Wheezing in tobacco farm workers in southern Brazil.

BACKGROUND: Tobacco workers are exposed to several respiratory occupational sensitizers. METHODS: A representative cross-sectional study was carried out on 2469 tobacco family farming growers. Gender-stratified multivariate analyses evaluated the association between wheezing and socio-demographic, behavioral, and occupational variables. RESULTS: Wheezing prevalence was 11.0% with no difference between genders. Among men, age, smoking, strenuous work, pesticide use, contact with vegetable dust and dried tobacco dust, lifting sticks with tobacco leaves to the curing barns, and green tobacco sickness (GTS) were risk factors for wheezing. Among women, family history of asthma, tying hands of tobacco, strenuous work, contact with chemical disinfectants, and GTS were positively associated with wheezing. Harvesting lower tobacco leaves was a protective factor for the outcome in both genders. CONCLUSIONS: Pesticides, dusts exposure, and GTS were risk factors for wheezing. The synergic effect of these factors needs to be better evaluated to improve prevention.

Acute Pesticide Poisoning in Tobacco Farming, According to Different Criteria.

BACKGROUND: Brazil is one of the world's largest pesticide consumers, but information on pesticide poisoning among workers is scarce. OBJECTIVE: To evaluate acute pesticide poisoning among tobacco growers, according to different criteria. METHODS: This was a two-step cross-sectional study with 492 pesticide applicators. It used a 25 question pesticide-related symptoms (PRS) questionnaire and medical diagnosis for comparison with toxicological assessment. Associations were evaluated using Poisson regression. RESULTS: 10.6% reported two or more PRS, while 8.1% reported three or more. Furthermore, 12.2% received a medical diagnosis of poisoning. According to toxicologists, possible cases accounted for 14.2% and probable cases for 4.3%. PRS increased during the period of greater exposure. Those exposed to dithiocarbamates, sulfentrazone, pyrethroids, fipronil and iprodione exhibited more PRS. The number of exposure types, multi-chemical exposure, clothes wet with pesticides and spillage on the body/clothes were associated with acute poisonings. All criteria showed sensitivity greater than 79% for probable cases but only greater than 70% for medical diagnosis when compared to possible cases, presenting substantial Kappa agreement. CONCLUSION: The prevalence of acute pesticide poisoning is much higher than officially recorded. Trained physicians can screen for pesticide poisoning. It is necessary to improve workers' education to reduce pesticide use and exposure to them.

Association between workplace bullying and common mental disorders in civil servants from a middle-income country.

Workplace bullying (WB) is associated with Common mental disorders (CMD) in high-income countries, but there is a lack of evidence relating to this subject in low- and middle-income countries. Therefore, this study aimed to investigate the association between bullying and CMD in Brazil. A cross-sectional study with 907 judicial civil servants from Porto Alegre, southern Brazil, was carried out. WB was measured by the Negative Acts Questionnaire (NAQ-r) and CMD by the Self-Reporting Questionnaire (SRQ-20). Logistic regression was used to analyse data and test hypotheses. The overall prevalence of CMD was 32.8%, while the overall prevalence of bullying was 18.3%. WB was strongly associated with CMD, even after controlling for confounders. After adjustment for sociodemographic, personality and occupational confounders, weekly and daily exposures to negative acts increased 4.32 (95% CI: 2.00-9.33) and 6.80 (95% CI: 3.42-13.51) times the risk of CMD, respectively. Considering the operational definition, bullied workers had a 3.45 (95% CI: 2.26-5.25) higher risk of CMD. The results are consistent with studies from high-income countries. Different ways of categorising exposure to WB and testing association with CMD are suggested. Interventions to prevent bullying, focusing on work processes and psychosocial factors at work, could reduce the risk of mental health problems.

The Role of Workplace Bullying in Low Back Pain: A Study With Civil Servants From a Middle-Income Country.

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation. PERSPECTIVES: As a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain.

Child Labor in Family Tobacco Farms in Southern Brazil: Occupational Exposure and Related Health Problems.

Tobacco farming is considered Hazardous Child Labor in Brazil. This study examined the work of children and adolescents in tobacco farming, characterizing the level of urinary cotinine and the occurrence of Green Tobacco Sickness (GTS), pesticide poisoning, respiratory symptoms, and musculoskeletal disorders. A cross-sectional descriptive study was conducted with a random sample of tobacco growers under 18 years old in Southern Brazil. Ninety-nine young people were interviewed at 79 family farms. The majority began working in agriculture before they were 14 and worked harvesting and tying hands of tobacco; 60% were 16 or 17 years old, and 51.5% were male. During their lifetime, 24.5% reported GTS, and 3% reported pesticide poisoning. In the previous year, 29.3% reported low back pain, 6.1% wheezing, and 16.2% coughing without having a cold. Half of the 12 young people evaluated had over 100 ng/mL of urinary cotinine. The study indicates that child laborers do various activities and present a high prevalence of health problems. Health workers should be trained to identify child laborers and their impacts on health. Full-time farm schools could provide knowledge about sustainable agricultural production, reducing the rates of age-grade mismatch, without taking young people away from rural areas.

Suicidality among South Brazilian tobacco growers.

OBJECTIVE: To assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation. METHODS: A cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question "Has the thought of ending your life been on your mind?". Suicide attempt was assessed by the question "Have you ever tried to kill yourself?". Investigation of factors associated with suicidal ideation was done by means of Poisson regression. RESULTS: Prevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6-9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation. CONCLUSION: Suicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers.

Estudos epidemiológicos ocupacionais em área rural: desafios metodológicos / Epidemiological occupational studies in rural areas: methodological challenges

Resumo Introdução: a produção agrícola no Brasil tem crescido nas últimas décadas e os trabalhadores rurais estão expostos a vários riscos ocupacionais. Estudos epidemiológicos sobre o tema ainda são limitados, especialmente pela complexidade metodológica. Objetivos: apresentar os principais desafios metodológicos para a realização de estudos epidemiológicos ocupacionais rurais. Métodos: as considerações apresentadas neste artigo têm como base a literatura e a experiência dos autores como pesquisadores desta temática. Resultados: foram abordados conceitos sobre população alvo, local de moradia e trabalho, classificação dos trabalhadores e caracterização do contexto da produção agrícola. Foram exploradas as estratégias de amostragem; a caracterização dos indicadores econômicos, incluindo produção agrícola e nível de mecanização; a exposição aos agrotóxicos, como tipos químicos, formas e frequência de exposição; a intoxicação por agrotóxicos; e a disponibilidade e o uso de Equipamentos de Proteção Individual. Foram descritos os cuidados com amostras biológicas, bem como aspectos envolvendo entrevistadores, treinamentos, trabalho de campo, questões climáticas e logísticas. Conclusão: apesar dos desafios metodológicos e logísticos, com o planejamento adequado é possível realizar com êxito pesquisas de grande complexidade e de alto nível científico sobre a relação saúde-trabalho na atividade agropecuária.

Abstract Introduction: agricultural production in Brazil has grown in recent decades, and rural workers are exposed to many occupational risks. Epidemiological studies on the topic remain limited, especially regarding methodological complexity. Objectives: to present the main methodological challenges to carrying out occupational epidemiological studies in rural areas. Methods: the considerations presented in this article are based on the literature and on the experience of the authors as researchers of this thematic. Results: we approached concepts about target population, living and working place, workers classification, and agricultural production context characterization. We discussed sampling strategies, characterization of economic indicators, including agricultural production and mechanization level, pesticide exposure, such as chemical types, forms, and frequency of exposure, pesticide poisonings, and availability and use of personal protective equipment. We described the necessary care with biological samples and aspects involving interviewers, training, field work, and clinical and logistical issues. Conclusion: despite the methodological and logistical challenges, adequate planning enables successful research studies, of great complexity and high scientific level, about the health-work relationship in agricultural activity.

Alcohol consumption among tobacco farmers: prevalence and associated factors. / Consumo de bebida alcoólica entre fumicultores: prevalência e fatores associados.

RESULTS: This study aims to describe the prevalence of heavy drinking, high-risk alcohol consumption and associated factors among tobacco farmers. A cross-sectional study was carried out with 2,469 tobacco farmers over 18 years old in 2011. High-risk alcohol consumption was considered the intake of three or more standard doses per day for men or two or more for women. Heavy drinking was considered the intake of four or more standard doses per day for men and three or more for women. Hierarchical multivariate analysis was performed to investigate the association with socioeconomic, behavioral, and occupational variables. : The prevalence of high-risk and heavy drinking was of 4.7% and 1.09% among women and 30.8% and 4.8% among men, respectively. The factors associated with high-risk drinking for men and women were the percentage of income tobacco accounted for (PR 1.3 and 0.4), being an employee (PR 1.3 and 3.1), and use of pesticides (PR 1.5 and 2.1), respectively. Heavy drinking among men was associated with losing the crop (PR 1.6), attending religious activities (PR 0.3), and hours working in agriculture (PR 0.6). Occupational factors were associated wit high-risk alcohol consumption among men. The associated factors vary according to the pattern of consumption assessed.

RESULTADOS: Este trabalho tem por objetivo descrever a prevalência do beber pesado e o consumo de risco de bebida alcoólica e fatores associados em agricultores que cultivam fumo. Foi realizado estudo transversal em 2469 fumicultores, maiores de 18 anos, no ano de 2011. Foi considerado consumo de risco de bebida alcoólica a ingestão de 3 ou mais doses padrão por dia em homens e 2 ou mais em mulheres. O beber pesado foi a ingestão de 15 ou mais doses padrão por semana em homens e 8 ou mais em mulheres. Foi realizada análise multivariada hierarquizada, que examinou a associação com variáveis socioeconômicas, comportamentais e ocupacionais. : A prevalência do consumo de risco e beber pesado foi 4,7% e 1,09% em mulheres e 30,8% e 4,8% em homens, respectivamente. Foram associados com consumo de risco em homens e mulheres: o percentual da renda representado pelo fumo (RP 1,3 e 0,4), ser empregado (RP 1,3 e 3,1) e uso de agrotóxico (RP 1,5 e 2,1), respectivamente. Foi associado a beber pesado em homens: perda da lavoura (RP 1,6), participação em atividades religiosas (RP 0,3) e horas de trabalho agrícola (RP 0,6). Existe associação de fatores ocupacionais com o consumo de risco de bebidas alcoólicas em homens. Os fatores associados variam conforme o padrão de consumo avaliado.

Urinary cotinine in tobacco farmers in Southern Brazil.

OBJECTIVE: To describe urinary cotinine levels in tobacco farmers. METHODS: A cross-sectional study was conducted in 2,570 tobacco farmers. All participants that reported green tobacco sickness in the week prior to the interview plus a subsample of 492 pesticide applicators were included. We collected urinary samples and information about sociodemographic, behavioral, dietary, occupational characteristics, and pesticide poisoning during their lifetime. Stratification by sex and smoking was performed and the Wilcoxon and Kruskal-Wallis non-parametrical tests were used to analyze cotinine means. RESULTS: This study included 582 individuals. There was no difference in urinary cotinine means between green tobacco sickness symptomatic and asymptomatic individuals. Among non-smokers, having picked tobacco in the previous week was associated with higher cotinine means in both genders. Cotinine levels were higher on the first day of symptoms and reduced exponentially with each day in female non-smokers. Male non-smokers had higher levels on the second day and a more gradual reduction. The cotinine level rose up to 15 cigarettes/day of consumption. CONCLUSIONS: The urinary cotinine measures exposure to nicotine up to its saturation point; while green tobacco sickness, affected by tolerance, indicates nicotine poisoning. Strategies to reduce nicotine exposure in tobacco production are needed. Mechanization could be an alternative, as long as it overcame the challenge of irregular terrain and did not affect the quality of the leaf. More studies are needed to evaluate the chronic effect of nicotine exposure.

Workplace Accident Prevalence and Associated Factors among Tobacco Farm in São Lourenço do Sul-RS, Brazil.

Agriculture has the highest risk of accidents. In Brazil the reality of this situation is unknown owing to scarcity of studies and underreporting of workplace accidents in rural areas. This article aims to evaluate workplace accident prevalence and associated factors among tobacco farm in Sao Lourenco do Sul-RS, Brazil. Cross-sectional study with 488 tobacco farmers, assessing sociodemographic, behavioural, labour characteristics and association with workplace accidents occurring in their lifetime. The injury prevalence was 24%. Being male (PR 1.62; 95%CI 1.04-2.52), and tenant farmer (PR 1.87; 95%CI 1.29-2.72), bundling tobacco leaves (PR 2.00; 95%CI 1.14-3.52) and having minor psychiatric disorders (PR 1.58; 95%CI 1.06-2.35) were positively associated with accidents. 46% of serious injuries caused superficial lesions and 26% caused fractures. Rural workplace accident prevention policies need to be established, particularly for tobacco farming. Larger studies are needed to understand work process-related aspects that increase the risk of accidents.

Mental health of public health workers in Bento Gonçalves, Rio Grande do Sul, Brazil.

BACKGROUND: Work-related mental disorders are an acknowledged global health problem. OBJECTIVE: The aim of the present study was to investigate the prevalence of and factors associated with common mental disorders and suicidal ideation among public health workers. METHODS: We conducted a cross-sectional study with municipal healthcare workers. We collected sociodemographic and occupational data including employment relationship, job area, professional category, length of work in current job and interpersonal conflict in the workplace (ICW). The analyzed mental health indicators were common mental disorders (CMD) and suicidal ideation by means of the Self Reporting Questionnaire (SRQ-20). Statistical analysis included the χ2 test and Poisson regression. RESULTS: The prevalence of CMD and suicidal ideation was 20.3% and 11.6%, respectively, among the 597 participants. Permanent and younger employees exhibited higher CMD rates, while suicidal ideation predominated among the participants with higher educational level and the widowed/separated/divorced. Physicians, administrative employees, cleaning personnel and community health agents exhibited the highest rates of CMD. In turn, there was no association between professional category and suicidal ideation on multivariate analysis. ICW was associated with poorer mental health indicators, the association being stronger when conflict involved supervisors and coworkers. CONCLUSION: Both analyzed indicators (CMD and suicidal ideation) point to a worrisome situation as concerns the mental health of professionals charged of collective health care. The possible limitations of the questionnaire applied notwithstanding, ICW was the main factor associated with poorer mental health indicators. These findings point to the need to develop specific approaches to improve the psychosocial work environment.

CONTEXTO: Os transtornos mentais relacionados ao trabalho são reconhecidos como um problema global de saúde. OBJETIVO: Este estudo buscou avaliar a prevalência e os fatores associados aos transtornos mentais mais frequentes, além da ideação suicida recorrente entre os trabalhadores públicos da área da saúde. MÉTODOS: Foi realizado um estudo transversal entre trabalhadores municipais que atuam na área da saúde. Coletaram-se dados sociodemográficos e fatores ocupacionais como tipo de vínculo, setor de atuação, função desempenhada, antiguidade no cargo e existência de conflitos interpessoais no trabalho (CIT). Os indicadores de saúde mental utilizados foram transtornos mentais comuns (TMC) e ideação suicida, usando Self Reporting Questionnaire (SRQ-20). A análise estatística recorreu aos métodos χ2 e regressão de Poisson. RESULTADOS: Entre os 597 entrevistados, verificou-se prevalência de TMC de 20,3% e de ideação suicida de 11,6%. Trabalhadores concursados e mais jovens apresentaram aumento nas taxas de TMC, enquanto a ideação suicida predominou entre pessoas com escolaridade alta e viúvos ou separados/divorciados. Os trabalhadores que exercem as funções de médicos, administrativos, higienizadoras e agentes comunitários apresentaram as prevalências mais elevadas de TMC. No entanto não houve associação entre função e ideação suicida após análise multivariada. A ocorrência de CIT associou-se com o aumento dos indicadores de saúde mental, de forma mais intensa quando relacionada a chefias e colegas. CONCLUSÃO: Os dois indicadores estudados (TMC e ideação suicida) alertam para uma situação preocupante quanto à saúde mental dos profissionais responsáveis por cuidar da saúde coletiva. Apesar de possíveis limitações do questionário utilizado para definir os critérios, o CIT foi o principal fator associado com a piora dos indicadores de saúde mental, sinalizando a necessidade de abordagens específicas para melhorar o ambiente psicossocial de trabalho.

Suicide rates in the State of Rio Grande do Sul, Brazil: association with socioeconomic, cultural, and agricultural factors.

Rio Grande do Sul State has the highest suicide rates in Brazil. Previous studies have suggested a possible role of agricultural activities, especially tobacco farming, where pesticide use is intensive. An ecological study was designed to assess associations between age-adjusted suicide rates based on death certificates and socioeconomic and agricultural factors. Suicide rates in males and females were inversely associated with schooling level and directly associated with divorce/marital separation. Rates for men were higher in areas where traditional Protestant religious were more prevalent, and rates for women were lower in areas with a higher proportion of single-inhabitant households. Multivariate analyses showed no associations between increased suicide rates and any of the agricultural variables. These results confirm the role of socioeconomic determinants of suicide, but do not support the hypothesis of a specific role of agricultural practices.

[Farm work, dust exposure and respiratory symptoms among farmers]. / Trabalho rural, exposição a poeiras e sintomas respiratórios entre agricultores.

OBJECTIVE: Environmental working conditions in rural areas, notably exposure to organic and mineral dusts, have been associated with increases in respiratory diseases. The objective of this study was to evaluate the prevalence of respiratory symptoms among farmers and the associations of these with occupational risk factors. METHODS: This cross-sectional study was undertaken in 1996 with 1,379 farmers from Southern Brazil. Sociodemographic and farming-production parameters were collected, as were levels of exposure to organic and mineral dusts. Respiratory symptoms were assessed by a modified version of American Thoracic Society-Division of Lung Disease questionnaire. Multiple logistic regression analysis was used in analyses, controlling for confounding factors. RESULTS: The majority (52%) of interviewees worked in activities with intense exposure to dust. Workers on farms with better economic indicators had a lower prevalence of respiratory symptoms. Poultry workers showed more symptoms of chronic respiratory disease (OR=1.60; 95% CI: 1.05-2.42). Farmers exposed to high concentrations of dust had more than 70% higher risk of asthma symptoms (OR=1.71; 95% CI: 1.10-2.67) and chronic respiratory disease symptoms (OR=1.77; 95% CI: 1.25-2.50). CONCLUSIONS: The rural workers studied herein were exposed to high levels of organic and mineral dusts. Those exposed to higher dust concentrations, such as poultry workers, showed an increased risk of work-related respiratory symptoms. The implementation of respiratory protection programs is recommended, emphasizing workers involved with poultry production.

[Smoking prevalence and associated factors among tobacco farmers in southern Brazil]. / Prevalência e fatores associados ao tabagismo em fumicultores do Sul do Brasil.

This study aimed to describe the prevalence of smoking and associated factors in a cross-sectional population-based sample of 2,464 tobacco farmers in 2011. Multivariate analysis in men assessed the association between smoking and socioeconomic, behavioral, and occupational variables. Some 31.2% of men and 3.1% of women were current smokers. In men, smoking was directly associated with age, schooling, income, heavy drinking, time at work in tobacco farming, and time of exposure to pesticides. Employment relationship was a risk factor for smoking, and participation in religious activities was a protective factor. Male tobacco farmers showed multiple risk behaviors and higher smoking prevalence than other farmers. Ignoring the risk and cultural legacy may be common factors for these behaviors and suggest combined approaches.

Pesticides and respiratory symptoms among farmers.

OBJECTIVE: Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS: A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS: More than half (55%) of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14) and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81) symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58) and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28). CONCLUSIONS: In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

Prevalence of chronic low back pain: systematic review.

OBJECTIVE: To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS: We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex. RESULTS: The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%. CONCLUSIONS: Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

Dor na coluna torácica e fatores associados em fumicultores / Thoracic spine pain and associated factors among tobacco farmers

Resumo Introdução: dor na coluna torácica diz respeito a traumas cumulativos envolvendo má postura, movimentos repetitivos e longos períodos na mesma posição. Objetivo: avaliar a prevalência de dor na coluna torácica e fatores associados em fumicultores no sul do Brasil. Métodos: estudo transversal cuja associação entre o desfecho e os fatores sociodemográficos e comportamentais, atividades laborais, cargas de trabalho e comorbidades foram examinadas pelo teste de Wald para heterogeneidade e tendência linear. A análise multivariável foi realizada utilizando modelo hierárquico e regressão de Poisson com variância robusta. Resultados: o estudo envolveu 2.469 indivíduos de ambos os sexos. A prevalência de dor na coluna torácica foi de 21,2%. Limpar equipamento para aplicação de agrotóxico, número de episódios de Doença da Folha Verde, sintomas respiratórios e transtornos psiquiátricos menores foram positivamente associados ao desfecho em ambos os sexos. Tabagismo e intoxicação por agrotóxicos foram associados ao desfecho entre as mulheres, enquanto escolaridade e passar varas com folhas de tabaco foram associados aos homens. Conclusões: reestruturação ergonômica, redução das cargas de trabalho, trocas de posição durante o turno de trabalho e mecanização do processo de trabalho são estratégias importantes para reduzir a exposição à nicotina, agrotóxicos e carga de trabalho ergonômica.

Abstract Introduction: thoracic spine pain concerns cumulative trauma involving poor posture, repetitive motion, and long periods of time in the same position. Objective: to assess the prevalence of thoracic spine pain and associated factors in tobacco tobacco farmers in southern Brazil. Methods: cross-sectional study whose association between the outcome and the sociodemographic and behavioural factors, work activities, workloads and comorbidities were examined using the Wald heterogeneity and linear trend tests. Multivariate analysis was performed using a hierarchical model and Poisson regression with robust variance. Results: the study comprised 2,469 individuals of both genders. Prevalence of thoracic spine pain was 21.2%. Cleaning equipments used to apply pesticides, number of episodes of green tobacco sickness, respiratory symptoms and minor psychiatric disorders were positively associated with the outcome in both genders. Smoking and pesticide poisoning were associated factors with the outcome in women, whilst schooling and lifting sticks with tobacco leaves for curing were associated with men. Conclusions: ergonomic restructuring, reduction of workload, position switches during work shift and mechanization of work process are important strategies to reduce exposure to nicotine, pesticides, and ergonomic workload.

Dolor cervical entre agricultores que producen tabaco en el sur de Brasil / Neck pain among tobacco farm workers in Southern Brazil

RESUMEN Este estudio tiene como objetivo evaluar la prevalencia del dolor cervical y los factores asociados entre agricultores que producen tabaco. Se realizó un estudio transversal en el que participaron 2.469 agricultores que producen tabaco en el sur de Brasil. Para la caracterización del dolor cervical se utilizó una adaptación del cuestionario nórdico para síntomas musculoesqueléticos. El análisis multivariante se realizó mediante la regresión de Poisson, siguiendo un modelo teórico jerárquico. La prevalencia del dolor cervical en el año previo entre la población estudiada fue del 7,4%. Las variables que se asociaron con el dolor cervical entre las mujeres trabajadoras fueron la edad, el consumo de tabaco, el enfardado del tabaco, el uso de motosierras pesadas, trabajar en un ritmo intenso o acelerado y la enfermedad del tabaco verde, mientras que, entre los varones, fueron la edad, el uso de motosierras pesadas, el trabajo sentado en el suelo, la intoxicación por plaguicidas y la enfermedad del tabaco verde. El estudio refuerza la importancia de las cargas de trabajo ergonómicas y fisiológicas en la determinación del dolor cervical. Se necesitan estudios futuros para comprender el papel de la exposición a los plaguicidas y a la nicotina en los problemas musculoesqueléticos. La mecanización de la cosecha del tabaco podría reducir la exposición ergonómica y química, mejorando así la salud de los agricultores.

ABSTRACT This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

[Rural work and pesticide poisoning]. / Trabalho rural e intoxicações por agrotóxicos.

Pesticide use is intensive in Brazilian agriculture. Population-based studies on the characteristics of pesticide use and pesticide poisoning are scarce. This study describes the profile of occupational exposure and pesticide poisoning incidence. Farm characteristics and pesticide occupational exposure were evaluated using a cross-sectional design. Among 1,379 farmers/farm workers, annual incidence of pesticide poisoning was 2.2 episodes per 100 exposed. Based on Poisson regression, applying pesticide, reentering crop fields after spraying, and working with pesticides on more than one farm were the types of exposure that presented a positive correlation with pesticide poisoning. The results may be useful for planning activities aimed at reducing occupational pesticide poisoning among rural workers.

[Epidemiological aspects of suicide in Rio Grande do Sul, Brazil]. / Características epidemiológicas do suicídio no Rio Grande do Sul.

OBJECTIVE: To describe epidemiological aspects of suicide mortality in a 10-year time series. METHODS: Suicide deaths reported in the state of Rio Grande do Sul (RS), Brazil, were put together as historical time series based on data from the Ministry of Health Mortality Reporting System for the period 1980 to 1999. Suicides were grouped according to the WHO criteria and analyzed using standard demographic variables. RESULTS: Suicide rates (proportional mortality and mortality rates) in RS during the study period were the highest in Brazil. The standardized rates grew from around 9 per 100,000 in the 1980s to 11 per 100,000 in 1999. This increase in mortality was attributed mainly to male mortality rates that grew from 14 per 100,000 to the current 20 per 100,000. The male:female ratio increased from 3 to 5. The highest ratios were seen among the elderly although this ratio has been increasing in young adults as well. Widows, widowers and farmers/fishers had the highest mortality rates. CONCLUSIONS: The study highlights suicide as a collective health problem in RS and shows aspects that could contribute to preventive action.