Apr 26, 2012 - ABSTRACT. Objectives As part of smoking surveillance, the authors conducted an epidemiologic investigation in southern. Brazil to identify the ...
Downloaded from oem.bmj.com on April 27, 2012 - Published by group.bmj.com
OEM Online First, published on April 26, 2012 as 10.1136/oemed-2011-100307 Environment
ORIGINAL ARTICLE
Epidemiologic investigation of an occupational illness of tobacco harvesters in southern Brazil, a worldwide leader in tobacco production Patrı´cia Bartholomay,1 Betine Pinto Moehlecke Iser,1 Patrı´cia Pereira Vasconcelos de Oliveira,1,2 Tania Esther Herc Holmer dos Santos,3 Deborah Carvalho Malta,2 Jeremy Sobel,4 Lenildo de Moura1,2 1 Field Epidemiology Training Program EPISUS, Health Surveillance Secretariat, Ministry of Health - Brazil, Brasilia, Distrito Federal, Brazil 2 Non-communicable Diseases Coordination, Health Surveillance Secretariat, Ministry of Health - Brazil, Brası´lia, Distrito Federal, Brazil 3 Non-communicable Diseases Coordination, State Center for Health Surveillance, State Health Secretariat, Porto Alegre, Rio Grande do Sul, Brazil 4 Center for Global Health Center, Centers for Disease Control and Prevention - CDC, Atlanta, Georgia, USA
Correspondence to Patrı´cia Bartholomay, Health Surveillance Secretariat, Ministry of Health - Brazil, Setor Comercial Sul, Quadra 4, Bloco A, Edifı´cio Principal, 1 andar, CEP:70304-000, Brasilia, Distrito Federal 70304000, Brazil; patricia.bartholomay@saude. gov.br Accepted 10 March 2012
ABSTRACT Objectives As part of smoking surveillance, the authors conducted an epidemiologic investigation in southern Brazil to identify the occurrence of Green Tobacco Sickness and risk factors for illness and to recommend control and prevention measures. Methods A 1:2 caseecontrol study matched by subjects’ smoking habits. The study population was residents of Candela´ria, Rio Grande do Sul state, who farm tobacco and provided a urine sample for cotinine measurement by high-performance liquid chromatography. Confirmed cases were persons with compatible clinical presentation (headache, nausea, vomit, dizziness or weakness) and cotinine level >10 ng/ml. Controls were persons without compatible signs or symptoms. The association measure was the matched OR with 95% CIs and p10 ng/ml. Controls were persons who presented no signs or symptoms of acute intoxication (headache, nausea, vomiting, dizziness or weakness) during the 7 days preceding interview. Case finding was conducted with the support of the local health services: three family health teams, one basic health unit, one hospital and a team of community health agents. Additionally, we advertised the investigation during the Rural Workers’ Unions radio program’s broadcast on local AM and FM radio stations. Their main audience is farmers residing in the county. For convenience, controls were systematically sought in homes to the left and then to the right of case homes. When more than one eligible potential control was identified in a household, they were listed by alphabetical order, and the control was selected using a random numbers table. Homes without occupant present at the time of the team visit were substituted. Data were collected using a standardised questionnaire about socioeconomic, individual and clinical characteristics, as well as questions on tobacco and pesticide exposure. The questionnaire was completed by the interviewer. Association between biologically plausible exposures and illness was subjected to univariate analysis, and those exposures found to be statistically significantly associated with illness were assessed for independence by conditional logistic regression models. Data analysis was conducted in Epi-info 3.5.1. We used the McNemar c2 test for categorical variables and the 2 of 5
KruskaleWallis test for continuous variables in non-matched analyses. We calculated matched ORs and 95% CIs; p
