The burden of lung cancer and mortality attributable to occupational risk factors between 1990 and 2019 in Brazil and federative units.

OBJECTIVE: The aim of this study was to analyse the attributable risk of mortality and DALYs (Disability Adjusted Life Years) due to occupational carcinogens for lung cancer between 1990 and 2019 in Brazil and federation units, as well as its relationship with the Socio-demographic Index (SDI). STUDY DESIGN: Epidemiological study. METHODS: This is an epidemiological study that used GBD 2019 (Global Burden of Disease Study) estimates of lung cancer mortality rates and DALYs attributable to occupational carcinogens. The relationship between these rates and SDI was assessed using panel data analysis. RESULTS: In Brazil, occupational exposure to asbestos, silica and diesel vapours accounted for more than 85.00% of lung cancer deaths and DALYs attributable to occupational carcinogens in both sexes between 1990 and 2019. An increase in both rates was observed in women for almost all the occupational carcinogens assessed, especially in the North and Northeast regions of the country, with diesel vapours standing out the most. CONCLUSIONS: The present study highlighted the urge to characterise exposure to occupational risks for lung cancer, especially for the female population in the North and Northeast regions of Brazil.

Incidence of lung cancer and mortality among civil construction industry workers: A protocol for a systematic review and meta-analysis.

BACKGROUND: The construction sector is one of the most stable growth industries in the world. However, many studies have suggested an association between occupational exposure in civil construction and lung cancer risk. Thus, this study aims to assess lung cancer risk in civil construction workers occupationally exposed to physical and chemical agents through a systematic review and meta-analysis. METHODS/DESIGN: Studies will be identified by searching PUBMED, Embase, SCOPUS, WEB OF SCIENCE and the reference list of included articles. Eligible study designs will be cohort, cross-sectional, and case-control studies that report occupational exposure to physical or chemical agents and lung cancer risk through mortality or incidence outcomes. A meta-analysis will be used to combine odds ratios (ORs) from case-control studies and relative risks (RR) from cohort studies. Two reviewers will independently screen articles, extract data, and assess scientific quality using standardized forms and ROBINS-E tool if available. Otherwise, the New-Castle Ottawa rating scale will be used. Any of those will also be used in combination with the GRADE approach for quality of evidence. Overall risk estimates and their corresponding 95% confidence intervals (CIs) will be obtained using the random-effects model meta-analysis. This systematic review and meta-analysis will be conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. DISCUSSION: This review will identify and synthesize studies investigating the association between occupational exposure in the construction industry and lung cancer. The findings will help governmental entities and researchers with evidence-based decision-making because they will integrate and validate the evidence on construction workers' health effects due to occupational exposure. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020164209.

Alerta Epidemiológica: COVID-19 en personal de salud - 31 de agosto de 2020 / Epidemiological Alert: COVID-19 in health personnel - August 31, 2020

Ante el incremento de casos y defunciones por COVID-19 en personal de salud de los países y territorios de la Región de las Américas, la Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) a través de esta alerta insta a los Estados Miembros a fortalecer las capacidades de los servicios de salud en todos sus niveles y mantener a los profesionales de salud dotados de los recursos y capacitación, asegurando una respuesta adecuada y oportuna de los sistemas de salud ante la pandemia.

Mortality from Selected Cancers among Brazilian Mechanics.

INTRODUCTION: Mechanics are exposed to known human carcinogens. This study aimed to compare mortality from selected cancers between male mechanics and the general population of the South and Southeast regions of Brazil. METHODS: Data on deaths, occurred between 2006-2017, among male mechanics and the general population, were obtained from the Mortality Information System. Occupations were classified using the Brazilian Classification of Occupations. Mortality Odds Ratio (MOR) and confidence intervals (95%) for selected cancers among mechanics, stratified by age (30-49, 50-69 years), race, and education compared to the general population, were estimated using logistic regression models. RESULTS: In general, mechanics showed higher mortality from oropharynx, hypopharynx, larynx, lung and bladder cancers, but lower mortality for all leukemias. Oropharynx and larynx cancer mortality risk was slightly higher among older mechanics, while hypopharynx cancer mortality was more noticeable among the youngest. Lower mortality from all leukemias was observed only among younger mechanics. Mortality by oropharynx and larynx cancers were higher among white mechanics. They were also the only ones to experience higher mortality by hypopharynx cancer, while lung cancer mortality were increased only among non-white ones. Mechanics of all educational levels were more likely to die by the oropharynx cancer. Those with 1-7 and 8 or more years of schooling also showed excess of death by the cancers of larynx and all leukemias. Significantly higher mortality by pancreas cancer was only observed among mechanics with no education, while those with 1-7 years of schooling showed higher risk to die by lung and bladder cancers. Those with 8 or more years of schooling show increased mortality risk for hypopharynx cancer. Increased mortality risk for myeloid leukemia was only observed when stratified by region of residence. CONCLUSION: Results of our study suggest a positive association between mechanic occupation and some specific cancers.
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[The cadaverous fever in Chile, death in the anatomical amphitheater]. / La infección cadavérica en Chile, muerte en el anfiteatro anatómico.

Cadaverous infection is a little-known nosological entity that affected the dissectors in the practice and teaching of anatomy, since working on the dissection of cadavers entails risks in relation to the occurrence of sharps injuries that produce infections and even death associated with the manipulation of them. The present investigation is motivated by a story about a student who was injured in the dissemination ward in 1937 at the Institute of Anatomy of the U. of Chile. Historical background is investigated associated to the death of students in the usual practice with cadavers through writings and stories since the beginning of the anatomical teaching in Chile since 1833, identifying the conditioning factors that modify the epidemiology of this condition according to medical advances. Therefore, it is concluded that the designation of a dissector, the use of disinfectants and gloves, as well as the advance in the use of cadaveric preservation products, drastically reduce the biological risk of acquiring an infection known as cadaverous in the permanent contact of the students with cadaverous material for dissection of teacher use.

La infección cadavérica en Chile, muerte en el anfiteatro anatómico / The cadaverous fever in Chile, death in the anatomical amphitheater

Resumen La infección cadavérica es una entidad nosológica poco conocida y que afectaba a los disectores en la práctica y enseñanza de la anatomía. La disección de cadáveres supone riesgos como la ocurrencia de heridas corto-punzantes causantes de infecciones e incluso la muerte asociadas a la manipulación de los mismos. La presente investigación nace por el relato sobre un alumno herido en el pabellón de disección en 1937 en el Instituto de Anatomía de la Universidad de Chile. Se indagaron los antecedentes históricos asociados al fallecimiento de alumnos en la práctica habitual con cadáveres, a través de escritos y relatos desde los inicios de la docencia anatómica en Chile, en 1833. Se relatan las condiciones que han modificado la epidemiología de esta afección, según los avances médicos. Por lo anterior, se concluye que la designación de un disector, el uso de productos desinfectantes y guantes, además del avance en el uso de productos de conservación cadavérica han disminuido drásticamente el riesgo biológico de adquirir alguna infección por el contacto con cadáveres para disección de uso docente.

Cadaverous infection is a little-known nosological entity that affected the dissectors in the practice and teaching of anatomy, since working on the dissection of cadavers entails risks in relation to the occurrence of sharps injuries that produce infections and even death associated with the manipulation of them. The present investigation is motivated by a story about a student who was injured in the dissemination ward in 1937 at the Institute of Anatomy of the U. of Chile. Historical background is investigated associated to the death of students in the usual practice with cadavers through writings and stories since the beginning of the anatomical teaching in Chile since 1833, identifying the conditioning factors that modify the epidemiology of this condition according to medical advances. Therefore, it is concluded that the designation of a dissector, the use of disinfectants and gloves, as well as the advance in the use of cadaveric preservation products, drastically reduce the biological risk of acquiring an infection known as cadaverous in the permanent contact of the students with cadaverous material for dissection of teacher use.

Danger and Dignity: Immigrant Day Laborers and Occupational Risk.

The plight of immigrant workers in the United States has captured significant scholarly attention in recent years. Despite the prevalence of discourses regarding this population, one set of issues has received relatively little attention: immigrant workers' exposure to unhealthy and unsafe working conditions, and their corresponding susceptibility to workplace injuries and illnesses. Researchers have consistently found that immigrant workers suffer disproportionately from occupational injuries and fatalities, even when controlling for industry and occupation. Why, then, are foreign-born workers at greater risk for workplace injuries and fatalities, when compared with their native-born counterparts? This Article seeks to develop answers to that question with the aid of empirical research and to build upon a growing interdisciplinary literature. This Article presents findings from a qualitative research study designed to explore the factors that shape occupational risks for immigrants. The study, conducted over several months in 2014, centered on in-depth interviews of eighty-four immigrant day laborers seeking employment in different parts of Northern Virginia. The workers' responses present a complex picture of the immigrant worker experience, reflecting persistent dangers alongside powerful expressions of worker dignity: while the Virginia day laborers continue to encounter significant occupational risks, many comfortably asserted their rights, complicating standard narratives of immigrant worker subordination and vulnerability. The results of the study also point to ongoing economic insecurities, and regulatory failures relating to the provision of training, use of protective equipment, and oversight of smaller worksites. The findings also signal the need for a more holistic approach to workplace regulation that concomitantly examines a range of workplace concerns, including wage violations, hostile work environments, and health and safety risks. Finally, the day laborers' experiences reveal that worker centers are well positioned to insulate immigrant workers from workplace risks, by promoting transparency and accountability in the employer-employee relationship.

Occupational Safety and Health in Venezuela.

INTRODUCTION: Venezuela has pioneered a preventive-focused and comprehensive movement for Occupational Safety and Health (OSH) in Latin America. However, despite being an oil-rich country, it has some of the lowest salaries for their workers and highest levels of hyperinflation, devaluation, crime, and violence of the world. OBJECTIVES: Review the current status and challenges on relevant aspects of OSH in Venezuela. METHODS: Review of literature and documents from national governments, UN agencies, NGOs, and the Venezuelan government concerning OSH and related topics since 1986. RESULTS: Reformed in 2005, the Organic Law on Prevention, Conditions and Environment (LOPCYMAT) was a fundamental moment of change for OSH. Factors which have impacted OSH the strongest are (i) the creation of the National Institute of Occupational Safety and Health (INPSASEL) and (ii) the socioeconomic crisis Venezuela is going through. Venezuela's laws are innovative and yet non-compliance is enormous. Almost half of the population works in the informal sector. Following the International Labor Office projections, 5 people die per day in Venezuela due to occupational accidents or diseases, making health and safety at work a luxury rather than a right. The quality of life for the average worker has deteriorated, affecting not only health but the overall well-being of all Venezuelans. The political and socio-economic situation has led to a mass exodus of more than 1.6 million highly qualified and talented professionals. Many statistics concerning OSH are not updated and are unreliable regarding occupational accidents and diseases. CONCLUSIONS: There is a substantial difference between what is written to protect individual Venezuelans in the workplace and the reality of workplace conditions. Substantial governmental actions are needed in the immediate future to improve occupational safety and health of Venezuelan workers.

[Notification of accidents and occupational diseases to the ministry of labor. Peru 2010-2014]. / Notificación de accidentes y enfermedades laborales al Ministerio de Trabajo. Perú 2010-2014.

In order to determine trends in accidents and illnesses reported to the Ministry of Labor of Peru, a descriptive study of secondary data from the reports of monthly newsletters from September 2010 to December 2014 was performed. At the national level, 54,596 non-fatal accidents were reported. The rates of non-fatal accidents increased in 2011-2013 (296.5 in 2011, 955.9 in 2012 and 1176.3 in 2013), decreasing in 2014 (878.9). There were 674 fatal accidents whose rates increased between 2011 and 2012 and were reduced between 2013 and 2014. 346 occupational diseases were reported; the most frequent were cases of hearing loss (77), illness by inadequate postures (57) and allergic dermatitis (44). Reports declined from 6.9 in 2011 to 2.3 in 2014. Reports of occupational diseases were declining, which could indicate significant underreporting.

Mortality among chemical plant workers exposed to acrylonitrile: 2011 follow-up.

OBJECTIVES: To update a cohort study of chemical workers and reevaluate lung cancer mortality in relation to acrylonitrile (AN) exposure. METHODS: Subjects were 2096 workers employed during 1955 to 2011. We identified 474 deaths through 2011, and quantitatively estimated worker exposures to AN. Analyses included national and county-based standardized mortality ratios and relative risk regression of internal cohort rates. RESULTS: We found no statistically significant excess mortality risks associated with Lima employment for any cause of death category, including lung cancer and other cancer sites implicated in previous studies. CONCLUSIONS: This update provides no evidence that exposure to AN at levels experienced by Lima workers is associated with an increased risk of lung cancer mortality, as suggested in original study. Earlier reported bladder cancer risks decreased to a much lower, not statistically significant level.

Evaluation of potential confounding by smoking in the presence of misclassified smoking data in a cohort study of workers exposed to acrylonitrile.

OBJECTIVES: To evaluate the extent to which lung cancer mortality risk estimates in relation to acrylonitrile (AN) exposure may have been confounded by smoking in the presence of misclassified smoking data. METHODS: Subjects were 992 white men employed for three or more months between 1960 and 1996 at a chemical plant in Lima, Ohio. We used Monte Carlo-based sensitivity analysis to address possible confounding by smoking. RESULTS: In Monte Carlo simulations that accounted for the relationship between smoking and AN exposure, mean relative risks for lung cancer mortality in relation to AN exposure decreased and we observed somewhat less evidence of an exposure-response relationship. CONCLUSIONS: Our simulations suggest that the relationship between AN exposure and lung cancer mortality was positively confounded by smoking in the original Lima cohort study.

Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico.

BACKGROUND: An estimate at the national level of the occupational cancer burden brought about by the industrial use of asbestos requires detailed routine information on such uses as well as on vital statistics of good quality. A causal association with asbestos exposure has been established for mesothelioma and cancers of the lung, larynx, and ovary. OBJECTIVES: The aim of this study was to provide estimates of the occupational burden of asbestos-related cancer for the Latin American countries that are or have been the highest asbestos consumers in the region: Argentina, Brazil, Colombia, and Mexico. METHODS: The burden of multifactorial cancers has been estimated through the approach suggested for the World Health Organization using the population attributable fraction. The following data were used: Proportion of workforce employed in each economic sector. Proportion of workers exposed to asbestos in each sector. Occupational turnover. Levels of exposure. Proportion of the population in the workforce. Relative risk for each considered disease for 1 or more levels of exposure. Data on the proportion of workers exposed to asbestos in each sector are not available for Latin American countries; therefore, data from the European CAREX database (carcinogen exposure database) were used. FINDINGS: Using mortality data of the World Health Organization Health Statistics database for the year 2009 and applying the estimated values for population attributable fractions, the number of estimated deaths in 5 years for mesothelioma and for lung, larynx, and ovary cancers attributable to occupational asbestos exposures, were respectively 735, 233, 29, and 14 for Argentina; 340, 611, 68, and 43 for Brazil; 255, 97, 14, and 9 for Colombia, and 1075, 219, 18, and 22 for Mexico. CONCLUSIONS: The limitations in compiling the estimates highlight the need for improvement in the quality of asbestos-related environmental and health data. Nevertheless, the figures are already usable to promote a ban on asbestos use.

Experiência de vigilância no setor canavieiro: desafios para interromper a "maratona" perigosa dos canaviais / Surveillance experience in the sugarcane sector: challenges in disrupting the perilous "marathon" of the sugarcane plantations

O setor sucroalcooleiro cresce anualmente com participação expressiva do estado de São Paulo que concentra atualmente cerca de 42,9 % das usinas do país. A cadeia produtiva é objeto de preocupação de órgãos públicos e da sociedade civil por expor trabalhadores migrantes a riscos decorrentes do processo de trabalho. Em São Paulo, de 2006-2009, a Vigilância em Saúde do Trabalhador construiu duas iniciativas para enfrentar problemas relacionados às condições de trabalho e moradia de trabalhadores da cana. O objetivo do artigo apresentado na modalidade de ensaio é analisar as experiências em seu contexto. O método usado associa análise documental à percepção dos autores que participaram das ações. As experiências possibilitaram melhorias nessas condições e início de debate público sobre as condições do trabalho exaustivo. As intervenções resultaram na definição de normas sanitárias e iniciativas no nível legislativo e judiciário, mas mesmo aquelas mais exitosas não conseguiram alcançar os determinantes organizacionais, especialmente a remuneração por produção, que desafia a ação tradicional de vigilância e tem seus impactos agravados pela fragilidade da representação dos trabalhadores.

The sugar-alcohol sector is growing year by year, especially in the state of Sao Paulo where approximately 42.9% of the sugar-ethanol plants are concentrated. The production chain is a subject for concern to public agencies and to civil society by exposing migrant workers to risks arising from the work process. In Sao Paulo, from 2006-2009, Occupational Health Surveillance (VISAT) set up two initiatives to address problems related to the housing and working conditions of sugarcane workers. The objective of this article presented in the form of an essay is to analyze the experiences in their context. The methodology used combines document analysis with the perception of the authors who participated in the actions. The experience led to improvements in these conditions and fostered public debate on the conditions of such physically demanding work. The interventions resulted in a definition of sanitary norms and initiatives at the legislative and judicial level, but even the most successful measures failed to attain the organizational targets, especially a production remuneration structure that challenges the traditional action of surveillance and the impacts were weakened due to the fragility of worker representation for the sector.

[Surveillance experience in the sugarcane sector: challenges in disrupting the perilous "marathon" of the sugarcane plantations]. / Experiência de vigilância no setor canavieiro: desafios para interromper a "maratona" perigosa dos canaviais.

The sugar-alcohol sector is growing year by year, especially in the state of Sao Paulo where approximately 42.9% of the sugar-ethanol plants are concentrated. The production chain is a subject for concern to public agencies and to civil society by exposing migrant workers to risks arising from the work process. In Sao Paulo, from 2006-2009, Occupational Health Surveillance (VISAT) set up two initiatives to address problems related to the housing and working conditions of sugarcane workers. The objective of this article presented in the form of an essay is to analyze the experiences in their context. The methodology used combines document analysis with the perception of the authors who participated in the actions. The experience led to improvements in these conditions and fostered public debate on the conditions of such physically demanding work. The interventions resulted in a definition of sanitary norms and initiatives at the legislative and judicial level, but even the most successful measures failed to attain the organizational targets, especially a production remuneration structure that challenges the traditional action of surveillance and the impacts were weakened due to the fragility of worker representation for the sector.

What are the health costs of uranium mining? A case study of miners in Grants, New Mexico.

BACKGROUND: Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny. OBJECTIVES: This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico. METHODS: Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs. RESULTS: Total health costs ranged from $2·2 million to $7·7 million per excess death. This amounts to between $22·4 million and $165·8 million in annual health costs over the 1955-1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185·4 miners per 100 000, with a range of 1419·8-2974·3 per 100 000. CONCLUSIONS: Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.

Cancer mortality among Brazilian dentists.

BACKGROUND: Previous studies have variably shown excess risks of elected cancers among dentists. METHODS: National Brazilian mortality data were used to obtain mortality patterns among dentists between 1996 and 2004. Cancer mortality odds ratios (MORs) and cancer proportional mortality ratios for all cancer sites were calculated, using the general population and physicians and lawyers as comparison groups. RESULTS: Female dentists from both age strata showed higher risks for breast, colon-rectum, lung, brain, and non-Hodgkin lymphoma. Compared to physicians and lawyers, higher MOR estimates were observed for brain cancer among female dentists 20-49 yr. Among male dentists, higher cancer mortality was found for colon-rectum, pancreas, lung, melanoma, and non-Hodgkin lymphoma. Higher risk estimates for liver, prostate, bladder, brain, multiple myeloma and leukemia were observed among 50-79 yr old male dentists. DISCUSSION: If confirmed, these results indicate the need for limiting occupational exposures among dentists in addition to establishing screening programs to achieve early detection of selected malignant tumors.

Lung cancer risk in painters: a meta-analysis.

We conducted a meta-analysis to quantitatively compare the association between occupation as a painter and the incidence or mortality from lung cancer. PubMed and the reference lists of pertinent publications were searched and reviewed. For the meta-analysis, we used data from 47 independent cohort, record linkage, and case-control studies (from a total of 74 reports), including > 11,000 incident cases or deaths from lung cancer among painters. Three authors independently abstracted data and assessed study quality. The summary relative risk (meta-RR, random effects) for lung cancer in painters was 1.35 [95% confidence interval (CI), 1.29-1.41; 47 studies] and 1.35 (95% CI, 1.21-1.51; 27 studies) after controlling for smoking. The relative risk was higher in never-smokers (meta-RR = 2.00; 95% CI, 1.09-3.67; 3 studies) and persisted when restricted to studies that adjusted for other occupational exposures (meta-RR = 1.57; 95% CI, 1.21-2.04; 5 studies). These results support the conclusion that occupational exposures in painters are causally associated with the risk of lung cancer.