Teses de doutorado

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    Saúde de agricultores do Espírito Santo: a complexa relação entre produção de alimentos, exposição a agrotóxicos e risco à saúde humana
    (Universidade Federal do Espírito Santo, 2019-09-06) Petarli, Glenda Blaser; Salaroli, Luciane Bresciani; https://orcid.org/0000000218810306; http://lattes.cnpq.br/3503255904138561; https://orcid.org/0000-0002-6828-1238; http://lattes.cnpq.br/9303477165627828; Nunes, Bruno Pereira; https://orcid.org/0000-0002-4496-4122; http://lattes.cnpq.br/9657804781475201; Neto, Edson Theodoro dos Santos; https://orcid.org/0000000273517719; http://lattes.cnpq.br/5430137427291413; Faria, Neice Muller Xavier; https://orcid.org/0000-0002-8135-5860; http://lattes.cnpq.br/; Zandonade, Eliana; http://lattes.cnpq.br/0983533134908583; Viana, Maria Carmen Moldes; http://lattes.cnpq.br/4338126917250074
    Introduction: Agricultural work often poses potential health hazards for rural workers, such as increasing exposure to pesticides. The transformations resulting from the mechanization and modernization of agricultural activities also had an impact on the physical, psychological and lifestyle aspects of these workers. Objectives: To assesss occupational exposure to pesticides, risk perception, safety practices along with factors associated with the use of Personal Protective Equipment (PPE) by farmerworkers, as well as to determine the prevalence of multimorbidity, complex multimorbidity and depression in this population. Methodology: This is a cross-sectional analytical epidemiological study conducted with 790 farmerworkers in the municipality of Santa Maria de Jetibá/ES. Data collection took place beyween December 2016 and April 2017. A semi-structured questionnaire was used to collect sociodemographic data, occupational contact with pesticides, lifestyle, clinical condition and job satisfaction. Anthropometric, biochemical and hemodynamic measurements were also undertaken Depressive episodes were identified through the Mini-International Neuropsychiatric Interview. Multimorbidity was defined as the presence of two or more chronic diseases in the same individual and using the complex multimorbidity concept . Results: 106 brands of pesticides, 45 chemical groups and 77 active ingredients were detected and glyphosate was identified as the predominant herbicide. Of the farmerworkers with direct contact with pesticides, approximately 90% reported the use of extremely toxic products, half did not read the pesticide label[s] , more than one third did not observe the grace period and 71.4% did not use PPE or misused it. Among the factors associated with non-use of these equipments are: socioeconomic class (p = 0.002), low education levels (p = 0.05), lack of technical support (p <0.001) and non-reading of labels (p <0.001). . The prevalence of multimorbidity was 41.5% (n = 328) and of complex multimorbidity 16.7% (n = 132). More than 77% of the sample had at least one chronic disease and arterial hypertension, dyslipidemia and depression were the most prevalent morbidities. 40 years or older (OR = 3.33; 95% CI = 2.06 - 5.39), previous diagnosis of pesticide poisoning (OR = 1.89; 95% CI = 1.03 - 3.44), perimeter high waist (OR = 2.82; 95% CI = 1.98 - 4.02) and poorer self-rated health (OR = 2.10; 95% CI = 1.52 - 2.91) significantly increased the chances of multimorbidity. The same associations were found for the diagnosis of complex multimorbidity. Regarding depression, 16.8% (n = 132) of the farmers presented symptoms of major depressive episode, 6% (n = 48) current depressive episode and 10.7% (n = 84) recurrent major depressive episode. The risk factors associated with this condition were: being separated / divorced or widowed (OR = 2.29; 95% CI = 1.12 - 4.70), not owning the land where they work (OR = 1.79; CI95 % = 1.10 - 2.91), job dissatisfaction (OR = 1.89; 95% CI = 1.11 - 3.23), history of pesticide poisoning (OR = 2.66; 95% CI = 1.33 - 5.34), negative self-rated health (OR = 3.14; 95% CI = 1.97 - 4.98) and previous depressive episodes (OR = 7.77; 95% CI = 3.35 - 18.04). Conclusion: Farmerworkers had prolonged occupational exposure to multiple highly toxic pesticides, and reported unsafe handling practices. A high prevalence of multimorbidity and depression was identified in these workers. Factors associated with these conditions are mostly subject to modification and control, such as excessive occupational exposure to pesticides. Sound public policies are needed to prevent, control and monitor the health status of this population.