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      Symptoms of Neurotoxicity among Carpenters Living in Rural Ecuador: A Population-based Study (The Atahualpa Project)

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          Abstract

          Background:

          There is no information on the prevalence of symptoms related to neurotoxicity among carpenters working in underserved populations. To assess the magnitude of the problem, we conducted a population-based study in Atahualpa, a rural Ecuadorian village, where most men work as carpenters under poor safety conditions.

          Methods:

          All men aged 40–75 years living in Atahualpa were identified during a door-to-door survey and evaluated with a general demographic questionnaire, the Q16 questionnaire, the depression axis of the Depression Anxiety Stress Scale-21, and the Montreal Cognitive Assessment (MoCA).

          Results:

          Among 230 participants, 63% were carpenters. Seventy participants (30%) had a positive Q16 questionnaire (≥6 points), which suggested neurotoxicity. In a logistic regression model adjusted for age, education, alcohol intake, symptoms of depression, and MoCA score, the proportion of Q16 positive persons was 39.1% for carpenters and 15.9% for noncarpenters (odds ratio: 3.53, 95% confidence interval: 1.75–7.15, P < 0.0001). In a generalized linear model, adjusted mean scores in the Q16 questionnaire were 4.9 for carpenters and 3.6 for noncarpenters (β: 1.285, standard error: 0.347, P < 0.0001). There was no correlation between scores in the Q16 questionnaire and the MoCA (Pearson correlation coefficient = −0.02), and the only significant covariate in the multivariate linear model was age, with every 10 years of age difference contributing 0.64 points in the Q16 questionnaire.

          Conclusion:

          This study shows a high prevalence of symptoms associated with neurotoxicity among carpenters after adjusting for a number of confounders. Long-term exposure to toxic solvents is the most likely explanation to this finding.

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          Most cited references11

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          The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates.

          We conducted two studies to examine the dimensions, internal consistency reliability estimates, and potential correlates of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). Participants in Study 1 included 887 undergraduate students (363 men and 524 women, aged 18 to 35 years; mean [M] age = 19.46, standard deviation [SD] = 2.17) recruited from two public universities to assess the specificity of the individual DASS-21 items and to evaluate estimates of internal consistency reliability. Participants in a follow-up study (Study 2) included 410 students (168 men and 242 women, aged 18 to 47 years; M age = 19.65, SD = 2.88) recruited from the same universities to further assess factorial validity and to evaluate potential correlates of the original DASS-21 total and scale scores. Item bifactor and confirmatory factor analyses revealed that a general factor accounted for the greatest proportion of common variance in the DASS-21 item scores (Study 1). In Study 2, the fit statistics showed good fit for the bifactor model. In addition, the DASS-21 total scale score correlated more highly with scores on a measure of mixed depression and anxiety than with scores on the proposed specific scales of depression or anxiety. Coefficient omega estimates for the DASS-21 scale scores were good. Further investigations of the bifactor structure and psychometric properties of the DASS-21, specifically its incremental and discriminant validity, using known clinical groups are needed. © 2012 Wiley Periodicals, Inc.
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            Applicability of the MoCA-S test in populations with little education in Colombia.

            The objectives of this study were to report on the use of the Spanish version of the Montreal Cognitive Assessment (MoCA-S) as cognitive screening tool in a population aged 65 to 74 years in the Andes Mountains of Colombia, assessing the influence of education, and to examine its test-retest reliability.
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              Evaluation of the Q16 questionnaire on neurotoxic symptoms and a review of its use.

              The questionnaire 16 (Q16) is commonly used to study prevalences of neurotoxic symptoms among workers exposed to organic solvents. It has also been recommended that exposed workers reporting more than six symptoms should be referred for further examination of possible chronic toxic encephalopathy. It would be useful to know whether symptoms reported in the questionnaire also reflect impairment of similar functions measured with objective or semiobjective methods in a formerly highly exposed group. 135 painters and 71 carpenters answered the Q16, were interviewed about symptoms compatible with an organic brain damage, and took a battery of psychometric tests. A subsample of 52 painters and 45 carpenters were interviewed for psychiatric diagnosis according to Diagnostic and Statistical Manual for Mental Disorders, 3rd version (DSM III) and their vibration thresholds in hands and feet were measured. The entire group was followed up in the register of diagnoses at early retirement 1971-93. The lifetime exposure to organic solvents was assessed. Current exposure to organic solvents was found to be low or none. The prevalence of people with more than six symptoms in the Q16 rose with increasing cumulative exposure to solvents. The sensitivity of the questionnaire (more than six symptoms) to detect people who were assessed to exhibit symptoms compatible with an organic brain damage was only 38%. One of seven people who had retired early with a diagnosis compatible with a chronic toxic encephalopathy, and two of five people with a psychiatric diagnosis compatible with this condition, had more than six symptoms in the Q16. The agreement between Q16 replies and psychometric test results, as well as other examinations, was low. The notable exposure-response relation indicates that the questionnaire is useful for comparison of groups with different exposures to organic solvents. There was low agreement between the number of symptoms on the questionnaire and the assessment of symptoms compatible with organic brain damage, as well as psychiatric, or early retirement diagnoses compatible with chronic toxic encephalopathy. The questionnaire does not seem useful for screening of patients with chronic toxic encephalopathy in groups without ongoing exposure to organic solvents.
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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                JNRP
                Journal of Neurosciences in Rural Practice
                Medknow Publications & Media Pvt Ltd (India )
                0976-3147
                0976-3155
                Oct-Dec 2017
                : 8
                : 4
                : 649-652
                Affiliations
                [1]School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador
                [1 ]Vanderbilt University Medical Center, Nashville, TN, USA
                [2 ]Community Center, The Atahualpa Project, Atahualpa, Ecuador
                [3 ]Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, USA
                Author notes
                Address for correspondence: Dr. Oscar H. Del Brutto, Air Center 3542, P.O. Box: 522970, Miami, FL, USA. E-mail: oscardelbrutto@ 123456hotmail.com
                Article
                JNRP-8-649
                10.4103/jnrp.jnrp_286_17
                5709893
                345a22d6-c18f-4c50-b4f0-b5ebbda64db0
                Copyright: © 2017 Journal of Neurosciences in Rural Practice

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Short Communication

                Neurosciences
                atahualpa,carpenters,ecuador,neurotoxicity,population-based studies,q16 questionnaire
                Neurosciences
                atahualpa, carpenters, ecuador, neurotoxicity, population-based studies, q16 questionnaire

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