Exposição ocupacional ao Sars-CoV-2: investigação das condições de saúde/segurança dos trabalhadores essenciais para subsidiar ações de mitigação de risco da Covid-19 / Occupational exposure to SARS-CoV-2: investigation of the health/safety conditions of essential workers to support COVID-19 risk mitigation actions

RESUMO Em janeiro de 2020, a Organização Mundial da Saúde declarou a Covid-19 como emergência de saúde pública no mundo. Diante da ausência de medidas farmacológicas, a única prevenção adotada foi o distanciamento físico. Porém, trabalhadores essenciais ficaram submetidos às políticas de gestão de saúde e segurança das empresas. O objetivo deste artigo é investigar as condições de saúde e segurança dos trabalhadores expostos ao Sars-CoV-2, por meio da aplicação de ferramentas de inovação tecnológica, para dar suporte e subsidiar ações de mitigação de risco da doença. Trata-se de estudo transversal, conduzido na plataforma REDCap, por instrumento autoaplicável de comunicação de risco de trabalhadores em atividade presencial e remota, no Brasil. Participaram 2.476 trabalhadores, dos quais, 723 foram aceitos por análise de consistência das respostas. A idade média foi de 43,5 anos, sexo feminino (53,3%), cor branca (62%), carga de 21-40 horas semanais (60%) e Covid-19 em 27,4% da amostra. A maioria (75,2%) considerou que a transmissão ocorreu no trabalho e que medidas de proteção coletiva foram insuficientes. Os achados apontam deficiências nos planos de contingência das empresas, que repercutem em insegurança e risco de exposição ao Sars-CoV-2, reduzindo a eficácia das medidas sanitárias e transformando o trabalho em lócus de disseminação do vírus.

ABSTRACT In January 2020, the World Health Organization declared COVID-19 a public health emergency worldwide. Given the absence of pharmacological measures, the only prevention adopted was physical distancing. However, essential workers were subject to the health and safety management policies of companies. The aim of this article is to investigate the health and safety conditions of workers exposed to SARS-CoV-2, using the application of technological innovation tools, to support and subsidize disease risk mitigation actions. This is a cross-sectional study, conducted in the Redcap platform, by a self-administered instrument of risk communication of workers in face-to-face and remote activities, in Brazil. A total of2,476 workers took part, 723 of whom were accepted by analysis of consistency of responses. The average age was 43.5 years, female (53.3%), white (62%), working 21-40 hours a week (60%) and Covid-19 in 27.4% of the sample. Most (75.2%) considered that the transmission occurred at work and the collective protection measures were insufficient. The findings point to deficiencies in the contingency plans of the companies, which have repercussions on the insecurity and risk of exposure to SARS-CoV-2, reducing the effectiveness of sanitary measures and transforming the work into locus of dissemination of the virus.

Network Analysis of Biomarkers Associated with Occupational Exposure to Benzene and Malathion.

Complex diseases are associated with the effects of multiple genes, proteins, and biological pathways. In this context, the tools of Network Medicine are compatible as a platform to systematically explore not only the molecular complexity of a specific disease but may also lead to the identification of disease modules and pathways. Such an approach enables us to gain a better understanding of how environmental chemical exposures affect the function of human cells, providing better perceptions about the mechanisms involved and helping to monitor/prevent exposure and disease to chemicals such as benzene and malathion. We selected differentially expressed genes for exposure to benzene and malathion. The construction of interaction networks was carried out using GeneMANIA and STRING. Topological properties were calculated using MCODE, BiNGO, and CentiScaPe, and a Benzene network composed of 114 genes and 2415 interactions was obtained. After topological analysis, five networks were identified. In these subnets, the most interconnected nodes were identified as: IL-8, KLF6, KLF4, JUN, SERTAD1, and MT1H. In the Malathion network, composed of 67 proteins and 134 interactions, HRAS and STAT3 were the most interconnected nodes. Path analysis, combined with various types of high-throughput data, reflects biological processes more clearly and comprehensively than analyses involving the evaluation of individual genes. We emphasize the central roles played by several important hub genes obtained by exposure to benzene and malathion.

Influence of Environmental Exposure to Steel Waste on Endocrine Dysregulation and PER3 Gene Polymorphisms.

OBJECTIVE: To evaluate the association between environmental exposure to the following chemical substances: cadmium (Cd), lead (Pb), nickel (Ni), manganese (Mn), benzene (BZN), and toluene (TLN), and Period Circadian Regulator 3 (PER3) gene variable number of tandem repeats (VNTR) polymorphisms, according to chronotype in a population living in a steel residue-contaminated area. METHODS: This assessment comprises a study conducted from 2017 to 2019 with 159 participants who completed health, work, and Pittsburgh sleep scale questionnaires. Cd, Pb, Ni, Mn, BZN, and TLN concentrations in blood and urine were determined by Graphite Furnace Atomic Absorption Spectrometry (GFAAS) and Headspace Gas Chromatography (GC), and genotyping was carried out using Polymerase Chain Reaction (PCR). RESULTS: A total of 47% of the participants were afternoon chronotype, 42% were indifferent, and 11% were morning chronotype. Insomnia and excessive sleepiness were associated with the indifferent chronotype, while higher urinary manganese levels were associated with the morning chronotype (Kruskal-Wallis chi-square = 9.16; p < 0.01). In turn, the evening chronotype was associated with poorer sleep quality, higher lead levels in blood, and BZN and TLN levels in urine (χ2 = 11.20; p < 0.01) in non-occupationally exposed individuals (χ2 = 6.98; p < 0.01) as well as the highest BZN (χ2 = 9.66; p < 0.01) and TLN (χ2 = 5.71; p < 0.01) levels detected in residents from the influence zone 2 (far from the slag). CONCLUSION: Mn, Pb, benzene, and toluene contaminants may have influenced the different chronotypes found in the steel residue-exposed population.

Systematic Review and Meta-Analysis of Metabolic Syndrome and Its Components in Latino Immigrants to the USA.

The Metabolic Syndrome (MetS) is an increasingly prevalent condition globally. Latino populations in the USA have shown an alarming increase in factors associated with MetS in recent years. The objective of the present systematic review was to determine the prevalence of MetS and its risk factors in immigrant Latinos in the USA and perform a meta-analysis of those prevalence. The review included cross-sectional, cohort, or case−control studies involving adult immigrant Latinos in the USA, published during the period 1980−2020 in any language. Studies involving individuals who were pregnant, aged <18 years, immigrant non-Latinos, published outside the 1980−2020 period, or with other design types were excluded. The Pubmed, Web of Science, Embase, Lilacs, Scielo, and Google Scholar databases were searched. The risk of bias was assessed using the checklists of the Joanna Briggs Institute. The review included 60 studies, and the meta-analysis encompassed 52 studies. The pooled prevalence found for hypertension, diabetes, general obesity, and abdominal obesity were 28% (95% Confidence Interval (CI): 23−33%), 17% (95% CI: 14−20%), 37% (95% CI: 33−40%), and 54% (95% CI: 48−59%), respectively. The quality of the evidence of the primary studies was classified as low or very low. Few studies including immigrants from South America were identified. Further studies of those immigrants are needed due to the cultural, dietary, and language disparities among Latin American countries. The research protocol was registered with the Open Science Framework (OSF).

Overweight and Obesity in Brazilian Immigrants in Massachusetts, USA: A Time Series Analysis (2009-2020).

INTRODUCTION: Obesity is considered a growing public health problem by the Brazilian Ministry of Health and a global epidemic by the World Health Organization (WHO). In 2020, the Centers for Disease Control and Prevention (CDC) estimated the prevalence of adult obesity at 31.9% in the USA. The USA is one of the main destinations for Brazilian immigrants in search of better living conditions, and Massachusetts is one of the states with the highest presence of Brazilians. Changes in lifestyle and eating habits are often associated with increases in overweight and obesity in immigrants in the USA, especially Hispanics, an official classification that does not, however, include Brazilians. The aim of this study was to describe the temporal trend of overweight and obesity in Brazilian immigrants assisted by the Cambridge Health Alliance (CHA) healthcare network in Massachusetts. METHODS: This was an ecological time series study of 128,206 records of Brazilians aged between 18 and 60 years based on hospital data from 2009 to 2020. RESULTS: Mean age was 38.9 (SD = 10.6), and 61% of the sample were women. The prevalence of overweight and obesity was 38.4% and 25.4%, respectively. Obesity exhibited an increasing trend, while eutrophy and overweight decreased during the study period. CONCLUSION: As little is known about the health of Brazilian immigrants in the USA, this study contributes to the literature on the subject. The observed increasing trends agree with the worldwide increase in obesity and indicate the need for future research exploring individual factors associated with immigrant acculturation.

Impacts of COVID-19 on the oil and gas industry in Brazil.

This study aimed to analyze the progression of COVID-19 cases on oil and gas workers in Brazil. This is a descriptive research based on secondary data available in the COVID-19 Monitoring Bulletins of the Ministry of Mines and Energy and news about outbreaks on digital media. The findings show that the numerous news reports published on digital media indicate unhealthy working conditions, and workers' representatives appear as the main source of these findings. Managers' failure in health surveillance of this working class were also observed as to the frequent omission of official data and compulsory notifications on the health and safety of oil and gas workers.

Este estudo teve como objetivo analisar a evolução dos casos de trabalhadores do setor de petróleo e gás afetados pela covid-19 no Brasil. Tratou-se de uma pesquisa descritiva, realizada a partir de dados secundários disponíveis nos boletins de monitoramento da covid-19 do Ministério de Minas e Energia e das notícias sobre surtos de covid-19 em petroleiros publicadas nas mídias digitais. Concluiu-se que as inúmeras notícias publicadas pelas mídias digitais refletem condições de trabalho insalubres, e os representantes dos trabalhadores surgem como a principal fonte desses achados. Foram observadas ainda falhas na vigilância em saúde por parte dos gestores dessa classe trabalhadora no que concerne à frequente omissão de dados oficiais e às notificações compulsórias sobre a saúde e a segurança dos petroleiros.

Assessing the quality of evidence in studies estimating prevalence of exposure to occupational risk factors: The QoE-SPEO approach applied in the systematic reviews from the WHO/ILO Joint Estimates of the Work-related burden of disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) have produced the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). For these, systematic reviews of studies estimating the prevalence of exposure to selected occupational risk factors have been conducted to provide input data for estimations of the number of exposed workers. A critical part of systematic review methodology is to assess the quality of evidence across studies. In this article, we present the approach applied in these WHO/ILO systematic reviews for performing such assessments on studies of prevalence of exposure. It is called the Quality of Evidence in Studies estimating Prevalence of Exposure to Occupational risk factors (QoE-SPEO) approach. We describe QoE-SPEO's development to date, demonstrate its feasibility reporting results from pilot testing and case studies, note its strengths and limitations, and suggest how QoE-SPEO should be tested and developed further. METHODS: Following a comprehensive literature review, and using expert opinion, selected existing quality of evidence assessment approaches used in environmental and occupational health were reviewed and analysed for their relevance to prevalence studies. Relevant steps and components from the existing approaches were adopted or adapted for QoE-SPEO. New steps and components were developed. We elicited feedback from other systematic review methodologists and exposure scientists and reached consensus on the QoE-SPEO approach. Ten individual experts pilot-tested QoE-SPEO. To assess inter-rater agreement, we counted ratings of expected (actual and non-spurious) heterogeneity and quality of evidence and calculated a raw measure of agreement (Pi) between individual raters and rater teams for the downgrade domains. Pi ranged between 0.00 (no two pilot testers selected the same rating) and 1.00 (all pilot testers selected the same rating). Case studies were conducted of experiences of QoE-SPEO's use in two WHO/ILO systematic reviews. RESULTS: We found no existing quality of evidence assessment approach for occupational exposure prevalence studies. We identified three relevant, existing approaches for environmental and occupational health studies of the effect of exposures. Assessments using QoE-SPEO comprise three steps: (1) judge the level of expected heterogeneity (defined as non-spurious variability that can be expected in exposure prevalence, within or between individual persons, because exposure may change over space and/or time), (2) assess downgrade domains, and (3) reach a final rating on the quality of evidence. Assessments are conducted using the same five downgrade domains as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach: (a) risk of bias, (b) indirectness, (c) inconsistency, (d) imprecision, and (e) publication bias. For downgrade domains (c) and (d), the assessment varies depending on the level of expected heterogeneity. There are no upgrade domains. The QoE-SPEO's ratings are "very low", "low", "moderate", and "high". To arrive at a final decision on the overall quality of evidence, the assessor starts at "high" quality of evidence and for each domain downgrades by one or two levels for serious concerns or very serious concerns, respectively. In pilot tests, there was reasonable agreement in ratings for expected heterogeneity; 70% of raters selected the same rating. Inter-rater agreement ranged considerably between downgrade domains, both for individual rater pairs (range Pi: 0.36-1.00) and rater teams (0.20-1.00). Sparse data prevented rigorous assessment of inter-rater agreement in quality of evidence ratings. CONCLUSIONS: We present QoE-SPEO as an approach for assessing quality of evidence in prevalence studies of exposure to occupational risk factors. It has been developed to its current version (as presented here), has undergone pilot testing, and was applied in the systematic reviews for the WHO/ILO Joint Estimates. While the approach requires further testing and development, it makes steps towards filling an identified gap, and progress made so far can be used to inform future work in this area.

Assessor burden, inter-rater agreement and user experience of the RoB-SPEO tool for assessing risk of bias in studies estimating prevalence of exposure to occupational risk factors: An analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: As part of the development of the World Health Organization (WHO)/International Labour Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury, WHO and ILO carried out several systematic reviews to determine the prevalence of exposure to selected occupational risk factors. Risk of bias assessment for individual studies is a critical step of a systematic review. No tool existed for assessing the risk of bias in prevalence studies of exposure to occupational risk factors, so WHO and ILO developed and pilot tested the RoB-SPEO tool for this purpose. Here, we investigate the assessor burden, inter-rater agreement, and user experience of this new instrument, based on the abovementioned WHO/ILO systematic reviews. METHODS: Twenty-seven individual experts applied RoB-SPEO to assess risk of bias. Four systematic reviews provided a total of 283 individual assessments, carried out for 137 studies. For each study, two or more assessors independently assessed risk of bias across the eight RoB-SPEO domains selecting one of RoB-SPEO's six ratings (i.e., "low", "probably low", "probably high", "high", "unclear" or "cannot be determined"). Assessors were asked to report time taken (i.e. indicator of assessor burden) to complete each assessment and describe their user experience. To gauge assessor burden, we calculated the median and inter-quartile range of times taken per individual risk of bias assessment. To assess inter-rater reliability, we calculated a raw measure of inter-rater agreement (Pi) for each RoB-SPEO domain, between Pi = 0.00, indicating no agreement and Pi = 1.00, indicating perfect agreement. As subgroup analyses, Pi was also disaggregated by systematic review, assessor experience with RoB-SPEO (≤10 assessments versus > 10 assessments), and assessment time (tertiles: ≤25 min versus 26-66 min versus ≥ 67 min). To describe user experience, we synthesised the assessors' comments and recommendations. RESULTS: Assessors reported a median of 40 min to complete one assessment (interquartile range 21-120 min). For all domains, raw inter-rater agreement ranged from 0.54 to 0.82. Agreement varied by systematic review and assessor experience with RoB-SPEO between domains, and increased with increasing assessment time. A small number of users recommended further development of instructions for selected RoB-SPEO domains, especially bias in selection of participants into the study (domain 1) and bias due to differences in numerator and denominator (domain 7). DISCUSSION: Overall, our results indicated good agreement across the eight domains of the RoB-SPEO tool. The median assessment time was comparable to that of other risk of bias tools, indicating comparable assessor burden. However, there was considerable variation in time taken to complete assessments. Additional time spent on assessments may improve inter-rater agreement. Further development of the RoB-SPEO tool could focus on refining instructions for selected RoB-SPEO domains and additional testing to assess agreement for different topic areas and with a wider range of assessors from different research backgrounds.

Perfil demográfico e clínico de casos ocupacionais de sensibilização a metilisotiazolinona e Kathon CG: estudo seccional / Demographic and clinical profile of occupational cases of sensitization to methylisothiazolinone and Kathon CG: a cross-sectional study

Resumo Introdução: a metilisotiazolinona isolada ou associada à metilcloroisotiazolinona (Kathon CG) é um conservante relacionado à dermatite de contato alérgica ocupacional. Objetivos: avaliar o perfil demográfico e clínico dos casos ocupacionais de sensibilização a isotiazolinonas no município do Rio de Janeiro e descrever a presença desses preservativos em tintas nacionais. Métodos: estudo transversal baseado em informações de prontuários de trabalhadores submetidos a testes de contato entre 2013-2017. Descreveu-se a prevalência de características clínicas, demográficas e ocupacionais e utilizou-se um modelo não-ajustado para investigar a associação entre variáveis. Buscou-se a presença e a concentração de isotiazolinonas nas fichas de composição química de tintas nacionais. Resultados: dentre os 768 trabalhadores submetidos aos testes, 68 apresentavam dermatose ocupacional com resultado positivo para sensibilização à metilisotiazolinona/Kathon CG. As profissões mais acometidas foram as relacionadas a atividades domésticas e limpeza. Houve maior chance de sensibilização às isotiazolinonas nas mulheres e naqueles com acometimento das mãos e das pernas. Entre as 61 tintas avaliadas, 26 possuíam alguma isotiazolinona, sendo a metilcloroisotiazolinona a mais comum. Conclusões: a sensibilização às isotiazolinonas pode impactar a saúde do trabalhador e demanda maior vigilância com materiais de limpeza e cosméticos, assim como a discussão da regulação da composição de tintas comercializadas no país.

Abstract Introduction: methylisothiazolinone alone or associated with methylchloroisothiazolinone (Kathon CG) is a preservative related to occupational allergic contact dermatitis. Objectives: to evaluate the demographic and clinical profile of occupational cases of sensitization to isothiazolinones in the city of Rio de Janeiro and to describe the presence of these preservatives in national paints. Methods: cross-sectional study based on information from medical records of workers who underwent patch testing between 2013-2017. The prevalence of clinical, demographic and occupational characteristics was described and an unadjusted model was used to investigate the association between variables. We sought the presence and concentration of isothiazolinones in the chemical composition sheets of national paints. Results: among the 768 workers submitted to the tests, 68 had occupational dermatosis with a positive result for sensitization to methylisothiazolinone/Kathon CG. The most affected occupations were those related to domestic activities and cleaning. There was a greater likelihood of sensitization to isothiazolinones in women and in those with involvement of the hands and legs. Among the 61 paints evaluated, 26 had some isothiazolinone, with methylchloroisothiazolinone being the most common. Conclusions: sensitization to isothiazolinones can impact workers' health and demands greater vigilance on cleaning materials and cosmetics, as well as discussing the composition regulation of the paints sold in Brazil.

Nocturnal awakenings of Brazilian immigrants in Massachusetts.

OBJECTIVE: The purpose of this study was to assess the relationship between the quantity of jobs and nocturnal awakenings of Brazilians living in Massachusetts. MATERIAL AND METHODS: We sampled of 48 documented Brazilians around the age of 45.5 years old. 52.1% of them were women. Data gathering occurred for three weeks, using the Pittsburgh Sleep Quality Index. Participants also wore wrist actigraph and filled sleep/wake diary for a week. RESULTS: The sleep quality of immigrants with one job (mean=8.58, SD=4.16) is better when compared to immigrants with 2-3 jobs (mean=12.7, SD=3.57) according to the PSQI scores. Immigrants with 2-3 jobs reported dissatisfaction on three components of the scale: sleep duration, sleep efficiency and sleep quality. DISCUSSION: There is a positive relationship between the quantity of jobs and nocturnal awakenings and between nocturnal awakenings and complaints related to sleep apnea among Brazilians in Massachusetts. The assessment of systemic morbidities associated with sleep pattern changes should be considered in future research.

The prevalence of occupational exposure to noise: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic and human data suggests that occupational exposure to noise may cause cardiovascular disease. In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to noise for estimating (if feasible) the number of deaths and disability-adjusted life years from cardiovascular disease that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to noise. DATA SOURCES: We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines, and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economies in any WHO Member and/or ILO member State, but excluded children (<15 years) and unpaid domestic workers. We included all study types with an estimate of the prevalence of occupational exposure to noise, categorized into two levels: no (low) occupational exposure to noise (<85dBA) and any (high) occupational exposure to noise (≥85dBA). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the RoB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. RESULTS: Sixty-five studies (56 cross-sectional studies and nine cohort studies) met the inclusion criteria, comprising 157,370 participants (15,369 females) across 28 countries and all six WHO regions (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). For the main analyses, we prioritized the four included studies that surveyed national probability samples of general populations of workers over the 58 studies of workers in industrial sectors and/or occupations with relatively high occupational exposure to noise. The exposure was generally assessed with dosimetry, sound level meter, or official or company records; in the population-based studies, it was assessed with validated questions. Estimates of the prevalence of occupational exposure to noise are presented for all 65 included studies, by country, sex, 5-year age group, industrial sector, and occupation where feasible. The pooled prevalence of any (high) occupational exposure to noise (≥85dBA) among the general population of workers was 0.17 (95% confidence interval 0.16 to 0.19, 4 studies, 108,256 participants, 38 countries, two WHO regions, I2 98%, low quality of evidence). Subgroup analyses showed that pooled prevalence differed substantially by WHO region, sex, industrial sector, and occupation. CONCLUSIONS: Our systematic review and meta-analysis found that occupational exposure to noise is prevalent among general populations of workers. The current body of evidence is, however, of low quality, due to serious concerns for risk of bias and indirectness. Producing estimates of occupational exposure to noise nevertheless appears evidence-based, and the pooled effect estimates presented in this systematic review are suitable as input data for the WHO/ILO Joint Estimates (if feasible). Protocol identifier: 10.1016/j.envint.2018.09.040 PROSPERO registration number: CRD42018092272.

The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (<85 dBA), on the prevalence, incidence and mortality of ischaemic heart disease (IHD), stroke, and hypertension. DATA SOURCES: A protocol was developed and published, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies up to 1 April 2019, including International Trials Register, Ovid MEDLINE, PubMed, Embase, Lilacs, Scopus, Web of Science, and CISDOC. The MEDLINE and Pubmed searches were updated on 31 January 2020. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of any occupational exposure to noise on CVD prevalence, incidence or mortality, compared with the theoretical minimum risk exposure level (<85 dBA). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We prioritized evidence from cohort studies and combined relative risk estimates using random-effect meta-analysis. To assess the robustness of findings, we conducted sensitivity analyses (leave-one-out meta-analysis and used as alternative fixed effects and inverse-variance heterogeneity estimators). At least two review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide tools and approaches adapted to this project. RESULTS: Seventeen studies (11 cohort studies, six case-control studies) met the inclusion criteria, comprising a total of 534,688 participants (39,947 or 7.47% females) in 11 countries in three WHO regions (the Americas, Europe, and the Western Pacific). The exposure was generally assessed with dosimetry, sound level meter and/or official or company records. The outcome was most commonly assessed using health records. We are very uncertain (low quality of evidence) about the effect of occupational exposure to noise (≥85 dBA), compared with no occupational exposure to noise (<85 dBA), on: having IHD (0 studies); acquiring IHD (relative risk (RR) 1.29, 95% confidence interval (95% CI) 1.15 to 1.43, two studies, 11,758 participants, I2 0%); dying from IHD (RR 1.03, 95% CI 0.93-1.14, four studies, 198,926 participants, I2 26%); having stroke (0 studies); acquiring stroke (RR 1.11, 95% CI 0.82-1.65, two studies, 170,000 participants, I2 0%); dying from stroke (RR 1.02, 95% CI 0.93-1.12, three studies, 195,539 participants, I2 0%); having hypertension (0 studies); acquiring hypertension (RR 1.07, 95% CI 0.90-1.28, three studies, four estimates, 147,820 participants, I2 52%); and dying from hypertension (0 studies). Data for subgroup analyses were missing. Sensitivity analyses supported the main analyses. CONCLUSIONS: For acquiring IHD, we judged the existing body of evidence from human data to provide "limited evidence of harmfulness"; a positive relationship is observed between exposure and outcome where chance, bias, and confounding cannot be ruled out with reasonable confidence. For all other included outcomes, the bodies of evidence were judged as "inadequate evidence of harmfulness". Producing estimates for the burden of CVD attributable to occupational exposure to noise appears to not be evidence-based at this time. PROTOCOL IDENTIFIER: 10.1016/j.envint.2018.09.040. PROSPERO REGISTRATION NUMBER: CRD42018092272.

Teaching work social temporality in a public university and health. / A temporalidade social do trabalho docente em universidade pública e a saúde.

This study aimed to analyze teaching work's temporality aspects in their relationship with health. Qualitative research was conducted with the participation of ten professors from a public university. Six meetings called "Worker's Health workshops" were held, a research methodology that gathers workers and researchers to discuss topics related to work and health. The material was analyzed through the content analysis technique, in the thematic modality. The main themes were identified from the transcribed materials of the workshops' dialogues, namely: working time intensification and extension, teacher's health, working time and sleep deprivation, and health advocacy strategies and solutions. We noted that health advocacy strategies are located in individuals and the workgroup, through cooperation and social time. The theme of an intensive and extensive combination of working time associated with insecure work conditions was identified. We concluded that teaching work time is underpinned by rules and social values under the historical determination of new managerial standards within the public university.

Perfil das aposentadorias por invalidez entre os servidores públicos federais da Fundação Oswaldo Cruz entre os anos de 2012 e 2016 / Profile of disability retirement among civil servants at Oswaldo Cruz Foundation, 2012­2016

Introdução: A aposentadoria por invalidez decorre da incapacidade laboral permanente. Estima-se que essas representem 14,5% do total de aposentadorias do Instituto Nacional do Seguro Social, não havendo dados disponíveis no setor público federal. Objetivo: Descrever o perfil epidemiológico das aposentadorias por invalidez entre os servidores da Fundação Oswaldo Cruz (FIOCRUZ), no período de 2012 e 2016. Métodos: Realizou-se um estudo transversal, utilizando-se como variáveis idade, sexo, tempo de trabalho total, tempo de trabalho na Fiocruz, cargo exercido e motivo da aposentadoria segundo capítulo da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde ­ 10ª edição (CID-10). Nas análises, um valor de p=0,05 e o intervalo de confiança de 95% (IC95%) foram sempre considerados. Resultados: A prevalência para aposentadoria por invalidez no período de 2012 a 2016 foi de 113/10.000 servidores. Se aposentar por invalidez representou cerca de 9 anos a menos de trabalho. Trabalhar como técnico (razão das prevalências ­ RP=6,83) e assistente técnico (RP=7,67) foi ter mais chance de se aposentar por invalidez. Os transtornos mentais e comportamentais foram os que mais motivaram o desfecho, representando 38,71% dos casos. Conclusão: As doenças crônicas não transmissíveis são as principais causas de aposentadoria por invalidez. Sugere-se reavaliar o dispositivo legal de aposentadoria compulsória aos 24 meses de afastamento. Faz-se necessária uma abordagem interdisciplinar de vigilância em saúde do trabalhador para conhecimento da realidade nos ambientes e o impacto dos processos de trabalho.

Background: Disability retirement, an outcome of permanent incapacity for work, represents 14.5% of pensions granted by the Brazilian National Social Security Institute. However, there are no data available for civil servants. Objective: To describe the epidemiological profile of disability retirement among employees at Oswaldo Cruz Foundation (FIOCRUZ) in the period from 2012 to 2016. Methods: Cross-sectional study in which we analyzed the following variables: age, sex, total working time, years of work at FIOCRUZ, position and reason for retirement as per ICD-10 codes. The significance level was set to p=0.05 and all the data are presented with 95% confidence interval. Results: The prevalence of disability retirement in the analyzed period was 113/10,000 employees. Employees granted disability retirement benefits worked about 9 years less. Odds for disability were higher for technicians (prevalence ratio­PR=6.83) and technical assistants (PR=7.67). Mental and behavioral disorders were the main reason for disability retirement (38.71%). Conclusion: Noncommunicable diseases are the main cause of disability retirement. We call the attention to the need to revise the legislation that establishes mandatory retirement after 24 months of sick leave. An interdisciplinary occupational health surveillance approach is necessary to obtain accurate knowledge of the actual situation in workplaces and of the impacts of work processes.

[Quality analysis of self-reported information on sleep duration in schoolchildren in the Study of Cardiovascular Risk Factors in Adolescents (ERICA)]. / Análise da qualidade da informação autorreferida sobre duração do sono de escolares do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA).

The study aimed to assess sleep behavior in adolescents 12 to 17 years of age participating in ERICA (Study of Cardiovascular Risk Factors in Adolescents), based on sociodemographic characteristics, school shift, and type of school, and to describe the correction of inconsistent sleep times in a nationally representative study in Brazil. Data were collected in 2013 and 2014. Four questions were asked on habitual time for sleeping and waking on weekdays and weekends, with 24 possible answers, one for each hour of the day. Analysis of inconsistencies considered the distribution of frequencies of answers as to sleeping and waking times, in addition to compatibility with the school shift. Sleep duration during the week and on weekends was obtained by the difference between sleeping and waking times, and differences of ≤ 4 or ≥ 14 hours were excluded. Mean total sleep duration in seven days was calculated by the formula (weekday sleep duration x 5 + weekend sleep duration x 2)/7. The following groups were created: original data (answers that did not require correction), corrected data (inconsistent, but amenable to correction), and excluded data (inconsistent, and for which there was no criterion for correction). Correction recovered inconsistent information for 5,988 adolescents, 8% of the 74,589 participants. A total of 7,937 (10.6%) answers were excluded. Adolescents whose information was corrected or excluded were younger, predominantly males, from public schools, and from the North of Brazil. Correction minimized losses and lent greater consistency to the data treatment. The study contributes to the improvement of data collection tools in observational studies, lending transparency to the way of dealing with inherent limitations in the data collection method.

Objetivou-se avaliar o comportamento do sono de adolescentes de 12 a 17 anos, participantes do ERICA (Estudo de Riscos Cardiovasculares em Adolescentes), estudo de representatividade nacional, segundo características sociodemográficas, turno e tipo de escola, e descrever a correção das horas inconsistentes. A coleta de dados ocorreu em 2013 e 2014. Foram feitas quatro perguntas sobre horas habituais de dormir e de acordar durante a semana e no final de semana, com 24 opções de respostas, uma para cada hora do dia. A análise das inconsistências considerou a distribuição de frequências das respostas quanto às horas habituais de dormir e de acordar, além da compatibilidade com o turno. A duração do sono durante a semana e final de semana foi obtida pela diferença entre horas habituais de dormir e de acordar e foi excluída se ≤ 4 ou ≥ 14 horas. A média de sono total da semana foi calculada pela fórmula: (duração do sono durante a semana x 5 + duração do sono no final de semana x 2)/7. Foram criados três grupos: dados originais (respostas que não necessitaram correções), dados corrigidos (inconsistentes, mas passíveis de correção) e dados excluídos (inconsistentes, para os quais não se tinha critério para correção). A correção recuperou informação inconsistente de 5.988 adolescentes (8%) dos 74.589 participantes. Foram excluídas 7.937 (10,6%) respostas. Os adolescentes cujas informações foram corrigidas ou excluídas são mais novos, do sexo masculino, de escolas públicas e da Região Norte. A correção minimizou perdas e conferiu maior consistência ao tratamento dos dados. O estudo contribui para o aprimoramento da construção de instrumentos de coleta de dados em estudos observacionais, tornando transparente a forma de lidar com as limitações inerentes ao método de coleta de dados.

El objetivo fue evaluar el comportamiento del sueño en adolescentes de 12 a 17 años, participantes en el ERICA (Estudio de Riesgos Cardiovasculares en Adolescentes), según características sociodemográficas, turnos y tipos de escuela, donde además se describe la corrección de las horas incompatibles en un estudio de nivel nacional en Brasil. La recogida de datos se realizó en 2013 y 2014. Se hicieron cuatro preguntas sobre las horas habituales de sueño y de despertarse durante la semana y el fin de semana, con 24 opciones de respuesta, una para cada hora del día. El análisis de las incompatibilidades consideró la distribución de frecuencias en las respuestas, respecto a las horas habituales de sueño y de despertarse, además de la compatibilidad con el turno. La duración del sueño durante la semana y fin de semana se obtuvo mediante la diferencia entre horas habituales de sueño y de despertarse y fue excluida si ≤ 4 ó ≥ 14 horas. La media de sueño total de la semana se calculó mediante la fórmula: (duración del sueño durante la semana x 5 + duración del sueño durante el fin de semana x 2)/7. Se crearon tres grupos: datos originales (respuestas que no necesitaron correcciones), datos corregidos (inconsistentes, pero plausibles de corrección) y datos excluidos (inconsistentes en los que no había criterio para la corrección). La corrección recuperó información inconsistente de 5.988 adolescentes (8%) de los 74.589 participantes. Se excluyeron 7.937 (10,6%) respuestas. Los adolescentes cuya información fue corregida o excluida son más jóvenes, sexo masculino, procedentes de escuelas públicas y de la región Norte. La corrección minimizó pérdidas y otorgó una mayor consistencia al tratamiento de los datos. El estudio contribuye al perfeccionamiento de la creación de instrumentos de recogida de datos en estudios observacionales, haciendo transparente la forma de enfrentarse a las limitaciones inherentes del método de recogida de datos.

Environmental Assessment and Evaluation of Oxidative Stress and Genotoxicity Biomarkers Related to Chronic Occupational Exposure to Benzene.

Environmental and occupational exposure to benzene from fuels is a major cause for concern for national and international authorities, as benzene is a known carcinogen in humans and there is no safe limit for exposure to carcinogens. The objective of this study was to evaluate the genotoxic effects of chronic occupational exposure to benzene among two groups of workers: filling station workers (Group I) and security guards working at vehicles entrances (Group II), both on the same busy highway in Rio de Janeiro, Brazil. Sociodemographic data on the workers were evaluated; the concentration of benzene/toluene (B/T) in atmospheric air and individual trans,trans-muconic acid (ttMA) and S-phenylmercapturic acid (S-PMA) were measured; oxidative stress was analyzed by catalase (CAT), glutathione S-transferase (GST), superoxide dismutase (SOD), thiol groups (THIOL) and malondialdehyde (MDA); genotoxicity was measured by metaphases with chromosomal abnormalities (MCA) and nuclear abnormalities, comet assay using the enzyme formamidopyrimidine DNA glycosylase (C-FPG), and methylation of repetitive element LINE-1, CDKN2B and KLF6 genes. Eighty-six workers participated: 51 from Group I and 35 from Group II. The B/T ratio was similar for both groups, but Group I had greater oscillation of benzene concentrations because of their work activities. No differences in ttMA and S-PMA, and no clinical changes were found between both groups, but linearity was observed between leukocyte count and ttMA; and 15% of workers had leukocyte counts less than 4.5 × 109 cells L-1, demanding close worker's attention. No differences were observed between the two groups for THIOL, MDA, MCA, or nuclear abnormalities. A multiple linear relationship was obtained for the biomarkers MCA and C-FPG. A significant correlation was found between length of time in current job and the biomarkers C-FPG, MCA, GST, and MDA. Although both populations had chronic exposure to benzene, the filling station workers were exposed to higher concentrations of benzene during their work activities, indicating an increased risk of DNA damage.