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1.
Artigo em Inglês | MEDLINE | ID: mdl-33603096

RESUMO

BACKGROUND: Exposure to environmental metals can cause nephrotoxicity. There is an international epidemic of chronic kidney disease of unknown cause (CKDu). Whether metal exposures contribute to kidney dysfunction in populations at risk for CKDu remains unresolved. OBJECTIVE: Urinary metals (arsenic, cadmium, nickel, and uranium) were examined in 222 sugarcane cutters in Guatemala at three time points over 1 year. METHODS: We explored the relationships between metal concentrations and markers of kidney function using multivariable linear mixed-effect models. RESULTS: Arsenic, cadmium, and nickel were detected in the majority of the 340 urine samples and were generally within limits previously considered to be nonnephrotoxic. Nevertheless, higher urine cadmium was inversely associated with estimated glomerular filtration rate (eGFR) (ß: -4.23, 95% confidence interval [CI]: -6.92, -1.54) and positively associated with neutrophil gelatinase-associated lipocalin (NGAL) (ß: 2.92, 95% CI: 1.20, 4.64). Higher urine arsenic was also inversely associated with eGFR (ß: -4.36, 95% CI: -7.07, -1.64). SIGNIFICANCE: Our findings suggest that exposures to metals, including cadmium and arsenic, might contribute to kidney toxicity seen in workers at risk for CKDu. These findings are consistent with the potential for metal nephrotoxicity at lower than expected levels in the setting of manual work in a very hot environment.

2.
PLoS One ; 16(1): e0245716, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33493190

RESUMO

The purpose of this study was to assess the validity of a practical diabetes risk score amongst two heterogenous populations, a working population and a non-working population. Study population 1 (n = 2,089) participated in a large-scale screening program offered to retired workers to discover previously undetected/incipient chronic illness. Study population 2 (n = 3,293) was part of a Colorado worksite wellness program health risk assessment. We assessed the relationship between a continuous diabetes risk score at baseline and development of diabetes in the future using logistic regression. Receiver operating curves and sensitivity/specificity of the models were calculated. Across both study populations, we observed that participants with diabetes at follow-up had higher diabetes risk scores at baseline than participants who did not have diabetes at follow-up. On average, the odds ratio of developing diabetes in the future was 1.38 (95% CI: 1.26-1.50, p < 0.0001) for study population 1 and 1.68 (95% CI: 1.45-1.95, p-value < 0.0001) for study population 2. These findings indicate that the diabetes risk score may be generalizable to diverse individuals, and thus potentially a population level diabetes screening tool. Minimally-invasive diabetes risk scores can aid in the identification of sub-populations of individuals at risk for diabetes.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33171945

RESUMO

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33218070

RESUMO

An epidemic of chronic kidney disease of unknown origin (CKDu) has emerged in the past two decades in agricultural communities, characterized by progressive renal failure with a dearth of early clinical symptoms. The aim of this study is to improve understanding of the natural history of this disease and to evaluate the impact of an educational and behavioral intervention on the trajectories of renal decline among a cohort of Guatemalan sugarcane workers. We identified groups of workers based on their kidney function during a longitudinal parent study conducted among sugarcane workers during the 2016-2017 harvest season. At the study's first time point in February 2017, workers who developed abnormal kidney function (AKF) (estimated glomerular filtration rate, eGFR, <60 mL/min per 1.73 m2) were placed in the AKF group, workers with reduced kidney function (RKF) (eGFR 60-89) were placed in the RKF group, and workers who maintained normal kidney function (NKF) (eGFR ≥ 90) were placed in the NKF group. As part of the study, a health promotion, behavioral and educational intervention centered on water, electrolytes, rest, and shade (WERS) was provided to all study participants. We then prospectively analyzed renal function at the three study time points in February, March, and April. Additional data collected from previous harvests allowed for retrospective analysis and we compared the rate of change in eGFR over the previous five years (2012 to 2016) for each identified group. Mixed effects linear regression with random intercepts for the workers was used to investigate the difference in rates of change for the three groups and to assess the impact of the intervention study on rate of change of kidney function during the study compared to each group's prior trajectory, utilizing the retrospective data collected during the five years prior to the study intervention. Between 2012 and 2016, eGFR declined at a rate of 0.18 mL/min per 1.73 m2 per year for the NKF group (95% CI: -0.66, 0.29, p = 0.45), 2.02 per year for the RKF group (95% CI: 1.00, 3.03, p = 0.0001) and 7.52 per year for the AKF group (95% CI: 6.01, 9.04, p < 0.0001). All study groups stabilized or improved their trajectory of decline during the intervention. This study supports the need to institute WERS interventions and to include mid-harvest screening protocols and longitudinal tracking of kidney function among sugarcane workers at high risk of CKDu. Early detection of rapid kidney function decline combined with appropriate interventions hold promise for stopping or slowing progression of renal insufficiency among these workers.

5.
J Occup Environ Med ; 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33177474

RESUMO

OBJECTIVE: This study examines employee perceptions of safety and health climates for well-being during the COVID-19 pandemic in a sample of small businesses. METHODS: We evaluated changes to employees' work and home life resulting from COVID-19 and perceptions of safety and health climates. Cross-sectional relationships were assessed using multivariable linear regression models for a sample of 491 employees from 30 small businesses in Colorado in May 2020. RESULTS: Employee perceptions of safety and health climates were significantly related to their self-reported well-being during the first wave of COVID-19, even when there were changes to childcare, the ability to work, and limited social contacts. CONCLUSION: Safety and health climates may influence employee well-being even when other disruptions occur, suggesting that during emergencies, small businesses with strong climates may be better prepared to maintain employee well-being.

6.
J Occup Environ Med ; 62(12): e696-e703, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33003044

RESUMO

OBJECTIVES: To evaluate impact of electrolyte supplementation on hydration status and health outcomes in Guatemalan agricultural workers performing heavy work under hot climatic conditions. METHODS: A 3-week pragmatic trial was conducted with a group of 50 workers during the 2017 to 2018 sugarcane harvest. Workers received an electrolyte hydration intervention during 2 of the 3 weeks. Blood and urine samples were collected each week. RESULTS: Increased electrolyte intake resulted in less muscle injury. Kidney function was maintained across the intervention period. Workers were adequately hydrated and average electrolyte levels remained in normal ranges. Mild indications of hyponatremia occurred at higher levels of fluid intake. CONCLUSIONS: This trial demonstrates the feasibility of maintaining workers' electrolyte levels under extremely hot and humid conditions while mitigating muscle injury. Electrolyte supplementation should be added to standard workplace water, rest, and shade interventions to protect workers.

7.
Kidney Int Rep ; 5(9): 1558-1566, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954081

RESUMO

Background: Chronic kidney disease of unknown origin (CKDu) is an epidemic that disproportionately affects young agriculture workers in hot regions. It has been hypothesized that repeated acute kidney injury (AKI) may play a role in the development of disease. Methods: Latent class mixed models were used to identify groups of Guatemalan sugarcane harvesters based on their daily changes in creatinine over 6 consecutive days in 2018. Exponential smoothing state space models were used to forecast end-of-season creatinine between the identified groups. Percent change in estimated glomerular filtration rate (eGFR) across the harvest was compared between groups. Results: Twenty-nine percent (n = 30) of the 103 workers experienced repeated severe fluctuations in creatinine across shift. The model with multiplicative error, multiplicative trend, and multiplicative seasonality was able to accurately forecast end-of-season creatinine in the severe group (mean percentage error [MPE]: -4.7%). eGFR of workers in the severe group on average decreased 20% across season compared to 11% decline for those in the moderate group (95% confidence interval for difference: -17% to 0%). Conclusions: Daily fluctuations in creatinine can be used to forecast end-of-season creatinine in sugarcane harvesters. Workers who experience repeat severe daily fluctuations in creatinine, on average, experience a greater reduction in kidney function across the season.

8.
Artigo em Inglês | MEDLINE | ID: mdl-32784623

RESUMO

BACKGROUND: Sugarcane workers in Central America experience a heavy burden of chronic kidney disease of unknown origin. We conducted a pilot study among worker proxies in Guatemala to characterize exposures to particulate matter, silica, heavy metals, and glyphosate, as well as to examine potential nephrotoxic exposures. METHODS: Air, soil, and ash samples were collected and analyzed using scanning electron microscopy, X-ray diffraction, inductively coupled plasma mass spectrometry, and an enzyme-linked immunosorbent assay. RESULTS: The average mass concentration for particulate matter (PM)2.5 and PM100 exposures were 360 µg/m3 (range: 32 to 1500 µg/m3) and 555 µg/m3 (range: 229 to 1170 µg/m3), respectively. The elemental composition of particles was largely silicon. The amount of crystalline silica was below 5 µg, yet the percentage of total silica was ~17% by weight. Putatively, the silica was in the amorphous form. Concentrations of aluminum and calcium ranged from 2-7 µg/m3. Glyphosate was not detectable in analyzed air samples but was detectable at concentrations ranging from 81-165 ppb in soil samples. CONCLUSION: Sugarcane workers are exposed to high concentrations of particulate matter. Future studies should investigate the potential role of silica, heavy metals, and agrochemicals in the etiology of chronic kidney disease in this population.


Assuntos
Doenças dos Trabalhadores Agrícolas/epidemiologia , Poluentes Atmosféricos/efeitos adversos , Monitoramento Ambiental , Exposição por Inalação/análise , Saccharum , Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Poluentes Atmosféricos/análise , Guatemala/epidemiologia , Humanos , Exposição por Inalação/efeitos adversos , Material Particulado/análise , Projetos Piloto , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/epidemiologia
9.
J Occup Environ Med ; 62(8): e384-e391, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32404840

RESUMO

OBJECTIVE: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. METHODS: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. RESULTS: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. CONCLUSIONS: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.

10.
PLoS One ; 15(3): e0229413, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142520

RESUMO

INTRODUCTION: Chronic kidney disease of unknown origin (CKDu) is an epidemic concentrated in agricultural communities in Central and South America, including young, male sugarcane harvesters. The purpose of this analysis is to understand early changes in kidney function among a cohort of first-time sugarcane harvesters and to determine risk factors for kidney function decline. METHODS: Joint latent class mixed models were used to model sub-population kidney function trajectory over the course of 4 years (2012-2016). Probability weighted logistic regression was used to determine personal health, community, and individual behavior risk factors associated with sub-population assignment. Data analysis occurred in 2019. RESULTS: Of 181 new workers median age 19 years old (IQR: 4), 39 (22%) were identified as having non-stable kidney function with an annual age-adjusted decline of estimated glomerular filtration rate (eGFR) of -1.0 ml/min per 1.73 m2 (95% CI: -3.4, 1.3). Kidney function (OR: 0.96; 95% CI: 0.93, 0.98), mild hypertension (OR: 5.21; 95% CI: 2.14, 13.94), and having a local home of residence (OR: 7.12; 95% CI: 2.41, 26.02) prior to employment in sugarcane were associated with non-stable eGFR sub-population assignment. CONCLUSIONS: Mild hypertension may be an early indicator of the development of CKDu. A better understanding of preexisting risk factors is needed to determine why individuals are entering the workforce with reduced kidney function and elevated blood pressure and increased risk of renal function decline.


Assuntos
Doenças dos Trabalhadores Agrícolas/fisiopatologia , Agricultura/métodos , Taxa de Filtração Glomerular , Hipertensão/complicações , Insuficiência Renal Crônica/epidemiologia , Saccharum , Adulto , Creatinina/sangue , Guatemala/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32213806

RESUMO

The purpose of this study was to investigate the relationship between Total Worker Health® (TWH) business strategies and employee perceptions of leadership commitment and safety and health climates. Using data from 53 small enterprises and 1271 of their workers collected as part of the Small + Safe + Well (SSWell) Study, we confirm the primacy of the relationship between leadership commitment to safety and workplace safety climate. After accounting for leadership commitment to safety, business-reported policies and practices that promote the health, safety, and well-being of workers (i.e., TWH strategies) were no longer related to safety climate. In contrast, the relationship between TWH strategies and health climate were significantly associated with the level of small business leadership commitment to worksite wellness. Relatedly, our results demonstrate that leadership is a common correlate to both safety climate and health climate. Future research should investigate integrated TWH leadership development strategies as a means of simultaneously improving safety and health climates.


Assuntos
Liderança , Saúde do Trabalhador , Empresa de Pequeno Porte , Envio de Mensagens de Texto , Adulto , Feminino , Humanos , Masculino , Cultura Organizacional , Local de Trabalho
12.
Ann Nutr Metab ; 76(1): 30-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32172243

RESUMO

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.

13.
J Occup Environ Med ; 62(5): 350-358, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32080015

RESUMO

OBJECTIVE: This study evaluates the motivational processes between employee occupational safety and health climates and behaviors using the Theory of Self-Determination in a sample of diverse small businesses. METHODS: We used cross-sectional data to assess whether employee safety/health intrinsic, identified, and external motives mediate the relationship between safety/health climate and behavior. RESULTS: All three types of motivation mediated the relationship between safety and health climates and behaviors. CONCLUSION: Small businesses seeking to engage employees in Total Worker Health efforts should build strong safety and health climates because of their influence on employees' motivation to participate in health promoting and health protective programs.

14.
J Expo Sci Environ Epidemiol ; 30(2): 262-270, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31641277

RESUMO

Previous research has found increased home ventilation, which may affect health by altering the composition of indoor air, is associated with improvement of respiratory health, but evidence linking home ventilation to objectively measured lung function is sparse. The Colorado Home Energy Efficiency and Respiratory health (CHEER) study, a cross-sectional study of low-income, urban, nonsmoking homes across the Northern Front Range of Colorado, USA, focused on elucidating this link. We used a multipoint depressurization blower door test to measure the air tightness of the homes and calculate the annual average infiltration rate (AAIR). Lung function tests were administered to eligible participants. We analyzed data from 253 participants in 187 homes with two or more acceptable spirometry tests. We used generalized estimating equations to model forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC z-scores as a function of AAIR. AAIRs ranged from 0.10 to 1.98 air changes per hour. Mean z-scores for FEV1, FVC, and FEV1/FVC were -0.57, 0.32, and -0.43, respectively. AAIR was positively associated with increased FEV1/FVC z-scores, such that a 1-unit change in AAIR corresponded to a half of a standard deviation in lung function (ß = 0.51, CI: 0.02-0.99). These associations were strongest for healthy populations and weaker for those with asthma and asthma-like symptoms. AAIR was not associated with FEV1 or FVC. Our study is the first in the United States to link home ventilation by infiltration to objectively measured lung function in low-income, urban households.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Pulmão/fisiopatologia , Ventilação , Adulto , Asma/fisiopatologia , Colorado , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pobreza , Testes de Função Respiratória , Espirometria , Capacidade Vital
15.
Int J Audiol ; 59(sup1): S48-S53, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31738616

RESUMO

Objective: To describe personal noise exposure measurements obtained on Guatemala sugar cane mill workers as a function of job category.Design: This is a descriptive evaluation of existing data.Sample: The data set included 51 representative noise dosimetry surveys utilising NIOSH sampling protocol, completed on workers performing 21 jobs in a Guatemalan sugar cane mill. Results: Noise doses ranged from a low of 50.9% to an extreme of 25174%. The highest observed mean noise doses were for evaporator cleaners (15761%) and juice extractors (2047%). Ninety percent of noise dosimetry samples were between 50% to 1200% dose. Annual noise exposures are also reported after considering the 7-month seasonal work schedule.Conclusions: The majority of sugar cane mill workers were exposed to hazardous occupational noise exceeding the Guatemalan permissible exposure limit (GMLSW), which is consistent with U.S. NIOSH recommended exposure limit of 100% noise dose (85 dBA time-weighted average). Consequently, the majority of workers should be enrolled in a hearing conservation programme including engineering noise control in order to prevent long-term adverse effects on workers' hearing.

16.
J Occup Environ Med ; 62(2): 156-162, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31834140

RESUMO

OBJECTIVE: Leadership is an important factor in creating a safe and healthy work environment. Little is known about its influence in small organizations. This study assessed the relationship between leadership, climate, and employee behavior in organizations with less than 500 employees. METHODS: We examined organizational factors and worker perceptions of leadership and safety/health behaviors in an analysis of 1271 employees in 53 Colorado small organizations. Cross-sectional relationships were assessed using multivariable linear regression models. RESULTS: Perceived leadership commitment to safety was associated with safety climate (ß = 0.67) and safety behaviors among employees (ß = 0.45). Perceived leadership commitment to worksite wellness was associated with health climate (ß = 0.66) and health behaviors (ß = 0.42). CONCLUSIONS: Leadership plays an important role in creating a positive work environment around safety and health.

17.
Cienc. tecnol. salud ; 7(1): 7-25, 2020. ^c27 cmilus
Artigo em Espanhol | LILACS | ID: biblio-1118317

RESUMO

El Centro para la Salud, el Trabajo y el Ambiente (CHWE por sus siglas en inglés) inició un proyecto de colaboración con Pantaleon, una empresa agrícola de caña de azúcar en Guatemala, para hacer frente a una epidemia de enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) que afecta a las comunidades agrícolas en Centroamérica y otros lugares. Este artículo describe el conocimiento actual de la epidemia en Centroamérica, las manifestaciones clínicas, el tratamiento y el manejo; las hipótesis actuales de su etiología, la colaboración y el enfoque de CHWE-Pantaleon. Nuestro enfoque de Total Worker Health® (TWH) para abordar la salud renal en Guatemala incluye múltiples estudios de investigación con trabajadores de caña de azúcar, para evaluar la prevalencia, incidencia y factores de riesgo de la lesión renal aguda y la ERC; se incluye también el desarrollo e implementación de medidas de prevención mejoradas e intervenciones para proteger a los trabajadores abordando los factores de riesgo ya conocidos. Se examinan también las necesidades futuras de investigación y las implicaciones globales de la ERCnT, al igual que la producción de bienes y la economía, así como las recomendaciones actuales para las estrategias de prevención ocupacional y comunitaria.


The Center for Health, Work and Environment (CHWE) began a collaborative project with Pantaleon, a Guatemalan sugarcane agribusiness, to address an epidemic of chronic kidney disease of unknown cause (CKDu) that affects agricultural communities in Central America and elsewhere. This paper describes the current knowledge of the epidemic in Central America including clinical manifestations, course, and management, current etiology hypotheses, and the CHWE-Pantaleon collaboration and approach. Our Total Worker Health® (TWH) approach to addressing kidney health in Guatemala has included multiple research studies with sugarcane workers to assess prevalence, incidence and risk factors for acute kidney injury and chronic kidney disease, as well as development and implementation of enhanced prevention measures and interventions to protect workers by addressing known risk factors. Future research needs and the global implications of CKDu including for economy and commodity production are discussed, as well as current recommendations for occupational and community prevention strategies.


Assuntos
Humanos , Masculino , Feminino , Fatores de Risco , Insuficiência Renal Crônica/prevenção & controle , Trabalhadores Rurais , Saúde do Trabalhador/economia , Insuficiência Renal Crônica/diagnóstico , Lesão Renal Aguda/prevenção & controle , Guatemala/epidemiologia
18.
Am J Physiol Renal Physiol ; 317(5): F1111-F1121, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390229

RESUMO

An epidemic of chronic kidney disease of unknown etiology (Mesoamerican nephropathy) has emerged in hot regions of Central America. We have demonstrated that dehydration associated with recurrent heat exposure causes chronic kidney disease in animal models. However, the independent influence of core body temperature on kidney injury has not been explored. In the present study, we tested the hypothesis that kidney injury could be accelerated by increasing body temperature independent of external temperature. Wild-type mice were exposed to heat (39.5°C, 30 min, 2 times daily) with or without the mitochondrial uncoupling agent 2,4-dinitrophenol (DNP) for 10 days. Core temperature, renal function, proteinuria, and renal histological and biochemical analyses were performed. Isolated mitochondria markers of oxidative stress were evaluated from kidney tissue. DNP increased body core temperature in response to heat by 1°C (42 vs. 41°C), which was transient. The mild increase in temperature correlated with worsening albuminuria (R = 0.715, P < 001), renal tubular injury, and interstitial infiltration of monocytes/macrophages. Tubular injury was marked in the outer medulla. This was associated with a reduction in kidney tissue ATP levels (nonheated control: 16.71 ± 1.33 nmol/mg and DNP + heat: 13.08 ± 1.12 nmol/mg, P < 0.01), reduced mitochondria, and evidence for mitochondrial oxidative stress. The results of the present study suggest that kidney injury in heat stress is markedly worsened by increasing core temperature. This is consistent with the hypothesis that clinical and subclinical heat stroke may play a role in Mesoamerican nephropathy.


Assuntos
Febre , Resposta ao Choque Térmico , Nefropatias/etiologia , 2,4-Dinitrofenol/toxicidade , Animais , Regulação da Expressão Gênica , Proteínas de Choque Térmico HSP70/genética , Proteínas de Choque Térmico HSP70/metabolismo , Medula Renal , Masculino , Camundongos , Mitocôndrias , Fatores de Tempo
20.
Am J Ind Med ; 62(8): 680-690, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31291037

RESUMO

BACKGROUND: Few studies investigate the influence of body part injured and industry on future workers' compensation claims. METHODS: Using claims incurred from 1 January 2005 to 31 July 2015 (n = 77 494) from the largest workers' compensation insurer in Colorado, we assessed associations between worker characteristics, second claims involving any body part and the same body part. We utilized Cox proportional hazards models to approximate the probability of a second claim. RESULTS: First claims represented 74.9% (n = 58 007) and second claims 25.2% (n = 19 487) of total claims. Sex, age, industry, and body part of the first claim were associated with the probability of second claims and the body part affected. The 5-year probabilities of second claims and same body part second claims were 27.0% (95% confidence interval [CI]: 26.6%-27.5%) and 6.2% (95% CI: 5.9%-6.5%) in males and 26.5% (95% CI: 26.0%-27.0%) and 6.7% (95% CI: 6.5%-7.0%) in females. Most second claims occurred within 3 years. CONCLUSIONS: Most second claims occur within 3 years. Body part and industry-specific injury patterns suggest missed opportunities for prevention.


Assuntos
Indústrias/estatística & dados numéricos , Traumatismos Ocupacionais/epidemiologia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Colorado/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo
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