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      Desarrollo de funciones de la enfermería del trabajo en la vigilancia de la salud laboral por exposición a tóxicos: el tolueno como ejemplo Translated title: Occupational health nurses' role in the occupational health surveillance of exposure to toxics: toluene as a case study

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          Abstract

          Resumen Introducción: El tolueno, hidrocarburo aromático presente en varios productos, se absorbe principalmente por vía respiratoria y afecta diferentes sistemas corporales. Los enfermeros/as del trabajo son clave para detectar exposiciones agudas y crónicas. Además, son responsables de recolectar y procesar las muestras para su biomonitorización. Sin embargo, la información sobre los requisitos de recogida y manipulación, así como de intervenciones enfermeras es escasa y heterogénea. Objetivo: Revisar la bibliografía disponible sobre el tolueno y la enfermería del trabajo, identificar requisitos de recogida y procesamiento de muestras, así como los signos y síntomas de exposición y relacionarlos con diagnósticos e intervenciones enfermeras. Métodos: Se realizó una revisión bibliográfica aplicando la estrategia PICO, no limitada por tipo de documento, fecha o idioma en PubMed, Web of Science y Scopus. Se clasificaron los signos y síntomas según sistema y prueba de enfermería realizada durante el examen de salud, identificando diagnósticos e intervenciones enfermeras. Resultados: No se encontraron estudios sobre tolueno y enfermería del trabajo. De 60 citas identificadas, 6 artículos señalaban requisitos de recogida de muestras. Se identificaron signos y síntomas de acuerdo a las pruebas de enfermería y se relacionaron con diagnósticos e intervenciones de enfermería. Conclusiones: La presencia de la enfermería del trabajo en la literatura científica sobre tolueno es escasa. Los criterios de recogida de muestras son heterogéneos y limitados. No se han encontrado estudios que relacionen signos y síntomas de exposición al tolueno con diagnósticos e intervenciones enfermeras. Se propone un cuadro relacional novedoso. Son necesarios estudios de toxicología laboral desde la perspectiva de la enfermería del trabajo.

          Translated abstract

          Abstract Introduction: Toluene, an aromatic hydrocarbon present in various products, is primarily absorbed through the respiratory tract and can affect different body organs. Occupational health nurses play a key role in detecting acute and chronic exposures. They are also responsible for collecting and processing samples for biomonitoring. However, information on the collection and handling requirements, as well as nursing interventions, is scarce and heterogeneous. Aims: We reviewed the existing literature linking toluene and occupational health nursing, identified sample collection and processing requirements, as well as signs and symptoms of exposure, and related them to diagnoses and nursing interventions. Methods: We conducted a literature search using the PICO strategy, without limitations on document type, date, or language, in PubMed, Web of Science, and Scopus databases. Signs and symptoms were classified according to the system and nursing test performed during the health examination, identifying possible diagnoses and nursing interventions. Results: We found no studies linking toluene and occupational health nursing. Seven out of 60 identified documents were selected, which provided information on sample collection requirements. Signs and symptoms were identified based on nursing tests and related to diagnoses and nursing interventions. Conclusions: The presence of occupational health nursing in studies on toluene is scarce. Sample collection criteria are heterogeneous and limited. There were no studies relating signs and symptoms of toluene exposure to diagnoses and nursing interventions. Further studies on occupational toxicology are needed from a nursing perspective.

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          The use of biomarkers in occupational health research, practice, and policy.

          Biomarkers are potentially useful tools for occupational health and safety research, practice, and policy. However, the full realization of this potential has not been achieved. In this paper, the progress made in these three usage areas is reviewed to identify what efforts can be taken to realize the full promise of biomarkers. Biomarker uses are described by a diverse taxonomy that builds on the categories of exposure, effect and susceptibility, and the continuum between exposure and disease prognosis. The most significant uses of biomarkers in occupational health have been in biological monitoring of workers. Other important uses have been in enhancing research and assessing mechanisms of action of occupational toxicants at low exposures. Seven critical areas will influence the extent to which the potential of biomarkers in occupational health and safety is realized. These include: (1) adequate investment in validation; (2) obtaining international agreement on exposure guidelines; (3) exploring the utility of biomarkers in regulation; (4) applying biomarkers to critical occupational safety and health questions; (5) developing the exposome; (6) utilizing biomarkers to address emerging occupational health issues; and (7) continuing to address the ethical and social justice issues related to biomarkers. Overall, if biomarkers are to make a major contribution to occupational health and safety then a more holistic approach to bringing them from the laboratory to practice will be needed.
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            Solvents in urine as exposure markers

            M. Ikeda (1999)
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              Comparison between blood and urinary toluene as biomarkers of exposure to toluene.

              To compare blood toluene (TOL-B) and urinary toluene (TOL-U) as biomarkers of occupational exposure to toluene, and to set a suitable procedure for collection and handling of specimens. An assay based on headspace solid-phase microextraction (SPME) was used both for the determination of toluene urine/air partition coefficient (lambdaurine/air) and for the biological monitoring of exposure to toluene in 31 workers (group A) and in 116 non-occupationally exposed subjects (group B). Environmental toluene (TOL-A) was sampled during the work shift (group A) or during the 24 h before specimen collection (group B). Blood and urine specimens were collected at the end of the shift (group A) or in the morning (group B) and toluene was measured. Toluene lambdaurine/air was 3.3 +/- 0.9. Based on the specimen/air partition coefficient, it was calculated that the vial in which the sample is collected had to be filled up to 85% of its volume with urine and 50% with blood in order to limit the loss of toluene in the air above the specimen to less than 5%. Environmental and biological monitoring of workers showed that the median personal exposure to toluene (TOL-A) during the work-shift was 80 mg/m3, the corresponding TOL-B was 82 microg/l and TOL-U was 13 microg/l. Personal exposure to toluene in environmentally exposed subjects was 0.05 mg/m3, TOL-B was 0.36 microg/l and TOL-U was 0.20 microg/l. A significant correlation (P < 0.05) was observed between TOL-B or TOL-U and TOL-A (Pearson's r = 0.782 and 0.754) in workers, but not in controls. A significant correlation was found between TOL-U and TOL-B both in workers and in controls (r = 0.845 and 0.681). The comparative evaluation of TOL-B and TOL-U showed that they can be considered to be equivalent biomarkers as regards their capacity to distinguish workers and controls and to correlate with exposure. However, considering that TOL-U does not require an invasive specimen collection, it appears to be a more convenient tool for the biological monitoring of exposure to toluene.
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                Author and article information

                Journal
                aprl
                Archivos de Prevención de Riesgos Laborales
                Arch Prev Riesgos Labor
                Societat Catalana de Salut Laboral y Asociación de Medicina del Trabajo de la Comunidad Valenciana (Barcelona, Barcelona, Spain )
                1578-2549
                December 2023
                : 26
                : 4
                : 291-308
                Affiliations
                [2] orgnameAsociación de Especialistas en Enfermería del Trabajo (AET) orgdiv1Comite de Toxicología Laboral España
                [1] San Roque Cádiz orgnameIndorama Ventures Química, S.L.U orgdiv1Servicio de Salud Laboral España
                Article
                S1578-25492023000400004 S1578-2549(23)02600400004
                10.12961/aprl.2023.26.04.04
                032ca594-9d9d-469c-8309-58f907af9c42

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 13 October 2023
                : 14 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 18
                Product

                SciELO Spain

                Categories
                Artículos Especiales

                manejo de especímenes,Toluene,Occupational Health Nursing,Occupational Health,Biomarker,Biological Monitoring,Specimen Handling,Tolueno,enfermería del trabajo,salud laboral,biomarcadores,monitoreo biológico

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