Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation.

BACKGROUND: Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings. METHOD: We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare. RESULTS: Each 1°C WBGT was associated with an 18% (95% confidence interval [CI]: [4, 33%]) higher AKI-CD rate on the same day and a 14% (95% CI [-5, 37%]) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases. DISCUSSION: Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.

[Effect of asymptomatic chodral on the recovery of the working patient after a traumatic injury of the knee]. / Efecto de las lesiones condrales asintomáticas en la recuperación del paciente laboral tras una lesión traumática de rodilla.

The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome. MATERIAL AND METHODS: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected. RESULTS: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology. CONCLUSION: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries.

El objetivo principal del estudio fue analizar la asociación entre la presencia de lesiones cartilaginosas asintomáticas en pacientes con lesiones traumáticas de rodilla y su tiempo de baja y gasto mutual. Los objetivos secundarios fueron describir la prevalencia y epidemiología de estas lesiones y analizar si se asocian con la presencia de obesidad y un peor resultado final. Material y métodos: Revisión retrospectiva de una cohorte de todos los pacientes a los que se les realizó una artroscopía de rodilla tras una lesión traumática en un centro mutual en el año 2018. Se recogieron datos demográficos, diagnóstico, patología condral concomitante, tratamiento, clínica al alta, tiempo total de baja y el gasto derivado de ésta. Resultados: Fueron analizados 123 pacientes con una media de edad de 47 años, no se encontraron diferencias entre sexos ni respecto a la obesidad entre los grupos con y sin lesión condral. Las lesiones cartilaginosas fueron diagnosticadas en más de un tercio de los pacientes valorados (35.25%), la mayoría entre 48 y 53 años. La presencia de patología condral no fue un condicionante que aumentara los días de baja o el gasto total (p > 0.05). En pacientes con meniscectomía, la lesión condral aumenta el tiempo de baja (p = 0.03). Los tratamientos enfocados en la lesión condral no produjeron diferencias en cuanto a la duración de la baja ni en el gasto. Conclusión: El manejo de una lesión condral concomitante a nivel de la rodilla sigue presentando controversia. Podría implicar un factor de mal pronóstico de recuperación en pacientes con meniscopatía y las terapias actuales no han mostrado un beneficio claro en estos pacientes del entorno laboral.

Enfermedades, lesiones y accidentes en trabajadores de la construcción en Uruguay, período 2014-2018 / Illnesses, injuries and accidents among construction workers in Uruguay, 2014-2018

El presente trabajo se realizó en el marco de las actividades de investigación y extensión del Departamento de Salud Ocupacional de la Facultad de Medicina Universidad de la República, por iniciativa de los trabajadores del sindicato único de la construcción y afines. El objetivo fue conocer el perfil de salud y enfermedad de los trabajadores del sector con el propósito de generar acciones que promuevan la salud laboral del colectivo involucrado. La investigación realizada es de carácter descriptivo a partir de fuentes secundarias. De los resultados se destacaron las enfermedades del aparato osteomioarticular, lesiones por traumatismos o envenenamiento y patologías del aparato respiratorio como principales causas de ausentismo de origen médico. La patología osteomioarticular fue la primera causa de incapacidad total y también es la primera causa de incapacidad para la tarea en el periodo estudiado. La tasa de incidencia acumulada de los accidentes en el año 2014 fue de 81,8 por 1.000 trabajadores cotizantes de la construcción, presentando una caída sostenida hasta el 2018 que alcanzó el valor de 60,2 por 1.000 trabajadores cotizantes. El tipo de accidente más frecuente observado en el periodo fueron las lesiones a esfuerzo excesivo. Con respecto a los accidentes mortales existe una caída marcada entre los años 2014 al 2016 con un ascenso progresivo en 2018. De la investigación surge como necesidad mejorar el reconocimiento de la patología profesional en el sector, profundizar las acciones en seguridad y salud con énfasis en aspectos ergonómicos de la carga física(AU)

This study was carried out under the framework of the research and outreach activities of the Department of Occupational Health of the School of Medicine of the University of the Republic, as an initiative of the workers of its single union of construction and related industries. The objective was to describe the health and disease profile of workers in the sector in order to generate actions to promote their occupational health. The study was descriptive and consisted of a secondary analysis of existing data. Musculoskeletal disorders, traumatic injuries, poisonings and respiratory illnesses were the main cause of sickness absence. Musculoskeletal disorders were the main cause of both work-related and total disability. The cumulative incidence rate of injuries in 2014 was 81.8 per 1000 dues-paying construction workers, and subsequently declined until 2018, to an incidence of 62.2 per 1000 dues-paying workers. Overexertion was the most common mechanism of injury. With respect to fatal accidents, there was a arked decline between 2014 and 2016, followed by a progressive increasein 2018. This study underscores the need to improve the recognition of occupational illness and injury in the construction and related industries sector, and to add depth to safety and health interventions, with an emphasis on ergonomic aspects of physical loads(AU)

Efecto de las lesiones condrales asintomáticas en la recuperación del paciente laboral tras una lesión traumática de rodilla / Effect of asymptomatic chodral on the recovery of the working patient after a traumatic injury of the knee

Resumen: El objetivo principal del estudio fue analizar la asociación entre la presencia de lesiones cartilaginosas asintomáticas en pacientes con lesiones traumáticas de rodilla y su tiempo de baja y gasto mutual. Los objetivos secundarios fueron describir la prevalencia y epidemiología de estas lesiones y analizar si se asocian con la presencia de obesidad y un peor resultado final. Material y métodos: Revisión retrospectiva de una cohorte de todos los pacientes a los que se les realizó una artroscopía de rodilla tras una lesión traumática en un centro mutual en el año 2018. Se recogieron datos demográficos, diagnóstico, patología condral concomitante, tratamiento, clínica al alta, tiempo total de baja y el gasto derivado de ésta. Resultados: Fueron analizados 123 pacientes con una media de edad de 47 años, no se encontraron diferencias entre sexos ni respecto a la obesidad entre los grupos con y sin lesión condral. Las lesiones cartilaginosas fueron diagnosticadas en más de un tercio de los pacientes valorados (35.25%), la mayoría entre 48 y 53 años. La presencia de patología condral no fue un condicionante que aumentara los días de baja o el gasto total (p > 0.05). En pacientes con meniscectomía, la lesión condral aumenta el tiempo de baja (p = 0.03). Los tratamientos enfocados en la lesión condral no produjeron diferencias en cuanto a la duración de la baja ni en el gasto. Conclusión: El manejo de una lesión condral concomitante a nivel de la rodilla sigue presentando controversia. Podría implicar un factor de mal pronóstico de recuperación en pacientes con meniscopatía y las terapias actuales no han mostrado un beneficio claro en estos pacientes del entorno laboral.

Abstract: The objective of this study was to investigate the prevalence and epidemiology of knee cartilage lesions in the work environment, and to assess whether they increase the patient's work leave and thus also cost. We also analyzed the prevalence of concomitant pathology and how it affected recovery and final outcome. Material and methods: Monocentric retrospective cohort of patients with occupational injuries who underwent knee arthroscopy during 2018. Demographic data, diagnosis, concomitant chondral pathology, treatment, symptoms and signs at discharge, work leave and total cost were collected. Results: 123 patients were analyzed, with a mean age of 47 years. No differences were found between sexes or with respect to obesity. Asymptomatic chondral lesions were found in 35.25% of the patients, primarily the older ones (48-53 years). The presence of cartilaginous pathology did not increase days of work leave or total cost (p > 0.05). In patients with meniscopathy in whom meniscectomy is performed, the chondral lesion increased the number of days of work leave (p = 0.03). There were no differences in the number of days of work leave nor total cost for different treatments of chondral pathology. Conclusion: The management of a concomitant chondral knee lesion is still controversial. These lesions might convey poorer functional prognosis in patients with meniscopathy. Current therapies have not shown a clear benefit in work injuries.

Wet Bulb Globe Temperature and Recorded Occupational Injury Rates among Sugarcane Harvesters in Southwest Guatemala.

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.

Zoonoses in rural veterinarians in the central region of Argentina.

OBJECTIVE: To estimate the frequency of zoonoses in rural veterinarians and to search for risk factors. DESIGN: Cross-sectional study based on an anonymously answered structured questionnaire. SETTING: The interviewees participated in mandatory continuing education classes scheduled throughout the province by the College of Veterinary Surgeons. PARTICIPANTS: Overall, 741 professionals were surveyed, and 75.8% (n = 562) of them completed the structured questionnaire. MAIN OUTCOME MEASURES: Cumulative incidence (CIR) and incidence density (IDR) rates, standardised rates, χ(2) , Student's t-test, Pearson's correlation coefficient and logistic regression. RESULTS: The CIR for all zoonoses was 34.1% (brucellosis, 29.1%; toxoplasmosis, 2.1%; leptospirosis, 0.6%; tuberculosis, 0.6%; anthrax, 0.6%; ringworm, 0.4%; other, 0.6%). The IDR for the period 1964-2008 was estimated to be 20.7% (19.5% for brucellosis). The brucellosis IDR decreased between 1964 and 2008 and was higher during early post-graduation. The risk of brucellosis was associated with the number of years of practice and the geographical area. Sixty-nine respondents had at least one day of absence from work (24.0 ± 27.8 days). CONCLUSIONS: A high frequency of zoonoses was reported by veterinarians with a large animal practice. Although the rate of zoonoses may be decreasing, further studies are needed to confirm this finding. A joint effort of all institutions is needed to prevent zoonoses among private practitioners.

Acidentes de trabalho no Brasil: prevalência, duração e despesa previdenciária dos auxílios-doença / Work-related injury and illness in Brazil: prevalence, duration, and incapacity benefit expenditure

Objetivo: estimar a prevalência, a duração e a despesa previdenciária dos benefícios de Auxílio-Doença por Acidente do Trabalho (ADAT) pagos pelo Instituto Nacional do Seguro Social (INSS) aos segurados empregados no Brasil em 2008. Método: As variáveis ADAT foram estratificadas segundo sexo, idade e agravos categorizados em capítulos da CID-10. Resultado: foram concedidos 306.908 ADAT com prevalência de 94,2 por 10.000 vínculos. Os agravos mais prevalentes foram os do capítulo XIX ? Lesões, envenenamento e algumas outras consequências de causas externas, do XIII ? Doenças do sistema osteomuscular e do tecido conjuntivo, e do V ? Transtornos mentais e comportamentais. A prevalência dos benefíciosfoi maior no sexo masculino (111,2) e na faixa etária ? 40 anos (116,9). A duração média foi de 75 ± 64 dias e a despesa média de R$ 2.181,00 ± 2.769,00, sendo maior para o Capítulo II ? Neoplasias (R$ 5.083,00 ± 5.702,00). A despesa-dia média foi R$ 29,00 ± 18,00, sendo superior para o Capítulo V (R$ 39,00 ± 23,00). A idade ? 40 anos apresentou maior prevalência, duração e despesa entre todos os capítulos, à exceção do XIX, que foi o mais prevalente entre os mais jovens.Conclusão: os dados de ADAT são sugestivos de subcaracterização da relação com o trabalho. A alta prevalência de agravos do Capítulo XIX sugere precariedade das medidas de segurança no trabalho. Homens e mulheres apresentam diferentes perfis de acidentabilidade sem interferência na duração do benefício.

Objective: To estimate the prevalence, duration, and expenditure with workrelatedincapacity benefits (WRIB) of the Brazilian National Institute of SocialWelfare, in 2008. Method: WRIB variables were stratified according to gender, age,and diseases categorized into ICD-10 chapters. Results: There were 306,908 WRIBgranted in 2008, with the prevalence of 94.2 per 10,000 insured workers. The mostprevalent ICD-10 chapters were: XIX - Injury, poisoning and some other externalcause consequences, XIII - Diseases of the musculoskeletal system and connectivetissue, and V-Mental and behavioral disorders. The prevalence was higher amongmen (111.2) and those ? 40 years of age (116.9). Benefit was received for 75 ±64 days independently of gender, and the average expenditure was R$ 2,181.00 ±2,769.00, being higher for Chapter II - Neoplasms (R$ 5,083.00 ± 5,702.00). Theaverage daily expenditure was R$ 29.00 ± 18.00, being higher for Chapter V (R$39.00 ± 23.00). Those ?40 years of age were the most prevalent, received benefitsfor the longest period and the highest expenses in all chapters, except in XIX, inwhich the highest prevalence was of younger workers. Conclusion: WRIB datasuggested underreporting of the work-relatedness of diseases. The prevalence ofchapter XIX suggested that work environment safety measures were inadequate.Men and women showed different profiles of work disability; however, there wasno gender difference in the length of benefit.