Rodrigo Dalke Meucci

Increase of chronic low back pain prevalence in a medium-sized city of southern Brazil

BackgroundChronic low back pain (CLBP) is a highly disabling morbidity with high social, economic and individual effects. Demographic, occupational and behavioral changes that took place in Brazil over the last decade are related with an increasing burden of chronic conditions. Despite these changes, comparison studies on CLBP prevalence and associated factors, over time are scarce in the literature in general, and unknown in Brazil. The present study compared the CLBP prevalence in a medium sized city in Brazil between the years 2002 and 2010 and examined factors associated with prevalence in 2010.MethodsTwo cross-sectional studies with similar methodology were conducted in a medium-sized city in southern Brazil, in 2002 and 2010. 3182 individuals were interviewed in the first study and 2732 in the second one, all adults aged twenty years or more. Those who reported pain for seven weeks or more in the last three months in the lumbar region where considered cases of CLBP.ResultsThe CLBP prevalence increased from 4.2% to 9.6% in 8 years. In most of the studied subgroups the CLBP prevalence has at least doubled and the increase was even larger among younger individuals with more years of education and higher economic status.ConclusionsIncrease in CLBP prevalence is worrisome because it is a condition responsible for substantial social impact, besides being an important source of demand for health services.

Green Tobacco Sickness Among Tobacco Farmers in Southern Brazil

Background Despite being the second largest tobacco producer in the world, Brazil does not have prevalence studies about green tobacco sickness (GTS). Methods A cross‐sectional study was carried out on a sample of Brazilian tobacco workers. The sample was described according to socio‐demographic, behavioral, and occupational variables. Gender‐stratified multivariate analyses examined variables associated with GTS. Results GTS prevalence among men in the previous month was 6.6%, while among women it was 11.9%. Among men, age, being a non‐smoker, hanging tobacco sticks in the barn, harvesting wet leaves, and exposure to physical exertion were risk factors for GTS. Among women, tying hands of tobacco, transporting bales, harvesting wet leaves, having had contact with pesticides, and exposure to physical exertion were positively associated with GTS. Conclusion Research is required to improve methods for GTS screening, as well as the ability to distinguish GTS from pesticide poisoning. Health professionals should be trained to diagnose and treat GTS. Am. J. Ind. Med. 57:726–735, 2014.

Association between pesticide exposure and suicide rates in Brazil

INTRODUCTION The association between pesticide use and an increased suicide risk is a controversial issue. Previous studies have shown higher rates of suicide among agricultural workers and people living in small municipalities, but have not identified the causes of these results. OBJECTIVE To investigate the association between pesticide exposure and suicide rates. METHODS Crude suicide rates of a 15-year time series (1996-2010) were examined, followed by an ecological study using age-standardized suicide rates for the period 2006-2010. The unit of analysis was all 558 Brazilian micro-regions. Pesticide exposure was evaluated according to the proportion of farms that used pesticides and had reported cases of pesticide poisonings. The statistics were analysed using Pearsons correlation and multiple linear regression adjusted for socioeconomic, demographic and cultural factors. RESULTS Among the age group that was analysed, the mean suicide rate was 6.4 cases/100,000 per year in the 2006-2010 period, with a male/female ratio of 4.2. The times series showed that there were higher suicide rates among people aged 35-64 years and among men aged 15-34 years. The ecological analysis showed that the suicide rates were higher in micro-regions with a higher proportion of farms run by 35-64 year olds, female workers and on farms with better economic indicators (higher farming income, level of mechanization and farm area). There was a positive association between the Catholic religion and suicide rates. Micro-regions with a greater use of pesticides, and with a high proportion of pesticide poisoning had the highest suicide rates for all three groups analysed: both genders, men, and women (p ranging from 0.01 to p<0.001). CONCLUSION This study reinforces the hypothesis that pesticide use and pesticide poisoning increase the suicide rates. However, due to the limitations of the studys ecological design, such as ecological fallacy, further appropriately designed studies are needed to confirm the causal relationships.

Asthenopia in schoolchildren

Objective To assess asthenopia prevalence and associated factors in schoolchildren aged 6–16. Methods This was a cross-sectional study of all children attending the first to eighth grades at two public schools in the urban region of a medium-sized town in Southern Brazil between April and December 2012. A questionnaire on socioeconomic and cultural matters was answered by parents, while the children answered a questionnaire on asthenopia-related symptoms. The children underwent a complete visual function examination, including measurement of visual acuity, refraction test, cover test, stereopsis, heterophoria assessment, near point of convergence, and accommodative convergence/accommodation ratio. Results Asthenopia prevalence was 24.7% in a total sample of 964 children. Visual acuity of 20/25 or better in both eyes was found in 92.8% of the children. The stereopsis test was normal in 99.4% of them, and some kind of strabismus was found in 3.5%. About 37.8% had astigmatism, 71.6% had mild hyperopia, 13.6% had moderate hyperopia, and 6.1% were myopic. Near point of convergence was abnormal in 14.0% of the children, and the accommodative convergence/accommodation ratio was found to be altered in 17.1% of them. Conclusion Children and adolescents have expressive prevalence of asthenopia. The prevalence of visual function alterations does not differ from the general population, and, therefore, they are not prerequisites. It is very important that its mechanisms and risk factors be better defined. Health professionals need to be on the lookout for complaints of visual fatigue because of its potential to influence learning and school performance.

Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children

BackgroundStudies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability.MethodsThis systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model.ResultsThe review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling.ConclusionFuture studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

Perfil de trabalho urbano de adolescentes de 14-15 anos: um estudo populacional no Sul do Brasil

The scope of this article was to describe the urban work patterns among 14 to 15-year-old youths from Southern Brazil. Child labor was characterized as any activity that resulted in retribution in the form of goods, services or money. The analyses were stratified by sex and economic level. Of the 4325 adolescents interviewed, the proportion of labor in the last year was 22.2%, namely 27.7% for the male sex, and 17% for the female sex. This proportion was also higher among the poorer strata of the population (30.0%) than the more affluent (14.3%). The majority of adolescents worked away from home and approximately half of them began working before 14 years of age, and around 80.0% reported that they worked by choice. Only 1.0% had a labor contract or work booklet, 30.0% worked more than six hours per day, and the average income was less than US

Chronic low back pain among tobacco farmers in southern Brazil

85/month. Domestic work predominated among the poorest teenagers. There is a need for greater surveillance of child labor and of interventions seeking to enforce prevailing legislation.

Moderate hyperopia prevalence and associated factors among elementary school students

Abstract Background: Despite tobacco farming involving intensive manual labor, chronic low back pain (CLBP) prevalence and associated factors are unknown among this occupational group. Methods: This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed. Socioeconomic and individual characteristics, occupational tasks, workloads, and comorbidities were investigated. Chronic low back pain prevalence was described in relation to independent variables, and associations were examined with Poisson regression. Results: Chronic low back pain prevalence was 8·4%. Increasing age, rearing two or more species of livestock (PR 1·65), exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP. Conclusions: This study found that CLBP is a relevant health problem among tobacco farmers and highlights understudied risk factors such as pesticide poisoning and GTS. Policies to minimize exposure to physiological and chemical workloads in tobacco planting to prevent CLBP are needed. Health professionals should be trained to diagnose and prevent acute low back pain episodes and thus prevent/minimize limitations and disabilities due to CLBP.

Amplitude of Accommodation in Schoolchildren.

Hyperopia is the most common refractive condition in childhood. There are few studies on moderate hyperopia and associated factors. This study aims to investigate the prevalence of moderate hyperopia and associated factors among school children. A cross-sectional study comprising 1,032 students attending 1st to 8th grades at two public schools was conducted in a Southern Brazilian urban area in 2012. Cycloplegia was used to examine both eyes and refractive error was measured through auto-refraction. A socioeconomic and cultural questionnaire was administered. Multivariable analysis was performed through Poisson regression. Moderate hyperopia prevalence was 13.4% (95% CI, 11.2-15.4) and 85% of these did not wear glasses. Age was inversely associated with moderate hyperopia, while female gender RP = 1.39 (95%CI, 1.02 - 1.90) and white skin RP = 1.66 (95%CI, 1.04 - 2.66) were risk factors for this outcome. This study makes progress in estimating mild and moderate hyperopia prevalence both by age range and specific age. It emphasizes how the lack of this condition being corrected in southern Brazil is a serious problem. It highlights the importance of detailing and characterizing the amount of time spent on close-range, long-range and outdoor activities.

Wheezing in tobacco farm workers in southern Brazil.

ABSTRACT Purpose: Hofstetter’s equations are based on studies of Amplitude of Accommodation (AA) with methodological limitations, particularly in the case of children younger than 10 years of age. The aim of this study is to evaluate AA by age, gender, economic status, and time of day as well as accommodative insufficiency prevalence. Methods: A cross-sectional study was conducted with 867 schoolchildren aged 6–16 years attending two public schools in the urban area of the South Brazilian city of Pelotas. Subjective refraction was performed using a monocular fogging method to standard end point of maximum plus for best visual acuity (20/25). AA was assessed using the push-up method. Results: The median AA value was 14.3D (P25 13.3–P75 16.7) among children aged 6–16 years, being 15.5D (P25 14.3D–P75 16.7) among children aged 6–10 years, 14.2D (P25 12.5D–P75 15.4) among 11–13-year-olds, 13.3D (P25 12.5D–P75 15.4) among children aged 14–15 and 12.9D (P25 11.1D–P75 14.3) among those aged 16. AA variability was 2.4D in those aged 6–8, 3.4D in children aged 9–12, and 2.9D in those aged 13–16. There was no significant difference in median AA according to gender, time of examination, or economic status; 2.8% of children showed AA of less than 2D lower than Hofstetter’s minimum reference value. Conclusions: This study reports AA in a large sample of children and therefore may contribute to current knowledge on AA norms. In order to avoid the impact of outliers, it proposes the use of the median and percentiles to define AA standards by specific age. A set of studies using precise AA measurement and large sample size are needed to determine clinical standards for AA.