RESUMO
Print workers are exposed to organic solvents, of which the systemic toxicant toluene is a main component. Toluene induces expression of cytochrome P450 2E1 (CYP2E1), an enzyme involved in its own metabolism and that of other protoxicants, including some procarcinogens. Therefore, we investigated the association between toluene exposure and the CYP2E1 response, as assessed by mRNA content in peripheral lymphocytes or the 6-hydroxychlorzoxazone (6OH-CHZ)/chlorzoxazone (CHZ) quotient (known as CHZ metabolic ratio) in plasma, and the role of genotype (5 -flanking region RsaI/PstI polymorphic sites) in 97 male print workers. The geometric mean (GM) of toluene concentration in the air was 52.80 ppm (10-760 ppm); 54% of the study participants were exposed to toluene concentrations that exceeded the maximum permissible exposure level (MPEL). The GM of urinary hippuric acid at the end of a work shift (0.041 g/g creatinine) was elevated relative to that before the shift (0.027 g/g creatinine; p < 0.05). The GM of the CHZ metabolic ratio was 0.33 (0-9.3), with 40% of the subjects having ratios below the GM. However, the average CYP2E1 mRNA level in peripheral lymphocytes was 1.07 (0.30-3.08), and CYP2E1 mRNA levels within subjects correlated with the toluene exposure ratio (environmental toluene concentration:urinary hippuric acid concentration) (p = 0.014). Genotype did not alter the association between the toluene exposure ratio and mRNA content. In summary, with further validation, CYP2E1 mRNA content in peripheral lymphocytes could be a sensitive and noninvasive biomarker for the continuous monitoring of toluene effects in exposed persons.
Assuntos
Citocromo P-450 CYP2E1/genética , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Exposição Ocupacional , RNA Mensageiro/genética , Tolueno/toxicidade , Sequência de Bases , Cromatografia Líquida de Alta Pressão , Citocromo P-450 CYP2E1/biossíntese , Primers do DNA , Indução Enzimática , Genótipo , Hipuratos/urina , Humanos , Fenótipo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tolueno/análiseRESUMO
BACKGROUND: The objective of this study was to describe the most prevalent physically disabling conditions for insured workers belonging to the Mexican Social Security Institute (IMSS) in the Valley of Mexico and to identify risk factors for disabling spondyloarthrosis. METHODS: Retrospective cases and prevalent controls from IMSS clinics in the Mexico City metropolitan area were studied. Eighty cases were IMSS workers reporting disability due to spondyloarthrosis; 80 controls were active workers at the same workplace and shared the economic activity of the cases. The 1995 IMSS Disability Report was reviewed. From this report congenital conditions of the musculoskeletal system, obesity, history of trauma, and sociodemographic patient characteristics were assessed. RESULTS: The most important risk factors were a history of spina bifida (odds ratio [OR] = 29.3, 95% confidence interval [95% CI] = 5.3-161; p = 0.0009), supernumerary vertebrae (OR = 21.3, 95% CI = 5.3-95; p = 0.0001), history of low back (lumbar) trauma (OR = 3.9, 95% CI = 1.9-8.3; p = 0.0004), flatfoot (OR = 11.7, 95% CI = 1.9-69, p = 0.02), and obesity (OR = 2.0, 95% CI = 1.06-4.03; p = 0.04). CONCLUSIONS: A history of congenital deformity of the musculoskeletal system, spinal column trauma, and obesity were risk factors most associated with work disability due to spondyloarthrosis.
Assuntos
Lesões nas Costas/diagnóstico , Dor nas Costas/diagnóstico , Adulto , Idoso , Lesões nas Costas/complicações , Lesões nas Costas/epidemiologia , Dor nas Costas/epidemiologia , Estudos de Casos e Controles , Pé Chato/complicações , Humanos , Masculino , México , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Retrospectivos , Fatores de Risco , Disrafismo Espinal/complicações , Coluna Vertebral/anormalidadesRESUMO
Objective. To construct and validate an indicator for evaluating the quality of care for femoral fractures, and to assess the contribution of the quality of health care as a determinant of partial permanent inability secondary to femoral fractures due to occupational accidents. Materials and methods. The study was conducted from January to December 1995 at Mexican Institute of Social Security. The instrument was designed with experts' contribution along different stages and validated using implicit criteria and factorial analysis. A case-control study was then conducted to evaluate the contribution of the quality of care to inability secondary to femoral fractures. Cases were 108 active workers with permanent inability secondary to femoral fracture; controls were 94 active workers with fractu-re of femur but no permanent inability. Logistic regression modeling was used to establish the association between quality of care and partial permanent inability, adjusting by relevant variables. Results. The ultimate indicator of quality of care consisted of the following: Timely care, pre-surgical management, surgical management, and fracture complications. A final score over 229 points meant that the worker had received good quality of care. Workers getting 229 or less points had received poor quality of care. Forty-eight (44 por ciento) cases and 66 (70 por ciento) controls received good quality of medical care. The likelihood of partial permanent inability was almost three times higher among workers given poor quality of care (OR 2.95; 95 por ciento CI 1.5 - 5.5). According to the multivariate model, predictors of partial permanent inability were: Having exposed or epiphysiary fractures, being re-submitted to surgery, having less than 90 days of rehabilitation care, and receiving deficient medical care. Conclusions. The constructed instrument was validated. The level of the quality of care received by workers is a determining factor for the generation of partial permanent inability. In workers having femoral fractures, it is important to consider timely medical care and early rehabilitation, to reduce the high incidence and prevalence of this medical problem in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html