Hepatitis B and C prevalence in waste pickers: a global meta-analysis.

BACKGROUND: The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide. METHODS: Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot. RESULTS: After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates. CONCLUSION: The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.

Health conditions and occupational risks in a novel group: waste pickers in the largest open garbage dump in Latin America.

BACKGROUND: The inadequate management of solid waste impacts populations' health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. METHODS: This is a cross-sectional study, based on survey design in an area of extreme social vulnerability - the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. RESULTS: One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36-45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). CONCLUSIONS: This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families.

The global distribution of epidemiological studies involving waste pickers: A systematic review.

Waste pickers, who work with the collection of recyclable materials in search of a source of income, are subject to various risks and diseases that are very well researched. The aim of this systematic review was therefore to identify and analyze the results of epidemiological research on waste pickers over the last 20 years as well as to investigate the geographical distribution and quality of these studies. The studies were selected from the literature by creating search keys with representative keywords in different databases. This systematic review exceptionally includes research qualified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. In total, 61 epidemiological studies with waste pickers were found in 15 different countries, with the largest number of studies carried out in the American continent compared to the African and Asian, respectively. Regarding the quality, 91.80 % were classified as excellent and 8.20 % as good. Although the results show a significant number of epidemiological studies with waste pickers, demonstrating scientific evidence, that there is still a lack of research focusing on waste pickers in different work scenarios, from different health perspectives and in different parts of the world, and it is not possible to highlight the trends in health research for this profession.

Prevalence of musculoskeletal disorders and risk factors in recyclable material waste pickers from the dump of the structural city in Brasília, Brazil.

Solid waste management is a global challenge impacting the lives of thousands of people, among them the recyclable materials waste pickers, through the separation and sale of these materials, make a living for themselves. These workers face unhealthy working conditions and are exposed to various occupational risks, which predispose the prevalence of musculoskeletal as chronic back problems. METHOD: Exploratory cross-sectional study with a semi-structured questionnaire to investigate the prevalence of back pain and related risk factors. RESULTS: 1.025 waste pickers were interviewed, and 970 records of chronic back pain were detected. Among them, 660 were women (68.04%), 310 were men (31.96%), the average age of 40.21 years; 597 were single (61.92%); 629 (64.84%) had over 11 years of work; 942 (97.11%) worked exclusively in the open dump, 899 (92.68%) with bags, 922 (95.05%) on dayshift. We found significant associations between gender (p < 0.001); age (p < 0.001); time at work (p < 0.022) and place at work (p < 0.001). After adjusting, there were higher prevalence of chronic back pain women (OR = 1.7), older age (OR = 2.64); working more than 11 years (OR = 1.09); and working on the open dump (OR = 2.8). CONCLUSION: The prevalence of subjective symptoms of musculoskeletal disorders was high. Women, over 36 years old, who worked more than 11 h a day in the open dump were more exposed to suffer from chronic back problems. The importance of urgently addressing the labor impacts related to solid waste management in developing countries to protect these workers and, especially, women involved in this work is emphasized.

Social vulnerabilities of female waste pickers in Brasília, Brazil.

Worldwide, waste pickers are exposed to adverse health effects resulting from hazards at work. This study aimed to identify possible gender disparities among waste pickers. A quantitative cross-sectional epidemiological study, using semi-structured data was conducted in Estrutural's dumpsite, Brasília, Brazil. It included 1,025 waste pickers, with 67% being female. Most of them lived without partners (73.7%), have 3 to 4 children (47.8%), and have a lower monthly income (62.6%

Vector-borne diseases in waste pickers in Brasilia, Brazil.

Solid waste management is a challenge in developing countries. The Structural dump in Brasilia, Brazil, was the largest Latin American open-air dump until its closure in 2018. Thus, this study sought to investigate the prevalence of self-reported dengue, Zika and Chikungunya arbovirus infections in waste pickers who worked at the dumpsite and assess its association with the sanitary conditions in their residences and workplaces. This research used a mixed methods study using a questionnaire for the quantitative method and semi-structured interviews for the qualitative portion. A cross-sectional, observational, epidemiological study along with a phenomenological study were carried out to characterize socio environmental, occupational and health-related aspects to vector-borne diseases in Structural dumpsite in Brazil. Of the 1,025 respondents, 301 (29.2%) reported to have gotten sick from dengue, Zika or chikungunya fevers. We found significant associations between place of residence of waste pickers (p = 0,003) and the work conditions, use of personal protective equipment (p < 0.001) and weekly workload (p = 0.04) and occurrence of vector-borne disease. Results were confirmed by qualitative data and geo-referencing, in relation to location of their homes and proximity to the dumpsite, as well as through the vulnerability due to their working conditions. This research confirms that waste pickers are highly susceptible to vector-borne diseases; this situation that needs to be immediately addressed by interdisciplinary and intersectoral approaches in waste management and public health. This information confirms vulnerability of waste pickers to diseases transmitted by Ae. aegypti mosquito as a result of sanitary conditions at their residence and workplace.

Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil.

BACKGROUND: Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers. OBJECTIVES: The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks. METHODS: A qualitative study was conducted, using interviews with 34 participants at Estrutural. RESULTS: Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care. CONCLUSIONS: Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016. COMPETING INTERESTS: The authors declare no competing financial interests.

Waterborne diseases in waste pickers of Estrutural, Brazil, the second largest open-air dumpsite in world.

Brazil was home to the second largest open-air dump in the world, Estrutural, which officially closed in January of 2018; however, many dumpsites throughout the country continue to operate informally. Prior to government-recognized closure, there were about 1200 waste pickers working at the dump. These workers were subject to a myriad of occupational and environmental risks; one primary hazard involved exposure to contaminated water, which significantly affects health and quality of life. As part of the official closure plan for Estrutural, a study was conducted to determine the occurrence of waterborne diseases and rates of intestinal worms among the workers. A convergent parallel mixed methods approach, using a cross-sectional study and semi-structured interviews, sought to uncover answers to these objectives. There were 1025 waste pickers used in this study. Data confirmed waste pickers experienced continuous bouts of waterborne disease cases through episodic diarrhea (24.9%), intestinal worms (12.6%), hepatitis A (1.7%) and leptospirosis (0.7%). People who lived in unregulated areas (favelas) had increased risk of diarrhea (OR = 1.72) and those who did not use filtered water were at increased risk of intestinal worms (OR = 1.87) and diarrhea (OR = 1.5). Qualitative and quantitative data confirmed that many workers suffered from waterborne diseases, and that women were at greater risk than men. These findings highlight unsanitary and poor occupational health conditions for waste pickers at dumpsites, which likely continue despite official dumpsite closures. Moreover, this data provide evidence of supplemental occupational hazards to assess at dumpsites worldwide, especially for women.

Ineffective waste site closures in Brazil: A systematic review on continuing health conditions and occupational hazards of waste collectors.

There are approximately 15 million people engaged in waste collection or recycling activities in the world. Some of these dump sites are informal and people work in environments that are labor-intensive, unregulated, unregistered, low-paid, unrecorded, and environmentally hazardous. A systematic review was conducted to assess consequential health conditions and occupational risks that affect waste collectors in Brazil. The search was limited to Brazil because although the government closed dump sites, open-air dumping-the worst type of waste disposal-still occurs in about half of the country; moreover, Brazil is the only country to systematically collect data on the occupation, with an estimated 229,568 recyclable collectors of all types country-wide, which offers relevant and pertinent data on the topic. The results of the search indicated that nearly every region has individuals that work as recyclable collectors. As expected, the sites are full of occupational hazards to the workers that can include: long working hours; exposures to physical, chemical, mechanical, biological, ergonomic and social agents; and frequent work accidents. Exposure to these risks can result both in physical and psychological illnesses. In view of these findings, public policies could be strengthened by supporting and providing incentives to municipalities, schools, universities, health professionals, and all others who will contribute to the closure of open-air waste or poor waste disposal systems. Moreover, an improved awareness should be provided to the general population about environmental education and correct disposal of garbage. The goal of healthy waste disposal conditions ultimately decreases environmental and public health effects, while improving the working conditions, quality of life, and health outcomes for recyclable collectors.

Enamel opacities removal using two different acids: an in vivo comparison.

Computerized analysis assessed quantitatively the efficacy of microabrasion using 37% phosphoric and 18% hydrochloric acids with pumice on removal of enamel opacities. Baseline and after one month photos were taken and analyzed by Paint Shop Pro 7 software and Image Pro Express 4.0. Nonparametric tests were used. Results depicted significant differences immediately versus one month post treatment for both acids. It was concluded that both acids can be used, and as time passes enamel color improvement occurs.

Correlação entre qualidade da água e ocorrência de diarreia e hepatite A no Distrito Federal/Brasil / Correlation between drinking water quality and occurrence of diarrhea and hepatitis A in the Federal District/Brazil

RESUMO O abastecimento público de água de maneira segura e eficiente ainda é um desafio no Brasil. Isso pode levar a um aumento na incidência de agravos como Doença Diarreica Aguda (DDA) e hepatite A. O objetivo deste trabalho foi associar a qualidade da água distribuída e a ocorrência de DDA e hepatite A no Distrito Federal (DF) (Brasil) entre 2012 e 2017. Os dados referentes aos índices de reclamação relativos à água e da não conformidade da sua qualidade foram cedidos pela Companhia de Abastecimento do DF. As taxas de ocorrência de DDA e hepatite A foram obtidos pela Secretaria de Saúde. Os índices de reclamação tiveram relação direta com os de não conformidades na concentração de cloro residual livre e de turbidez da água; no entanto, essa relação foi inversa aos agravos. Isso mostra que o monitoramento realizado pelo controle de qualidade da concessionária teve relevância na redução desses agravos, inclusive durante o período de intermitência no abastecimento (2017). O canal de comunicação entre os usuários e o prestador de serviços, portanto, foi fundamental para as ações corretivas da empresa, o que refletiu na redução de casos de DDA e de hepatite A.

ABSTRACT Safe and efficient public water supply is still a challenge in Brazil. This may lead to an increased incidence of diseases such as Acute Diarrheal Disease (ADD) and hepatitis A. The aim of this study was to associate the quality of water distributed and the occurrence of ADD and hepatitis A in the Federal District (FD) (Brazil) between 2012 and 2017. Data regarding the complaint rates related to water and the non-compliance of its quality were provided by the Supply Company of the FD. The occurrence rates of ADD and hepatitis A were obtained by the Department of Health. Complaint rates were directly related to the non-conformities in relation to free residual chlorine concentration and turbidity of water; however, that relation was inverse to the injuries. This shows that the monitoring carried out by the concessionaire's quality control was relevant in reducing these problems, even during the intermittent supply period (2017). Therefore, the communication channel between users and the service provider was fundamental for the company's corrective actions, which reflected in the reduction of ADD and hepatitis A cases.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children.

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.

Prevalence of dental caries and caries-related risk factors in premature and term children.

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75% of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.

Prevalence of enamel defects and associated risk factors in both dentitions in preterm and full term born children

OBJECTIVES: The aim of this study was to evaluate the prevalence of enamel defects and their risk factors on primary and permanent dentitions of prematurely born children and full-term born children born at Regional Hospital of Asa Sul, Brasília, DF, Brazil. MATERIAL AND METHODS: Eighty 5-10-year-old children of both genders were examined, being 40 born prematurely (G1) and 40 born full term (G2). The demographic variables, medical history and oral health behaviors were retrieved using a questionnaire and data obtained from clinical examination were recorded. The teeth were examined and the presence of enamel defects was diagnosed according to the DDE Index and registered in odontograms. Subsequently, the defects were categorized in four groups according to one of the criteria proposed in 1992 by the FDI Commission on Oral Health, Research and Epidemiology. Kruskal-Wallis, Chi-square, Kappa, Mann-Whitney tests and logistic regression were used for statistical analysis. RESULTS: 75% of total sample had enamel defects. There was a major prevalence of hypoplasia of the enamel in G1 (p<0.001). There was a significant relationship between low weight and presence of the imperfections on the enamel in G1 on the primary dentition. The logistic regression model showed that the other risk factors such as monthly per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases were not associated with enamel defects and caries. CONCLUSIONS: Pre-term labor can be a predisposing factor for the presence of the enamel hypoplasia in the primary dentition.