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

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

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

PERFIL DOS ÓBITOS NAS INTERNAÇÕES POR DOENÇA FALCIFORME, BRASIL, 2006 a 2017

Introduction: Sickle cell disease is considered a public health problem in Brazil, because despite advances in health care policies, it remains related to the high prevalence of complications, hospitalizations and low life expectancy. Objective: To describe the profile of deaths in hospitalizations in individuals with sickle cell disease in Brazil. Methods: Descriptive and exploratory study, with secondary data from the reduced hospitalization authorizations (AIH) of the Hospital Information System, Unified Health System (HIS-UHS). The variables analyzed were: sex, age group, race, region, death diagnosis (International Classification of Diseases, ICD-10), federation units and days of hospitalization. The absolute and relative frequencies of the variables were analyzed for all deaths due to sickle cell disorders registered, for three-year period, from 2006 to 2017. Results: Deaths increased in the period studied, with a discreet higher proportion among men, in the age group from 31 to 59 years, black people, concentrating on the Southeast and Northeast regions. The causes of death were recorded as the Sickle disorders, as well as the pulmonary and cardiovascular systems complications, with a hospitalization period of 7 days. Conclusion: Deaths among black young adults related to sickle cell disorders indicate that health policy and programs have advanced in the identification and recognition of the problem, but are still unable to prevent complications and early mortality related to illness.Introdução: A Doença Falciforme é considerada um problema de Saúde Pública no Brasil, porque apesar dos avanços das políticas de atenção à saúde, persiste relacionada a elevada prevalência de complicações, de internações e baixa expectativa de vida. Objetivo: Descrever o perfil dos óbitos nas internações de indivíduos com Doença Falciforme no Brasil. Métodos: Estudo descritivo e exploratório, com dados secundários das autorizações de internações reduzidas (AIH) do Sistema de Informações Hospitalares, Sistema Único de Saúde (SIH-SUS). As variáveis analisadas foram: sexo, faixa etária, raça/cor, região, diagnóstico do óbito (Classificação Internacional das Doenças, CID-10), unidades da federação e tempo internação. Foram analisadas as frequências absolutas e relativas das variáveis para a totalidade de óbitos por transtornos falciformes registrados, por triênios, de 2006 a 2017. Resultados: Os óbitos aumentaram no período estudado, com pequena maior proporção entre homens, de 31 a 59 anos, pardos e negros, concentrando-se nas regiões Sudeste e Nordeste. As causas dos óbitos foram registradas como os próprios transtornos falciformes, além de acometimentos dos sistemas pulmonar e cardiovascular, com um tempo de internação de até 7 dias. Conclusão: Os óbitos entre adultos jovens, negros e pardos, relacionados aos transtornos falciformes indicam que a política de saúde e programas avançaram na identificação e reconhecimento do problema, mas ainda não conseguem prevenir as complicações e mortalidade precoce relacionadas ao adoecimento. &nbsp

Dorsalgias e incapacidades funcionais relacionadas ao trabalho: registros do sistema de informação de agravos de notificação (SINAN/DATASUS)

Resumo Introdução: dorsalgias e incapacidades são problemas de saúde do trabalhador com repercussões econômicas e sociais. Objetivo: descrever os casos notificados de dorsalgia e de incapacidade funcional no Brasil. Métodos: estudo de casuística das dorsalgias relacionadas ao trabalho registradas como Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) no Sistema de Informação de Agravos de Notificação (SINAN), Ministério da Saúde, no Brasil, de 2007 a 2012. Calcularam-se as frequências das variáveis sociodemográficas e ocupacionais e os coeficientes de incidência (CI) para as dorsalgias e incapacidades permanentes. Resultados: foram registrados 8.172 casos de dorsalgias no período. O CI da dorsalgia foi 1,1 por 100.000 trabalhadores em 2007 e 1,9 por 100.000 em 2012 e o da incapacidade funcional relacionada ao trabalho foi 0,12 por 100.000 em 2007 e 0,10 por 100.000 em 2012. Trabalhadores de bens e serviços industriais e trabalhadores de serviços/vendedores de loja apresentaram os maiores percentuais para dorsalgias (54,4% e 20,7%) e incapacidade funcional permanente (54,7% e 16,3%). Conclusões: O aumento das notificações das dorsalgias ocupacionais e a redução das incapacidades funcionais representam um avanço em relação ao reconhecimento, diagnóstico, notificação e atenção ao problema, mas continuam representando um desafio para a atenção à saúde dos trabalhadores