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Bastos MLA, Silva de Carvalho TG, Mattos Lacerda E, Monteiro Ferreira MJ. Absenteeism Due to Mental Disorders in Agents Fighting Endemic Diseases in Ceará/Northeast Brazil. J Occup Environ Med 2023; 65:e534-e537. [PMID: 37167963 DOI: 10.1097/jom.0000000000002881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study is to quantify the days away from work by mental disorders (MDs) in endemic fighting agents (EFAs) in the state in Northeast Brazil. METHODS This is a historical cohort carried out from the survey of 584 expert medical records of EFA. The association measures were performed using Poisson regression models. RESULTS The days away from work increased over time. Endemic fighting agents who have been on sick leaves by mood disorders ([cumulative incidence like relative risk (IRR)], 21.37; 95% CI, 12.36-36.93), alcoholism (IRR, 17.12; 95% CI, 10.04-29.34), and stress-related disorders (IRR, 10.32; 95% CI, 6.05-17.63) have a higher risk of absenteeism longer than 15 days. CONCLUSION This study reinforces the importance of actions for coping with MD in EFA.
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Affiliation(s)
- Maria Luiza Almeida Bastos
- From the Federal University of Ceará, Medical School, Fortaleza, Ceará, Brazil (M.L.A.B., T.G.S.C., M.J.M.F.); and London School of Hygiene and Tropical Medicine, London, United Kingdom (E.M.L.)
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Brellier F, Pujades-Rodriguez M, Powell E, Mudie K, Lacerda EM, Nacul L, Wing K. Correction: Incidence of Lyme disease in the United Kingdom and association with fatigue: A population-based, historical cohort study. PLoS One 2022; 17:e0274408. [PMID: 36067190 PMCID: PMC9447894 DOI: 10.1371/journal.pone.0274408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Brellier F, Pujades-Rodriguez M, Powell E, Mudie K, Mattos Lacerda E, Nacul L, Wing K. Incidence of Lyme disease in the United Kingdom and association with fatigue: A population-based, historical cohort study. PLoS One 2022; 17:e0265765. [PMID: 35320297 PMCID: PMC8942220 DOI: 10.1371/journal.pone.0265765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Estimations of Lyme disease incidence rates in the United Kingdom vary. There is evidence that this disease is associated with fatigue in its early stage but reports are contradictory as far as long-term fatigue is concerned. Methods and findings A population-based historical cohort study was conducted on patients treated in general practices contributing to IQVIA Medical Research Data: 2,130 patients with a first diagnosis of Lyme disease between 2000 and 2018 and 8,510 randomly-sampled patients matched by age, sex, and general practice, followed-up for a median time of 3 years and 8 months. Main outcome measure was time to consultation for (1) any fatigue-related symptoms or diagnosis; or (2) myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Adjusted hazard ratios (HRs) were estimated from Cox models. Average incidence rate for Lyme disease across the UK was 5.18 per 100,000 person-years, increasing from 2.55 in 2000 to 9.33 in 2018. In total, 929 events of any types of fatigue were observed, leading to an incidence rate of 307.90 per 10,000 person-years in the Lyme cohort (282 events) and 165.60 in the comparator cohort (647 events). Effect of Lyme disease on any subsequent fatigue varied by index season: adjusted HRs were the highest in autumn and winter with 3.14 (95%CI: 1.92–5.13) and 2.23 (1.21–4.11), respectively. For ME/CFS, 17 events were observed in total. Incidence rates were 11.76 per 10,000 person-years in Lyme patients (12 events) and 1.20 in comparators (5 events), corresponding to an adjusted HR of 16.95 (5.17–55.60). Effects were attenuated 6 months after diagnosis but still clearly visible. Conclusions UK primary care records provided strong evidence that Lyme disease was associated with subsequent fatigue and ME/CFS. Albeit weaker on the long-term, these effects persisted beyond 6 months, suggesting patients and healthcare providers should remain alert to fatigue symptoms months to years following Lyme disease diagnosis.
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Affiliation(s)
| | | | - Emma Powell
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathleen Mudie
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eliana Mattos Lacerda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luis Nacul
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- British Columbia Womens Hospital and Health Centre, Complex Chronic Diseases Program, Vancouver, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kevin Wing
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Westermeier F, Lacerda EM, Scheibenbogen C, Sepúlveda N. Editorial: Current Insights Into Complex Post-infection Fatigue Syndromes With Unknown Aetiology: The Case of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Beyond. Front Med (Lausanne) 2022; 9:862953. [PMID: 35280890 PMCID: PMC8907997 DOI: 10.3389/fmed.2022.862953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
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de Carvalho TGS, Araújo LF, Lima EDP, de Andrade ALA, Bastos MLA, Lacerda EM, Ferreira MJM. Burden and Protection: Heterogeneous Effects of Occupational and Operational Stressors on Burnout Dimensions Among Firefighters. J Occup Environ Med 2021; 63:e899-e904. [PMID: 34608892 DOI: 10.1097/jom.0000000000002398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the association between occupational stressors and Burnout dimensions among Brazilian firefighters. METHOD A cross-sectional study about firefighters (n = 237) was developed in Fortaleza, Northeast of Brazil. Logistic regression analysis was applied to investigate the association between high strain (high demand and low job control), low social support, high operational exposure, and Burnout dimensions (emotional exhaustion, depersonalization, and low personal accomplishment). RESULTS High strain was associated to emotional exhaustion (odds ratio [OR] = 11.65; 95% confidence interval [CI]: 3.92 to 34.60) and depersonalization (OR = 5.43; 95% CI: 2.03 to 14.58). Low social support was associated to emotional exhaustion (OR = 2.86; 95% CI: 1.24 to 6.60) and low personal accomplishment (OR = 2.59; 95% CI: 1.36 to 4.93). High operational exposure did not increase the odds of emotional exhaustion and depersonalization and decreased the odds of low personal accomplishment (OR = 0.31; 95% CI: 0.10 to 0.94). CONCLUSION The study highlights the heterogeneous effects that operational and organisational stressors have on each dimension of Burnout.
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Affiliation(s)
- Thalyta Gleyane Silva de Carvalho
- Post Graduated Program in Public Health, School of Medicine, Federal University of Ceará (Dr Carvalho, Dr Araújo, Dr Bastos, Dr Ferreira); Post Graduated Program in Public Health, Federal University of Minas Gerais (Dr Lima); Military Fire Department of Minas Gerais (Dr Lima); Military Fire Department of Ceará (Mr Andrade), Brazil; London School of Hygiene & Tropical Medicine (Dr Lacerda, Dr Ferreira), London City, United Kingdom
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Gonçalves-Macedo L, Lacerda EM, Markman-Filho B, Lundgren FLC, Luna CF. Trends in morbidity and mortality from COPD in Brazil, 2000 to 2016. ACTA ACUST UNITED AC 2019; 45:e20180402. [PMID: 31778424 PMCID: PMC7447544 DOI: 10.1590/1806-3713/e20180402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022]
Abstract
Objective: To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models. Methods: This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017. Results: Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated. Conclusions: In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.
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Affiliation(s)
- Liana Gonçalves-Macedo
- . Serviço de Pneumologia, Hospital Otávio de Freitas, Secretaria de Saúde do Estado de Pernambuco, Recife (PE) Brasil
| | - Eliana Mattos Lacerda
- . Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brivaldo Markman-Filho
- . Serviço de Cardiologia, Departamento de Clínica Médica, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | - Carlos Feitosa Luna
- . Departamento de Estatística e Geoprocessamento, Fundação Oswaldo Cruz - Fiocruz - Recife (PE) Brasil
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Nacul LC, Mudie K, Kingdon CC, Clark TG, Lacerda EM. Hand Grip Strength as a Clinical Biomarker for ME/CFS and Disease Severity. Front Neurol 2018; 9:992. [PMID: 30538664 PMCID: PMC6277492 DOI: 10.3389/fneur.2018.00992] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/05/2018] [Indexed: 01/19/2023] Open
Abstract
Background: The diagnosis of myalgic encephalomyelitis (ME/CFS) in research and clinical practice has largely relied on clinical history, which can be subjective in nature. Clinical signs are often subtle, overlap with other conditions, and are not formally included as part of diagnostic workup. The characterization of clinical signs and biomarkers is needed for better diagnosis and classification of patients and to monitor treatment response. Hand grip strength (HGS) has been used as an objective measure of muscle strength and fatigue, which is a primary symptom of ME/CFS. We assessed the potential usefulness of HGS as a diagnostic marker in ME/CFS. Methods: We compared HGS measurements from participants in the UK ME/CFS Biobank, with groups consisting of people with ME/CFS of differing severity (n = 272), healthy (n = 136), multiple sclerosis (n = 76) controls, and others with chronic fatigue not meeting the diagnosis of ME/CFS (n = 37). We correlated the maximum and minimum of, and differences between, 3 repeated HGS measurements with parameters of disease severity, including fatigue and pain analog scales, and physical and mental component summaries from the SF-36v2TM questionnaire across recruitment groups. Results: HGS indicators were associated with having ME/CFS, with magnitudes of association stronger in severely affected than in mild/moderately affected patients. Compared with healthy controls, being severely affected was associated with a reduction in minimum HGS of 15.3 kg (95%CI 19.3-11.3; p < 0.001), while being mild/moderately affected was associated with a 10.5 kg (95%CI 13.2-7.8; p < 0.001) reduction. The association persisted after adjusting for age, sex and body mass index. ME/CFS cases also showed lower values of maximum HGS and significant drops in values from the first to second and third trials, compared to other study groups. There were significant correlations between HGS indicators and clinical parameters of disease severity, including fatigue analog scale (Spearman's Rho = -0.40, p < 0.001), pain analog scale (Rho = -0.38, p < 0.001), and physical component summary (Rho = 0.42, p < 0.001). Discussion: HGS is markedly reduced in ME/CFS, particularly in patients with more severe disease, and may indicate muscle and fatigue related symptoms. HGS is a potential diagnostic tool in ME/CFS, and could also be used to enhance patient phenotyping and as an outcome measure following interventions.
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Affiliation(s)
- Luis Carlos Nacul
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathleen Mudie
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Caroline C Kingdon
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Taane G Clark
- Department of Infectious Disease Epidemiology, Faculty of Infectious and Tropical Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eliana Mattos Lacerda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Costa RDO, Silva JP, Lacerda EM, Dias R, Pezolato VA, Silva CAD, Krinski K, Correia MADV, Cieslak F. Overweight effect on spirometric parameters in adolescents undergoing exercise. Einstein (Sao Paulo) 2017; 14:190-5. [PMID: 27462892 PMCID: PMC4943352 DOI: 10.1590/s1679-45082016ao3612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/08/2016] [Indexed: 05/29/2023] Open
Abstract
Objective To evaluate effects of overweight on spirometric parameters in adolescents who underwent bronchial provocation test for exercise. Methods We included 71 male adolescents. The diagnosis of asthma was done based on participants’ clinical history and on the International Study Questionnaire Asthma and Allergies in Childhood, and the diagnosis of obesity was based on body mass index above 95th percentile. The bronchospasm induced by exercise was assessed using the run-walk test on a treadmill for eight minutes. The decrease in forced expiratory volume in one second > or equal to 10% before exercise was considered positive, and to calculate the intensity in exercise-induced bronchospasm we measured the maximum percentage of forced expiratory volume in one second and above the curve area. Data analysis was carried out using the Mann-Whitney U test and Friedman test (ANOVA), followed by Wilcoxon test (p<0.05). In addition, we used Fisher’s exact test to analyze the exercise-induced bronchospasm frequency. Results Significant differences were observed among obese adolescents in exercise-induced bronchospasm frequency (p=0,013) and in relation to time required for recovery after exercise (p=0,007). Conclusion Overweight can influence the increase in the exercise-induced bronchospasm frequency in non-asthmatic adolescents compared with eutrophic adolescents.
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Affiliation(s)
| | | | | | - Rodrigo Dias
- Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
| | | | | | - Kleverton Krinski
- Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
| | | | - Fabrício Cieslak
- Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil
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Rodrigues CR, Motta SS, Cordeiro AA, Lacerda EM, Reichenheim ME. [Prevalence of iron deficiency anemia and risk indicators in children from 12 to 18 months attended at the outpatient clinic of Instituto de Puericultura e Pediatria Martagão Gesteira]. J Pediatr (Rio J) 1997; 73:189-94. [PMID: 14685415 DOI: 10.2223/jped.538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The prevalence of iron deficiency anemia and the associated risk indicators were studied in children from 12 to 18 months at the outpatient unit of IPPMG, in order to evaluate and monitor the service. METHODS This is a cross-sectional descriptive study of 288 children seen at the outpatient unit of IPPMG, from January to December 1993. Anemia was diagnosed by dosage of seric hemoglobin. The studied risk indicators were: prenatal care, birth weight, pediatric follow-up, socio-economic aspects, breast-feeding pattern, nutritional status, and iron prescription. Data were computerized and analyzed by EPIINFO and EGRET softwares. Statistical analysis was performed by Pearson chi(2), and breast-feeding pattern was analyzed by the Kaplan-Meier survival curves. RESULTS Fifty percent of all children had anemia and 13.2% had severe anemia. Children had an early entry to follow-up at the clinic, and the number of consultations was adequate, according to the recommendations of the Ministry of Health. Only 27% of families had a "per capita" income above one minimum salary, although most had adequate housing and environmental conditions. The median duration of breast-feeding was 7.8 and of exclusive breast-feeding was 3.2 months. No association between anemia and income, early weaning, low-birth weight or undernutrition was found. CONCLUSION The prevalence of anemia was extremely high, indicating the need for a specific monitoring system for the occurrence of iron deficiency anemia in this service.
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Affiliation(s)
- C R Rodrigues
- Pediatra do Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro
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