RESUMO
BACKGROUND: Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. METHODS: We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. RESULTS: The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30-49 years: OR = 2.38, 95% CI 1.03-5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14-25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18-5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. CONCLUSION: Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.
Assuntos
Insuficiência Renal Crônica , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Prevalência , Autorrelato , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , América Central/epidemiologia , Doenças Renais Crônicas Idiopáticas , Sri Lanka/epidemiologiaRESUMO
OBJECTIVE: Identify the psychometric properties of a measure of Employment Precariousness (EP) in six Central American Spanish-speaking countries (Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama) through the items of the EPRES scale (Employment Precariousness Scale) included in the II Central American Survey of Working Conditions and Health (II ECCTS) of 2018. METHODS: The sample was 3,782 salaried persons, aged 18 and older, formal and informal, who participated in the II ECCTS. An EP measure of 10 items was constructed, grouped in the dimensions of temporality, salary, labor rights, and exercise of these rights. RESULTS: The sample was composed mostly of men, with a permanent contract, with a working age of between 2 to 5 years, a salary between $301 and $500s, who have labor rights and who exercise them. The factorial structure could not be verified. However, nine of the ten articles showed a high factorial load with their dimensions. A high acceptability of the EP measure was observed, and the Cronbach's Alpha coefficients of the dimensions were between 0.59 and 0.72, except for temporality (0.30). The reliability of the total scale was 0.68 and the EP patterns in women, youth, temporary and lower income countries were as expected. CONCLUSIONS: The EP measure constructed from the items available from the EPRES scale in the II ECCTS questionnaire shows acceptable psychometric properties to approximate the epidemiological quantification of job insecurity in Central America.
OBJETIVO: Establecer las propiedades psicométricas de una medida de Precariedad Laboral (PL) en seis países centroamericanos de habla española (Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua y Panamá) mediante un conjunto de ítems incluidos en la II Encuesta Centroamericana de Condiciones de Trabajo y Salud (II ECCTS) de 2018 que se correspondían con ítems de la Escala de Precariedad Laboral (EPRES). Método: A partir de una muestra de 3.782 personas asalariadas de 18 años o más, formales e informales, en la II ECCTS, se construyó una medida de PL de 10 ítems representando cuatro dimensiones: temporalidad, salario, derechos y ejercicio de derechos. RESULTADOS: La muestra estuvo compuesta en su mayoría por hombres, con contrato permanente, con antigüedad laboral de entre 2 a 5 años, un salario entre 301 a 500 dólares, que reportaban tener derechos laborales y ejercerlos. La estructura factorial no pudo ser comprobada. Sin embargo, nueve de los diez ítems arrojaron alta carga factorial en sus dimensiones correspondientes. Se observó una alta aceptabilidad de medida de PL y los coeficientes de Alpha de Cronbach de las cuatro dimensiones fueron >0,59 excepto para temporalidad (0,30). La confiabilidad de la escala fue de 0,68 y los patrones de PL en mujeres, jóvenes, temporales y países con menores ingresos fueron los esperados. Conclusiones: La medida de PL construida a partir de ítems disponibles de la escala EPRES en el cuestionario de la II ECCTS evidencia propiedades psicométricas aceptables para aproximarnos a la cuantificación epidemiológica de la precariedad laboral en Centroamérica.
Assuntos
Emprego , Humanos , Adolescente , Masculino , Feminino , Psicometria/métodos , Reprodutibilidade dos Testes , América Central , Inquéritos e QuestionáriosRESUMO
The aim of this study was to evaluate heat exposure, dehydration, and kidney function in rice workers over the course of three months, in Guanacaste, Costa Rica. We collected biological and questionnaire data across a three-month-period in male field (n = 27) and other (n = 45) workers from a rice company where chronic kidney disease of unknown origin (CKDu) is endemic. We used stepwise forward regression to determine variables associated with estimated glomerular filtration rate eGFR at enrollment and/or change in eGFR, and Poisson regression to assess associations with incident kidney injury (IKI) over the course of three months. Participants were 20−62 years old (median = 40 in both groups). Dehydration was common (≥37%) in both groups, particularly among other workers at enrollment, but field workers were more exposed to heat and had higher workloads. Low eGFR (<60 mL/min/1.73 m2) was more prevalent in field workers at enrollment (19% vs. 4%) and follow-up (26% vs. 7%). Field workers experienced incident kidney injury (IKI) more frequently than other workers: 26% versus 2%, respectively. Age (ß = −0.71, 95%CI: −1.1, −0.4), current position as a field worker (ß = −2.75, 95%CI: −6.49, 0.99) and past work in construction (ß = 3.8, 95%CI: −0.1, 7.6) were included in the multivariate regression model to explain eGFR at enrollment. The multivariate regression model for decreased in eGFR over three month included current field worker (ß = −3.9, 95%CI: −8.2, 0.4), current smoking (ß= −6.2, 95%CI: −13.7−1.3), dehydration (USG ≥ 1.025) at both visits (ß= −3.19, 95%CI: −7.6, 1.2) and pain medication at follow-up (ß= −3.2, 95%CI: −8.2, 1.95). Current fieldwork [IR (incidence rate) = 2.2, 95%CI 1.1, 5.8) and being diabetic (IR = 1.8, 95%CI 0.9, 3.6) were associated with IKI. Low eGFR was common in field workers from a rice company in Guanacaste, and being a field worker was a risk factor for IKI, consistent with the hypothesis that occupational heat exposure is a critical risk factor for CKDu in Mesoamerica.
Assuntos
Oryza , Insuficiência Renal Crônica , Adulto , Costa Rica/epidemiologia , Desidratação/complicações , Desidratação/epidemiologia , Fazendeiros , Feminino , Taxa de Filtração Glomerular , Temperatura Alta , Humanos , Rim , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Adulto JovemRESUMO
Objectives. To analyze changes in occupational health inequity between 2011 and 2018 among workers in Central America. Methods. Data were collected by face-to-face interviews at the workers' homes for the 2 Central America Working Conditions Surveys (n = 12 024 in 2011 and n = 9030 in 2018). We estimated health inequity gaps by means of absolute and relative population attributable risks and the weighted Keppel index. We stratified all analyses by gender. Results. Between 2011 and 2018, the proportion of workers reporting poor self-perceived health decreased both in women (from 32% to 29%) and men (from 33% to 30%). However, the health inequity gaps remained wide in the 4 stratifiers. Measured by the Keppel index, health inequity gaps between countries increased from 22% to 39% in women and from 20% to 29% in men. Conclusions. While health improved between 2011 and 2018, health inequity gaps remained wide. Wider health inequity gaps were observed between countries than by gender, age, occupation, or education. Public Health Implications. This first benchmark of occupational health inequities in Central America could be useful when developing and evaluating the impact of public policies on work.
Assuntos
Disparidades nos Níveis de Saúde , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Saúde Ocupacional , Adolescente , Adulto , Idoso , Etarismo , América Central/epidemiologia , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Ocupações , Percepção , Pesquisa Qualitativa , Distribuição por Sexo , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: The constant increase on the psychosocial demands experienced at work seems to contribute to the increase in health problems such as musculoskeletal pain (MSP). This association may be especially important in low-income and middle-income countries, where there is a large proportion of informal workers among whom there is little research. We analysed the association between psychosocial work risk factors and MSP among formal and informal workers using the First Central American Survey of Working Conditions and Health. METHODS: This is a representative sample (n=12 024) of the economically active population of the six Spanish-speaking countries of Central America. Prevalence ratios (PR) and corresponding 95% CIs from Poisson regression models were used to estimate the association between psychosocial work risk factors and the MSP. RESULTS: Compared with formal workers, informal workers reported higher prevalence of MPS in the body regions analysed (ie, cervicodorsal, lumbosacral, upper extremities) and higher exposure to psychosocial work risk factors. However, on the whole, the associations between the exposure to psychosocial work risk factors and the prevalence of MSP were similar for both formal and informal workers. Only the association between exposure to high demands and MSP in the upper extremities was higher (p=0.012) among formal (PR=1.69, 95% CI 1.46 to 1.96) than among informal workers (PR=1.40; 95% CI 1.30 to 1.51). CONCLUSION: Exposure to adverse levels of psychosocial work risk factors is associated with higher prevalence of MPS among both formal and informal workers. However, the role of employment informality in this association is complex and requires further examination.