Alterações hematológicas induzidas por poluição industrial em moradores e industriários de Cubatão, SP (Brasil)

Foram analisados 496 indivíduos de Cubatão, SP (Brasil), cidade com alto teor de poluição industrial, com o objetivo de verificar alterações hematológicas induzidas por poluentes industriais. Dos estudos citológicos dos eritrócitos dessa população estudada, foram observadas 188 (38%) com alterações, isoladas ou combinadas em um único indivíduo, das quais 26% apresentaram policromatofilia, 24% com pontilhados basófilos, 15% com corpos de Heinz, e 8% com reticulocitose. As freqüências de metahemoglobinemia e sulfohemoglobinemia foram,respectivamente, de 35% e 32% em moradores da vila Parisi - um bairro cercado pela maioria das indústrias de Cubatão - 15% e 5% em operários das indústrias, e 12% e 4% em habitantes de áreas distantes entre 3 e 8 km do polo industrial. Esses resultados indicam que as alterações são causadas por poluentes tóxico-oxidantes e que as conseqüências fisio-patológicas no sangue dos moradores de Cubatão parecem indicar que estão relacionadas com o tempo de exposição e com a proximidade dos focos emissores de poluentes.

Trabalho industrial e câncer de pulmão

Com base em populações hospitalares, foram entrevistados 316 casos e 536 controles para obtenção de informações sobre histórias de trabalho, tabagismo, tabagismo passivo, ocorrência de outros cânceres na família, migração e situação socioeconômica. Os entrevistadores utilizaram um questionário padronizado. Casos e controles foram emparelhados por hospital, sexo e idade. O estudo foi desenvolvido entre 1º de julho de 1990 e 31 de janeiro de 1991 em 14 hospitais da Região Metropolitana de São Paulo, SP (Brasil). Foi elaborada uma classificação por escores como forma de ordenar os indivíduos estudados segundo suas histórias de exposições ocupacionais a cancerígenos, conhecidos para o pulmão, acumulando informações sobre a exposição nos locais de trabalho durante a vida, considerando o tipo de atividade, setor de trabalho e tempo em cada emprego. A análise de regressão logística não-condicional mostrou odds ratio: 1,97 (95% IC: 1,52 a 2,55) para os trabalhadores com maiores escores de exposição. Os resultados permitiram inferir que trabalhadores ligados aos setores de produção de diferentes ramos industriais têm duas vezes o risco de desenvolverem neoplasia pulmonar quando comparados aos trabalhadores envolvidos em atividades não-industriais.

Mortalidade por câncer na região urbano-industrial da Baixada Santista, SP (Brasil)

INTRODUÇÃO: Visando a estudar a relação entre câncer e industrialização analisou-se a evolução da mortalidade por câncer da região na Baixada Santista, SP (Brasil), importante complexo industrial-portuário cujos municípios se agrupam em duas diferentes áreas quanto ao processo de industrialização. MÉTODOS: Selecionaram-se 8.546 óbitos por câncer (CID-9), de indivíduos do sexo masculino acima de dez anos de idade, residentes nos municípios da Baixada Santista, no período de 1980 a 1993. Calcularam-se as taxas de mortalidade padronizada pela população mundial e as respectivas razões entre as taxas para a região e seus estratos: Estrato I (complexo industrial-portuário - Santos, São Vicente, Cubatão e Guarujá), e Estrato II (não industrializado - Praia Grande, Mongaguá, Itanhaém e Peruíbe). RESULTADOS: A taxa anual média de mortalidade da Baixada Santista mostrou ­ se alta (197,9/100.000). Houve diferença estatisticamente significante entre as taxas de mortalidade observadas para os Estratos I e II, respectivamente 209,2 e 146,7/100.000, com razão de 1,42 (IC 1,36 - 1,51). CONCLUSÕES: Supõe-se que a exposição ocupacional e ambiental a agentes químicos carcinogênicos relacionados ao processo produtivo do complexo industrial, vários deles já identificados, sejam fatores importantes na determinação da mortalidade por câncer. Nesse sentido outros estudos epidemiológicos são necessários para melhor caracterizar o excesso de mortalidade na área industrial da região estudada.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES: To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities. METHODS: A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries. RESULTS: Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines. CONCLUSIONS: The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.

Shiftworking families: parents' working schedule and sleep patterns of adolescents attending school in two shifts

OBJECTIVE: To explore whether parents' engagement in shift work affects the sleep habits of their adolescent children who attend school in two shifts. METHODS: The data were drawn from an extensive survey of sleep and daytime functioning of adolescents attending school one week in the morning and the other in the afternoon. The participants were 1,386 elementary and high school students (11-18 years old) whose parents were both employed. The data were analyzed using MANOVA, with parents' work schedule, adolescents' gender and type of school as between-subject factors. RESULTS: Parents' working schedule significantly affected the sleep patterns of high school adolescents. When attending school in the morning, adolescents whose parents were both day workers woke up somewhat later than adolescents with one shiftworking parent. In addition, they slept longer than adolescents whose parents were both shift workers. On weekends, adolescents whose parents both worked during the day went to bed earlier than adolescents whose parents were both shiftworkers. They also had smaller bedtime delay on weekends with respect to both morning and afternoon shifts than adolescents for whom one or both parents worked shifts. A significant interaction between parents' working schedule, adolescents' gender and type of school was found for sleep extension on weekends after afternoon shift school. CONCLUSIONS: Parental involvement in shift work has negative effects on the sleep of high school adolescents. It contributes to earlier wake-up time and shorter sleep in a week when adolescents attend school in the morning, as well as to greater bedtime irregularity.

Desenvolvimento, complexo industrial da saúde e política industrial

O artigo situa a questão da saúde no contexto do desenvolvimento nacional e da política industrial. Tomou-se a idéia de corte estruturalista, marxista e schumpeteriano, onde a indústria e as inovações constituem os elementos determinantes do dinamismo das economias capitalistas e de sua posição relativa na economia mundial. Todos os países que se desenvolveram e passaram a competir em melhores condições com os países avançados associaram uma indústria forte com uma base endógena de conhecimento, de aprendizado e de inovação. Todavia, na área da saúde essa visão é problemática, uma vez que os interesses empresariais se movem pela lógica econômica do lucro e não para o atendimento das necessidades da saúde. A noção de complexo industrial da saúde constitui uma tentativa e fornecer um referencial teórico que permita articular duas lógicas distintas: a sanitária e a do desenvolvimento econômico. O trabalho procurou mostrar, com base em dados de comércio exterior, como a desconsideração da lógica do desenvolvimento nas políticas de saúde levou a uma situação de vulnerabilidade econômica do setor que pode limitar os objetivos de universalidade, eqüidade e integralidade. Nesse contexto, propõe-se uma ruptura cognitiva e política com as visões antagônicas que colocam, de um lado, as necessidades da saúde e, de outro, da indústria. Um país que pretende chegar a uma condição de desenvolvimento e de independência requer, ao mesmo tempo, indústrias fortes e inovadoras, e um sistema de saúde inclusivo e universal.

Factors associated with depression symptoms in high school students in São Paulo, Brazil

OBJECTIVE: To assess factors associated with depression symptoms in high school students. METHODS: A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8%) and unemployed (22.9%) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status. RESULTS: Overall prevalence rate of depression was 7.5%. Rates according to gender were 39 (10.3%) in females and 15 (4.3%) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35). CONCLUSIONS: The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These ndings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

Prevalence and correlates of physical activity among adolescents from Southern Brazil

OBJECTIVE: To estimate the prevalence and identify correlates of physical activity among adolescents. METHODS: Cross-sectional study nested within a cohort of 4,325 subjects from the city of Pelotas, Southern Brazil, aged 14-15 years in 2008. Physical activity was analyzed using three different approaches: (1) prevalence of any leisure-time physical activity; (2) prevalence of any active commuting to school; and (3) prevalence of engaging in at least 300 minutes per week of both (1) and (2) combined. Independent variables included sociodemographic, behavioral, social, and biological characteristics, and number of different leisure-time physical activites practiced. Statistical analyses were carried out using Poisson regression. RESULTS: The proportion of adolescents involved in any type of leisure-time physical activity was 75.6%, while 73.4% displayed some form of active commuting to school. Prevalence of total physical activity score (> 300 min/week) was 48.2%, being greater among boys (62.6%) than among girls (34.5%). Furthermore, prevalence increased along with the number of physical activity modalities practiced (p<0.001). Factors associated with greater physical activity (leisure + commuting) at the recommended levels were: nonwhite skin color, having failed at school, and playing videogames. Lower socioeconomic status, more time spent on the computer, and parental physical activity were associated with the outcome only among girls. CONCLUSIONS: Less than half the adolescents reached recommended levels of physical activity, and this proportion tended to decrease among subjects with higher socioeconomic level. Associated factors were different for leisure-time and commuting. Engaging in a wide variety of physical activities should be encouraged already during childhood.

Efeitos respiratórios da exposição ao talco industrial em ex-trabalhadores de mineração

OBJETIVO: Avaliar efeitos respiratórios tardios da inalação ocupacional de talco contaminado por asbesto. MÉTODOS: Análise de série de casos de 29 ex-trabalhadores de mineração de talco contaminado com asbestos provenientes de Carandaí, MG, atendidos no Centro de Referência Estadual de Saúde do Trabalhador de Minas Gerais em 2004-2005. Os ex-trabalhadores foram submetidos a anamnese clínico-ocupacional, radiografia de tórax e espirometria. Foi criado um escore de exposição que, multiplicado pela duração, originou um índice de exposição cumulativa ao talco. Para verificar a associação do índice de exposição cumulativa com a presença de alterações radiológicas, sugestivas de pneumoconiose e/ou alterações pleurais, foi ajustado um modelo de regressão logística exata. RESULTADOS: Todos os ex-trabalhadores eram homens, com média de idade de 48,2 anos. Nas radiografias de tórax foram encontradas alterações pleurais em três deles, opacidades parenquimatosas compatíveis com pneumoconiose em um e suspeita em seis. Alterações espirométricas ocorreram em três. A regressão logística apontou odds ratio de 1,059 (IC 95%: 1,012;1,125) para o índice acumulado, ou seja, cada unidade no índice resulta em um aumento de 5,9% na chance de apresentar alteração radiológica compatível ou suspeita de pneumoconiose. Em relação à mediana do tempo estimado de latência entre o início da exposição até o diagnóstico das placas pleurais, ocorreu diferença significativa (p = 0,013) entre os casos (27,0 anos) e não casos (14,3 anos). CONCLUSÕES: Os achados apontam a necessidade de controle clínico nos trabalhadores que foram expostos a asbesto, particularmente devido aos efeitos tardios da exposição a esse mineral.

O complexo econômico-industrial da saúde e a dimensão social e econômica do desenvolvimento

O papel estratégico da saúde na agenda de desenvolvimento nacional tem sido crescentemente reconhecido e institucionalizado. Além de sua importância como elemento estruturante do Estado de Bem-Estar Social, a saúde é protagonista na geração de inovação - elemento essencial para a competitividade na sociedade do conhecimento. Contudo, a base produtiva da saúde ainda é frágil, o que prejudica tanto a prestação universal de serviços em saúde quanto uma inserção competitiva nacional em ambiente globalizado. Essa situação sugere a necessidade de uma análise mais sistemática das complexas relações entre os interesses produtivos, tecnológicos e sociais no âmbito da saúde. Consequentemente, é necessário aprofundar o conhecimento sobre o Complexo Econômico-Industrial da Saúde devido ao seu potencial de contribuir para um modelo de desenvolvimento socialmente inclusivo. Isso significa reverter a hierarquia entre os interesses econômicos e os sociais no campo sanitário, e assim minimizar a vulnerabilidade da política de saúde brasileira.

Senses of body image in adolescents in elementary school

OBJECTIVE To comprehend the perception of body image in adolescence. METHODS A qualitative study was conducted with eight focus groups with 96 students of both sexes attending four public elementary school institutions in the city of Rio de Janeiro, Southeastern Brazil, in 2013. An interview guide with questions about the adolescents’ feelings in relation to: their bodies, standards of idealized beauty, practice of physical exercise and sociocultural influences on self-image. In the data analysis we sought to understand and interpret the meanings and contradictions of narratives, understanding the subjects’ context and reasons and the internal logic of the group. RESULTS Three thematic categories were identified. The influence of media on body image showed the difficulty of achieving the perfect body and is viewed with suspicion in face of standards of beauty broadcast; the importance of a healthy body was observed as standards of beauty and good looks were closely linked to good physical condition and result from having a healthy body; the relationship between the standard of beauty and prejudice, as people who are not considered attractive, having small physical imperfections, are discriminated against and can be rejected or even excluded from society. CONCLUSIONS The standard of perfect body propagated by media influences adolescents’ self-image and, consequently, self-esteem and is considered an unattainable goal, corresponding to a standard of beauty described as artificial and unreal. However, it causes great suffering and discrimination against those who do not feel they are attractive, which can lead to health problems resulting from low self-esteem.

Public school teachers’ perceptions about mental health

OBJECTIVE To examine public school teachers’ perceptions about general health and mental health, and the way in which they obtained this information. METHODS Qualitative research was conducted with 31 primary and secondary school teachers at a state school in the municipality of Sao Paulo, SP, Southeastern Brazil, in 2010. The teachers responded to a questionnaire containing open-ended questions about mental health and general health. The following aspects were evaluated: Teachers’ understanding of the terms “health and “mental health,” the relevance of the need for information on the subject, the method preferred for obtaining information, their experience with different media regarding such matters, and perceptions about the extent to which this available information is sufficient to support their practice. The data were processed using the Qualiquantisoft software and analyzed according to the Discourse of the Collective Subject technique. RESULTS From the teachers’ perspective, general health is defined as the proper physiological functioning of the body and mental health is related to the balance between mind and body, as a requirement for happiness. Most of the teachers (80.6%) showed great interest in acquiring knowledge about mental health and receiving educational materials on the subject. For these teachers, the lack of information creates insecurity and complicates the management of everyday situations involving mental disorders. For 61.3% of the teachers, television is the medium that provides the most information on the topic. CONCLUSIONS The data indicate that there is little information available on mental health for teachers, showing that strategies need to be developed to promote mental health in schools.

Pre-harvest cane burning and health: the association between school absences and burning sugarcane fields

The objective of this study was to investigate an association between pre-harvest sugarcane burning and respiratory diseases in children under five years of age. The following data were collected in five schools in the city of Araraquara, SP, Southeastern Brazil, between March and June 2009: daily records of absences and the reasons stated for these absences, total concentration of suspended particulate matter (µg/m3), and air humidity. The relationship between the percentage of school absences due to respiratory problems and the concentration of particulate matter in March and from April to June presented a distinct behavior: absences increased alongside the increase in particulate matter concentration. The use of school absences as indicators of this relationship is an innovative approach.

ERICA: prevalence of asthma in Brazilian adolescents

ABSTRACT OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.

ERICA: leisure-time physical inactivity in Brazilian adolescents

ABSTRACT OBJECTIVE To evaluate the prevalence of leisure-time physical inactivity in Brazilian adolescents and their association with geographical and sociodemographic variables. METHODS The sample was composed by 74,589 adolescents participating in the Study of Cardiovascular Risks in Adolescents (ERICA). This cross-sectional study of school basis with national scope involved adolescents aged from 12 to 17 years in Brazilian cities with more than 100 thousand inhabitants. The prevalence of leisure-time physical inactivity was categorized according to the volume of weekly practice (< 300; 0 min). The prevalences were estimated for the total sample and by sex. Poisson regression models were used to assess associated factors. RESULTS The prevalence of leisure-time physical inactivity was 54.3% (95%CI 53.4-55.2), and higher for the female sex (70.7%, 95%CI 69.5-71.9) compared to the male (38.0%, 95%CI 36.7-39.4). More than a quarter of adolescents (26.5%, 95%CI 25.8-27.3) reported not practicing physical activity in the leisure time, a condition more prevalent for girls (39.8%, 95%CI 38.8-40.9) than boys (13.4%, 95%CI 12.4-14.4). For girls, the variables that were associated with physical inactivity were: reside in the Northeast (RP = 1.13, 95%CI 1.08-1.19), Southeast (RP = 1.16, 95%CI 1.11-1.22) and South (RP = 1.12, 95%CI 1.06-1.18); have 16-17 years (RP = 1.06, 95%CI 1.12-1.15); and belong to the lower economic class (RP = 1.33, 95%CI 1.20-1.48). The same factors, except reside in the Southeast and South, were also associated with not practicing physical activity in the leisure time for the same group. In males, as well as the region, being older (p < 0.001) and declaring to be indigenous (RP = 0.37, 95%CI 0.19-0.73) were also associated with not practicing physical activities in the leisure time. CONCLUSIONS The prevalence of leisure-time physical inactivity in Brazilian adolescents is high. It presents regional variations and is associated with age and low socioeconomic status. Special attention should be given to girls and to those who do not engage in any physical activity during the leisure time, so that they can adopt a more active lifestyle.