Incompletude da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade, Brasil, 2020-2021 / Incompleteness of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases, Brazil, 2020-2021

Resumo Objetivo: descrever a incompletude da informação sobre profissão/ocupação nas bases de dados de síndrome respiratória aguda grave (SRAG), síndrome gripal (SG) e no Sistema de Informações sobre Mortalidade (SIM) no Brasil. Métodos: estudo descritivo utilizando os bancos de dados de SRAG, SG e SIM. Calcularam-se percentuais de incompletude na variável profissão/ocupação segundo sexo, macrorregiões e unidades da federação, em 2020-2021. Resultados: o percentual de incompletude foi de 94,7% no banco de SG; 97,7% no de SRAG; e 17,0% no SIM. Em todas as macrorregiões a incompletude foi superior a 91,0% nos bancos de SG e SRAG; e superior a 13,0% no SIM. Todas as unidades da federação apresentaram percentuais de incompletude acima de 90,0% para SG; de 74,0% para SRAG; e de 6,8% para óbitos. Amapá apresentou maior percentual de incompletude na base de dados de SG (98,1%); Rio Grande do Sul (99,4%) na de SRAG; e Alagoas (45,0%) no SIM. Conclusões: observaram-se elevados percentuais de incompletude da variável profissão/ocupação nos sistemas de informação estudados. Recomenda-se uma articulação intersetorial, envolvendo representantes dos governos e dos trabalhadores, para formulação de estratégias que contornem a falta de informação sobre ocupação/profissão nas bases de dados relevantes para a vigilância em saúde.

Abstract Objective: to describe the incomplete filling out of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil. Methods: descriptive study with secondary data from flu-like syndrome (FLS), severe acute respiratory syndrome (SARS) and mortality databases (SIM). We calculeted the absolute and relative filling frequencies of the profession/occupation variable according to State, gender, regions, and federative units, for 2020 and 2021. Results: we found a 94.7% incompleteness on the FLS database, 97.7% of missing profession/occupation data on the SARS, and 17.0% on the SIM database. Incompleteness frequency was above 91.0% in all Brazilian regions for FLS and SARS. Incompleteness on the mortality database was over 13.0%. All federative units presented incompleteness above 90.0% for FLS, 74.0% for SARS, and 6.8% for mortality in all genders. Higher levels of missing data were found in the states of Amapá for FLS (98.1%), Rio Grande do Sul for SARS and Alagoas (45.0%) for mortality (99.4%). Conclusions: all databases showed a high incompleteness of the profession/occupation variable. We recommend an articulation between the Ministry of Health, Ministry of Labor and workers' representations to solve this lack of data on occupation/profession in public databases.

Genetic polymorphisms and their effects on the severity of silicosis in workers exposed to silica in Brazil.

OBJECTIVE: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. METHODS: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. RESULTS: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. CONCLUSIONS: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.

[Heat and burden of diseases: impacts and future projections in capitals of the Legal Amazon.] / Calor y carga de enfermedades: impactos y proyecciones futuras en capitales de la Amazonía Legal.

OBJECTIVE: Under the influence of climate change, environmental exposure to heat and pollution grows, exacerbated by extreme events, increasing the risk of mortality in vulnerable areas. We aimed to evaluate the present (2000-2019) and future effects of heat on the burden of cardiovascular (in people aged 45 years or older), respiratory (in people aged 60 years or older) and all-cause (in people aged 1 year or more) diseases in capitals of the Legal Amazon (Brazil). METHODS: An ecological study was conducted to initially estimate, for the period 2000-2019, the relative risk (RR) of exposure-response related to the effects of temperature on years of life potentially lost (YLL) using the generalized linear regression model (GLM), combined with the distributed non-linear lag model (DLNM); and the fractions of YLL attributable to heat from the prospective perspective (forward). Subsequently, the results were estimated in the baseline period (1970-2005) and projected into the future in the specific levels of warming and periods: 1.5 ºC (2010-2039), 2 ºC (2040-2069) and 4 ºC (2070-2099), considering the temperature data from the WCRP CORDEX regional climate model in RCP8.5 scenario. RESULTS: The RR of YLL increased significantly in the capitals due to exposure to heat and marked thermal amplitudes between 2000-2019, with the major effects on respiratory diseases in Río Blanco (14%), due to all causes in Manaus (12%) and cardiovascular in Cuiabá (9%). Compared with the baseline period, the period 2040-2069 showed the largest increase (10.40 times) in the fraction of the number of YLL attributable to heat in the region, with the predominance of cardiovascular diseases. The findings were not completely conclusive, the low precision of the estimated confidence intervals did not show the significance of the negative effect of heat. CONCLUSIONS: Regardless of its significance, heat increases the risk of years of life lost in the short and medium term. The results support the need to include climate change mitigation and adaptation measures as public health protection policies.

OBJETIVO: Bajo la influencia del cambio climático crece la exposición ambiental al calor y a la contaminación, exacerbados por eventos extremos, incrementando el riesgo de mortalidad en áreas vulnerables. En este trabajo se evaluaron los efectos presentes (2000-2019) y futuros del calor sobre la carga de enfermedades cardiovasculares (en personas con 45 años o más), respiratorias (en personas con 60 años o más) y por todas las causas (en personas con 1 año o más) en capitales de la Amazonía Legal (Brasil). METODOS: Se realizó un estudio ecológico. Se estimaron inicialmente, para el período 2000-2019, el riesgo relativo (RR) de exposición-respuesta relacionado a los efectos de la temperatura sobre los años de vida potencialmente perdidos (AVPP) mediante el modelo de regresión lineal generalizada (GLM), combinado con el modelo no lineal de desfasajes (lag) distribuidos (DLNM); y las fracciones de AVPP atribuibles al calor desde la perspectiva prospectiva (forward). Posteriormente los resultados fueron estimados en período base (1970-2005) y proyectados a futuro en los niveles específicos de calentamiento y períodos: 1,5 ºC (2010-2039), 2 ºC (2040-2069) y 4 ºC (2070-2099), considerando los datos de temperatura del modelo climático regional WCRP CORDEX en escenario RCP8.5. RESULTADOS: Entre 2000-2019 el RR de AVPP se incrementó significativamente en las capitales ante la exposición al calor y las marcadas amplitudes térmicas, con los mayores efectos sobre las enfermedades respiratorias en Río Blanco (14%), por todas las causas en Manaos (12%) y cardiovasculares en Cuiabá (9%). Comparado con el período base, el período 2040-2069 mostró el mayor aumento (10,40 veces) de la fracción de número de AVPP atribuibles al calor en la región, con predominio de las causas cardiovasculares. Los hallazgos encontrados no fueron totalmente concluyentes, la baja precisión de los intervalos de confianza estimados no mostró significancia en el efecto negativo del calor. CONCLUSIONES: Independiente de su significancia, el calor aumenta el riesgo de AVPP a corto y mediano plazo. Los resultaron sustentan la necesidad de inclusión de medidas de mitigación y adaptación al cambio climático como políticas públicas de protección a la salud.

Calor y carga de enfermedades: impactos y proyecciones futurasen capitales de la Amazonía Legal / Heat and burden of diseases: impacts and future projections in capitals of the Legal Amazon

FUNDAMENTOS: Bajo la influencia del cambio climático crece la exposición ambiental al calor y a la contaminación, exacerbados por eventos extremos, incrementando el riesgo de mortalidad en áreas vulnerables. En este trabajo se evaluaron los efectos presentes (2000-2019) y futuros del calor sobre la carga de enfermedades cardiovasculares (en personas con 45 años o más), respiratorias (en personas con 60 años o más) y por todas las causas (en personas con 1 año o más) en capitales de la Amazonía Legal (Brasil). MÉTODOS: Se realizó un estudio ecológico. Se estimaron inicialmente, para el período 2000-2019, el riesgo relativo (RR) de exposición-respuesta relacionado a los efectos de la temperatura sobre los años de vida potencialmente perdidos (AVPP) mediante el modelo de regresión lineal generalizada (GLM), combinado con el modelo no lineal de desfasajes (lag) distribuidos (DLNM); y las fracciones de AVPP atribuibles al calor desde la perspectiva prospectiva (forward). Posteriormente los resultados fueron estimados en período base (1970-2005) y proyectados a futuro en los niveles específicos de calentamiento y períodos: 1,5 ºC (2010-2039), 2 ºC (2040-2069) y 4 ºC (2070-2099), considerando los datos de temperatura del modelo climático regional WCRP CORDEX en escenario RCP8.5. RESULTADOS: Entre 2000-2019 el RR de AVPP se incrementó significativamente en las capitales ante la exposición al calor y las marcadas amplitudes térmicas, con los mayores efectos sobre las enfermedades respiratorias en Río Blanco (14%), por todas las causas en Manaos (12%) y cardiovasculares en Cuiabá (9%). Comparado con el período base, el período 2040-2069 mostró el mayor aumento (10,40 veces) de la fracción de número de AVPP atribuibles al calor en la región, con predominio de las causas cardiovasculares. Los hallazgos encontrados no fueron totalmente concluyentes, la baja precisión de los intervalos de confianza estimados no mostró significancia en el efecto negativo.(AU)

BACKGROUND: Under the influence of climate change, environmental exposure to heat and pollution grows, exacerbated by extreme events, increasing the risk of mortality in vulnerable areas. We aimed to evaluate the present (2000-2019) and future effects ofheat on the burden of cardiovascular (in people aged 45 years or older), respiratory (in people aged 60 years or older) and all-cause (in people aged 1 year or more) diseases in capitals of the Legal Amazon (Brazil). METHODS: An ecological study was conducted to initially estimate, for the period 2000-2019, the relative risk (RR) of exposure-response related to the effects of temperature on years of life potentially lost (YLL) using the generalized linear regression model (GLM), combined with the distributed non-linear lag model (DLNM); and the fractions of YLL attributable to heat from the prospective perspective (forward). Subsequently, the results were estimated in the baseline period (1970-2005) and projected into the future in the specific levels of warming and periods: 1.5 ºC (2010-2039), 2 ºC (2040-2069) and 4 ºC (2070-2099), considering the temperature data from the WCRP CORDEX regional climate model in RCP8.5 scenario. RESULTS: The RR of YLL increased significantly in the capitals due to exposure to heat and marked thermal amplitudes between 2000-2019, with the major effects on respiratory diseases in Río Blanco (14%), due to all causes in Manaus (12%) and cardiovascular in Cuiabá (9%). Compared with the baseline period, the period 2040-2069 showed the largest increase (10.40 times) in the fraction of the number of YLL attributable to heat in the region, with the predominance of cardiovascular diseases. The findings were not completely conclusive, the low precision of the estimated confidence intervals did not show the significance of the negative effect of heat.(AU)

What can we learn with the data we didn't have? The case of the variable profession/ occupation on flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil / ¿Qué podemos aprender con los datos que no tenemos? El caso de la variable profesión /ocupación sobre base de datos de la síndrome gripal, síndrome respiratorio agudo severo y de mortalidad en Brasil / O que aprendemos diante dos dados que não temos? O caso da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade no Brasil

Objective: To describe the completeness of the profession/ occupation on flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil between 2020 and 2021 Methods:  the absolute and relative frequencies of the completeness of the variable occupation were calculated for each state for the between 2020 and 2021. Results: For the study period, there was 94.83% incompleteness for notifications of Flu-like syndrome, 97.73% for notified cases of SARS and 17.06% for deaths from all causes. Conclusions: We recommend an articulation between the Ministry of Health, Ministry of Labor and Welfare and workers' representations, such as councils and unions, to solve the problem of lack of data on occupation/profession in public databases.

Objetivo: descrever o preenchimento da variável profissão/ocupação nos bancos de dados do Sistema de Informação de Mortalidade (SIM), de Síndrome Respiratória Aguda Grave (SRAG) e Síndrome Gripal (SG) entre 2020 e 2021 no Brasil. Métodos: foram calculadas as frequências absolutas e relativas do preenchimento da variável profissão/ocupação por Unidade da Federação para cada base de dados durante o período de estudo. Resultados: Para o período de estudo, verificou-se 94,83% de incompletude para as notificações de SG, 97,73% para casos notificados de SRAG e 17,06% para óbitos por todas as causas. Conclusões: Recomendamos uma articulação entre o Ministério da Saúde, Ministério do Trabalho e Previdência e representações de trabalhadores, como conselhos e sindicatos para formulação de estratégias para contornar o problema da falta de dados de ocupação/profissão nos bancos de dados públicos.

Genetic polymorphisms and their effects on the severity of silicosis in workers exposed to silica in Brazil / Polimorfismos genéticos e seus efeitos na gravidade da silicose em trabalhadores expostos à sílica no Brasil

ABSTRACT Objective: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. Methods: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. Results: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. Conclusions: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.

RESUMO Objetivo: A silicose é uma pneumoconiose caracterizada por fibrose do parênquima pulmonar causada por inalação de partículas de sílica. Fatores genéticos podem desempenhar um papel na gravidade da silicose. Nosso objetivo foi avaliar a influência de polimorfismos dos genes ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1 e TNF na gravidade da silicose. Métodos: Nove polimorfismos foram genotipados por meio de PCR em uma amostra composta por 143 pacientes com silicose no estado do Rio de Janeiro, Brasil. Resultados: A silicose foi classificada em simples em 57 (40%) dos pacientes e em complicada, em 86 (60%). O genótipo TT do polimorfismo rs1800469 do gene TGFB1 teve efeito protetor contra a silicose complicada (OR = 0,35; IC95%: 0,14-0,92; p = 0,028) em comparação com os outros dois genótipos (CC+CT). O alelo T polimórfico do polimorfismo rs763110 do gene FASLG (OR = 0,56; IC95%: 0,31-0,99; p = 0,047) e um modelo dominante do alelo T (TT+CT: OR = 0,37; IC95%: 0,15-0,96; p = 0,037) também tiveram efeito protetor. Quando se compararam os pacientes que tinham silicose simples com um tempo maior de exposição à sílica (> 44.229 horas) àqueles que tinham silicose complicada com um tempo menor de exposição à sílica, o alelo T do polimorfismo rs763110 do gene FASLG (OR = 0,20; IC95%: 0,08-0,48; p < 0,0001) e modelos dominantes e recessivos (OR = 0,06; IC95%: 0,00-0,49; p = 0,01 e OR = 0,22; IC95%: 0,06-0,77; p = 0,014, respectivamente) tiveram efeito protetor contra a gravidade da silicose. Conclusões: Polimorfismos rs1800469 do gene TGFB1 e polimorfismos rs763110 do gene FASLG parecem estar envolvidos na gravidade da silicose. Como há poucos estudos que tenham estabelecido relações entre polimorfismos genéticos e a gravidade da silicose, esses resultados devem ser replicados em outras populações.

Health and environment in the 25 years of ciência & Saúde coletiva. / A Saúde e Ambiente nos 25 anos da Ciência & Saúde Coletiva.

The Journal Ciência & Saúde Coletiva appeared in the 1990s simultaneously to essential events that addressed the relationships between production, environment, health, and development, which generated an essential set of initiatives and scientific production and contributed to the development of Health and Environment in Brazil. We analyzed the papers published on this topic over the past 25 years to examine this Journal's contribution to the field. We examined 24 volumes and 170 issues and supplements of the Journal from 1996 to 2019. The texts were classified according to 4 domains. A total of 243 texts were included in the analysis, which represents about 5% of all scientific production published on the Journal's pages in the period. The production is quite varied, highlighting discussions about inequalities, vulnerabilities, development or economic aspects related to environmental issues and their impacts on health, the analysis of the production system and its relationship with health, and the predominance of studies on pesticides. We concluded that production in this field has been growing and tending to include affected territories, populations, and communities to produce this knowledge.

A revista Ciência & Saúde Coletiva surgiu na década de 1990 contemporaneamente a importantes eventos que trataram das relações produção-ambiente-saúde-desenvolvimento, o que gerou um importante conjunto de iniciativas e de produção científica, que contribuíram para o desenvolvimento do campo de práticas da Saúde e Ambiente no Brasil. Para examinar a contribuição dessa revista a esse campo, analisamos os artigos publicados sobre essa temática ao longo dos últimos 25 anos. Foram examinados 24 volumes e 170 números e suplementos da revista entre 1996 e 2019. Os textos foram classificados de acordo com 4 domínios. Foram incluídos na análise 243 textos, que representam cerca de 5% de toda a produção científica publicada nas páginas da revista nesse período. A produção é bastante variada destacando-se discussões sobre desigualdades, vulnerabilidades, desenvolvimento ou aspectos econômicos ligados a questões ambientais e seus impactos na saúde, a análise do sistema produtivo e sua relação com a saúde e o predomínio dos estudos sobre agrotóxicos. Conclui-se que a produção nesse campo vem crescendo e com tendência a incluir territórios, populações e comunidades afetadas no processo de produção desse conhecimento.

Combined forced oscillation and fractional-order modeling in patients with work-related asthma: a case-control study analyzing respiratory biomechanics and diagnostic accuracy.

BACKGROUND: Fractional-order (FrOr) models have a high potential to improve pulmonary science. These models could be useful for biomechanical studies and diagnostic purposes, offering accurate models with an improved ability to describe nature. This paper evaluates the performance of the Forced Oscillation (FO) associated with integer (InOr) and FrOr models in the analysis of respiratory alterations in work-related asthma (WRA). METHODS: Sixty-two individuals were evaluated: 31 healthy and 31 with WRA with mild obstruction. Patients were analyzed pre- and post-bronchodilation. The diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUC). To evaluate how well do the studied models correspond to observed data, we analyzed the mean square root of the sum (MSEt) and the relative distance (Rd) of the estimated model values to the measured resistance and reactance measured values. RESULTS AND DISCUSSION: Initially, the use of InOr and FrOr models increased our understanding of the WRA physiopathology, showing increased peripheral resistance, damping, and hysteresivity. The FrOr model (AUC = 0.970) outperformed standard FO (AUC = 0.929), as well as InOr modeling (AUC = 0.838) in the diagnosis of respiratory changes, achieving high accuracy. FrOr improved the curve fitting (MSEt = 0.156 ± 0.340; Rd = 3.026 ± 1.072) in comparison with the InOr model (MSEt = 0.367 ± 0.991; Rd = 3.363 ± 1.098). Finally, we demonstrated that bronchodilator use increased dynamic compliance, as well as reduced damping and peripheral resistance. CONCLUSIONS: Taken together, these results show clear evidence of the utility of FO associated with fractional-order modeling in patients with WRA, improving our knowledge of the biomechanical abnormalities and the diagnostic accuracy in this disease.

A Saúde e Ambiente nos 25 anos da Ciência & Saúde Coletiva / Health and environment in the 25 years of ciência & Saúde coletiva

Resumo A revista Ciência & Saúde Coletiva surgiu na década de 1990 contemporaneamente a importantes eventos que trataram das relações produção-ambiente-saúde-desenvolvimento, o que gerou um importante conjunto de iniciativas e de produção científica, que contribuíram para o desenvolvimento do campo de práticas da Saúde e Ambiente no Brasil. Para examinar a contribuição dessa revista a esse campo, analisamos os artigos publicados sobre essa temática ao longo dos últimos 25 anos. Foram examinados 24 volumes e 170 números e suplementos da revista entre 1996 e 2019. Os textos foram classificados de acordo com 4 domínios. Foram incluídos na análise 243 textos, que representam cerca de 5% de toda a produção científica publicada nas páginas da revista nesse período. A produção é bastante variada destacando-se discussões sobre desigualdades, vulnerabilidades, desenvolvimento ou aspectos econômicos ligados a questões ambientais e seus impactos na saúde, a análise do sistema produtivo e sua relação com a saúde e o predomínio dos estudos sobre agrotóxicos. Conclui-se que a produção nesse campo vem crescendo e com tendência a incluir territórios, populações e comunidades afetadas no processo de produção desse conhecimento.

Abstract The Journal Ciência & Saúde Coletiva appeared in the 1990s simultaneously to essential events that addressed the relationships between production, environment, health, and development, which generated an essential set of initiatives and scientific production and contributed to the development of Health and Environment in Brazil. We analyzed the papers published on this topic over the past 25 years to examine this Journal's contribution to the field. We examined 24 volumes and 170 issues and supplements of the Journal from 1996 to 2019. The texts were classified according to 4 domains. A total of 243 texts were included in the analysis, which represents about 5% of all scientific production published on the Journal's pages in the period. The production is quite varied, highlighting discussions about inequalities, vulnerabilities, development or economic aspects related to environmental issues and their impacts on health, the analysis of the production system and its relationship with health, and the predominance of studies on pesticides. We concluded that production in this field has been growing and tending to include affected territories, populations, and communities to produce this knowledge.

Prevalência e fatores associados a sintomas respiratórios em trabalhadores da construção civil: uma proposta de vigilância em saúde do trabalhador / Prevalence and factors associated with respiratory symptoms among civil construction workers: an occupational health surveillance proposal

INTRODUÇÃO: O setor da construção civil é um dos que mais adoecem e matam trabalhadores no Brasil. Apesar da relevância epidemiológica, ainda são frágeis as ações de vigilância em saúde do trabalhador na Atenção Básica. OBJETIVO: Analisar a prevalência e os fatores associados a sintomas respiratórios em trabalhadores da construção civil de Cuiabá, Mato Grosso. Métodos: Trata-se de um estudo transversal, analítico, realizado com 545 trabalhadores da construção civil, de modo a qualificar as ações de vigilância em saúde do trabalhador. A presença de sintomas respiratórios foi determinada através do instrumento British Medical Research Council. Realizou-se o teste do χ2 de Mantel Haenszel na análise bivariada e regressão de Poisson na análise multivariada. O nível de significância adotado foi de 5%. RESULTADOS: A maioria dos participantes é de adultos jovens. Quase metade dos participantes foram classificados como sintomático-respiratórios. Trabalhadores expostos a substâncias químicas apresentaram maiores chances para a ocorrência de tosse (RP=1,70; IC95% 1,22­2,37) e expectoração (RP=1,63; IC95% 1,14­2,23). Trabalhadores que não realizaram os testes espirométricos nos exames admissionais obtiveram maiores chances de apresentar sibilos (RP=1,57; IC95% 1,17­2,10). CONCLUSÃO: O monitoramento biológico dos trabalhadores da construção civil pode servir como uma importante ferramenta para a qualificação das ações de vigilância em saúde do trabalhador na Atenção Básica.

BACKGROUND: The civil construction industry is associated with the some of the highest morbidity and mortality rates in Brazil. Despite their epidemiological relevance, occupational health surveillance actions within the primary care setting still exhibit weaknesses. OBJECTIVE: To analyze the prevalence of and factors associated with respiratory symptoms among civil construction workers in Cuiaba, Mato Grosso, Brazil. METHODS: Cross-sectional analytic study conducted with 545 civil construction workers to analyze occupational health surveillance actions. Presence of respiratory symptoms was investigated by means of the British Medical Research Council questionnaire on respiratory symptoms. The Mantel-Haenszel χ2 test was used for bivariate analysis and Poisson regression for multivariate analysis. The significance level was set to 5%. RESULTS: Most participants were young adults and almost half exhibited respiratory symptoms. The odds to develop cough were higher for the participants exposed to chemicals (PR=1.70; 95%CI 1.22­2.37). The odds to develop wheezing were higher for the participants who had not undergone pre-employment spirometry (PR=1.57; 95%CI 1.17­2.10). CONCLUSION: Biological monitoring of civil construction workers might be useful to improve occupational health surveillance actions within the primary care setting.

Entropy Analysis for the Evaluation of Respiratory Changes Due to Asbestos Exposure and Associated Smoking.

Breathing is a complex rhythmic motor act, which is created by integrating different inputs to the respiratory centres. Analysing nonlinear fluctuations in breathing may provide clinically relevant information in patients with complex illnesses, such as asbestosis. We evaluated the effect of exposition to asbestos on the complexity of the respiratory system by investigating the respiratory impedance sample entropy (SampEnZrs) and recurrence period density entropy (RPDEnZrs). Similar analyses were performed by evaluating the airflow pattern sample entropy (SampEnV') and recurrence period density entropy (RPDEnV'). Groups of 34 controls and 34 asbestos-exposed patients were evaluated in the respiratory impedance entropy analysis, while groups of 34 controls and 30 asbestos-exposed patients were investigated in the analysis of airflow entropy. Asbestos exposition introduced a significant reduction of RPDEnV' in non-smoker patients (p < 0.0004), which suggests that the airflow pattern becomes less complex in these patients. Smoker patients also presented a reduction in RPDEnV' (p < 0.05). These finding are consistent with the reduction in respiratory system adaptability to daily life activities observed in these patients. It was observed a significant reduction in SampEnV' in smoker patients in comparison with non-smokers (p < 0.02). Diagnostic accuracy evaluations in the whole group of patients (including non-smokers and smokers) indicated that RPDEnV' might be useful in the diagnosis of respiratory abnormalities in asbestos-exposed patients, showing an accuracy of 72.0%. In specific groups of non-smokers, RPDEnV' also presented adequate accuracy (79.0%), while in smoker patients, SampEnV' and RPDEnV' presented adequate accuracy (70.7% and 70.2%, respectively). Taken together, these results suggest that entropy analysis may provide an early and sensitive functional indicator of interstitial asbestosis.

Prevalence and factors associated with respiratory symptoms among civil construction workers: an occupational health surveillance proposal.

BACKGROUND: The civil construction industry is associated with the some of the highest morbidity and mortality rates in Brazil. Despite their epidemiological relevance, occupational health surveillance actions within the primary care setting still exhibit weaknesses. OBJECTIVE: To analyze the prevalence of and factors associated with respiratory symptoms among civil construction workers in Cuiaba, Mato Grosso, Brazil. METHODS: Cross-sectional analytic study conducted with 545 civil construction workers to analyze occupational health surveillance actions. Presence of respiratory symptoms was investigated by means of the British Medical Research Council questionnaire on respiratory symptoms. The Mantel-Haenszel χ 2 test was used for bivariate analysis and Poisson regression for multivariate analysis. The significance level was set to 5%. RESULTS: Most participants were young adults and almost half exhibited respiratory symptoms. The odds to develop cough were higher for the participants exposed to chemicals (PR=1.70; 95%CI 1.22-2.37). The odds to develop wheezing were higher for the participants who had not undergone pre-employment spirometry (PR=1.57; 95%CI 1.17-2.10). CONCLUSION: Biological monitoring of civil construction workers might be useful to improve occupational health surveillance actions within the primary care setting.

INTRODUÇÃO: O setor da construção civil é um dos que mais adoecem e matam trabalhadores no Brasil. Apesar da relevância epidemiológica, ainda são frágeis as ações de vigilância em saúde do trabalhador na Atenção Básica. OBJETIVO: Analisar a prevalência e os fatores associados a sintomas respiratórios em trabalhadores da construção civil de Cuiabá, Mato Grosso. MÉTODOS: Trata-se de um estudo transversal, analítico, realizado com 545 trabalhadores da construção civil, de modo a qualificar as ações de vigilância em saúde do trabalhador. A presença de sintomas respiratórios foi determinada através do instrumento British Medical Research Council. Realizou-se o teste do χ 2 de Mantel Haenszel na análise bivariada e regressão de Poisson na análise multivariada. O nível de significância adotado foi de 5%. RESULTADOS: A maioria dos participantes é de adultos jovens. Quase metade dos participantes foram classificados como sintomático-respiratórios. Trabalhadores expostos a substâncias químicas apresentaram maiores chances para a ocorrência de tosse (RP=1,70; IC95% 1,22­2,37) e expectoração (RP=1,63; IC95% 1,14­2,23). Trabalhadores que não realizaram os testes espirométricos nos exames admissionais obtiveram maiores chances de apresentar sibilos (RP=1,57; IC95% 1,17­2,10). CONCLUSÃO: O monitoramento biológico dos trabalhadores da construção civil pode servir como uma importante ferramenta para a qualificação das ações de vigilância em saúde do trabalhador na Atenção Básica.

Formação profissional como ação estratégica para implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora / Professional qualification as a strategic action for the implementation of the Brazilian Workers' Health Policy

Resumo Introdução: a criação da Rede Nacional de Atenção Integral à Saúde do Trabalhador é considerada a principal estratégia para a Política Nacional de Saúde do Trabalhador e da Trabalhadora. O Ministério da Saúde priorizou a qualificação profissional das equipes dos centros de referência em saúde do trabalhador, considerados nucleares na rede. Foi firmado um convênio com o Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, da Escola Nacional de Saúde Pública, da Fundação Oswaldo Cruz, para o desenvolvimento de um Curso de Especialização em Saúde do Trabalhador na modalidade a distância. Objetivo: descrever e analisar o desenvolvimento do curso no período de 2006 a 2015. Métodos: análise documental. Resultados: o curso ocorreu nas regiões Norte, Nordeste, Centro-Oeste e Sudeste, com 1.703 inscritos, 70% de concluintes aprovados e evasão de 28%. Valorizou-se a opinião dos profissionais participantes sobre o curso e o material didático e analisou-se sua relação com a política e o desempenho dos alunos e tutores. Conclusão: o processo pioneiro cumpriu os objetivos abrindo novos caminhos para ações em saúde do trabalhador e identificando evidências positivas da capacitação sobre os serviços e a rede.

Abstract Introduction: the creation of the National Workers' Health Comprehensive Care Network is considered the main strategy for the Brazilian Workers' Health Policy. The Ministry of Health prioritized the professional training of the teams from workers' health reference centers, which are considered crucial within the network. The Ministry of Health signed an agreement with the Centre of Studies for Worker's Health and Human Ecology of the Oswaldo Cruz Foundation National School of Public Health, aiming at organizing a distance education course on Workers' Health. Objective: to describe and analyze the course development from 2006 to 2015. Methods: documentary analysis. Results: the course was held in the North, Northeast, Midwest and Southeast regions of Brazil, with 1,703 enrollees, from which 70% were approved and 28% dropped out. The participants' opinions about the course and its materials were taken into account. We analyzed the relationship between the course and the workers' health policy, as well as the performance of students and tutors. Conclusion: the courses pioneering process achieved its objectives, carving new paths for actions in workers' health, and making it possible to identify positive evidence of the training on services and the network.

Alterações respiratórias, auditivas e citogenéticas em trabalhadores de um estaleiro no Rio de Janeiro: estudo de caso / Respiratory, audiologic and cytogenetic alterations in workers of a shipyard in Rio de Janeiro: case study

Resumo Introdução Este estudo avaliou alterações respiratórias, auditivas e citogenéticas em trabalhadores de um estaleiro em Angra dos Reis, no Estado do Rio de Janeiro, relacionadas à exposição de pintores a solventes, metais e ruído no ambiente de trabalho. Métodos Foram avaliados função pulmonar, perdas auditivas e índice de reconhecimento da fala, e alterações citogenéticas pelo teste de aberrações cromossômicas. Foram avaliados manganês e chumbo em sangue por espectrometria de absorção atômica. Os indicadores de efeito utilizados para chumbo foram ALAD e ALA-U, determinados por espectrofotometria e cromatografia líquida, respectivamente. Resultados Seis dos 9 trabalhadores avaliados apresentaram alteração funcional respiratória. Quase 70% dos 18 trabalhadores avaliados apresentaram audição reduzida, com associação entre PAIR e chumbo em sangue. O percentual médio de recuperação da ALAD foi de 32,9%, com médias de ALA-U de 1,7 mg g-1 creatinina, 4,65 µg dL-1 para Pb-S e 10 µg L -1 para Mn-S entre os trabalhadores. Foram observadas associações entre ALA-D ativada com Mn-S e com a presença de aberrações cromossômicas. As alterações citogenéticas identificadas foram aneuploidias, separação prematura centromérica e aberrações como formação de anéis, quebras e união de cromátides irmãs. Conclusão os trabalhadores do estaleiro apresentam alterações que podem ser associadas à exposição ocupacional.

Abstract Introduction This study evaluated respiratory, audiological and cytogenetic alterations in shipyard workers in Angra dos Reis, state of Rio de Janeiro/Brazil, and their correlation to the occupational exposure of painters to solvents, metals and noise present. Methods We evaluated pulmonary function, hearing loss and speech recognition, as well as cytogenetic alterations. Indicators of exposure to lead and manganese in blood were evaluated by atomic absorption spectrometry. The determination of ALAD and ALA-U was performed by spectrophotometry and liquid chromatography, respectively. Results Six of the 9 workers evaluated for lung function had respiratory functional impairment. Almost 70% of the 18 evaluated workers had reduced hearing, with association between PAIR and values of lead in blood. The average percentage of recovery of ALAD was 32.9%; average was 1.7 mg g-1 creatinine for ALA-U, 4.65 µg dL-1 for Pb-B and 10 µg L-1 for Mn-B. We observed associations between activated ALA-D with Mn-B and the presence of chromosomal aberrations. Furthermore, we identified cytogenetic alterations as aneuploidy, premature centromere separation; as well as ring formation, breakage, and sister chromatid union. Conclusion Shipyard workers presented alterations that can be associated with occupational exposure.

Early Diagnosis of Respiratory Abnormalities in Asbestos-Exposed Workers by the Forced Oscillation Technique.

BACKGROUND: The current reference test for the detection of respiratory abnormalities in asbestos-exposed workers is spirometry. However, spirometry has several shortcomings that greatly affect the efficacy of current asbestos control programs. The forced oscillation technique (FOT) represents the current state-of-the-art technique in the assessment of lung function. This method provides a detailed analysis of respiratory resistance and reactance at different oscillatory frequencies during tidal breathing. Here, we evaluate the FOT as an alternative method to standard spirometry for the early detection and quantification of respiratory abnormalities in asbestos-exposed workers. METHODOLOGY/PRINCIPAL FINDINGS: Seventy-two subjects were analyzed. The control group was composed of 33 subjects with a normal spirometric exam who had no history of smoking or pulmonary disease. Thirty-nine subjects exposed to asbestos were also studied, including 32 volunteers in radiological category 0/0 and 7 volunteers with radiological categories of 0/1 or 1/1. FOT data were interpreted using classical parameters as well as integer (InOr) and fractional-order (FrOr) modeling. The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). Exposed workers presented increased obstruction (resistance p<0.001) and a reduced compliance (p<0.001), with a predominance of obstructive changes. The FOT parameter changes were correlated with the standard pulmonary function analysis methods (R = -0.52, p<0.001). Early respiratory abnormalities were identified with a high diagnostic accuracy (AUC = 0.987) using parameters obtained from the FrOr modeling. This accuracy was significantly better than those obtained with classical (p<0.001) and InOr (p<0.001) model parameters. CONCLUSIONS: The FOT improved our knowledge about the biomechanical abnormalities in workers exposed to asbestos. Additionally, a high diagnostic accuracy in the diagnosis of early respiratory abnormalities in asbestos-exposed workers was obtained. This makes the FOT particularly useful as a screening tool in the context of asbestos control and elimination. Moreover, it can facilitate epidemiological research and the longitudinal follow-up of asbestos exposure and asbestos-related diseases.

[Challenges for the construction of 'Health and Environment "in view of its Thematic Group in the Brazilian Association of Collective Health]. / Desafios para a construção da 'Saúde e Ambiente" na perspectiva do seu Grupo Temático da Associação Brasileira de Saúde Coletiva.

'Health and Environment' is the nucleus of knowledge and practices surrounding the relations between society and nature, mediated by the mode of production and human labor, which help to understand the determination of the health-disease process of different social classes and groups. This paper discusses the challenges to build this field from the perspective of its Thematic Group of the Association of Collective Health. The three core themes of the 2nd Brazilian Symposium on Environmental Health are taken as the theoretical framework for analysis. A timeline of the group's trajectory, in its historical context, helps to identify the contemporary challenges. Among the main challenges identified, the challenge of building an interdisciplinary, intersectoral and participatory scientific practice, which could build knowledge and dialogue with social movements, is highlighted.

Desafios para a construção da 'Saúde e Ambiente" na perspectiva do seu Grupo Temático da Associação Brasileira de Saúde Coletiva / Challenges for the construction of 'Health and Environment "in view of its Thematic Group in the Brazilian Association of Collective Health

'Saúde e Ambiente' é o núcleo de saberes e práticas em torno das relações entre a sociedade e a natureza, mediadas pelo modo de produção e o trabalho humano, que ajudam a compreender a determinação do processo saúde-doença das diferentes classes e grupos sociais. Este artigo discute os desafios para a construção desse campo na perspectiva do seu Grupo Temático da Associação Brasileira de Saúde Coletiva. Como marco teórico de análise adotam-se os três eixos do 2º Simpósio Brasileiro de Saúde Ambiental. Para ajudar a identificar os desafios contemporâneos é traçada uma linha do tempo da trajetória do grupo no seu contexto histórico. Dentre os principais desafios identificados, destaca-se o de construir uma práxis científica interdisciplinar, intersetorial e participativa, que dialogue e construa conhecimentos com movimentos sociais.

'Health and Environment' is the nucleus of knowledge and practices surrounding the relations between society and nature, mediated by the mode of production and human labor, which help to understand the determination of the health-disease process of different social classes and groups. This paper discusses the challenges to build this field from the perspective of its Thematic Group of the Association of Collective Health. The three core themes of the 2nd Brazilian Symposium on Environmental Health are taken as the theoretical framework for analysis. A timeline of the group's trajectory, in its historical context, helps to identify the contemporary challenges. Among the main challenges identified, the challenge of building an interdisciplinary, intersectoral and participatory scientific practice, which could build knowledge and dialogue with social movements, is highlighted.