Precarious work and methodological challenges to study hard-to-reach populations.

OBJECTIVE: To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS: The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS: The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers' meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION: The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.

Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update.

This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.

Changing smoking habits and the occurrence of lung cancer in Sweden-a population analysis.

BACKGROUND: The objective is to estimate the importance of the decrease of smoking habits in Sweden for the occurrence of lung cancer. METHODS: The change in smoking habits in the general population was retrieved from surveys and on taxation of sale of cigarettes. We used data from the Swedish Cancer Register on incidence of lung cancer between 1970 and 2021, stratified for sex, age and cell type, and compared the occurrence overtime in ages between 40 and 84 years. RESULTS: The sale of cigarettes peaked in 1980 to 1800 cigarettes per person and decreased to 600 per person in 2021. The change in incidence rates of squamous cell cancer and other cell types varied over time, sex, and age in a pattern that partly seems to be explained by change in the prevalence of daily smokers. The incidence of adenocarcinoma was similar in men and women 1970-2021 and increased, e.g. for women and men 75-79 years of age from around 20 cases in early 1970s to around 120 cases per 100 000 person-years in the 2020s. CONCLUSIONS: Our data indicate that the risk of lung cancer several years after smoking cessation is less favourable than previously studies have indicated. There is a similar increase in the incidence of adenocarcinoma in men and women which is hard to explain only with changing smoking habits. The change from non-filter to filter cigarettes in the 1960s-1970s may be a contributing factor.

Asbestos and disease - a public health success story?

OBJECTIVE: This paper discusses the failure and success of society to decrease the adverse health effects of asbestos exposure on workers' health in relation to scientific knowledge. METHODS: The findings are based on a narrative literature review. RESULTS: Early warnings of the adverse health effects of workplace exposure to asbestos were published already in the 1930s. Serious health effects, such as malignancies and fibrosis due to occupational asbestos exposure, were highlighted in major medical journals and textbooks in late 1960s. New technologies could detect also asbestos fibers in the lung of non-occupational exposed persons in the 1970s. The first bans for using asbestos came in the early 1970s, and more general bans by authorities came in the 1980s and continue until today. CONCLUSIONS: The rather late recognition of adverse effects of asbestos exposure in the general population and measures to decrease the exposure through more general bans came rather late. However, the very strong measures such as general bans in many countries have been a success. A Swedish study showed that the general ban and other measures have decreased the risk of malignancies due to occupational exposure. The effect of the bans on adverse effects in the general population has yet to be studied. Analysis of fibers in the lungs of persons born after the bans could be an efficient method.

Air pollution and childhood respiratory consultations in primary care: a systematic review.

BACKGROUND: Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care. OBJECTIVE: To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses. METHODS: A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies. RESULTS: From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 µm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations. CONCLUSIONS: The evidence suggests CO, SO2, NO2, PM10 and PM2.5 are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution. PROSPERO REGISTRATION NUMBER: CRD42022259279.

Physical and psychosocial work-related exposures and the incidence of carpal tunnel syndrome: A systematic review of prospective studies.

This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.

Sleep quality, sleep duration, and sleep disturbances among hospital night workers: a prospective cohort study.

PURPOSE: This study aimed to assess among hospital night workers (i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and (ii) associations between sociodemographic factors, lifestyle factors and work characteristics and sleep components. METHODS: Data were used from 467 hospital night workers participating in the Klokwerk + study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and sleep disturbances were measured by the Medical Outcomes Study Sleep Scale. The overlap between the three sleep measures was visualized with a Venn diagram and the proportions of overlap was calculated. Associations between independent variables (sociodemographic factors, lifestyle factors and work characteristics) and the three sleep outcomes were estimated using between-within Poisson regression models. RESULTS: About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in one of the sleep components only (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed. CONCLUSION: Our findings suggest that sleep quality, sleep duration and sleep disturbances are separate entities and should be studied separately. Lifestyle factors and work characteristics were generally not associated with poor sleep. Since these factors can have an acute effect on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Trial registration Netherlands Trial Register trial number NL56022.041.16.

Precarious work and methodological challenges to study hard-to-reach populations

ABSTRACT OBJECTIVE To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers' meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.

Objective Voice Parameters in Colombian School Workers with Healthy Voices / Parámetros objetivos de la voz de trabajadores escolares colombianos con voces saludables / Parâmetros de voz objetivas de funcionários da escola colombianos com vozes saudáveis

Objectives: To characterize the objective voice parameters among school workers, and to identify associated factors of three objective voice parameters, namely fundamental frequency, sound pressure level and maximum phonation time. Materials and methods: We conducted a cross-sectional study among 116 Colombian teachers and 20 Colombian non-teachers. After signing the informed consent form, participants filled out a questionnaire. Then, a voice sample was recorded and evaluated perceptually by a speech therapist and by objective voice analysis with PRAAT software. Short-term environmental measurements of sound level, temperature, humidity, and reverberation time were conducted during visits at the workplaces, such as classrooms and offices. Linear regression analysis was used to determine associations between individual and work-related factors and objective voice parameters. Results: Compared with men, women had higher fundamental frequency (201 Hz for teachers and 209 for non-teachers vs. 120 Hz for teachers and 127 for non-teachers) and sound pressure level (82 dB vs. 80 dB), and shorter maximum phonation time (around 14 seconds vs. around 16 seconds). Female teachers younger than 50 years of age evidenced a significant tendency to speak with lower fundamental frequency and shorter MPT compared with female teachers older than 50 years of age. Female teachers had significantly higher fundamental frequency (66 Hz), higher sound pressure level (2 dB) and short phonation time (2 seconds) than male teachers. Conclusion: Female teachers younger than 50 years of age had significantly lower F0 and shorter MPT compared with those older than 50 years of age. The multivariate analysis showed that gender was a much more important determinant of variations in F0, SPL and MPT than age and teaching occupation. Objectively measured temperature also contributed to the changes on SPL among school workers.

Objetivos: Caracterizar los parámetros objetivos de la voz en trabajadores escolares e identificar los factores asociados de tres parámetros objetivos de la voz (frecuencia fundamental, presión sonora y tiempo máximo de fonación). Materiales y métodos: Estudio transversal en el que participaron 116 profesores y 20 no profesores colombianos. Después de firmar el consentimiento informado, los participantes diligenciaron un cuestionario. Posteriormente, grabaron una muestra de voz, la cual fue analizada, perceptualmente, por una fonoaudióloga y, objetivamente, con el software PRAAT. Se realizaron mediciones ambientales de niveles de ruido, temperatura, humedad y tiempos de reverberación durante las visitas a los lugares de trabajo, tales como salones y oficinas. Análisis de los factores individuales y ocupacionales asociados con los parámetros de la voz fueron realizados por medio de regresiones lineales. Resultados: Comparadas con sus pares masculinos, las trabajadoras escolares registraron frecuencia fundamental más aguda (201 Hz para las profesoras y 209 para las no-profesoras frente a 120 Hz para los profesores y 127 para los no-profesores) e intensidad más alta (82 dB frente 80 dB), y tiempo máximo de fonación más corto (14 segundos aproximadamente frente a 16 segundos aproximadamente). Las profesoras menores de 50 años evidenciaron una tendencia significativa a producir una frecuencia fundamental más baja y un TMF más corto, comparadas con las profesoras mayores de 50 años. Las profesoras registraron frecuencia fundamental significativamente más alta (66 Hz), intensidad más alta (2 dB) y tiempo máximo de fonación más corto (2 segundos) comparadas con los profesores. Conclusión: Las profesoras menores de 50 años registraron frecuencia fundamental más baja y TMF más corto compradas con las profesoras mayores de 50 años. El análisis multivariado mostró que género fue una variable mucho más importante para determinar la variación en F0, SPL y TMF que edad u ocupación. La temperatura dentro de los lugares de trabajo (medida objetivamente) también contribuye a los cambios en intensidad de la voz entre los trabajadores escolares.

Objetivos: Caracterizar os parâmetros objetivos da voz em trabalhadores escolares, e identificar os fatores associados de três parâmetros objetivos da voz (frequência fundamental, pressão sonora e tempo máximo de fonação). Métodos: Estudo transversal no que participaram 116 professores e 20 professores não colombianos. Depois de assinar o consentimento informado, os participantes preencheram um questionário. Posteriormente, gravaram uma amostra de voz, a qual foi analisada perceptualmente por uma fonoaudióloga; e objetivamente utilizando o software PRAAT. Realizaram-se medições ambientais de níveis de barulho, temperatura, humidade e tempos de reverberação durante as visitas aos lugares de trabalho, tais como salas e escritórios. Análise dos fatores individuais e ocupacionais, associados com os parâmetros da voz, foi realizada através e regressões lineares. Resultados: comparadas com os seus pares masculinos, as trabalhadoras escolares registraram frequência fundamental mais aguda (201 Hz para as professoras e 209 para as não-professoras vs. 120 Hz para os professores e 127 para os não-professores) e intensidade maior (82 dB vs. 80 dB), e tempo máximo de fonação menor (14 segundos aproximadamente). As professoras menores de 50 anos evidenciaram uma tendência significativa a produzir uma frequência fundamental mais baixa e um MF mais curto comparadas com as professoras maiores de 50 anos. As professoras registraram frequência fundamental significativamente maior (66Hz), intensidade maior (2 dB) e tempo máximo de fonação mais curto (2 segundos) comparadas com os professores. Conclusão: as professoras menores de 50 anos registraram frequência fundamental mais baixa e TMF mais curto compradas com as professoras maiores de 50 anos. A análise multivariada mostrou que gênero foi uma variável muito mais importante para determinar a variação em F0, SPL e TMF que idade ou ocupação. A temperatura dentro dos lugares de trabalho (mesurada objetivamente) também contribui às mudanças em intensidade da voz entre os trabalhadores escolares.

Lifestyle factors, direct and indirect costs for a Brazilian airline company / Fatores de estilo de vida, gastos diretos e indiretos por companhia aérea brasileira

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. .

OBJETIVO Analisar fatores de estilo de vida relacionados aos gastos diretos com saúde e indiretos com absenteísmo de trabalhadores de companhia aérea brasileira. MÉTODOS Coorte retrospectiva com 2.201 trabalhadores de uma companhia área de São Paulo, SP, em 2010. Os desfechos de interesse foram: gastos com serviços de saúde e com ausência no trabalho. As variáveis independentes sexo, idade, nível educacional, tipo de trabalho, estresse e fatores relacionados ao estilo de vida (índice de massa corporal, atividade física e tabagismo) foram obtidas por entrevista. Informações sobre absenteísmo foram obtidas dos registros da companhia aérea e dados sobre serviços de saúde foram informados pela operadora de saúde responsável pelo plano de saúde dos funcionários da empresa. Foi realizada regressão linear múltipla para analisar a associação entre as variáveis. RESULTADOS A média de gastos por trabalhador foi de US$505,00 com serviços de saúde e US$249,00 devido ao absenteísmo nos 12 meses de seguimento. Gastos diretos foram superiores aos gastos indiretos e ambos foram maiores em mulheres. Índice de massa corporal e tabagismo associaram-se a gastos diretos e indiretos, respectivamente. CONCLUSÕES Excesso de peso e tabagismo significaram maiores gastos dentro de um ano, o que sugere que dieta saudável, atividade física e controle do tabagismo são importantes alvos em programas de promoção da saúde para a população estudada. .

Caracterizacao da exposicao de populacao a organoclorados: uma aplicacao da analise de cluster / Characterization of population exposure to organochlorines: a cluster analysis application

O presente trabalho objetivou apresentar os resultados da aplicação da análise de agrupamento (cluster) para a caracterização da exposição a organoclorados, através de variáveis relacionadas ao tempo e à dose de exposição. Características de 354 sujeitos de uma população exposta a resíduos de pesticidas organoclorados relacionadas ao tempo e à dose de exposição foram submetidas à análise de cluster para separá-las em subgrupos. Foi realizada a análise de cluster hierárquico. Para avaliar a precisão da classificação, foram comparadas a variabilidade intragrupo e a variabilidade inter-grupos através do teste de ANOVA para cada dimensão. A estratégia de agregação foi realizada pelo método de Ward. Para criação dos clusters, foram comparadas as variáveis associadas à exposição e às rotas de contaminação. As informações referentes às doses estimadas de ingesta do composto foram usadas para ponderar os valores de tempo de exposição a cada uma das rotas, de forma a obter valores proxy de intensidade de exposição. Os resultados indicaram 3 clusters: o cluster 1 (n = 45), com características de maior exposição; o cluster 2 (n = 103), de exposição intermediária, e o cluster 3 (n = 206), de menor exposição. As análises bivariadas realizadas com os grupos evidenciaram que são grupamentos com diferença estatisticamente significativa. Este estudo evidenciou a aplicabilidade da análise de cluster para categorizar populações expostas a organoclorados, e aponta para a relevância de estudos tipológicos que possam contribuir para uma melhor classificação de sujeitos expostos a agentes químicos, condição típica dos estudos de epidemiologia ambiental, para uma mais ampla compreensão dos aspectos etiológicos, preventivos e terapêuticos da contaminação.

This study aimed to show the results from a cluster analysis application in the characterization of population exposure to organochlorines through variables related to time and exposure dose. Characteristics of 354 subjects in a population exposed to organochlorine pesticides residues related to time and exposure dose were subjected to cluster analysis to separate them into subgroups. We performed hierarchical cluster analysis. To evaluate the classification accuracy, compared to intra-group and inter-group variability by ANOVA for each dimension. The aggregation strategy was accomplished by the method of Ward. It was, for the creation of clusters, variables associated with exposure and routes of contamination. The information on the estimated intake doses of compound were used to weight the values of exposure time at each of the routes, so as to obtain values proxy exposure intensity. The results showed three clusters: cluster 1 (n = 45), characteristics of greatest exposure, the cluster 2 (n = 103), intermediate exposure, and cluster 3 (n = 206), less exposure. The bivariate analyzes performed with groups that are groups showed a statistically significant difference. This study demonstrated the applicability of cluster analysis to categorize populations exposed to organochlorines and also points to the relevance of typological studies that may contribute to a better classification of subjects exposed to chemical agents, which is typical of environmental epidemiology studies to a wider understanding of etiological, preventive and therapeutic contamination.