[Health and environment in public policies of tobacco farming municipalities in southern Brazil]

Profile of clinical information in medical records of tobacco farmers in Alagoas, Brazil

Background

The study of the profile of medical records of tobacco growers contributes to discussions on the establishment of diagnosis and its causal correlation with work.

Objective

To investigate the profile of clinical information in medical records of tobacco growers.

Methods

The present was a descriptive field and documentary study, with quantitative approach, of 149medical records of farmers who visited basic health units in rural communities in the municipality of Arapiraca, Alagoas, Brazil, from 2008 to 2013.

Results

About 66% of the investigated population was female, with average age 58.6 years old (standard deviation ±16.4). The most significant clinical complaint found in the records was headache (16.71%), followed by low back pain (10.20%), dysuria or other urinary problems (8.90%) and stomachache (8.30%). Medical diagnoses included gastritis (15.1%), depression (7.1%), anxiety (7.1%), myalgia (7.1%) and arthritis/arthralgia (5.3%). Correlation between clinical complaints and work performed by tobacco growers was registered on one single medical record.

Conclusion

The clinical profile of tobacco growers described in the medical records might be associated with their social and working conditions and related to pesticide and nicotine poisoning. However, the scarcity of information on the environmental and occupational risk context limits the establishment of a causal link. As a function of the relevance of the occupational-clinical conditions of this population of workers, improving medical records is necessary, as the temporal relationship between exposure and outcomes might account for the occurrence of the reported symptoms.

Environmental exposure and effects on health of children from a tobacco-producing region

Children may be environmentally exposed to several hazards. In order to evaluate the health of children living in a tobacco-producing region, different biomarkers of exposure and effect, as well as hematological parameters, were evaluated. Biomarkers of exposure to the following xenobiotics were assessed: pesticides, nicotine, toxic elements, and organic solvents. Oxidative damage markers malondialdehyde (MDA) and protein carbonyls (PCO), vitamin C, microalbuminuria (mALB) levels, and N-acetyl-β-D-glucosaminidase (NAG) activity were also evaluated. Peripheral blood samples and urine were collected from 40 children (6-12 years), at two different crop periods: in the beginning of pesticide applications (period 1) and in the leaf harvest (period 2). The Wilcoxon signed-rank test for paired data was used to evaluate the differences between both periods. Biomarkers of exposure cotinine in urine and blood chromium (Cr) levels were increased in period 1 when compared to period 2. Moreover, a significant reduced plasmatic activity of butyrylcholinesterase (BuChE) was observed in period 2 in relation to period 1. Blood Cr levels were above the recommended by WHO in both evaluations. The biomarkers MDA and PCO as well as the kidney dysfunction biomarker, mALB, presented levels significantly increased in period 1. Additionally, decreased lymphocytes and increased basophils were also observed. Cotinine was positively associated with PCO, and Cr was positively associated with PCO and MDA. The increased Cr levels were associated with decreased lymphocytes and increased basophils. Our findings demonstrate that children environmentally exposed to xenobiotics in rural area may present early kidney dysfunction, hematological alterations, as well as lipid and protein damages, associated with co-exposure to different xenobiotics involved in tobacco cultivation.