Perfil sociodemográfico, clínico e ocupacional de agricultores expostos a agrotóxicos e neoplasias hematológicas : um estudo no Rio Grande do Sul.

Abstract

The population groups most exposed to pesticides are the agricultural sectors and agricultural communities. Studies have been analyzing whether occupational exposure to some types of pesticides may contribute to the development of cancer, especially for hematological malignancies, since the cancer presents as a multifactorial disease, which may be the result of genetic factors, associated with an individual's lifestyle, as well as exposure to environmental factors and carcinogens substances. Objective: To analyze the relationship between the variables of the social demographic, clinical and occupational profile of farmers exposed to pesticides with the presence of hematological neoplasm. Article 1: Farmers affected by hematological neoplasms and exposed to pesticides: a study in southern Brazil. Objective: To analyze the relationship between the variables of the social demographic, clinical and occupational profile of farmers exposed to pesticides with the presence of hematological neoplasm. Method: Prospective, quantitative and descriptive cross-sectional study. Data were collected from farmers being treated at a reference oncology unit. The collection instrument was a questionnaire with variables such as sex, age, municipality and area of residence, education, smoking, alcoholism, income, medical diagnosis, time of illness, family history of cancer, relationship with work, age of onset in agriculture , time as a farmer, which agricultural products are grown, use of individual safety equipment, which pesticides are used, how the packaging of these products has been discarded, daily working hours in the fields, pesticide poisoning and discomfort after work. The data were tabulated and later analyzed using the Statistical Package for the Social Sciences software (version 25.0). Descriptive statistical analysis was used, with the results expressed as average, standard deviation, frequency and percentage. One-Way ANOVA (normal distribution) and Kruskal-Wallis test (non-normal distribution) were used to compare means. For categorical variables, the Chi-Square test was used, considering p <0.05. To calculate the estimate of the odds ratio between the groups, Multinomial Logistic Regression was used. Results: Of the 72 farmers with neoplasms, the low level of education of the participants (87.4%) stands out, the period of more than 30 years of exposure to pesticides by the majority (62.3%), as well as the early start in activities agricultural (95.8%). The lack of use of PPE frequently (71.1%) and the large number of farmers who used more than two different types of pesticides (66.6%). Regarding cultivation, as expected, the large proportion of tobacco producers (72.2%) and the small amount of yerba mate producers (13.9%) called attention, which may suggest that in the region where this plant is grown, the number of hematological neoplasms is lower. It was possible to identify a positive association with the health region and with the cultivation of tobacco with the presence of hematological neoplasms. When related to previous comorbidities with hematological neoplasms, depression showed a significant difference (p = 0.026). The use of the types of pesticides was also compared and a significant difference was observed regarding the initial age in agriculture (p = 0.027), daily working hours (p = 0.035) and tobacco cultivation (p≤0.01). Conclusion: The low level of education of the participants, the early start in agricultural activities, the use of different types of pesticides by the majority, the long period of exposure to pesticides and the non-use of PPE were the characteristics of the profile of farmers affected by hematological neoplasms. Among the findings of the study, it stands out that there was statistical significance in the analysis of the associations between the variables tobacco cultivation and the location of the farmers' health region with the existence of the disease, suggesting a possible relationship between them. Statistical significance was also found when comparing the initial age in agriculture and the daily working hours with the use of different types of pesticides, suggesting that the younger the age and the more daily working hours, the greater the consumption of different types of pesticides. Article 2: Health problems in agricultural workers occupationally exposed to pesticides. Objective: describe the health problems related to occupational exposure to agrochemicals in rural workers. Method: Descriptive study characterized as an integrative literature review, using as data source articles published in journals indexed in Lilacs, Scielo and PubMed, from January 2015 to October 2018, with the following health descriptors: “Agrochemicals”, “occupational health”, “occupational exposure” and “farmers”. We investigated the health problems identified in rural workers due to occupational exposure to pesticides. Results: The research resulted in 35 articles, with studies conducted in various countries and continents of the world, in which evidence of the vulnerability of this population is predominant, especially regarding the misuse of personal safety equipment and the lack of knowledge of their correct use. Several health problems were investigated and in most studies, there was a positive relationship between pesticide use and the development of these problems, including cancer. Conclusion: The accomplishment of this review made it possible to find studies that showed human health problems related to occupational exposure to agrochemicals in rural workers in several countries around the world. In addition, it was notice that there is a concern in conducting research that identifies these diseases. Thus, the articles in this review show damage to farmers' health due to excessive exposure to pesticides during their work activities. These damages are mainly related to hematological changes, respiratory problems, endocrine changes and neurotoxicity, infertility and, with greater concern, risk for the development of some types of cancer. Article 3: Hematological neoplasms and exposure to pesticides: relationship with rural work. Objective: To describe evidence and associations found in the literature between the use of pesticides and hematological malignancies among rural workers. Results: The neoplasms and hematological neoplasms were contextualized. The incidence of neoplasms in Brazil is increasing over the years. Farmers' exposure to pesticides can lead to health problems. Studies suggest the association of this exposure with the development of some cancers, including hematologic neoplasms. Conclusion: It is concluded that further studies are needed to address evidence and associations between pesticide use and hematological malignancies in rural workers and to investigate this relationship, especially in Brazil. Final considerations: Through the results obtained in this master's research, it was evidenced that the occupational activity of farmers involves a high exposure of these workers to pesticides, leaving them vulnerable to acute or chronic intoxications; that pesticides are responsible for damage to health; the level of education of these workers is low, with the majority not having completed primary school, thus making it difficult to understand the reading of labels and packaging of these products, being a facilitator for intoxications and their improper use; PPE is not used properly and often. It was noticed that there is awareness of the danger of the use of products by farmers, but that there is no care or safety practices at work. In addition, there are relationships between variables of farmers undergoing cancer treatment diagnosed with hematological neoplasms, such as the health region where they are located and the cultivation of tobacco. Thus, it is believed that the results were important and showed that more variables need to be investigated and that more studies in the area are important in investigating the association of exposure to pesticides with the presence of hematological neoplasms. Even so, it is important to note that there was no intention to prove the direct relationship between pesticide use and hematological neoplasms due to the multifactorial causes of the disease, however, one must pay attention to these research results.