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«FICHA TÉCNICA Título Segurança e Higiene Ocupacionais - SHO 2012 - Livro de Resumos Autores/Editores Arezes, P., Baptista, J.S., Barroso, M.P., ...»

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Rueden, K. et al. 2010. Secondary traumatic stress in trauma nurses: prevalence and exposure, coping and personal/ environmental characteristics. Journal of Trauma in Nursing, 17(4), 191- 201.

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Ruído e Saúde Ocupacional: o que existe para além do óbvio...

Noise and Occupational Health: What lies beyond the obvious… Santos, Mónica Cliwork, Medicisforma, Atlanticare, email: s_monica_santos@hotmail.com

1. INTRODUÇÃO Entre os profissionais de saúde ocupacional é associado facilmente o ruído à hipoacusia/ surdez; contudo, ao longo dos últimos anos têm-se desenvolvido projetos de investigação que, apesar de ainda não serem alvo de consenso alargado, associam o ruído a muitas outras alterações de saúde (quer físicas, quer emocionais), com atingimento pessoal e profissional.

Ruído define-se como sendo um som (ou conjunto de sons) não desejado(s) e/ ou desagradável(eis) (Thompkins, 2009).

Os efeitos para a saúde irão variar com a intensidade, frequência (Prashanth, 2008; Fallon, ?), impulsividade, intermitência/ continuidade (Prashanth, 2008) e duração (Prashanth, 2008; Fallon, ?), bem como género, estado de saúde, profissão, personalidade, sensibilidade e adaptabilidade do indivíduo. Considera-se que o risco fica particularmente potenciado a partir dos 90 dBA (Fallon, ?). A perceção do ruído é subjectiva e depende também do facto se este é ou não manipulável; logo, muito variável (Thompkins, 2009).

As consequências não auditivas do ruído não resultam directamente da energia sonora produzida, mas sim do stress causado (Thompkins, 2009; Clark, 2007). Este faz libertar catecolaminas que preparam o organismo para reações rápidas, como atitudes de sobrevivência e de luta (Thompkins, 2009), mas que também originam outras consequências com alguma nocividade.

2. MATERIAIS E MÉTODOS Foi executada uma pesquisa em maio de 2011, nas bases de dados “CINAHL plus with full text, MedLine with full text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, MedicLatina e Academic Search Complete”; utilizando as seguintes palavras/ expressões- chave: “noise” conjugada com ”occupational health, hypertension, blood pressure, ischemic heart disease, ischemic heart rate, myocardial infarctation, respiratory diseases, sleep, mental health, cholesterol, immune system e fetal development”. Os critérios de seleção dos artigos relacionaram-se com a data de publicação igual ou superior ao ano 2000, acesso a texto completo (preferencialmente), língua inglesa, qualidade metodológica e pertinência para o objetivo da revisão.

3. RESULTADOS E DISCUSSÃO





3.1.Hipoacúsia Acredita-se que o ruído induz a produção de radicais livres que, entre outras consequências, diminui a circulação sanguínea coclear. Quando a exposição laboral é contínua a hipoacúsia é geralmente mais grave, uma vez que fica diminuído o tempo de recuperação disponível. Por vezes, a exposição simultânea ao ruído e a alguns agentes químicos acaba por apresentar sinergismo (Chou, 2005). Algumas investigações também concluíram que a exposição simultânea ao tabaco está em situação equivalente (Mohammadi, 2010; Kurmis, 2007; Chou, 2005; Indue, 2005), diretamente proporcional ao número de cigarros consumido. O mecanismo subjacente envolve o aumento da viscosidade sanguínea (pela nicotina e pelo monóxido de carbono) e hipoxia, diminuindo a circulação sanguínea coclear (Mohammadi, 2010;

Wild, 2005; Nomura, 2005); acredita-se que o risco nos tabagistas é quase seis vezes superior (Mohammadi, 2010).

O uso de proteção auricular em trabalhadores que já ouvem mal constitui uma preocupação especial porque estes terão ainda mais dificuldade em ouvir os colegas e as chefias- daí que possa existir resistência extra ao seu uso; por vezes a atenuação sonora também não é a adequada às frequências alvo. Existem equipamentos mais sofisticados (e, por isso, mais dispendiosos também) que atenuam os sons de elevada frequência mas ampliam outros com baixa frequência, de forma a manter a comunicação oral viável (Chalupka, 2005). Para além disso, a eficácia da proteção auricular também depende do treino no uso da mesma; algumas marcas estudaram a eficácia de formação presencial versus por vídeo ou através de material escrito e concluíram existir mais sucesso na primeira hipótese (Murphy, 2011).

A hipoacúsia representa uma parte substancial das doenças profissionais na generalidade dos países, pelo que implica um custo avultado, quer económico, quer social (devido ao isolamento, depressão, maior risco de acidentes, menor qualidade de vida geral). A condição geralmente é irreversível mas, obviamente, sujeita a prevenção (Mohammadi, 2010).

3.2.Outras consequências para além da hipoacúsia Nos últimos anos têm sido publicadas investigações que provam ou sugerem a possibilidade do ruído também se associar a várias alterações cardiovasculares como hipertensão arterial (Prashanth, 2008; Fallon, ?; Bodin, 2009; Clark, 2007;

Selander, 2009; Jarup, 2008; Chang, 2010 e 2007; Jensen, 2009; Bockelbrink, 2008; Tomey, 2005; Babisch, 2008;

VanKempen, 2002; Weinhold, 2002; Tomey, 2000; Tamaian, ?), taquicardia (Bodin, 2009; Clark, 2007; Lusk, 2004;

Babish, 2003; Marks, 2007) e isquemia do miocárdio (Selander, 2009; Jensen, 2009; Chang, 2007; Vankempen, 2002;

Weinhold, 2002; Babish, 2009); alterações do sono (Penney, 2004; Clark, 2007; Vankempen, 2002; Marcks, 2007;

Basner, 2008; Schapkin, 2006); respiratórias; obstétricas (Magann, 2005); imunológicas e gastrointestinais (Veerappa, 2011); bem como consequências a nível de desempenho e variáveis psicológicas e/ ou neuropsiquiátricas (como ansiedade, depressão, alterações na concentração- Jensen, 2009 e Veerappa, 2011, irritabilidade- Prashanth, 2008;

Penney, 2004; Clark, 2007;Vankempen, 2002; Marks, 2007; Secic, 2011) e alterações na aprendizagem- Veerappa, 2011), para além da intensificação de algias. Ainda assim existem investigações que apresentam conclusões opostas (daí não existirem ainda consensos amplamente aceites), provavelmente devido a diferentes metodologias.

4. CONCLUSÕES Muito frequentemente as chefias e trabalhadores banalizam a exposição ao ruído, mesmo associando tal a um risco aumentado de hipoacúsia/ surdez. Cabe à equipa de Saúde Ocupacional clarificar esta consequência mais clássica e estar a par das investigações mais recentes acerca das restantes sequelas que se julgam estar associadas a este factor de risco laboral, de forma a garantir uma melhor segurança e saúde.

5. REFERÊNCIAS Babisch, W. 2008. Road traffic noise and cardiovascular risk. Noise & Health, 10(38): 27-33.

Babisch, W. et al. 2009. Exposure- response relationship of the association between aircraftnoise and the risk of hypertension, Noise & Health, 11(44), 161- 168.

Basner, M. 2008. Nocturnal aircraft noise exposure increases objectively assessed daytime sleepiness. Somnologie, 12: 110-117.

Bodin, T. et al. 2009. Roadtraffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden.

Enviromental Health, 8(38), 1-10.

Chalupka,S. 2005. Challenges in hearing conservation- the hearing impaired worker. AAOHN Journal, 348.

Chang, T. et al. 2007. Effects of occupational noise exposure on 24h ambulatory vascular properties in male workers. Environmental Medicine, 115(11), 1660-1664.

Chang, T. et al. 2010. Co-exposure to noise, N,N- dimethylformamide and toluene on 24- hour ambulatory blood pressure in synthetic leather works. Journal of Occupational and Environmental Hygiene, 7, 14-22.

Chou, Y. et al. 2009. Effects of shifwork on noise-induced hearing loss. Noise & Health, 11(45), 185-188.

Clark,C. et al. 2007. The effect of transportation noise on health and cognitive development: a review of recent evidence. International Journal of Comparative Psychology, 20: 145-158.

Fallon, L. ?. An overview of noise-induced hearing loss hypertension and leisure activities. Journal of Controversial Medical Claims, 13(3): 11-16.

Gan, W. et al. 2011. Exposure to occupational noise and cardiovascular disease in the United States: the National Health and Nutrition Examination Survey 1999- 2004. Occupational and Environmental Medicine, 68(3), 183- 190.

Hazard, M. et al. 2005. Exposure to aircraft noise and risk of psychiatry disorders: the Elamas survey- society of Psychiatry and Psychiatry Epidemiologists, 40: 24-26.

Indue, M. et al. 2005. Cross- sectional study on occupational noise and hypertension in the workplace. Archives of Environmental & Occupactional Health, 60(9): 106-110.

Jensen, A. et al. 2009. Non-auditory health effects among air force crew chiefs exposed to high level sound. Noise & Health, 11(44): 176-181.

Kurmis, A. et al. 2007. Occupational- acquired noise-induced hearing loss: a senseless workplace hazard. International Journal of Occupational Medicine and Environmental Health, 20(2): 127-136.

Magann, E. 2005. The effects of standing, lifting and noise exposure on preterm birth, growth restriction and perinatal death in healthy low-risk working military women. The Journal of Maternal-Fetal and Neonatal Medicine, 18(3): 155- 162.

Marks, A. et al. associations between noise sensitivity and sleep, subjectively evaluated sleep quality, annoyance and performance after exposure to nocturnal traffic noise. Noise & Health, 9, 1-7.

Mohammadi, S. et al. 2010. Effect of simultaneous exposure to occupational noise and cigarette smoke on binaural hearing impairment. Noise & Health, 12(48), 187-190.

Murphy, W.I. et al. 2011. Effects of training on hearing protector attenuation. Noise & Health, 13(51), 132- 141.

Nomura, K. et al. 2005. Hearing loss associated with smoking and occupational noise exposure in a Japanese metal working company.

International Archives of Occupational Environmental Health, 78: 178-184.

Penney, P. et al. 2004. Occupational noise and effects on blood pressure. AAOHN Journal, 52 (11): 476-481.

Prashanth, K. et al. 2008. The relationship between noise frequency components and physical, physiological and psychological effects of industrial workers. Noise & Health, 10(40): 90-98.

Schapkin, S. 2006. Executive brain functions after exposure to nocturnal trafficnoise: effects of task difficult and sleep quality.

European Journal of Applied Physiology, 96: 693-702.

Secic, D. et al. 2011. Hypertriglyceridemia among workers exposed to noise. Health Medicine, 4(4), 934- 939.

Selander et al. 2009. Longterm study of road traffic noise, health impacts. Noise & vibration Wordwide, 21-22.

Tamaian, L. ?. Railway noise annoyance and hypertension risk in populations living around train station, S19-20.

Tomey, F. et al. 2000. Hypertension and Chronic Exposure to noise. Archives of Environmental Health, 55(5): 319-326.

Tomey,F. et al. 2005. Occupational exposure to noise and hypertension in pilots. International Journal of Environmental Health Research, 15(2): 99-106.

Tompkings, O. 2009. Secondhand Noise and stress. AAOHN Journal, 426.

Van Kempen, E. et al. 2002. The association between noise exposure and blodpressure and ischemic heart disease: a meta-analysis.

Environmental Health Perspectives, 110: 307- 317.

Veerappa, M.P. et al. 2011. The possible influence of noise frequency components on the health of exposed industrial workers- a review. Noise & Health, 13(50), 16- 25.

Weinhold, B. 2002. How earplugs can help your heart. Environmental Health Perspectives, 110(3): A151.

Wild, D. 2005. Noise-induced hearing loss is exacerbated by long-term smoking. Clinical Otolaryngology, 30: 517-520.

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