Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin.

OBJECTIVES: Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS: We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS: There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION: Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.

Cancer risks in a population-based study of agricultural workers: results from the Taiwan's Farmers and Health Cohort study.

OBJECTIVE: The purpose of this study was to assess cancer risk among agricultural workers compared to the general population. METHODS: The study utilized data from Farmers' Health Insurance (FHI) in Taiwan, which enrolled agricultural workers (N=1 175 149). The enrolled workers were matched to a general population (N=1 175 149) of the same age, gender, township, and enrollment year. The study population was linked to the National Cancer Registry to identify new cancer cases between 2000 and 2018. The Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval for outcomes. RESULTS: During the study period, 136 913 new cancers among agricultural workers were identified. The study found that male farmers had an increased cancer risk, including lymphocytic leukemia, chronic myelogenous leukemia, non-Hodgkin's lymphoma (NHL), oral cancer, lip cancer, esophagus cancer, rectum and rectosigmoid junction cancer, liver and intrahepatic bile duct cancer, lung cancer, trachea and bronchi cancer, and other non-melanoma skin cancer, even when considering the latency period. Female farmers had an elevated risk of multiple myeloma and other non-melanoma skin cancer. Moreover, only lymphoma, NHL, other lymphoid, and multiple myeloma, were both found to occur at different insurance periods. CONCLUSIONS: This study provides farmer cancer patterns and risk, adding to the evidence that farmers are at increased risk of certain types of cancer, especially for hematological cancers. As exposure varies by farm operation type, individual farmer exposure may vary widely. Further understanding of the complex relationship between occupational exposure, environmental factors, and lifestyle factors is needed.

Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study.

Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980-2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers.

Effectiveness of interventions to promote pesticide safety and reduce pesticide exposure in agricultural health studies: A systematic review.

OBJECTIVE: There is a relationship between pesticide exposure and farmworkers' health. Well-conducted evaluations can provide an insight into how to develop and implement more effective interventions to prevent farmers and farmworkers' exposure to pesticides. This review aimed to summarize the literature on the effectiveness of interventions to promote pesticide safety and reduce pesticide exposure among farmers and farmworkers. METHODS: A comprehensive search on PubMed, Embase, ISI Web of Science, Scopus, Science Direct, Agricola, NIOSHTIC, and Agris databases was performed to identify relevant studies published from 2000 to 2019. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effectiveness of interventions on a variety of outcomes related to pesticide exposure were considered. The searches were restricted to articles written in English. The methodological quality of included reviews was appraised using the Effective Public Health Practice Project quality assessment tool (EPHPP). RESULTS: The initial search led to 47912 records, 31 studies of which including nine RCTs and twenty-two quasi-experimental studies met the criteria. The majority of the included studies focused on the educational/ behavioral approach. The studies that applied this approach were effective in improving the participants' knowledge and attitude; however, these interventions were less effective in terms of making changes in participants' behaviors and their risk of exposure to toxic pesticides. Multifaceted interventions were moderately effective in terms of improving farmers' and farmworkers' behaviors and reduction in exposure to toxic pesticides. We did not find any studies that had evaluated the effectiveness of engineering/technological, and legislation/enforcement interventions. CONCLUSIONS: Although the majority of studies were based on an educational/behavioral approach and did not assess the effect of interventions on objective measures, the results of this review highlight the significant effectiveness of educational programs and some potential key elements of these interventions. These findings may inform policymakers to develop interventions to reduce pesticide exposure among farmers and farmworkers.

Risk factors associated among respiratory health and banana farming.

Pesticides cause risks to the respiratory health of banana farming workers. To investigate the prevalence of ventilatory dysfunction in workers and characteristics of work in banana production in a region of the Ribeira Valley, Brazil. A questionnaire containing sociodemographic, work and health data was applied, as well as spirometry. The data were statistically analyzed with participants divided into two groups (presence or absence of ventilatory dysfunction). The majority were males, low schooling, mean age 39.6 years and 13.8 years of working time in banana farming. The prevalence of moderate obstructive disorder (10.0%), mild obstructive disorder (13.3%) and mild mixed disorder (3.3%) were observed. Obstructive disorders predominated, with decreased FEV1 and FEV1/FVC, in addition to being correlated with working time in banana farming. It was concluded that one-third of the workers had some type of ventilatory dysfunction and there was a relationship with work in banana farming.

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

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.

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.

Evidence of nickel and other trace elements and their relationship to clinical findings in acute Mesoamerican Nephropathy: A case-control analysis.

BACKGROUND: Although there are several hypothesized etiologies of Mesoamerican Nephropathy (MeN), evidence has not yet pointed to the underlying cause. Exposure to various trace elements can cause the clinical features observed in MeN. METHODS AND FINDINGS: We measured 15 trace elements, including heavy metals, in renal case-patients (n = 18) and healthy controls (n = 36) in a MeN high-risk region of Nicaragua. Toenails clippings from study participants were analyzed using inductively coupled plasma mass spectrometry. A case-control analysis was performed, and concentrations were also analyzed over participant characteristics and clinical parameters. Nickel (Ni) concentrations were significantly higher in toenails from cases (1.554 mg/kg [0.176-42.647]) than controls (0.208 mg/kg [0.055-51.235]; p<0.001). Ni concentrations correlated positively with serum creatinine levels (p = 0.001) and negatively with eGFR (p = 0.001). Greater Ni exposure was also associated with higher leukocyte (p = 0.001) and neutrophil (p = 0.003) counts, fewer lymphocytes (p = 0.003), and lower hemoglobin (p = 0.004) and hematocrit (p = 0.011). CONCLUSIONS: Low-dose, chronic environmental exposure to Ni is a possible health risk in this setting. Ni intoxication and resulting systemic and renal effects could explain the clinical signs observed during early MeN. This study provides compelling evidence for a role of Ni in the acute renal impairment observed in this MeN high-risk population. Additional work to assess exposure levels in a larger and heterogeneous population, identify environmental sources of Ni and exposure pathways, and evaluate the link between Ni and MeN pathogenesis are urgently needed.

Potential exoskeleton uses for reducing low back muscular activity during farm tasks.

BACKGROUND: As the sustainability of the agricultural workforce has been threatened by the high prevalence of back pain, developing effective interventions to reduce its burden within farming will contribute to the long-term health and productivity of workers. Passive back-support exoskeletons are being explored as an intervention to reduce the physical demands on the back muscles, and consequently mitigate the risk of back pain, in many industrial sectors. METHODS: This study investigated whether exoskeleton use could reduce farmers' low back muscle load. Electromyography was used to evaluate exoskeleton use in field and laboratory settings. A total of 14 farmers (13 males and 1 female) with a mean age of 49 (SD = 12) years and 6 female nonfarmers (mean age 28, SD = 5 years) performed a standardized set of tasks that included symmetric and asymmetric lifting and sustained trunk flexion. Following the standardized tasks, 14 farmers also performed regular, real-world, farm tasks with and without use of the exoskeleton at their farms. RESULTS: Exoskeleton use decreased back muscular load during farming activities up to 65%, 56%, and 48% in static, median, and peak muscle activity, respectively. This indicates potential benefits of exoskeleton use to help farmers work under less muscular load. Paradoxically, exoskeleton use during standardized tasks increased muscle activity for some participants. CONCLUSIONS: This study demonstrates the potential effects of using passive exoskeletons in agriculture through observational and experimental research, and is among the first that explores the potential for using exoskeletons during actual work tasks in farm settings.

Comparisons of physical exposure between workers harvesting apples on mobile orchard platforms and ladders, part 1: Back and upper arm postures.

This study compared farmworkers' exposure to non-neutral postures using a new mobile platform apple harvesting method and the traditional method using ladders. Twenty-four workers were recruited and assigned into three groups: ladder workers (n = 8) picking apples from full trees using a ladder, mobile platform workers (n = 8) picking apples from upper part of the trees while standing on a moving platform, and ground-based mobile platform workers (n = 8) picking apples from lower part of the trees which the mobile platform workers left out. Upper arm and back inclinations were continuously monitored during harvesting using tri-axial accelerometers over full work shifts (~8 h). Upper arm posture was characterized as the percentage of time that upper arm flexion and abduction exceeded 30°, 60°, and 90°. Back posture was characterized as the percentage of time that torso angles (sagittal flexion or lateral bending) exceeded 10°, 20°, and 30°. The 10th, 50th, and 90th postural percentiles were also calculated. The platform workers had lower exposures to upper arm flexion and abduction than the ground and ladder workers. There were no differences in torso angles between the ladder and mobile platform workers; however, the ground workers were exposed to more and greater percentages of time in torso flexions.

Comparisons of physical exposure between workers harvesting apples on mobile orchard platforms and ladders, part 2: Repetitive upper arm motions.

Farmworkers are exposed to physical risk factors including repetitive motions. Existing ergonomic assessment methods are primarily laboratory-based and, thus, inappropriate for use in the field. This study presents an approach to characterize the repetitive motions of the upper arms based on direct measurement using accelerometers. Repetition rates were derived from upper arm inclination data and with video recordings in the field. This method was used to investigate whether harvesting with mobile platforms (teams harvesting apples from the platform and the ground) increased the farmworkers' exposure to upper arm repetitive motions compared to traditional harvesting using ladders. The ladder workers had higher repetitive motions (13.7 cycles per minute) compared to the platform and ground workers (11.7 and 12.2 cycles per minutes). The higher repetitions in the ladder workers were likely due to their ability to work independently and the additional arm movements associated with ladder climbing and walking.

A multicomponent ergonomic intervention involving individual and organisational changes for improving musculoskeletal outcomes and exposure risks among dairy workers.

A field intervention study was implemented to evaluate the effects of individual (physical exercise programme and worker ergonomics training) and organisational changes (optimising work-rest schedule and revised task procedure) on musculoskeletal outcomes and their exposure risks among milking workers in a dairy plant. A questionnaire survey (including the Cornell Musculoskeletal Discomfort Questionnaire [CMDQ]) and direct observations of working postures by using the Quick Exposure Check (QEC) method were used at baseline and 12-month follow-up. Shoulder, lower back and neck discomfort were found to be the most common problems. The results showed significant improvements in the frequency (neck, shoulder, lower back, forearm and knee symptoms), severity (shoulder, lower back and knee symptoms) and interference with work (particularly due to lower back symptoms) as well as in the exposure risks to musculoskeletal problems (using the QEC method) after the intervention. The findings support the effectiveness of implemented multiple component intervention for improving musculoskeletal health and exposure risks in the studied occupational group.

The influence of long-term shoulder loading on sagittal spino-pelvic morphology: a population-based retrospective study of Chinese farmers from radiology.

BACKGROUND: To investigate associations between long-term shoulder loading and sagittal spino-pelvic morphology in Chinese farmers from radiology evidences. METHODS: We retrospectively analyzed 463 back pain patients who attended outpatient and inpatient departments of two hospitals from January 2016 to December 2018, and who had long, standing lateral X-rays according to inclusion and exclusion criteria. One hundred eighty-four of them were farmers with a long history of heavy shoulder loading for over 20 years in their young age, while others were office workers with no reported long-term shoulder loading history. The following parameters were measured by three researchers independently and then analyzed statistically: thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), T9 sagittal offset (T9SO), T1 sagittal offset (T1SO), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), C7 tilt (C7T), spino-pelvic angle (SSA), and sagittal vertical axis (SVA). RESULTS: The "Loading group" included 86 males and 98 females with average age 73.3 (SD 8.3) years, whereas the "Non-loading group" included 126 males and 153 females with average age 63.7 (SD 14.1) years. Age was significantly higher in the loading group (p < 0.001), but gender, height, weight, BMI, and BMD were not significantly different (p > 0.05). The following spino-pelvic parameters were significantly greater (p < 0.05) in the loading group: TK (mean 39.1° vs 32.8°), TLK (25.8° vs 10.1°), and T9SO (12.2° vs 10.1°). Other values were not significantly different between the two groups (p > 0.05). CONCLUSION: Long-term shoulder loading in youth is a risk factor for pathological thoracic kyphosis especially in the lower thoracic spinal segments when farmers getting older.

Association of Copeptin, a Surrogate Marker of Arginine Vasopressin, with Decreased Kidney Function in Sugarcane Workers in Guatemala.

BACKGROUND: Vasopressin is elevated in response to heat and dehydration and has been postulated to have a role in the chronic kidney disease of unknown origin being observed in Central America. The aims of this study were to examine whether the vasopressin pathway, as measured by copeptin, is associated with the presence of kidney dysfunction, and to examine whether higher fluid intake is associated with lower circulating copeptin and thereby preserves kidney health among sugarcane workers exposed to hot conditions. METHODS: Utilizing a longitudinal study of 105 workers in Guatemala, we examined relationships between hydration indices, plasma copeptin concentrations, and kidney function markers at 3 times during the 6-month harvest. We also examined whether baseline copeptin concentrations increased the odds of developing an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. RESULTS: Copeptin concentrations were positively associated with serum creatinine (ß 1.41, 95% CI 0.88-2.03) and negatively associated with eGFR (ß -1.07, 95% CI -1.43 to -0.70). In addition, as workers improved their hydration (measured by increases in fluid balance), copeptin concentrations were reduced, and this reduction was associated with an improvement in kidney function. CONCLUSIONS: Results suggest that copeptin should be studied as a potential prognostic biomarker.

Inhalable and Respirable Particulate and Endotoxin Exposures in Kentucky Equine Farms.

Adverse respiratory health effects in the agricultural industry have been linked to particulate endotoxin exposure. However, whether the endotoxin concentration is significantly correlated to the size of the particle remains an open question. To date, limited research has been conducted to assess particulate endotoxin exposures in the agricultural industry in general or the equine industry in particular. A task-based exposure assessment was conducted to characterize the endotoxin levels of inhalable and respirable particles on four Kentucky farms during the summer season. We conducted personal sampling of respirable and inhalable particles (n = 75) across all four farms and particulate endotoxin (n = 58) on two of them. Simultaneously, we collected real-time area samples across all four farms by task - horse care, filing hooves, cleaning stalls, cleaning barns, cleaning dry lots, and cleaning trucks. The endotoxin concentration of inhalable particles (geometric mean: 50.2-1,024 EU/m3) was ~50 times higher than that of respirable particles (geometric mean: 1.72-19.0 EU/m3). Horse care generated the lowest endotoxin concentrations for both particle sizes, while cleaning tasks tended to produce higher concentrations. There was no significant correlation between the endotoxin and particle concentrations for each size fraction based on tasks by farm (R2 = 0.069 for inhalable; 0.214 for respirable). The equine workers in this study were exposed to higher endotoxin concentrations than workers in other industries, such as the swine industry. Providing exposure control guidelines and recommendations to the equine industry is necessary to reduce long-term endotoxin exposure and to prevent adverse respiratory symptoms.

Personal and occupational factors contributing to biomechanical risk of the distal upper limb among dairy workers in the Lombardy region of Italy.

Biomechanical overload in the wrist flexor and extensor muscles, together with awkward hand positions during work activities, can result in occupational wrist and hand disorders. Dairy workers, specifically those that work in the milking parlor, are exposed to highly repetitive and forceful exertions of the upper limb throughout their work shift. There are very few studies that have investigated the determinants that contribute to the risk of distal upper limb musculoskeletal disorders among dairy workers. The purpose of the present study was to identify the variables affecting the biomechanical overload of the distal upper limb among milking parlor workers, define risk profiles, and propose possible interventions to reduce the high physical loads to the distal upper limb during milking activities. Forty male workers from the three most common milking parlor systems in Lombardy Italy were recruited to participate in this study. Multiple correspondence analysis of personal characteristics and occupational risk factors, followed by cluster analysis, led to the identification of three distinct groups of workers. Low, medium and high risk profiles were assigned to each group based on the risk assessments performed using the Strain Index and electromyography of the distal upper limb. The main risk determinants were workstation characteristics, work organization and milking routine. A well-organized milking routine, milking cluster weight below 2.4 kg or the use of supporting arms for the milking cluster may reduce the risk of biomechanical overload.

Mycotoxins feed contamination in a dairy farm - potential implications for milk contamination and workers' exposure in a One Health approach.

BACKGROUND: Dairy farming feed can be contaminated with mycotoxins, affecting animals' health and milk quality. Dairy farming is also prone to occupational exposure to mycotoxins, and feed is recognized as a source of contamination in the workplace. An exploratory study was developed in a dairy farm located in Portugal intending to assess the mycotoxins present in the feed. RESULTS: All the samples analyzed presented contamination by at least two mycotoxins and up to a maximum of 13 mycotoxins in the same sample. Zearalenone (ZEA) was detected in all the samples (n = 10) followed by deoxynivalenol (DON), which was reported in eight samples, and ochratoxin A (OTA), reported in five samples. CONCLUSION: The results point to the possible contamination of milk by several mycotoxins and raise the possibility of occupational exposure to mycotoxins due to feed contamination. An adequate One Health approach for dairy production should address these issues through effective preventive actions such as avoiding the use of feed contaminated with mycotoxins. This represents an important challenge due to climate change. It requires proper attention and accurate management measures. © 2019 Society of Chemical Industry.

Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica.

OBJECTIVE: Estimates of pesticide exposure among applicators from low- and middle-income countries (LMICs) are scarce, and exposure assessment methods are sometimes costly or logistically unfeasible. We examined the variability in weeklong pesticide exposure among applicators in Costa Rica and its predictors. METHODS: We conducted a cross-sectional survey among 221 pesticide applicators from organic, sustainable and conventional farms in 2016. We administered structured questionnaires to assess pesticide application practices at two time points (4-6 weeks apart). We adapted an existing algorithm to fit the context of smallholders and derive weekly pesticide exposure scores. We used linear mixed-effect models to examine within-worker and between-worker score variability. We then identified sociodemographic and occupational predictors of weekly pesticide exposure scores. RESULTS: We observed high within-worker and between-worker variability in weekly pesticide exposures (eg, up to 180-fold and 70-fold differences in average weekly exposures within and between workers, respectively; intraclass correlation coefficient=0.4). Applicators working on conventional and sustainable farms had exposure scores twofold and 1.5-fold higher than those working in organic farms, respectively. Farm workers who received training on pesticide use had weekly pesticide exposure scores of 33% (95% CI 1% to 55%) lower than those who did not receive any training. CONCLUSIONS: In this study of applicators from smallholder farms in Costa Rica, we determined the importance of collecting questionnaire data on self-reported pesticide use repeatedly due to its high variability within workers and absence of application records. Our questionnaire-based exposure algorithm could allow the calculation of semiquantitative estimates of average pesticide exposure for applicators from other LMICs.

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.