Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions
Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions
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DOI：
10.1136/oemed-2020-106406
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发表时间：
2020-08-01
影响因子：
4.9
通讯作者：
Wegman, David H.
中科院分区：
文献类型：
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作者：
Glaser, Jason;Hansson, Erik;Wegman, David H.
目的 评估尼加拉瓜奇奇加尔帕地区甘蔗收割工人与热应激相关的工作条件的改善是否与肾脏健康状况的改善有关，该地区深受非传统慢性肾病流行的影响。方法 根据我们在 2017-2018 年收获（收获 1）期间的发现，在 2018-2019 收获（收获 2）之前提出了加强休息时间表并改善水合作用和遮荫的建议。然后观察收获期间 2 的实际工作条件。在收获前和收获结束时测量血清肌酐 (SCr)，并使用回归模型比较收获 1 和收获 2 之间三项不同体力工作量的估计肾小球滤过率 (eGFR) 和意外肾损伤（IKI，即 SCr 增加 >= 0.30 mg/dL 或 >= 1.5 倍基线值）的交叉收获变化。与收获期间离开的工人在家中进行了联系，以解决健康工人选择效应。结果 在烧伤的甘蔗切割机中，与收获 1 的数据相比，收获 2 的平均交叉收获 eGFR 降低了 6 mL/min/1.73 m(2)（95% CI 2 至 9 mL/min/1.73 m(2)），IKI 降低了 70%（95% CI 90% 至 50%）。在实施干预措施不太成功的割种机群体中，没有看到这样的改善。结论 从事繁重工作的工人肾损伤风险再次升高。研究结果支持进一步努力，通过改善水、休息和遮荫的机会，防止甘蔗工人和其他热应激工人的肾损伤。应认识到此类干预措施的设计和实施之间的区别。
Objectives To assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin. Methods Based on our findings during the 2017-2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018-2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by >= 0.30 mg/dL or >= 1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect. Results In burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m(2)(95% CI 2 to 9 mL/min/1.73 m(2)) less and IKI was 70% (95% CI 90% to 50%) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation. Conclusion Kidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.