worth remembering that the indication of psychotherapy involves the; title: subjective implication of who undergoes such treatment. The indication of psychotherapy should be done; title: gently.; title: 5 PREVENTION; title: The prevention of professional work-related neuroses involves changes in the culture of the; title: organization of work, such as setting restrictions on the operation of individual performance, collective; title: goals that include seeking the welfare of each.; title: Requires an integrated, coordinated care across sectors and surveillance, it is desirable that the; title: service is done by a multidisciplinary team, with an interdisciplinary approach, able to deal and support; title: the suffering psíquicogthe worker and the social aspects and intervention in the workplace.; title: The intervention on the conditions of work is based on ergonomic analysis of the actual work or; title: activity, emphasis is, among other factors:; title: •content of the tasks, operational methods and work stations;; title: •pace and intensity of work;; title: •mechanical factors and physical conditions of employment and production standards;; title: •shift systems;; title: •Incentive systems;; title: •psychosocial factors and individual;; title: •working relationships between colleagues and managers;; title: •protection measures implemented by the collective and individual companies;; title: •the individual and collective strategies adopted by the workers.; title: Employee participation and managerial levels is essential for the implementation of corrective; title: measures and health promotion which involve changes in work organization.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: The diagnosis of a case professional neurosis should be approached as a sentinel event; title: investigation and indicate the work situation, evaluating the role of work organization in determining the; title: symptomatology. Psychosocial interventions may be indicated to support the group where the affected; title: workers came.; title: DISORDER OF SLEEP-WAKE CYCLE FACTORS DUE TO NON-ORGANIC ICD-10; title: F51.2 Nonorganic; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Thedisorder of sleep-wake cycle due to non-organic factors is defined as a loss of synchrony; title: between the sleep-wake cycle of the individual sleep-wake cycle and socially established as normal,; title: resulting in insomnia, early interruption of sleep or excessive sleepiness. These disorders can be; title: psychogenic or organic assumed, depending on the relative contribution of psychological, psychosocial or; title: organic.; title: Thedisorder of sleep-wake cycle-related work can be included in that category, since, by; title: definition, is given a day's work at night or scheme fixed by the alternation of daytime hours, evening and; title: / or night, under a rotation of shifts.; title: The shift work is a form of work organization, in which teams of workers take turns to ensure the; title: achievement of the same activity in a project of schedules that differ significantly from normal working; title: hours for the average population. It is considered normal daytime working hours the division of working; title: time in hours between 6 and 18 hours, based on the six-day week and the forty-four hours per week. In; title: shift work, workers perform their activities by modifying their work schedules during the week, month; title: (alternating shifts) or remain on a fixed schedule morning, evening or night. Also considered are the; title: schemes of work shifts and irregular hours of input and output at work every day, week or month.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: The ratio of disorder of sleep-wake cycle due to non-organic factors, as conceptualized above, the; title: work can be linked to the "factors influencing health status: (...) potential health hazards related to; title: socioeconomic and psychosocial circumstances ( Z55 and Z65-section of ICD-10) or the "additional; title: factors related to the causes of morbidity and mortality elsewhere classified" (Section Y90-Y98 and the; title: ICD-10):; title: •problems related to employment and unemployment, poor adaptation to the organization of time; title: work (shift work or night work) (Z56.6);; title: •circumstance relating to working conditions (Y96).; title: Workers who perform their activities in alternating shifts and / or night work, with adjustment; title: difficulties, the diagnosis of disorder of sleep-wake cycle-related work, excluded other non-occupational; title: causes, can be classified in Group I of the Classification of Schilling in that work plays the role of a; title: necessary cause.; title: In particular cases of workers previously labile or hipersusceptíveis, circumstances such as those; title: described above by ICD-10 could eventually trigger, aggravate or contribute to disease relapse, leading to; title: situate it in Group III of the Classification of Schilling.; title: 3 CLINICAL AND DIAGNOSTIC; title: Depending on the working hours and night shifts may occur either as an advance late stages of the; title: sleep-wake cycle. These findings may be due to conflicts between the external temporal synchronizers; title: (working hours and other social activities, for example) and internal biological oscillators, the latter; title: responsible for the regulation of biological rhythms. Workers who have one or more of the following; title: complaints:; title: trouble falling asleep, frequent interruptions in sleep, excessive sleepiness during waking and sleep; title: perception of poor quality should be tested differential diagnosis (PSG) to confirm the absence of sleep; title: disorders not related to work organization.; title: The code F51.2 Nonorganic is reserved for the disorders of sleep-wake cycle in which; title: psychological factors play the most important role. Cases of suspected organic origin should be classified; title: in G47.2 group, as non-psychogenic disorders of sleep-wake cycle. Thus, the trial if psychological factors; title: are whether or not it is of primary importance to the clinician in each case.; title: The following clinical features are essential for a definitive diagnosis:; title: •sleep-wake pattern of the individual out of sync with the desired sleep-wake cycle, which is; title: normal in a given society and private shared by most people in the same environment; title: cultural;; title: •as a result of disruption of the sleep-wake cycle, individuals with insomnia during the main period; title: of sleep and excessive sleepiness during waking almost every day for at least a month or recurrently for; title: shorter periods of time;; title: •quantity, quality and sleep time as unsatisfactory because of marked personal distress or; title: interference with personal functioning in daily life, social or occupational functioning;; title: •absence of causative organic factor, such as neurological condition or another medical condition,; title: disorder, psychoactive substance use or a drug.; title: Note: the presence of psychiatric symptoms such as anxiety, depression or hypomania, does not; title: invalidate the diagnosis of a nonorganic disorder of sleep-wake cycle, since this disorder is prevalent in; title: the patient's condition.; title: 4 TREATMENT AND OTHER CONDUITS; title: Environments are given intra rest days to allow workers to shift the practice of napping during; title: breaks. In severe cases, it is recommended to change working hours.; title: •It is suggested that the worker to avoid the consumption of substances with caffeine in their; title: composition about 6 hours before the sleep period.; title: •The practice of regular physical exercise is not exhaustive, should be encouraged. However, these; title: should not be conducted at times near the onset of sleep.; title: •The intake of foods containing high levels of lipids should be avoided, especially during the; title: night.; title: •The onset of daytime sleep after night work should be as far as possible, postponed.; title: •The lower the number of hours between the end of sleep and starting work, the less sleepiness; title: during night work.; title: •The use of sleep inducing drugs is not recommended.; title: Shift workers and night workers are subject to greater risk of suffering cardiovascular diseases,; title: gastrointestinal and mental disorders. Therefore, disorders of sleep-wake cycle may be accompanied by; title: other health effects. It is imperative to observe these effects preclude the employee from continuing in; title: their active working life, or the inability to transfer to day work, be entitled to special retirement.; title: 5 PREVENTION; title: The prevention of disorder of sleep-wake cycle-related work means to organize work so that the; title: shift system is used to a minimum. That is, the economic dimension of shift work should be assessed as; title: having consequences for the health of the worker. The shift system should provide a greater number of; title: hours of rest for workers to recover from fatigue.; title: On suspicion or diagnosis of a disorder of sleep-wake cycle-related work shall:; title: •notify the case to the information systems in health, DRT / MTE and the labor union;; title: •promote medical, psychological and social conditions and changes in working hours on fixed; title: shift;; title: •promote the company or organization where there is shift work and night, discussions about the; title: organization of work systems in order to implement improvements in shift schedules. Priority should be; title: implemented organizational changes to reduce the number of night shifts and / or the number of days; title: worked irregular hours and the number of people exposed to conflicts of biological and social; title: synchronizers;; title: •trigger the surveillance agencies in health: especially SESMT, CIPA, MTE, DRT, unions and; title: state and municipal health programs (outpatient and occupational health).; title: The prevention of these diseases requires an integrated, coordinated between the health care and; title: surveillance, to ensure that the patient is cared for by a multidisciplinary team, with an interdisciplinary; title: approach that gives an account of both aspects of support to psychological distress the worker and the; title: social aspects and intervention in the workplace.; title: Employee participation and managerial levels of awareness are essential to the implementation of; title: measures that involve changes in work organization. Practices that promote health and healthy work; title: environments should include education activities and discussions about the organization of work systems; title: in order to implement improvements in shift schedules. Should be applied primarily organizational; title: changes to reduce the number of night shifts and / or the number of days worked irregular hours and the; title: number of people exposed to conflicts of synchronizers biological, and social diagnosis of a case; title: ofdisorder of sleep-wake cycle-related work should be approached as a sentinel event investigation and; title: indicate the work situation, evaluating the role of work organization in determining the symptomatology.; title: Interventions may be indicated in the shift system, as well as measures of support group where the; title: affected workers came.; title: SENSE OF BEING FINISHED; title: (SYNDROME BURN-OUT DEPLETION SYNDROME OR PROFESSIONAL) ICD-10; title: Z73.0; title: 1 DEFINITION OF DISEASE - DESCRIPTION; title: Thefeeling of being finished and the burnout syndrome is a kind of prolonged response to chronic; title: emotional and interpersonal stressors at work. Has been described as the result of professional experience; title: in a context of complex social relations, involving the representation that the person has of himself and; title: others. A worker who was once very involved emotionally with their customers, with their patients or the; title: work itself, and wears at a given moment, you give up, loses power or if "Burning" completely. The; title: worker loses the sense of its relationship with work, is not interested, and every effort seemed useless to; title: him.; title: According to Maslach & Jackson in 1981 and 1986, and Maslach, in 1993, burnout syndrome; title: comprises three core elements:; title: •emotional exhaustion (feelings of emotional exhaustion and emotional drain);; title: •depersonalization (negative reaction insensitive or excessive deviation of the public who should; title: receive the services or patient care);; title: •reduction of personal involvement in work (feeling of reduced competence and sucessono work).; title: Should be a differentiation between burn-outgo, it would be a response to chronic job stress, other forms; title: of stress response.Syndrome burn-out involves attitudes and negative behaviors with respect to users,; title: customers, organization and work, being a subjective experience that is detrimental to practical and; title: emotional for the worker and the organization. The traditional picture of stress does not involve such; title: attitudes and conduct, is an exhaustion that interferes with the personal lives of individuals, but not so; title: direct in its relationship with work.; title: May be associated with an increased susceptibility to physical illness, alcohol or other drugs (to; title: obtain relief) and for suicide.; title: EPIDEMIOLOGY 2 - RISK FACTORS OF OCCUPATIONAL NATURE KNOWN; title: The syndrome affects mainly professionals or carers services, when in contact diretocom users,; title: employees of education, health, police, social workers, prison officers, teachers, and others.; title: Lately, have been reported increases in prevalence of burnout syndrome workers from work; title: environments that undergo organizational changes, such as job layoffs reduced work week, no; title: replacement of substitutes, and downsizing (downsizing); title: call in restructuring.; title: The risk of burnout syndrome is greater for those living the threat of mandatory changes in; title: working hours and significant decline in economic status. All factors of social and economic insecurity; title: increases the risk (incidence) of burnout in all age groups.; title: In general, factors related to work are more strongly related to the work itself than with the factors; title: biographical or personal. The most important predisposing factors are: role conflict, loss of control or; title: autonomy and lack of social support.; title: The ratio of burn-out syndrome gor burnout with the work, according to ICD-10, may be linked to; title: the "factors influencing health status: (...) potential health hazards related to socioeconomic and; title: psychosocial circumstances (Z55-Z65 Section of the ICD-10):; title: •pace of drudgery (Z56.3);; title: •other physical and mental difficulties related to work (Z56.6).; title: If there is epidemiological evidence of the incidence of the syndrome in certain occupational; title: groups, their occurrence can be classified as work related disease, the Group II of the Classification of; title: Schilling.; title: The work can be considered a risk factor in the set of risk factors associated with etiology; title: multicausaldesta disease. This is an epidemiological link, the probabilistic nature, especially when; title: information about working conditions, properly investigated, are consistent with the epidemiological; title: evidence available.; title: 3 CLINICAL AND DIAGNOSTIC; title: The clinical picture can be identified:; title: •history of high subjective involvement with work, employment, profession or undertaking given,; title: it often gains the character of the mission;; title: •feelings of wear emotional emptiness and affective (emotional exhaustion);; title: •complaints of negative reaction insensitive or excessive deviation of the public who should; title: receive the services or patient care (depersonalization);; title: •complaining of feeling of reduced competence and success at work.; title: Generally, these are associated with nonspecific symptoms such as insomnia, fatigue, irritability,; title: sadness, indifference, apathy, anxiety, tremors and restlessness, characterizing depressive syndrome and /; title: or anxious. The diagnosis of these syndromes associated with the completion of the above criteria leads to; title: a diagnosis of burnout syndrome.; title: 4 TREATMENT AND OTHER CONDUITS; title: The treatment of burnout syndrome involves psychotherapy, pharmacological and psychosocial; title: interventions. However, the intensity of the prescription of each of the therapeutic resources depends on; title: the severity and specificity of each case.; title: PSYCHOTHERAPY: Psychotherapy is indicated even when they are prescribed psychiatric; title: drugs, because the burnout syndrome refers to a process of disinvestment in the emotional work that had; title: been the object of all or much of that investment. The patient therefore needs time and space to rethink; title: (and resign ourselves); title: their integration at work and in life. The patient is frail and in need of emotional support;; title: PHARMACOLOGICAL TREATMENT: the prescription of antidepressants or anxiolytics is; title: indicated according to the presence and severity of depressive and anxiety symptoms. Currently there are; title: a variety of antidepressant drugs and regimens available. The prescription should be accompanied by an; title: expert, at least in referral system. Often, they are indicated Benzodiazepines to control symptoms of; title: anxiety and insomnia, early treatment, because the therapeutic effect of antidepressants begins, on; title: average, after two weeks of use;; title: PSYCHOSOCIAL INTERVENTIONS: one of the central features of burnout syndrome is the; title: removal of the affective work, compromising the performance, and often their own ability to work. The; title: physician should carefully evaluate the indication of absenteeism through sick leave. The physician; title: should involve the patient in that decision, trying to help you both away from work if necessary for; title: treatment, and to return to work when recovered.; title: In addition, the physician and other members of the healthcare team should be able to justify each; title: of its recommendations to the organization where the patient works, social security and health system,; title: seeking to ensure respect for the clinical situation of the worker. The doctor should be able to cope with; title: the difficulties involved in a process of withdrawal and return to work, for example, the threat of; title: dismissal after the return to work.; title: Often, the burnout syndrome featuring a moment of life of the subject in great changes that take; title: place position, the post; title: Working in the hierarchy or even employment. Sometimes burnout syndrome a sequel is found in; title: a patient unemployed. These situations require social support, crucial to ensuring the quality of life; title: achieved in securing the right to treatment, access to health services, social security and recognition of the; title: suffering. The health team should be able to counsel patients and their families about these rights and; title: guide family members, coworkers, bosses, bosses and managers to deal with the situation of the patient's; title: illness until he resume his work capacity *. Special attention should be given to the implementation of; title: decisions, opinions, certificates and issue of CAT, in recognition social (including health insurance and /; title: or Social Security) from an ailment that, even though they showed apparent injury, compromises the; title: ability working.; title: 5 PREVENTION; title: The prevention of burnout syndrome involves changes in the culture of the organization of work,; title: establishing restrictions on the operation of individual performance, decreased labor intensity, reduced; title: competitiveness, seeking collective goals that include the welfare of each. The prevention of these; title: diseases requires an integrated, coordinated between the health care and surveillance. It is important that; title: the patient is cared for by a multidisciplinary team, with interdisciplinary approach that addresses both; title: aspects of support for psychological distress the worker and the social aspects and intervention in the; title: workplace.; title: Suspected or confirmed disease compared with the work, you must:; title: •inform the employee;; title: •examine the exposed, to identify other cases;; title: •notify the case to the systems of health information (epidemiological, health and / or health; title: worker), through its own instruments, the DRT / MTE and the labor union;; title: •provide for the issuance of CAT, where the worker is insured by the SAT of Social Security, as; title: described in Chapter 5;; title: •direct the employer to adopt the technical and managerial procedures to eliminate or control risk; title: factors.; title: Among the health problems, mental disorders are responsible for as many days off work, or That; title: is, health problems that are; title: workers away from work for long periods. Moreover, as this is not a visible injury or a measurable; title: physical process, often patients do not have the legitimately recognized their suffering.; title: The diagnosis of a case burnout syndrome should be approached as a sentinel event investigation; title: and indicate the work situation, evaluating the role of work organization in determining the; title: symptomatology. Interventions may be indicated in the work organization, as well as measures of support group where the affected workers came.