Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem.

In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

The Brazilian System for Monitoring Workers and General Population Exposed to Asbestos: Development, Challenges, and Opportunities for Workers' Health Surveillance.

The lack of safe levels of asbestos exposure and the long latency of asbestos-related disease (ARD) makes workers' health surveillance challenging, especially in lower-income countries. This paper aims to present the recently developed Brazilian system for monitoring workers and general population exposed to asbestos (Datamianto), and to discuss the main challenges and opportunities for workers' health surveillance. METHODS: a descriptive study of the Datamianto development process, examining all the stages of system planning, development, improvement, validation, availability, and training of health services for its use, in addition to presenting the main challenges and opportunities for its implementation. RESULTS: The system was developed by a group of software developers, workers' health specialists, and practitioners, and it was recently incorporated by the Ministry of Health to be used for workers' health surveillance. It can facilitate the monitoring of exposed individuals, epidemiological data analysis, promote cooperation between health services, and ensure periodical medical screening guaranteed to workers by labor legislation. Moreover, the system has a Business Intelligence (BI) platform to analyze epidemiologic data and produce near real-time reports. CONCLUSIONS: Datamianto can support and qualify the healthcare and surveillance of asbestos-exposed workers and ARD, promoting a better quality of life for workers and improving companies' compliance with legislation. Even so, the system's significance, applicability, and longevity will depend on the efforts aimed at its implementation and improvement.

Prevalence of congenital malformations from 2015 up to 2019, in Rondônia (RO), Amazon, Brazil / Prevalência de malformações congênitas entre 2015 e 2019 em Rondônia (RO), Amazônia, Brasil

Abstract Objectives: to determine and characterize the prevalence of congenital malformations among live births in Rondônia, from 2015 to 2019. Methods: an ecological study was conducted using publicly available data at Sistema de Informações sobre Nascidos Vivos collected in January 2021. The prevalence of congenital malformation and possible associations were calculated. The strength of the association between variables was measured using the odds ratio. Variables that were statistically significant at the 5% level were selected for adjusted odds ratio calculation using logistic regression models. The R programming language was used for all analyses and interactions with the database. A 95% confidence interval was considered. Results: a total of 1,110 records were analyzed. The overall prevalence of congenital malformation was 8.36, with higher rates observed among mothers over 35 years, those with low educational levels, unmarried status, and preterm birth. Infants with low birth weight and low Apgar scores also had higher prevalence rates of congenital malformations. Conclusion: the prevalence of congenital malformations in the state was similar to the national average, but regional disparities were observed and warrant further investigation.

Resumo Objetivos: determinar e caracterizar a prevalência de malformações congênitas entre nascidos vivos em Rondônia, no período de 2015 a 2019. Métodos: estudo ecológico, com dados públicos disponíveis no Sistema de Informações sobre Nascidos Vivos coletados em janeiro de 2021. Foi calculada a prevalência das malformações e as possíveis associações. A força de associação entre as variáveis foi medida pela razão de odds. Aquelas variáveis consideradas estatisticamente significante ao nível de 5% foram selecionadas para o cálculo de razão de odds ajustada, usando modelo de regressão logística. A linguagem de programação R foi usada para todas as análises e interação com o banco de dados. O Intervalo de Confiança considerado foi de 95%. Resultados: foram analisados 1.110 registros. A prevalência geral de malformação congênita foi de 8,36, sendo maior entre mães com idade acima de 35 anos, baixa escolaridade, solteiras, com partos prematuros; crianças com baixo peso ao nascer e baixos escores de Apgar. Conclusão: a prevalência de malformação congênita no estado foi próxima da nacional, mas houve discrepâncias entre as regiões de saúde que merecem uma investigação futura.

COVID-19 and isolation: Risks and implications in the scenario of new variants.

With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

COVID-19 and isolation: Risks and implications in the scenario of new variants

Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

Conhecimentos, atitudes e práticas de agricultores familiares brasileiros sobre a exposição aos agrotóxicos / Knowledge, attitudes and practices of the Brazilian family farmers on exposure to pesticides

Resumo O artigo discute conhecimentos, atitudes e práticas (CAP) de agricultores familiares brasileiros a respeito dos impactos na saúde e no ambiente gerados pelo uso de agrotóxicos. Trata-se de um estudo transversal misto, realizado em 2014 em São José de Ubá, RJ. A pesquisa é composta por uma etapa qualitativa, baseada em observações em campo e entrevistas com 25 participantes sobre CAP, no que se refere ao uso de agrotóxicos. A etapa quantitativa abrange avaliação sociodemográfica e de exposição aos agrotóxicos de 78 agricultores. Apesar de reconhecerem parcialmente os perigos dos agrotóxicos, os agricultores enfrentam os riscos da exposição e comumente adotam práticas laborais inadequadas. Fatores como a carência de apoio técnico e treinamento laboral, baixa escolaridade, dificuldade de compreensão das orientações de bulas e rótulos dos agrotóxicos, valor elevado e desconforto causado pelo equipamento de proteção individual (EPI), além da crença da dependência do uso de agrotóxicos, explicam parcialmente as atitudes não seguras. É preciso promover práticas agrícolas mais sustentáveis, fortalecer o apoio técnico e treinamento laboral, melhorar a comunicação e o gerenciamento dos riscos e reduzir as desigualdades de gênero entre os agricultores brasileiros, como a forma mais eficaz e imediata de prevenir os agravos relacionados ao trabalho com agrotóxicos.

Abstract This paper discusses the knowledge, attitudes, and practices (KAP) of the Brazilian family farmers regarding the impact of pesticides on health and the environment. This mixed cross-sectional study was conducted in 2014 in São José de Ubá, Rio de Janeiro. It encompasses two stages: a qualitative one, based on field observations and interviews with 25 participants on KAP about the use of pesticides; and a quantitative one, assessing sociodemographic data and exposure to pesticides among 78 farmers. Despite partially recognizing the danger of pesticides, farmers face the risks of exposure and usually adopt inappropriate work practices. Lack of technical support and occupational training, low schooling, difficulty in understanding the instructions on pesticides labels and package inserts, high price and discomfort caused by the use of Personal Protective Equipment (PPE), and the belief in the need for using pesticides, partially explain the unsafe attitudes. Effective and immediate prevention of pesticides-related injuries and diseases requires promoting more sustainable agricultural practices, strengthening technical support and occupational training, improving communication and pesticides risk management, and reducing gender inequalities among the Brazilian farmers.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil.

OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Respiratory and Allergic Effects in Children Exposed to Pesticides-A Systematic Review.

Pesticide exposure may affect children's respiratory and allergic health, although results from epidemiological studies have not reached consensus. This review aims to analyze the scientific evidence on respiratory and allergic effects of exposure to agricultural pesticides in children aged up to 12 years old. The databases PubMed, Web of Science, Scielo, and Lilacs were screened to select articles published in English, Spanish, or Portuguese, and 21 articles were included in this review. Most investigations were conducted in North America (mostly in the United States), while no studies conducted in Latin America or Africa were found, despite their intensive use of pesticides. Children are exposed to pesticides through multiple pathways from the prenatal period throughout later developmental stages and may experience several respiratory effects. Most studies (79%) found positive associations with pesticide exposure and children's respiratory and allergic effects such as asthma, wheezing, coughs, acute respiratory infections, hay fever, rhinitis, eczema, chronic phlegm, and lung function impairments. Contrastingly, 21% of the studies found no associations between pesticide exposure and children's respiratory health. The vast differences among the characteristics of the studies hamper any comparison of the results. Exposure to pesticides may have several impacts on childhood respiratory health. More studies must be conducted, especially in low- and middle-income countries, preferably with comparable research protocols adapted to local realities. Efforts should be made to develop comprehensive risk mitigation strategies and behavioral interventions to reduce children's exposure to pesticides used in agriculture and respiratory health effects, and to ensure healthy childhood growth.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Efeitos à saúde por exposição ambiental e ocupacional aos pesticidas de uso agrícola / Health effects of environmental and occupational exposure to agricultural pesticides

Introdução: O uso excessivo e descuidado de pesticidas tem se tornado um problema global de saúde pública, especialmente nos países de baixa e média renda. O Brasil é o maior consumidor mundial de pesticidas desde 2018, mas poucos estudos epidemiológicos exploram os seus efeitos à saúde. Objetivos: Avaliar os efeitos da exposição aos pesticidas à saúde de agricultores familiares em São José de Ubá (SJU), Estado do Rio de Janeiro, e analisar os efeitos respiratórios em crianças por exposição aos pesticidas, a partir de revisão da literatura. Métodos: Na safra de 2014, 82 agricultores familiares convenientemente selecionados foram entrevistados sobre a exposição aos pesticidas e submetidos à avaliação clínica com anamnese, avaliação respiratória (questionário e espirometria) e rastreamento de saúde mental (SRQ-20). Analisou-se as enzimas colinesterase (AChE e BChE) como biomarcadores de efeito. A avaliação respiratória foi repetida na entressafra de 2015 para comparação entre os períodos de maior e menor uso de pesticidas. Os participantes foram comparados com valores de referência e entre os grupos ocupacionais (aplicadores ou ajudantes) e os efeitos respiratórios foram analisados por regressão múltipla. Para ampliar o olhar aos riscos da exposição ambiental, realizou-se uma revisão sistemática sobre os efeitos dos pesticidas à saúde respiratória de crianças. Resultados: Os agricultores familiares avaliados em SJU estavam ocupacionalmente e ambientalmente expostos aos pesticidas desde tenra idade, trabalhavam sem apoio técnico e uso de equipamentos de proteção individual (EPI) completo, estavam expostos a complexas misturas de pesticidas frequentemente e apresentaram diversos sintomas de intoxicação aguda, mentais, respiratórios e alterações na espirometria. No geral, observou-se uma maior prevalência de efeitos respiratórios na safra do que na entressafra e associações significativas entre alterações espirométricas e os indicadores de exposição tanto na safra quanto na entressafra. Enquanto os aplicadores eram principalmente homens e apresentaram mais alterações de BChE, os ajudantes eram majoritariamente mulheres, tiveram ainda menos treinamento, usavam menos EPI e relataram maior prevalência de sintomas de intoxicação, saúde mental e o dobro apresentou um possível transtorno mental comum (depressão e ansiedade). A revisão da literatura sobre efeitos da exposição aos pesticidas agrícolas à saúde infantil apresentou vasta evidência sobre efeitos respiratórios e alérgicos. Conclusões: É fundamental melhorar o apoio técnico e treinamento ocupacional dos agricultores familiares brasileiros e promover práticas laborais e alternativas de cultivo mais sustentáveis. São necessários mais estudos sobre os efeitos dos pesticidas à saúde dos agricultores familiares e à saúde respiratória de crianças no Brasil e em outros países de menor renda, que usam métodos mais convencionais de cultivo e possuem maior população infantil no campo. Recomenda-se o fortalecimento de políticas públicas e a implementação de ações integrais e transversais a todos os níveis de atenção à saúde e áreas de governo, além da promoção de estratégias mais abrangentes de mitigação de riscos e intervenções comportamentais para reduzir o uso de pesticidas, a exposição e os riscos à saúde.

Introduction: Excessive and careless use of pesticides has become a global public health problem, especially in low- and middle-income countries. Brazil is the world's largest consumer of pesticides since 2018, but few epidemiological studies explore its health effects. Objectives: To evaluate the health effects of pesticide exposure on family farmers in São José de Ubá (SJU), State of Rio de Janeiro, and to analyze the respiratory effects of pesticide exposure among children, based on a literature review. Methods: In the crop season of 2014, 82 family farmers conveniently selected were interviewed about pesticide exposure and subjected to clinical evaluation with anamnesis, respiratory assessment (questionnaire and spirometry), and mental health screening (SRQ-20). Cholinesterase enzymes (AChE and BChE) were analyzed as effect biomarkers. The respiratory assessment was repeated in the off-season period (2015) to compare periods of higher and lower pesticide use. Participants were compared with reference values and between occupational groups (applicators or helpers), and respiratory effects were analyzed by multiple regression. A systematic review of the pesticide effects of children's respiratory health was conducted to broaden the understanding of the pesticide risks of environmental exposure. Results: Family farmers evaluated in SJU were occupationally and environmentally exposed to pesticides from an early age, worked without technical support and use of full personal protection equipment (PPE), were frequently exposed to complex mixtures of pesticides and presented several symptoms of acute intoxication, mental, respiratory, and changes in spirometry. Overall, there was a higher prevalence of respiratory effects in the crop season than in the off-season and significant associations between spirometric changes and exposure indicators in both the crop season and off-season. While the applicators were mostly men and had more BChE depletion, the helpers were mostly women, had even less occupational training, used less PPE, and reported a higher prevalence of pesticide poisoning symptoms, mental health, and twice as much as a probable common mental disorder (depression and anxiety). The literature review on the effects of agricultural pesticide exposure on children's health has provided ample evidence on respiratory and allergic effects. Conclusions: It is essential to improve the technical support and occupational training of Brazilian family farmers and to promote more sustainable labor practices and farming alternatives. Further studies are needed on the effects of pesticides on family farmer's health and children's respiratory health in Brazil and other lower-income countries that use more conventional cultivation methods and have a larger child population in the countryside. Strengthening public policies and implementing comprehensive and crosscutting actions at all levels of health care and areas of government is recommended, along with the promotion of broader risk mitigation strategies and behavioral interventions to reduce pesticide use, exposure, and health risks.

Data on pesticide exposure and mental health screening of family farmers in Brazil.

This dataset is part of a risk assessment project that evaluated the human health effects of pesticide exposure in São José de Ubá, State of Rio de Janeiro. This region is one of the greatest tomato producers in Brazil, and pest control is commonly based on the use of pesticides. We interviewed 78 smallholder family farmers about sociodemographic characteristics, pesticide use and exposure, assessed blood cholinesterase as biomarkers (n = 70), and screened all participants for probable common mental disorders through the Self-Reporting Questionnaire (SRQ-20).

Avaliação da condição respiratória em população rural exposta a agrotóxicos no município de São José de Ubá, Estado do Rio de Janeiro / Assessment of respiratory status in rural population exposed to pesticides in the community of Sao Jose de Uba, State of Rio de Janeiro, Brazil

O uso excessivo de produtos agrotóxicos na agricultura se tornou um problema de saúde pública e representa um risco à saúde humana, especialmente dos trabalhadores rurais e seus familiares. Os agrotóxicos são responsáveis por várias doenças e o sistema respiratório é especialmente sensível a esses contaminantes. Em São José de Ubá (SJU), a economia local é extremamente dependente do plantio de tomates, que demandam uso intensivo de agrotóxicos, principalmente organofosforados, carbamatos e piretróides. O monitoramento da saúde das populações expostas pode ser essencial para reduzir danos e mitigar riscos. Objetivo geral: Avaliar a prevalência de sintomas respiratórios e função pulmonar de trabalhadores rurais e familiares expostos a agrotóxicos no município de SJU. Materiais e Métodos: Estudo transversal com amostragem por conveniência em 48 trabalhadores rurais e 34 familiares. Foi realizada uma caracterização da área e população de estudo, entrevistas orientadas por questionário, levantamento de dados de morbidade e mortalidade, análise de marcadores biológicos, pesquisa de sintomas respiratórios e avaliação da função pulmonar.

Excessive use of pesticides in agriculture has become a public health problem and poses a risk to human health, especially of rural workers and their families. Pesticides are responsible for various diseases and respiratory system is especially sensitive to these contaminants. In Sao Jose de Uba - SJU, the local economy is heavily dependent on the planting of tomatoes, which require intensive use of pesticides, especially organophosphates, carbamates and pyrethroids. Monitoring the health of exposed populations may be essential to reduce damage and mitigate risks. Objective: To evaluate the prevalence of respiratory symptoms and lung function of rural workers and family members exposed to pesticides in SJU. Materials and Methods: Cross-sectional study with convenience sampling composed by 48 rural workers and 34 family members. A characterization of the area and population, interviews guided by questionnaire of exposure data and respiratory symptoms, data collection of morbidity and mortality, analysis of biomarkers and evaluation of lung function was conducted in the period of season (2014).