Silvia Ferrite

Exposição ao ruído na indústria de transformação no Brasil

Occupational noise exposure is the most important modifiable risk factor for hearing loss in adults. The manufacturing industry has elevated levels of noise exposure that affect a large number of workers. The Brazilian norms state that noise and hearing function must be monitored, along with safeguards to protect workers, these are compulsory for all companies. However norms enforcement is weak and little is known about noise exposure distribution in the country. The purpose of this study is to investigate and summarize the distribution of noise exposure and use of hearing protection devices among workers in the manufacturing industry in Brazil. Among the manufacturing industry trends the minimum prevalence of noise exposure is 45%, and there are only a few data on the use of hearing protection device against hearing loss. Comparing available data from different industry trades, levels of noise exposure are higher in the logging and wood processing industry, together with a lower proportion of hearing protection device usage. The lack of data on work conditions, noise exposure and hearing protection limits the strength of hearing health among public health priorities in Brazil.

Cobertura estimada da triagem auditiva neonatal para usuários do Sistema Único de Saúde, Brasil, 2008-2011

Objectives: to estimate and describe the coverage of newborn hearing screening (NHS) among users of the Brazilian National Health System (SUS) between 2008 and 2011. Methods: an ecological study of time series was conducted using data from the SUS’s Outpatients Information System (SIA-SUS), the Live Births Information System (SINASC), the Interagency Health Information Network (RIPSA) and the Beneficiaries Information System (SIB) of the National Supplementary Health Agency (ANS). Coverage was estimated based on the NHS procedures authorized by the SUS and the live newborns are users of SUS, for every year for each federal unit. Results: national NHS coverage among SUS users was estimated to have been 7.1% in 2008, and rose to 21.8% in 2011, with evidence disparities between and within regions. More extensive coverage was found in the states of Rio Grande do Sul (60.1%) and Parana (59.4%), while, in the states of Rondonia, Espirito Santo and Pernambuco, coverage was less than 5%. Conclusions: in Brazil, more than two thirds of newborns who are users of the SUS did not undergo hearing screening, even in 2011, the following year the passing of a law making the procedure obligatory. Although there has been progress, the goal should be universal coverage.

Gathering Occupational Health Data from Informal Workers The Brazilian Experience

This study describes how occupational health data have been gathered by the Brazilian Unified Health System (SUS) to provide morbidity and mortality estimates for formal and informal workers. In 2007, data on work-related diseases and injuries was incorporated into the compulsory notification system (SINAN) and analyzed by the SUS occupational health service network, which covers all Brazilian states. However, this work has not been fully implemented, resulting in the large-scale undercounting and underreporting of cases, particularly in relation to informal workers. This is suggestive of barriers that prevent access to services and good quality health care. The inclusion of work-related diseases and injuries in SINANs appears to be a feasible strategy for the collection of useful data for the surveillance of the entire universe of workers, particularly in countries where informal workers prevail within the labor force. Attention needs to be paid to the disparities in access and quality that affect low-paid, informal workers.

Gender and other factors associated with the use of hearing protection devices at work

OBJECTIVE To analyze whether sociodemographic, occupational, and health-related data are associated with the use of hearing protection devices at work, according to gender. METHODS A cross-sectional study was conducted in 2006, using a random sample of 2,429 workers, aged between 18 and 65 years old, from residential sub-areas in Salvador, BA, Northeastern Brazil. Questionnaires were used to obtain sociodemographic, occupational, and health-related data. Workers who reported that they worked in places where they needed to shout in order to be heard were considered to be exposed to noise. Exposed workers were asked whether they used hearing protection devices, and if so, how frequently. Analyses were conducted according to gender, with estimates made about prevalence of the use of hearing protection devices, prevalence ratios, and their respective 95% confidence intervals. RESULTS Twelve percent (12.3%) of study subjects reported that they were exposed to noise while working. Prevalence of the use of hearing protection devices was 59.3% for men and 21.4% for women. Men from higher socioeconomic levels (PR = 1.47; 95%CI 1.14;1.90) and who had previous audiometric tests (PR = 1.47; 95%CI 1.15;1.88) were more likely to use hearing protection devices. For women, greater perceived safety was associated with the use of protection devices (PR = 2.92; 95%CI 1.34;6.34). This perception was specifically related to the presence of supervisors committed to safety (PR = 2.09; 95%CI 1.04;4.21), the existence of clear rules to prevent workplace injuries (PR = 2.81; 95%CI 1.41;5.59), and whether they were informed about workplace safety (PR = 2.42; 95%CI 1.23;4.76). CONCLUSIONS There is a gender bias regarding the use of hearing protection devices that is less favorable to women. The use of such devices among women is positively influenced by their perception of a safe workplace, suggesting that gender should be considered as a factor in hearing conservation programs.

Interaction between noise and cigarette smoking for the outcome of hearing loss among women: a population-based study.

BACKGROUND We investigated the interaction between exposure to noise and smoking in relation to prevalence of hearing loss among women. METHODS A sample of women aged 20-49 years (n = 1,723) from a population-based cross-sectional study carried out in Brazil in 2006 was examined. Hearing loss was assessed using a yes-no validated question. Biological interaction was analyzed using the additive scale and measured with interaction contrast ratio (ICR) and assessment of dose-response relationship. RESULTS The combined effect of exposure to noise and cigarette smoking on hearing loss (adjusted prevalence ratio (PRadj) = 3.94, 95% confidence interval (CI): 2.81, 5.52) was greater than expected based on the additive single effects of smoking (PRadj = 1.39, 95% CI: 1.07, 1.81) and noise (PRadj = 2.66, 95% CI: 1.86, 3.82). ICR estimates were not statistically significant. The prevalence of hearing loss among noise-exposed women increased with duration of smoking (P trend = 0.026), number of cigarettes smoked per day (P trend = 0.034), cumulative tobacco use (P trend = 0.030), and early age at smoking initiation (P trend = 0.047). CONCLUSIONS Noise and smoking may have a combined effect on hearing loss but further studies are still needed. A dose-response relation of smoking for the noise effect among women is suggested.

LETTER TO THE EDITOR: CONTEMPORARY EPIDEMIOLOGY AND SPEECH-LANGUAGE-HEARING SCIENCES

Conflict of interest: non-existent Voice Day; in analysing communication activities amongst adolescents, investigating new language patterns; in assessing the use of new modes of social interaction by deaf and hard-of-hearing people3; in finding out how mothers exchange information about the speech and language development of their children4; amongst others applications. The Big Data era. According to Laura Rodrigues from the London School of Hygiene and Tropical Medicine, in a few years’ time, conducting research on a million individuals will be routine. “Mega data” is a consequence of the current magnitude and speed of data production and integration between different systems. One example is in the linkage of all the databases in a country’s health network, updated in real time. The speaker reinforced the potential for Brazil in view of its current Information Systems. This presents an unprecedented opportunity, since by using Big Data knowledge production becomes fast and accurate and involves an important cost reduction5. Researchers with a wide range of interests may use these databases and the statistical power conferred on studies will enable the testing of hypotheses that have thus far presented challenges to science. Speech, Language and Hearing Sciences. Subjects from the field of Speech, Language and Hearing Sciences have begun to be addressed by studies using large-scale databases, such as the those regarding prevalence of hearing loss and tinnitus6 and the relationship between speech-in-noise perception and cognition7, both of which were investigated through the UK Biobank database, the result of a project that monitored the health of 500 thousand United Kingdom residents, which may be accessed by a range of researchers. Countries that maintain Information Systems have data available for knowledge production. Recently, To the Editors

Qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil

ABSTRACT OBJECTIVE To evaluate the quality of the data on fatal workplace injuries in Brazil, in the Mortality Information System (SIM) and the Information System of Notifiable Diseases (SINAN-AT), analyzing the spatial and temporal distribution between 2007 and 2012. METHODS We identified fields related to fatal workplace injuries, which were examined for completeness and the use of the “ignored” option. From the SIM, we extracted the records of deaths from external causes, which require the completing of the field about their relation with work. From the SINAN, we analyzed the field, which allows us to identify fatal cases among s severe workplace injuries. RESULTS In the SIM, from 469,121 records, the field was left unfilled or filled as ignored in 84.2% of them; the Brazilian region with the highest proportion was the Northeast (79.1%), from which the state of Alagoas (94.4%) had the highest amount. There was a 5.5% decreasing trend between 2007 (86.6%) and 2012 (81.8%). Among the 251,681 records found in the SINAN-AT, 28.3% had unfilled or ignored responses for , varying from 39.7% in 2007 to 23.2% in 2012, a 41.6% decrease. CONCLUSIONS The quality of the records on the fields of interest needed to identify fatal workplace injuries is poor in the SIM, but gradually improving. Recording quality was better for SINAN-AT, which has also been strongly getting better lately.OBJETIVO Avaliar a qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil nos Sistema de Informacao sobre Mortalidade (SIM) e Sistema de Informacao de Agravos de Notificacao para acidentes de trabalho grave (Sinan-AT), analisando a distribuicao espacial e temporal entre 2007 e 2012. METODOS Identificaram -se os campos relacionados ao acidente de […]

Ear canal collapse prevalence and associated factors among users of a center of prevention and rehabilitation for disabilities

Purpose: to investigate the prevalence of the ear canal collapse when using supra-aural earphones and to verify if this event is influenced by sex, age, color of the skin and prominent ear. Methods: the collapse was assessed by a visual inspection after the positioning of a detached cushion, pressured against the external ear. Results: a total of 436 individuals, aged 3 to 97 years, participated in the study. Ear canal collapse was observed in 11.4% of the subjects, being mostly bilateral (90.0%). The prevalence ranged from 6.3% to 36.6% across age groups. Males, aged 65 years or above and presence of prominent ear were independently identified as associated factors for the occurrence of ear canal collapse (p<0.05). Despite a higher prevalence for those self-identified as white skinned when compared to non-whites, the difference was not statistically significant. Conclusion: the ear canal collapse, when supra-aural earphones are used, is more likely to occur in men, in elderly people, and among those with prominent ears. The prevalence of the event in this population raises the necessity of a careful examination, previous to any evaluation using supra-aural earphones.

0427 Occupational exposures among home-based informal workers in a poor urban area of brazil

Background In Brazil, the National Health System provides primary health care, PHC, in which interdisciplinary teams support community health agents, CHA, responsible for families living in catchment areas. Objectives To describe occupational exposures among informal home-based workers, HBW, in order to integrate occupational health and safety into PHC. Methods Based on PHC families’ files, home-based informal workers were listed and recruited. Trained interviewers and CHAs visited worksites to identify hazards using a checklist, assessing levels of noise and formaldehyde in the air, and other self-reported threats to health. Tablets with ODK Collect software were used. Results There were 450 worksites and 468 invited workers agreed to participate. The majority comprises women (77.1%), of black skin colour (92.5%), 18–50 years of age (54.7%), 6–9 school years (65.4%), and an average US

Atuação do fisioterapeuta nos Centros de Referência em Saúde do Trabalhador: indicadores das notificações dos Dort

300.00 income per month (75.4%). Prevailing trades were retail (35.3%), food (25.8%) and personal beauty care (17.1%). Almost all workers reported to be self-employed (92.5%), had no resting days (45%) and 45 to 135 work hours per week (48.5%). All worksites had occupational exposures of interest for health. From 19.6 hours continuous assessment, the noise level was 77 dB(A), and formaldehyde exposure over threshold limit value was detected in five beauty salons out of 10 investigated. Conclusions Home-based businesses is a mainly women survivorship strategy, who work for long journeys, in poor urban areas of Brazil. The integration of workers’ health into PHC can identify, in this context, situations of health problems and support planning of preventive measures.