Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18-Year Prospective Study.

BACKGROUND: Psychosocial stressors at work, defined by the job strain and effort-reward imbalance at work (ERI) models, were shown to increase coronary heart disease risk. No previous study has examined the adverse effect of psychosocial stressors at work from both models on atrial fibrillation (AF) incidence. The objective of this study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in a prospective cohort study. METHODS AND RESULTS: A total of 5926 white-collar workers (3021 women and 2905 men) free of cardiovascular disease at baseline were followed for an average of 18 years. Job strain (high psychological demands combined with low decision latitude) and ERI were assessed using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression models, controlling for socioeconomic characteristics and lifestyle-related and clinical risk factors. A total of 186 AF incident events were identified over 18 years. Workers exposed to job strain (HR, 1.83 [95% CI, 1.14-2.92]) and ERI (HR, 1.44 [95% CI, 1.05-1.98]) had a higher risk of AF in fully adjusted models. Combined exposure to job strain and ERI was associated with a 2-fold AF risk increase (HR, 1.97 [95% CI, 1.26-3.07]). CONCLUSIONS: Psychosocial stressors at work from the job strain and ERI models are associated with an increased risk of AF, separately and in combination. Workplace prevention strategies targeting these psychosocial stressors at work may be effective to reduce the burden associated with AF.

Heat-related fatalities in North Carolina 1999-2017.

OBJECTIVES: Research shows the highest rates of occupational heat-related fatalities among farm laborers and among Black and Hispanic workers in North Carolina (NC). The Hispanic population and workforce in NC have grown substantially in the past 20 years. We describe the epidemiology of heat-related fatal injuries in the general population and among workers in NC. METHODS: We reviewed North Carolina death records and records of the North Carolina Office of the Chief Medical Examiner to identify heat-related deaths (primary International Classification of Diseases, Tenth Revision diagnosis code: X30 or T67.0-T67.9) that occurred between January 1, 1999, and December 31, 2017. Decedent age, sex, race, and ethnicity were extracted from both the death certificate and the medical examiner's report as well as determinations of whether the death occurred at work. RESULTS: In NC between 1999 and 2017, there were 225 deaths from heat-related injuries, and 25 occurred at work. The rates of occupational heat-related deaths were highest among males, workers of Hispanic ethnicity, workers of Black, multiple, or unknown race, and in workers aged 55-64. The highest rate of occupational heat-related deaths occurred in the agricultural industry. CONCLUSIONS: Since the last report (2001), the number of heat-related fatalities has increased, but fewer were identified as workplace fatalities. Rates of occupational heat-related deaths are highest among Hispanic workers. NC residents identifying as Black are disproportionately burdened by heat-related fatalities in general, with a wider apparent disparity in occupational deaths.

Challenges with misclassification of American Indian/Alaska Native race and Hispanic ethnicity on death records in North Carolina occupational fatalities surveillance.

As frequently segregated and exploitative environments, workplaces are important sites in driving health and mortality disparities by race and ethnicity. Because many worksites are federally regulated, US workplaces also offer opportunities for effectively intervening to mitigate these disparities. Development of policies for worker safety and equity should be informed by evidence, including results from research studies that use death records and other sources of administrative data. North Carolina has a long history of Black/white disparities in work-related mortality and evidence of such disparities is emerging in Hispanic and American Indian/Alaska Native (AI/AN) worker populations. The size of Hispanic and AI/AN worker populations have increased in North Carolina over the last decade, and North Carolina has the largest AI/AN population in the eastern US. Previous research indicates that misidentification of Hispanic and AI/AN identities on death records can lead to underestimation of race/ethnicity-specific mortality rates. In this commentary, we describe problems and complexities involved in determining AI/AN and Hispanic identities from North Carolina death records. We provide specific examples of misidentification that are likely introducing bias to occupational mortality disparity documentation, and offer recommendations for improved data collection, analysis, and interpretation. Our primary recommendation is to build and maintain relationships with local community leadership, so that improvements in the ascertainment of race and ethnicity are grounded in the lived experience of workers from communities of color.

Noise and sleep quality: study among physical education instructors / Ruído e qualidade do sono: estudo entre instrutores de educação física

ABSTRACT This study ivestigated the association between noise and impaired sleep quality in 150 physical education instructors, in bodybuilding gyms. Two questionnaires were applied: evaluation of subjective sleep quality and analysis of explanatory variables. Noise exposure was analyzed. For the data analysis, was used the technique of non-conditional logistic regression, to obtain the values of the adjusted odds ratios (OR) of the significant variables. Two proper adjustment models stood out. The first model presented the significant variables: incorrect performance of the meals (OR = 2.58, 95% CI 1.08 to 6.02); skin color - black ou brown (OR = 0.53, 95% CI 0.25 to 1.12) and exposure to noise level above or equal to 80 dB(A) (OR = 1.90; 95% CI 0.87 to 4.12). The second model presented the significant variables: incorrect performance of the meals (OR = 2.35, 95% CI 0.1 to 5.56); exposure level standardized above or equal to 80 dB(A) (OR = 2.03, 95% CI 0.92 to 4.47) and use 0of drugs for depression/anxiety (OR = 0.26; 95% CI 0.53 to 1.33). This research identified the variables that were significantly associated with impaired sleep quality, as exposure to noise, contributing to the adoption of preventive measures.

RESUMO Este estudo investigou a associação entre ruído e qualidade prejudicada do sono em 150 instrutores de educação física, em academias de musculação. Dois questionários foram aplicados: avaliação da qualidade subjetiva do sono e sobre variáveis explanatórias. A exposição ao ruído foi avaliada. Para a análise dos dados, utilizou-se a técnica de regressão logística não-condicional, para obter os valores das Razões de Chances (RC) das variáveis significativas. Dois modelos finais se destacaram. O primeiro apresentou as variáveis significativas: realização incorreta das refeições (RC = 2,58, IC 95% 1,08 a 6,02); cor da pele - preta ou parda (RC = 0,53; IC 95% 0,25 a 1,12) e exposição ao ruído acima ou igual a 80 dB(A) (RC = 1,90; IC95% 0,87 a 4,12). O segundo modelo apresentou as variáveis significativas: realização incorreta das refeições (RC = 2,35, IC 95% 0,1 a 5,56); nível de exposição padronizado acima ou igual a 80 dB (A) (RC = 2,03, IC 95% 0,92 a 4,47) e uso de medicamentos para depressão/ansiedade (RC = 0,26; IC95% 0,53 a 1,33). Esta pesquisa identificou as variáveis que se associaram significativamente com a qualidade do sono prejudicada, como a exposição ao ruído, contribuindo para a adoção de medidas preventivas.

Epidemiological and occupational profile of eye trauma at a referral center in Espírito Santo, Brazil / Aspectos epidemiológicos e trabalhistas do trauma ocular em um centro de referência no Espírito Santo, Brasil

ABSTRACT Objective: To draw an epidemiological and occupational profile of eye trauma at a Brazilian referral center, make comparisons with the literature and provide subsidies for the adoption of adequate prevention and enforcement measures. Methods: Descriptive and prospective epidemiological study using a standardized questionnaire to collect data from 60 patients presenting with eye trauma at an ophthalmology service (HUCAM) between 1 april 2013 and 1 october 2013. Results: The male gender was predominant (80%). Ages ranged from 8 to 60 years. Most accidents (56.7%) occurred in the workplace, followed by the home (28.3%). Most injuries were closed, predominantly contusions, followed by foreign body on the external eye. Importantly, 82.9% of the victims of work-related trauma wore no eye protection at the time of the accident. Conclusions: Eye trauma in the workplace and elsewhere is an important problem of public health as it affects primarily the economically active population and may have serious consequences. A considerable proportion of eye trauma is easily avoidable by using personal protective equipment. To minimize the incidence of eye trauma, more attention should be given to instruction in and enforcement of the use of such equipment, supported by frequent prevention campaigns.

RESUMO Objetivo: Caracterizar os aspectos trabalhistas e epidemiológicos regionais envolvidos no trauma ocular, comparar os dados obtidos com os já publicados na literatura e fornecer subsídios para a elaboração de medidas de prevenção e fiscalização adequadas. Metodologia: Estudo epidemiológico, descritivo, prospectivo, realizado no serviço de Oftalmologia do HUCAM, em 60 pacientes com trauma ocular, no período de 01 de abril a 01 de outubro de 2013, quando foram colhidos dados, por meio de questionário padronizado. Resultados: Houve predomínio de indivíduos do sexo masculino (80%) e em sua maioria os pacientes tinham idades que variavam entre 8 e 60 anos. Predominaram os acidentes no ambiente de trabalho (56,7%) seguido dos acidentes domiciliares (28,3%). A maioria dos traumas foi do tipo fechado, com predomínio das contusões seguidas pelo corpo estranho na superfície ocular. Observou-se também que 82,9% dos pacientes que tiveram o trauma no ambiente de trabalho não usavam o equipamento de proteção individual. Conclusões: Trauma ocular é um importante problema de saúde pública, pois acomete principalmente a população economicamente ativa e pode ter graves consequências. Grande parte destes acidentes poderiam ser facilmente preveni-da através do uso apropriado de equipamentos de proteção individual. Desta forma, orientação, fiscalização para o fornecimento e uso dos EPIs e campanhas de prevenção são importantes para redução desses acidentes.

Caracterização do nexo técnico epidemiológico pela perícia médica previdenciária nos benefícios auxílio-doença / Characterization of the technical epidemiological nexus in social security sickness benefits by medical experts

Introdução o Nexo Técnico Epidemiológico Previdenciário (NTEP) modificou a caracterização da etiologia ocupacional de agravo que justifica benefício previdenciário auxílio-doença no Brasil. Objetivo descrever o perfil de requerimentos em que houve indicação de NTEP pelo sistema previdenciário e analisar fatores associados à caracterização/descaracterização do nexo pela perícia médica. Métodos estudo retrospectivo analítico, com amostra de 822 laudos médicos periciais emitidos em São Paulo, entre 2008 e 2011. Realizada regressão logística para avaliar a associação entre a caracterização do NTEP e sexo, idade e diagnóstico incapacitante. Resultados o perfil dos segurados foi de homens (60,6%), na faixa etária de 30-39 anos (31,8%), com lesão por causa externa (35,0%). Foi descaracterizado o NTEP em 59% das situações, a maioria devido ao relato dos trabalhadores de que a lesão não tinha ocorrido no trabalho (70,9%). Houve associação entre a caracterização do NTEP e o diagnóstico da doença incapacitante, principalmente em relação aos distúrbios osteomusculares (OR 7,45; IC 95% 4,88-11,38). Conclusão o diagnóstico é um fator fortemente associado à aplicação do NTEP pela perícia médica. Há uma descaracterização frequente da espécie acidentária nos requerimentos, o que pode minimizar a justiça social ao trabalhador lesionado em decorrência do exercício do seu trabalho. .

Background the Technical Epidemiological Nexus of Social Security (NTEP in Portuguese) has modified the characterization of occupational injuries during evaluation for sickness benefits in Brazil. Objective to describe the profile of sickness benefit requirements when NTEP was indicated by the social security system, and to analyze the factors associated with its characterization/mischaracterization through medical evaluation. Methods retrospective analytical study with a sample of 822 expert medical reports issued in Sao Paulo between 2008 and 2011. A logistic regression model analysis was performed to assess the association between the characterization of NTEP and sex, age, and diagnosis. Results the profile of the beneficiaries was as follows: males (60.6%), aged 30-39 (31.8%), and presenting sickness due to injuries by external causes (35.0%). NTEP was mischaracterized in 59% of the cases, mostly because workers reported that the injury had not occurred at work (70.9%). There was an association between NTEP characterization and disabling diagnosis, mainly due to musculoskeletal disorders (OR 7.45; 95%CI 4.88-11.38). Conclusion the disabling diagnosis is a factor strongly associated with NTEP characterization by medical experts. Commonly, there is a mischaracterization of its application, which could minimize social justice for workers with occupational injury. .

Endotoxin and cancer: [review] / Endotoxina e câncer: [revisão]

Exposure to endotoxin, a component of gram-negative bacterial cell walls, is widespread in many industrial settings and in the ambient environment. Heavy-exposure environments include livestock farms, cotton textile facilities, and saw mills. In this article, we review epidemiologic, clinical trial, and experimental studies pertinent to the hypothesis that endotoxin prevents cancer. Since the 1970s, epidemiologic studies of cotton textile and other endotoxin-exposed occupational groups have consistently demonstrated reduced lung cancer risks. Experimental animal toxicology research and some limited therapeutic trials in cancer patients offer additional support for an anticarcinogenic potential. The underlying biological mechanisms of anticarcinogenesis are not entirely understood but are thought to involve the recruitment and activation of immune cells and proinflammatory mediators (e.g., tumor necrosis factor α and interleukin-1 and - 6). In view of the current state of knowledge, it would be premature to recommend endotoxin as a cancer-chemopreventive agent. However, further epidemiologic and experimental investigations that can clarify further dose-effect and exposure-timing relations could have substantial public health and basic biomedical benefits.

A exposição à endotoxina, componente de paredes celulares bacterianas gram-negativas, é muito comum em plantas industriais e no meio ambiente. Ambientes de alta exposição incluem fazendas de criação de animais, instalações têxteis de algodão e moinhos. Neste artigo, revemos estudos experimentais, epidemiológicos e ensaios clínicos sobre a hipótese de que a endotoxina previne o câncer. Desde os anos 70, estudos epidemiológicos em têxteis de algodão e outros grupos ocupacionais expostos à endotoxina demonstram redução no risco de câncer de pulmão. Pesquisa experimental de toxicologia animal e ensaios terapêuticos limitados em pacientes com câncer dão suporte para um potencial anticarcinogênico. Os mecanismos biológicos anticarcinogênicos de base ainda não são completamente compreendidos, mas acredita-se que incluem recrutamento e ativação de células imunológicas e mediadores pró-inflamatórios (ex.: fator de necrose tumoral α e interleucina-1 e - 6). Devido ao estágio atual de conhecimento, seria prematuro recomendar a endotoxina como agente quimiopreventivo. Porém, pesquisas epidemiológicas e experimentais que esclareçam relações de dosagem-efeito e exposição-relações temporais podem trazer benefícios para a saúde pública e a biomedicina básica.