Neice Muller Xavier Faria

Intoxicação por agrotóxicos no Brasil: os sistemas oficiais de informação e desafios para realização de estudos epidemiológicos

Brazil is one of the world leaders in pesticide consumption and exposed workers are numerous and diversified. Acute poisonings are just the most visible aspect of pesticide impact on human health. An assessment of many official information systems that notify pesticide poisoning concluded that none of them performed appropriately the role of a surveillance system. Only acute and severe cases are notified. One of the main gaps concerns exposure information: the only official source (the Agronomic Prescriptions) has many limitations and is not available for research. A review of published articles in Brazil shows a quantitative and qualitative increase of studies in this area with many different approaches. The impact of such a high chemical burden and the huge numbers of workers exposed are two important reasons for the development of an epidemiological research on pesticide poisoning, an issue that has still a vast field to cover in Brazil.

Epidemiological aspects of suicide in Rio Grande do Sul, Brazil

OBJECTIVE To describe epidemiological aspects of suicide mortality in a 10-year time series. METHODS Suicide deaths reported in the state of Rio Grande do Sul (RS), Brazil, were put together as historical time series based on data from the Ministry of Health Mortality Reporting System for the period 1980 to 1999. Suicides were grouped according to the WHO criteria and analyzed using standard demographic variables. RESULTS Suicide rates (proportional mortality and mortality rates) in RS during the study period were the highest in Brazil. The standardized rates grew from around 9 per 100,000 in the 1980s to 11 per 100,000 in 1999. This increase in mortality was attributed mainly to male mortality rates that grew from 14 per 100,000 to the current 20 per 100,000. The male:female ratio increased from 3 to 5. The highest ratios were seen among the elderly although this ratio has been increasing in young adults as well. Widows, widowers and farmers/fishers had the highest mortality rates. CONCLUSIONS The study highlights suicide as a collective health problem in RS and shows aspects that could contribute to preventive action.

Estudo transversal sobre saúde mental de agricultores da Serra Gaúcha (Brasil)

OBJETIVO: Considerando a escassez de estudos rurais de base populacional, buscou-se avaliar as associacoes entre caracteristicas do trabalho rural e a ocorrencia de morbidade psiquiatrica menor- MPM. METODOS: Utilizando delineamento transversal, estudaram-se 1.282 agricultores de 446 estabelecimentos. As informacoes foram coletadas por entrevista direta, a partir da percepcao do trabalhador. O indice de Kappa foi adotado para controle de qualidade. Caracterizaram-se as condicoes produtivas, dados sociodemograficos e indicadores de saude mental. RESULTADOS: A prevalencia de MPM afetou 37,5% dos agricultores. As prevalencias foram maiores entre produtores de feijao e menores entre os de maca. Encontrou-se risco aumentado nos estabelecimentos de 26 a 50 ha, e risco reduzido associado a maior mecanizacao e aumento de escolaridade. A ocorrencia de intoxicacao por agrotoxicos mostrou forte associacao com MPM, embora nao se possa definir a direcao dessa associacao. CONCLUSOES: Os resultados alertam para a dimensao dos problemas e para a urgencia de medidas que visem a proteger a saude dos agricultores.

Prevalence of chronic low back pain: systematic review

OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

Trabalho rural e intoxicações por agrotóxicos

Pesticide use is intensive in Brazilian agriculture. Population-based studies on the characteristics of pesticide use and pesticide poisoning are scarce. This study describes the profile of occupational exposure and pesticide poisoning incidence. Farm characteristics and pesticide occupational exposure were evaluated using a cross-sectional design. Among 1,379 farmers/ farm workers, annual incidence of pesticide poisoning was 2.2 episodes per 100 exposed. Based on Poisson regression, applying pesticide, reentering crop fields after spraying, and working with pesticides on more than one farm were the types of exposure that presented a positive correlation with pesticide poisoning. The results may be useful for planning activities aimed at reducing occupational pesticide poisoning among rural workers.

Pesticides and respiratory symptoms among farmers

OBJECTIVE Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS More than half (55%) of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14) and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81) symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58) and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28). CONCLUSIONS In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

Trabalho rural, exposição a poeiras e sintomas respiratórios entre agricultores

OBJETIVO: As condicoes ambientais do trabalho rural, em especial a exposicao as poeiras orgânicas e minerais, tem sido associadas ao aumento de doencas respiratorias. O objetivo do estudo foi avaliar a prevalencia de sintomas respiratorios entre agricultores e sua associacao com fatores de risco ocupacionais. METODOS: Estudo de delineamento transversal com 1.379 agricultores, de Antonio Prado e Ipe, na Serra Gaucha, em 1996. Foram coletados dados sobre caracteristicas sociodemograficas e producao agricola, bem como a exposicao a poeiras orgânicas e minerais. Os sintomas respiratorios foram aferidos por meio de questionario da American Thoracic Society-Division of Lung Disease modificado. Foi realizada analise de regressao logistica multipla, controlada para fatores de confusao. RESULTADOS: A maioria (52%) dos entrevistados trabalhava em atividades com exposicao intensa a poeiras. Os trabalhadores de estabelecimentos com melhores indicadores economicos referiram menor frequencia de sintomas respiratorios do que os demais agricultores. Os avicultores relataram maior prevalencia de sintomas de doenca respiratoria cronica (OR=1,60; IC 95%: 1,05-2,42). Os agricultores com exposicao intensa a poeiras apresentaram uma elevacao de mais de 70% no risco de sintomas de asma (OR=1,71; IC 95%: 1,10-2,67), como tambem de doenca respiratoria cronica (OR=1,77; IC 95%: 1,25-2,50). CONCLUSOES: Os trabalhadores rurais apresentaram grande exposicao ocupacional a poeiras orgânicas e minerais. Agricultores expostos a concentracoes mais elevadas, como os avicultores, tiveram maior risco de apresentar sintomas respiratorios relacionados ao trabalho. Recomenda-se a implementacao de programas de protecao respiratoria, principalmente para os trabalhadores envolvidos com a producao de aves.

Intoxicações por agrotóxicos entre trabalhadores rurais de fruticultura, Bento Gonçalves, RS

OBJETIVO: Descrever a exposicao ocupacional e a incidencia de intoxicacoes agudas por agrotoxicos, especialmente os organofosforados. METODOS: Estudo descritivo com 290 agricultores da fruticultura do municipio Bento Goncalves, RS, conduzido em duas etapas, no ano 2006. Ambas etapas foram completadas por 241 trabalhadores: no periodo de baixo uso e de intenso uso dos agrotoxicos. Foram coletados dados sobre a propriedade, exposicao ocupacional aos agrotoxicos, dados sociodemograficos e frequencia de problemas de saude utilizando-se questionario padronizado. As intoxicacoes foram caracterizadas por relato de episodios, sintomas relacionados aos agrotoxicos e exames de colinesterase plasmatica. Os casos foram classificados segundo a matriz proposta pela Organizacao Mundial de Saude (OMS). RESULTADOS: Em media foram usados 12 tipos de agrotoxicos em cada propriedade, principalmente glifosato e organofosforados. A maioria usava trator durante a aplicacao de pesticidas (87%), entregava as embalagens para a coleta seletiva (86%) e usava equipamentos de protecao durante as atividades com agrotoxicos (>94%). Dentre os trabalhadores, 4% relataram intoxicacoes por agrotoxicos nos 12 meses anteriores a pesquisa e 19% em algum momento da vida. Segundo o criterio proposto pela OMS, 11% foram classificados como casos provaveis de intoxicacao aguda. Entre os que tinham usado organofosforados nos dez dias anteriores ao exame, 2,9% apresentaram dois ou mais sintomas relacionados aos agrotoxicos, assim como reducao de 20% da colinesterase. CONCLUSOES: A ocorrencia de intoxicacoes a partir da percepcao dos trabalhadores esteve dentro do esperado, mas a estimativa com base na classificacao da OMS captou uma proporcao maior de casos. A quebra na safra reduziu o uso de inseticidas e pode explicar a baixa ocorrencia de alteracoes laboratoriais. Os criterios para definicao de intoxicacao por agrotoxicos, bem como os parâmetros oficiais de monitorizacao, devem ser reavaliados buscando proteger melhor os trabalhadores.

Suicide rates in the State of Rio Grande do Sul, Brazil: association with socioeconomic, cultural, and agricultural factors

Rio Grande do Sul State has the highest suicide rates in Brazil. Previous studies have suggested a possible role of agricultural activities, especially tobacco farming, where pesticide use is intensive. An ecological study was designed to assess associations between age-adjusted suicide rates based on death certificates and socioeconomic and agricultural factors. Suicide rates in males and females were inversely associated with schooling level and directly associated with divorce/marital separation. Rates for men were higher in areas where traditional Protestant religious were more prevalent, and rates for women were lower in areas with a higher proportion of single-inhabitant households. Multivariate analyses showed no associations between increased suicide rates and any of the agricultural variables. These results confirm the role of socioeconomic determinants of suicide, but do not support the hypothesis of a specific role of agricultural practices.

Sistema de Informação em Saúde do Trabalhador: desafios e perspectivas para o SUS

O presente artigo identifica e discute alguns desafios e perspectivas relativos a implantacao de um Sistema de Informacoes em Saude do Trabalhador (SIST) no âmbito do Sistema Unico de Saude (SUS). Os desafios para a coleta, producao e a analise de dados e a disseminacao continuada de informacoes sobre o estado de saude dos trabalhadores e seus determinantes sao revisados. Ha destaque para a necessidade de investimentos em capacitacao de recursos humanos, articulacao e harmonizacao das bases de dados de interesse a saude do trabalhador, implantacao de infra-estrutura de informatica nos niveis locais e da coleta das informacoes na rede de servicos do SUS, e integracao e articulacao interministerial. A realizacao da 3a Conferencia Nacional de Saude do Trabalhador e a recem aprovada Politica Nacional de Seguranca e Saude do Trabalhador representam reforcos importantes para o debate sobre a implantacao do SIST e sua prioridade na agenda do SUS. A relativa sintonia entre as agendas de tecnicos, pesquisadores, trabalhadores e liderancas sindicais na defesa comum de um sistema de informacoes tambem e vista como um apoio a implantacao do SIST e seu efetivo controle social.