William Waissmann

Self-Reported Health and Sleep Complaints Among Nursing Personnel Working Under 12 h Night and Day Shifts

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables—health conditions, sleep complaints, and insufficient time for nonprofessional activities—was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12 h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR = 0.71; CI = 0.55–0.92 and PR = 0.71; CI = 0.52–0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57–0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR = 0.76; CI = 0.59–0.98) and ex-night workers (PR = 0.68; CI = 0.50–0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07–6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR = 1.96; CI = 1.38–2.78) and rest/leisure (PR = 1.54; CI = 1.20–1.99). These results can be related to the “social value of time,” as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.

Production of iodine-124 and its applications in nuclear medicine

Until recently, iodine-124 was not considered to be an attractive isotope for medical applications owing to its complex radioactive decay scheme, which includes several high-energy gamma rays. However, its unique chemical properties, and convenient half-life of 4.2 days indicated it would be only a matter of time for its frequent application to become a reality. The development of new medical imaging techniques, especially improvements in the technology of positron emission tomography (PET), such as the development of new detectors and signal processing electronics, has opened up new prospects for its application. With the increasing use of PET in medical oncology, pharmacokinetics, and drug metabolism, (124)I-labeled radiopharmaceuticals are now becoming one of the most useful tools for PET imaging, and owing to the convenient half-life of I-124, they can be used in PET scanners far away from the radionuclide production site. Thus far, the limited availability of this radionuclide has been an impediment to its wider application in clinical use. For example, sodium [(124)I]-iodide is potentially useful for diagnosis and dosimetry in thyroid disease and [(124)I]-M-iodobenzylguanidine ([(124)I]-MIBG) has enormous potential for use in cardiovascular imaging, diagnosis, and dosimetry of malignant diseases such as neuroblastoma, paraganglioma, pheochromocytoma, and carcinoids. However, despite that potential, both are still not widely used. This is a typical scenario of a rising new star among the new PET tracers.

Can living in the surroundings of a petrochemical complex be a risk factor for autoimmune thyroid disease

BACKGROUND Based on a suspicion raised by a health professional and due to a subsequent legal request, a cross-sectional study was made with a comparison group to investigate a possible excess of Hashimotos thyroiditis-HT and antibodies-ATA in the surroundings of a Petrochemical Complex. METHODS People of both sexes aged over 20 years were investigated in a random sample of residents in the area surrounding the Petrochemical Complex. Controls were investigated in an area with steel industries. In the areas searched, participants were chosen randomly and stratified a priori by sex and age group. As a result, 90.5% of the expected sample was obtained, totaling 1533 individuals. HT and ATA prevalences were compared by the chi-square test. Logistic regression was used to control the possible confounding factors for HT and ATA. RESULTS Both TH (9.3%) and ATA (17.6%) prevalences were higher in the Petrochemical Complex area than in the control area (3.9% and 10.3%, respectively). After controlling the possible confounding factors, the POR for living in the surroundings of the Complex and presenting HT was 2.39 (CI95%: 1.42-4.03). According to the ATA criterion, the POR for living in the surroundings of the Complex was 1.78 (CI95%: 1.23-2.60). CONCLUSIONS The authors have found higher prevalence and risk of developing thyroiditis and anti-thyroid antibodies among residents of areas surrounding the Petrochemical Complex and think these findings need to be further studied in similar areas.

Health surveillance and endocrine disruptors

The author discusses the extreme relevance of research on the presence of endocrine disruptors (EDs) in products of interest to health surveillance (HS). Focusing on EDs, the author highlights the urgency of changes already under way in the direction of HS. The shift should be from product and product-registration approaches to the productive process and its realization in consumption, generation of contaminants, and alterations in the health of workers and the overall population. He briefly describes: regulatory gaps for dealing with EDs; difficulty in evaluating risk and suspension of the production and use of products with its characteristics and the need, as exemplified by such products, to enhance the inter-relationship among all stakeholders and to turn HS into a state-of-the-art technological setting, associated with the academic community and accountable to the public. The author reports on measures already taken in relation to EDs, including the establishment of a reference laboratory for analyzing persistent organic pollutants (POPs), interruption of the use of various POPs in Brazil and an initial review of requirements for registering pesticides under the Brazilian National Health Surveillance Agency (ANVISA).

Agrotóxicos e doenças não transmissíveis

A agricultura intensiva é um dos esteios históricos da lógica exportadora do estado brasileiro. Mais que significar um espaço produtivo gerador de bens populares, vem significando, ao longo dos séculos, momento perpetuador do uso abusivo e exclusivo do solo, a permitir desde a utilização da força de trabalho escrava até a expulsão da terra de levas intermináveis de migrantes que acabam por fluir aos grandes centros. A violência do trabalho em meio rural mal era abordada nas primeiras normas acidentárias brasileiras (Lei no 3.724/1919), quando só se admitia haver lesão indenizável oriunda de trabalho agrícola quando este fosse relacionado a máquinas à combustão, como se estas fossem freqüentes em um país ainda pouco urbanizado e pobre no início do século XX. Mas, se houve melhorias normativas com as décadas, as mazelas também se diferenciaram qualitativamente. Os agrotóxicos, subprodutos da tecnologia de guerra, tiveram seu uso fortemente estimulado por política de estado a partir da década de 1970, com a concessão de crédito agrícola naquele período sendo vinculada à sua aquisição, e por oferta que exaltava suas propriedades de reduzir trabalho com pragas e de beneficiar alimentos, população e trabalhadores. Passaram os agrotóxicos a compor a vida diária de milhões de trabalhadores do campo, que a eles se expõem ocupacionalmente com suas famílias, assim como também se incorporaram à dieta dos brasileiros do campo e das cidades, presentes que estão nos alimentos. De fato, os quase 4,5 bilhões de dólares que se estima terem sido as vendas brasileiras de agrotóxicos em 2004 estão ao alcance dos pratos e das implicações relacionadas à saúde. Consulta ao Sistema Integrado de Informações sobre Agrotóxicos (SIA), mantido pela Agência Nacional de Vigilância Sanitária (ANVISA), revela, como exemplo, que para a cana-de-açúcar e a soja, duas das grandes culturas agrícolas nacionais, há autorização de utilização de 61 e 127 ingredientes ativos diferentes de agrotóxicos, respectivamente, dos mais variados grupos químicos e classificações toxicológicas. De mais de 4.000 amostras de vegetais coletadas em supermercados de doze capitais, entre 2001 e 2004, analisadas em programa de monitoramento coordenado pela ANVISA, detectouse resíduos de agrotóxicos em mais de 50%, sendo que, destas, quase um terço apresentavam resíduos irregulares, ou seja, acima de quantidades permitidas ou oriundos de agrotóxicos de uso não autorizado para os vegetais onde foram encontrados. Fato lembrado por Miranda et al., no artigo que serve de base a estas observações, e que aqui se ressalta, é a possibilidade de associação entre exposição a agrotóxicos e doenças crônicas não transmissíveis como cânceres, endocrinopatias, neuropatias e outras. A prevalência de algumas destas afecções tem se elevado e contaminantes ambientais, como é o caso dos agrotóxicos, podem estar associados às suas gêneses muitas vezes multifatoriais. Reconhecer essa possibilidade associativa é importante para o sistema de vigilância em saúde, que deve estar alerta para potenciais efeitos advindos de contaminações ambientais e ocupacionais e buscar a pesquisa de causas ambientais, como os agrotóxicos, na gênese de agravos de natureza crônica. É assim que, ao lado de se reconhecer o potencial carcinogênico de alguns agrotóxicos em animais, estudos epidemiológicos em humanos apontam a possibilidade de associação entre vários tipos de cânceres e exposição a agrotóxicos. Dentre os cânceres mais proeminentes encontram-se os linfohematopoiéticos, com destaque para exposição ocupacional e infantil, e os hormônio-dependentes, havendo ainda, em nosso meio, possível relevância para os cânceres gastroesofágicos. Vários agrotóxicos possuem efeitos estrogênicos e/ou anti-estrogênicos e/ou anti-androgênicos ou sobre outros segmentos do sistema endócrino na dependência de suas características

Condições de trabalho e perfil profissional dos nutricionistas egressos da Universidade Federal de Ouro Preto, Minas Gerais, entre 1994 e 2001

The study presents the professional profiles and work conditions of nutritionists who graduated from the Ouro Preto Federal University, Minas Gerais State, Brazil, in their various spheres of action. A quanti-qualitative approach was adopted through questionnaires completed by all professionals graduating from this University between 1994 and 2001 (N=356), in addition to semi-structured interviews with fourteen professionals selected from the universe of the respondents (n=90). An analysis of these questionnaires showed that 67% of them work with Clinical Nutrition, 44% with Collective Nutrition, 14% with Education Programs and 11% with Social Nutrition. Most (57%) of the respondents expressed the desire to remain in the field where they were working. Among those wishing to move into a different area, 44.5% work with Collective Nutrition. Despite clearly precarious employment links, Clinical Nutrition is the field with the largest number of professionals satisfied with their work conditions. The findings of this study explore the work conditions of a group of nutritionists for whom job stability is not always the main factor for professional satisfaction.

Development of a food frequency questionnaire in a probabilistic sample of adults from Niterói, Rio de Janeiro, Brazil

With the purpose of generating a list of foods for a food-frequency questionnaire, data from 24h dietary recalls on a typical day from a probabilistic sample of 1,724 adults of Niterói, Rio de Janeiro, Brazil, were analyzed. The frequency of food intake, the total intake of energy and macronutrients and the relative contribution of each food item to total energy and macronutrient intake were calculated. The most frequently reported food items (> 50% of adults) were rice, coffee, beans, refined canesugar, and bread. Whole milk was consumed more frequently then skimmed milk or semi-skimmed milk. Beef was consumed by more adults than chicken, pork or fish. Approximately 90% of energy and macronutrients intake was explained by 65 food items. The list of food items generated in the present analysis is similar to those found in other samples of adults from urban areas in Brazil. It may be possible to generate a core list of common foods with addition of regional foods to be used nationally in urban areas of the country.

Seasonal variation in food intake and the interaction effects of sex and age among adults in southern Brazil.

Background/objectives:Because studies have evidenced variations in nutrient intake, further investigation of the interaction between demographic characteristics and the seasons is necessary. We aimed to test the differences in food intake throughout the seasons and the interaction between the seasons and sex and age.Subjects/methods:This study included 273 individuals. Food intake was evaluated with 24-hour dietary recalls, and the reported food items were sorted into food groups. We performed the test on the differences in intake of food groups throughout the seasons with repeated measures and on the interaction effect by using the Generalized Estimate Equation.Results:Intake of fruits and natural fruit juices and sweetened beverages was lower, whereas that of grains and derivatives was higher in the winter. The intake of leafy vegetables and fish and seafood was lower in the autumn. The consumption of coffee and eggs was higher in the spring. Intake of chocolate powder and sugar, salt and lean poultry was higher in the winter. The variation in consumption of grains and derivatives, eggs, fatty poultry and processed meat over the seasons was more likely to be modified by sex. Age interacted with the seasons for leafy vegetables, beans and lentils, lean beef, lean poultry, low fat milk and light yogurt, vegetable oil and unsalted margarine, chocolate powder and sugar and processed meat.Conclusions:This study shows that food intake may change seasonally and that seasonal variation depends on sex and age, which might aggregate a specific co-variation component.

Reprodutibilidade de um questionário para avaliação de conhecimentos, percepções e práticas em segurança sanitária alimentar de portadores de HIV/AIDS ambulatoriais

HIV-positive patients are at increased risk of acquiring infections, particularly those related to water and food. The risk could be reduced by educational interventions in the clinical setting related to food safety for the prevention of food-borne diseases. The current study aimed to analyze food safety knowledge, perceptions, and practices among HIV-positive outpatients. A questionnaire was organized with five behavioral areas (cross contamination; personal hygiene; household hygiene; temperature control; and control of unsafe foods). The test-retest procedure demonstrated the questionnaires reliability. Kappa values varied among the questions: high for 84.6% (33); moderate for 12.8% (5); and low for 2.5% (1). Based on the results, the instrument showed good reliability for most of the questions and can be used for surveys on food safety in HIV-positive outpatients.

Variacao sazonal na ingestao alimentar de adultos de Niteroi, Rio de Janeiro

The measurement of usual food intake (FI) is necessary to accurately establish the relationship between diet and disease. In most studies data are collected at one particular time of the year, which may influence the interpretation of the results. The purpose of this study was to investigate the effect of seasonality on FI in a sample of adults from Niterói, RJ, Brazil. A total of 102 healthy subjects (69 women) aged between 20 and 69 years were interviewed to obtain six 24-hour dietary recalls, three in summer and three in winter. In both seasons, the intake of energy (EI) and 23 nutrients was determined and the percent of subjects who met the recommendations for the nutrients were computed. The data of FI were deattenuated considering the within-person variability and adjusted for energy. The intake of energy and some nutrients were significantly different between men and women. EI did not differ between seasons, for both sexes, but the intake of macro and micronutrients was different. The results of this study suggest that the seasonality in the measurement of FI should be considered in order to improve the methods and instruments used in population dietary surveys.