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1.

Condiciones de salud y laborales de la población trabajadora informal en situación de desplazamiento de Bucaramanga, Colombia/ Health conditions and work of the informal working population in displacement Bucaramanga, Colombia

Ardila Jaimes, Claudia Patricia; Rodriguez Amaya, Reynaldo Mauricio
| Idioma(s): Español
Introducción: el trabajo informal se ha convertido en la forma de sustento de las personas en condición de desplazamiento en el pais; el hecho de que muchos no cuenten con cobertura de calidad dentro del sistema de salud y no están dentro del sistema de riesgos laborales, conduce a que carezcan de detecciónn, analisis y control del riesgo en salud fisica, mental y laboral, haciéndolos mas vulnerables y reduciendo su calidad de vida. Métodos: se realizó un estudio de corte transversal, donde la población seleccionada fueron personas en situación de desplazamiento forzado y mayores de edad de la ciudad de Bucaramanga. El tamaño de muestra 741 personas; el tipo de muestreo no probabilistico. A los participantes se les aplicó un instrumento validado que pretendió a medir variables socio-demograficas, socioeconomicas, de salud y laborales. Resultados: en la muestra predomin el género femenino con 64%; relativo a escolaridad 31% no han completado la primaria. El mayor motivo para ser desplazado es el factor violencia con 94%. En salud, 32% tienen sobrepeso y12% son obesos. En percepción de salud, cerca del 20% la catalogan como muy buena o excelente y 38,6% la perciben como regular. En hábitos tóxicos 30% son o fueron fumadores, y 32% reportaron consumir bebidas alcohólicas. En aspectos laborales el sector donde mas se labora fue comercio (39%) y servicios (37%). Sobre seguridad ocupacional, 12% tuvieron por lo menos un accidente de trabajo en los 12 meses previos a la encuesta, 53% perciben su lugar de trabajo como inseguro y 80% no cuentan con suministros de elementos de protección personal.Conclusiones: la población trabajadora informal desplazada de Bucaramanga es una población joven, adulta, en su mayor a mujeres, con limitadas condiciones de salud y precarias condiciones de trabajo, en donde se requiere de manera urgente estrategias de mejoramiento que brinden garantías para disminuir su vulnerabilidad. (AU)
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2.

German health-related environmental monitoring: assessing time trends of the general population's exposure to heavy metals.

Becker K; Schroeter-Kermani C; Seiwert M; Rüther M; Conrad A; Schulz C; Wilhelm M; Wittsiepe J; Günsel A; Dobler L; Kolossa-Gehring M
| Idioma(s): Inglés
The German system of a health-related environmental monitoring is based upon two instruments: The German Environmental Survey (GerES) and the Environmental Specimen Bank (ESB). The ESB is a tool to describe time trends of human exposure. Each year approx. 500 students from 4 sampling locations are analysed for their heavy metal contents in blood, blood plasma, and urine. GerES is a nationwide representative cross-sectional study that has been conducted four times up to now. Both instruments have been used to measure heavy metals over the last decades and thus provide complementary information. Both instruments are useful to describe time trends. However, combining the two has an added value, which is demonstrated for heavy metals for the first time in this paper. Major results and the changing importance of sources of exposure to heavy metals (Pb, Cd, Hg, Au, Pt, U and Ni) are shown. This leads to the following conclusion about the today's relevance of exposure in Germany. For the study participants of the city of Muenster, lead in whole blood decreased from about 70 µg/l in 1981 to levels below 15 µg/l in 2009. GerES data of young adults confirmed this time trend and GerES IV on children revealed the decreasing relevance of lead in outdoor air and in drinking water. The concentrations of mercury in urine decreased because in Germany it is no longer recommended to use amalgam fillings for children. However, GerES IV and ESB data also demonstrate that despite the decline of these heavy metals exposures to nickel and uranium originating from drinking water are still of importance.
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3.

Exploration of health risks related to air pollution and temperature in three Latin American cities.

Romero-Lankao P; Qin H; Borbor-Cordova M
| Idioma(s): Inglés
This paper explores whether the health risks related to air pollution and temperature extremes are spatially and socioeconomically differentiated within three Latin American cities: Bogota, Colombia, Mexico City, Mexico, and Santiago, Chile. Based on a theoretical review of three relevant approaches to risk analysis (risk society, environmental justice, and urban vulnerability as impact), we hypothesize that health risks from exposure to air pollution and temperature in these cities do not necessarily depend on socio-economic inequalities. To test this hypothesis, we gathered, validated, and analyzed temperature, air pollution, mortality and socioeconomic vulnerability data from the three study cities. Our results show the association between air pollution levels and socioeconomic vulnerabilities did not always correlate within the study cities. Furthermore, the spatial differences in socioeconomic vulnerabilities within cities do not necessarily correspond with the spatial distribution of health impacts. The present study improves our understanding of the multifaceted nature of health risks and vulnerabilities associated with global environmental change. The findings suggest that health risks from atmospheric conditions and pollutants exist without boundaries or social distinctions, even exhibiting characteristics of a boomerang effect (i.e., affecting rich and poor alike) on a smaller scale such as areas within urban regions. We used human mortality, a severe impact, to measure health risks from air pollution and extreme temperatures. Public health data of better quality (e.g., morbidity, hospital visits) are needed for future research to advance our understanding of the nature of health risks related to climate hazards.
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4.

The Ciclovia and Cicloruta programs: promising interventions to promote physical activity and social capital in Bogotá, Colombia.

Torres A; Sarmiento OL; Stauber C; Zarama R
| Idioma(s): Inglés
OBJECTIVES: We compared participants from the Ciclovia (streets temporarily closed to motorized vehicles and open for pedestrians) and Cicloruta (bicycle paths) programs in Bogotá, Colombia, to assess associations of program participation with physical activity, safety, social capital, and equity. METHODS: We conducted 2 cross-sectional studies in October 2009 with intercept surveys: one among 1000 Ciclovia participants and the other among 1000 Cicloruta participants. RESULTS: Most Ciclovia participants met the physical activity recommendation in leisure time (59.5%), and most Cicloruta participants met it by cycling for transportation (70.5%). Ciclovia participants reported a higher perception of safety (51.2% regarding traffic and 42.4% about crime) and social capital (odds ratio = 2.0; 95% confidence interval = 1.4, 2.8) than did Cicloruta users. Most Cicloruta users reported living in low socioeconomic status categories (53.1%), had lower educational attainment (27%), and did not own cars (82.9%). Most Ciclovia participants reported living in middle socioeconomic status categories (64%), had low-to-middle educational attainment (51.1%), and did not own cars (66.1%). CONCLUSIONS: The Ciclovia and Cicloruta programs have the potential to equitably promote physical activity and provide a mobility alternative in complex urban settings such as Bogotá.
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5.

Targeting preschool children to promote cardiovascular health: cluster randomized trial.

Céspedes J; Briceño G; Farkouh ME; Vedanthan R; Baxter J; Leal M; Boffetta P; Woodward M; Hunn M; Dennis R; Fuster V
| Idioma(s): Inglés
BACKGROUND: School programs can be effective in modifying knowledge, attitudes, and habits relevant to long-term risk of chronic diseases associated with sedentary lifestyles. As part of a long-term research strategy, we conducted an educational intervention in preschool facilities to assess changes in preschoolers' knowledge, attitudes, and habits toward healthy eating and living an active lifestyle. METHODS: Using a cluster design, we randomly assigned 14 preschool facilities in Bogotá, Colombia to a 5-month educational and playful intervention (7 preschool facilities ) or to usual curriculum (7 preschool facilities ). A total of 1216 children aged 3-5 years, 928 parents, and 120 teachers participated. A structured survey was used at baseline, at the end of the study, and 12 months later to evaluate changes in knowledge, attitudes, and habits. RESULTS: Children in the intervention group showed a 10.9% increase in weighted score, compared with 5.3% in controls. The absolute adjusted difference was 3.90 units (95% confidence interval [CI], 1.64-6.16; P <.001). Among parents, the equivalent statistics were 8.9% and 3.1%, respectively (absolute difference 4.08 units; 95% CI, 2.03 to 6.12; P <.001), and among teachers, 9.4% and 2.5%, respectively (absolute difference 5.36 units; 95% CI, -0.29-11.01; P = .06). In the intervened cohort 1 year after the intervention, children still showed a significant increase in weighted score (absolute difference of 6.38 units; P <.001). CONCLUSIONS: A preschool-based intervention aimed at improving knowledge, attitudes, and habits related to healthy diet and active lifestyle is feasible, efficacious, and sustainable in very young children.
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6.

Morbilidad respiratoria asociada con la exposición a material particuladao en el ambiente/ Respiratory morbidity associated with exposure to particulate matter in the environment

Martínez, Elkin; Quiroz, Carlos; Rúa, Jessica
| Idioma(s): Español
Se supone que la exposición prolongada a material particuladoen el aire en los lugares donde se vive o trabaja puede afectarlas vías respiratorias. La provisión de evidencias localesen este sentido se hace necesaria para demandar medidasde control que busquen proteger la salud de las personas.Métodos: se estudia la morbilidad respiratoria en personasque habitan o trabajan en las zonas urbanas de Medellín(alta contaminación por material particulado, promedio dePM10 60 μg/m3) y se contrasta con la morbilidad respiratoriade una muestra comparable de habitantes de los municipiosdel oriente antioqueño (baja contaminación, promedio dePM10 30 μg/m3). Resultados: los grupos comparados sonsimilares respecto de las variables sociodemográficas y otrasvariables potencialmente confusoras. En las zonas urbanasde Medellín se registra un mayor riesgo de signos y síntomasrespiratorios con respecto al grupo control. La congestiónnasal, la dificultad respiratoria y la tos son los síntomas quese presentan en un mayor contraste con riesgos relativos de2,60 ic 95% (1,93, 3,62); 2,22 ic 95% (1,56, 3,15) y 2,14 ic95% (1,63, 2,81), respectivamente. Conclusión: los nivelesaltos de pm10 como indicador de la contaminación del aire en elentorno urbano donde viven y trabajan las personas contribuyea un riesgo mayor de enfermedad respiratoria, lo cual conllevaconsecuencias desfavorables en los campos económico ysocial. El control de tal situación constituye por lo tanto unimperativo social y laboral. (AU) Introduction: it is assumed that prolonged exposure toairborne pollutants in the areas where people live or workcan affect their respiratory systems. In order to demand forcontrol measures aimed at protecting the community’s health,it is necessary to provide evidence for this claim. Methods: therespiratory morbidity of people living or working in urban areasof Medellín was analyzed (high particulate matter pollution.The average of PM10 is 60 μg/m3) and then compared withthe respiratory morbidity of a matched sample of inhabitantsliving in the municipalities located in eastern Antioquia (lowpollution. The average of PM10 is 30 μg/m3). Results: thegroups that were compared were similar with respect to sociodemographicand other potential confounding variables. Uponcomparing the two groups, a higher risk of respiratory signs and symptoms can be observed for subjects from the urban areas of Medellín. Nasal congestion, respiratory distress, and cough are the symptoms that occur in sharper contrast with relative risk of 2.60 95% CI (1.93, 3.62); 2.22 95% CI (1.56, 3.15) and 2.14 95% CI (1.63, 2.81) respectively. Conclusion: high pm10 levels as an indicator of air pollution in urban environments where people live and work contribute to a higher risk of respiratory disease. This implies adverse consequences both in economic and social terms. The control of such a situation hence becomes a social and professional priority Alteraciones neuropsicológicas en escolares de un municipio con niveles elevados de vapor de mercurio medioambiental, Colombia, 2008-2009.(AU)
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7.

Trabajo en el sector salud: implementación de la promoción de la salud en los lugares de trabajo/ Working in the health sector: implementation of workplace helath promotion

Castro, Eliana; Muñoz, Alba Idály
| Idioma(s): Español
Objetivo: exponer aspectos relevantes para implementar lapromoción de la salud en los lugares de trabajo (pslt) en procesosde organización del sector salud, asumida como una herramientaestratégica para gestionar la salud y la seguridad enambientes laborales. Metodología: tras una revisión conceptualsobre pslt en el 2009, se realizó un estudio de caso sobreel desarrollo de la estrategia en tres hospitales de tercer nivelde Bogotá. Se trata de un estudio descriptivo-transversal aprobadopor el Comité de Ética de la Facultad de Enfermería de laUniversidad Nacional de Colombia. Resultados: aunque existenprogramas de salud ocupacional que imprimen el espíritude la pslt en su contenido, el nivel de desarrollo no es coherente con ello. Se analizaron los siguientes criterios: estrategia y compromiso, recursos humanos y organización, responsabilidad social, planificación, desarrollo y resultados, que no fueron bien valorados por trabajadores. Discusión: el enfoque tradicional sobre salud ocupacional y la precaria incorporación de los principios de la pslt en procesos organizacionales se refleja en las acciones desarrolladas y en las expectativas frente al tema; por tanto, es necesario desarrollar acciones desde la política pública y fortalecer la capacidad institucional para garantizar la viabilidad de la pslt en el sector salud. (AU) Objective: to discuss issues that are relevant to theimplementation of workplace health promotion (whp) inorganization processes of the health sector as a strategic toolto manage health and safety at the workplace. Methods: aftera conceptual review of whp in 2009, a qualitative case studyon the development of this strategy in third level hospitals ofBogotá was carried out. This descriptive and cross-sectionalstudy was approved by the Ethics Committee of the Faculty ofNursing at the National University of Colombia. Results:although there are occupational health programs that conveythe spirit of whp in their content, its level of developmentis not consistently linked to it. The following criteria were analyzed: strategy and commitment, human resources and organization, social responsibility, planning, and development and results, all of which were not well valued by workers. Final considerations: the traditional approach to occupational health and the poor integration of the WHP principles into organizational processes are reflected in the actions taken and the expectations regarding the subject. Therefore, actions should be taken in terms of public policies to strengthen the institutional capacity to ensure the feasibility of whp in the health sector. (AU)
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8.

La salud mental: una mirada desde suevolución en la normatividad colombiana: 1960-2012/ Mental health: an insight on its evolution in Colombian law: 1960-2012/ Saúde mental: um olhar desde a suaevolução na normatividade colombiana: 1960-2012

Ardón Centeno, Nelson; Cubillos Novella, Andrés
| Idioma(s): Español
La naturaleza del concepto de salud mental y los enfoques a los que se refiere determinan un marco contextual y político normativo internacional, nacional y distrital amplio, referente a los derechos y a las condiciones de vida: educación, vivienda, trabajo, sociales, económicas y del medio ambiente; por ello, este artículo aborda la legislación y las políticas concernientes a la salud mental de los distintos grupos poblacionales, ciclos de vida, etnia y género, condiciones y situaciones como pobreza, discapacidad (y rehabilitación), desplazamiento y conflicto armado, para realizar un recuento de su evolución vista a través de las normas que han sido promulgadasen Colombia desde 1960 hasta la actualidad. Se pretende, además de hacer un análisis de la aplicación y de la evolución de dichas normas, realizar un seguimiento de los avances logrados ylas diferentes perspectivas bajo las cuales se ha abordado esta legislación, tanto a nivel nacional como en Bogotá, específicamente...(AU) The nature of the concept of mental health and the approaches to which it relates, determine a contextual framework normative political and international, national and district wide, regarding the rights and conditions of life: education, housing, employment, social, economic and environment; Therefore, this article discusses the legislation and policies concerning the mental health of the various population groups, life cycles, ethnicity and gender, to conditions and situations such as poverty, disability (and rehabilitation), displacement and armed conflict, toperform a count in your evolution view through the rules that have been enacted in Colombia from 1960 to the present. Pretending, in addition to making an analysis of the application anddevelopment of the same, follow up on the progress made and the different perspectives from which has addressed this legislation; both at the national level, such as in Bogota specifically...(AU) A natureza do conceito de saúde mental e as abordagens a que ela se refere, determinar um enquadramento contextual e político normativo internacional, nacional e distritais ampla, sobre os direitos e condições de vida: educação, habitação, emprego, sociais, económicos e ambientais;Por conseguinte, este artigo discute a legislação e políticas relativas à saúde mental dos diversos grupos populacionais, ciclos de vida, etnia e gênero, condições e situações tais como a pobreza, deficiência e reabilitação), deslocamento e conflitos armados, para efectuar uma contagem em sua evolução vista através das regras que tenham sido decretadas na Colômbia desde 1960 até o presente. Fingir, para além de fazer uma análise da aplicação e desenvolvimento da mesma, o acompanhamento dos progressos realizados e as diferentes perspectivas a partir das quais se debruçou sobre esta legislação; tanto a nível nacional como em Bogotá especificamente...(AU)
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9.

Factores sociales y económicos asociados a la obesidad: los efectos de la inequidad y de la pobreza/ Social and economic factors associated with obesity: the effects from inequality and poverty/ Fatores sociais e econômicos associados à obesidade: efeitos da iniquidade e pobreza

Álvarez Castaño, Luz Stella; Goez Rueda, Juan Diego; Carreño Aguirre, Cristina
| Idioma(s): Español
Objetivo: establecer los factores sociales y económicos asociados con la obesidad en adultos en Medellín. Métodos: estudio descriptivo, transversal. Muestra constituida por 5556 adultos entre 18 y 64 años de edad. Se analizó el ingreso familiar, el nivel educativo, la actividad ocupacionaly el estrato social. Resultados: se encontró mayor obesidad en las mujeres que en los hombres y en el grupo de mayor edad. El nivel educativo, el estrato social y los ingresos familiares seasociaron con mayor riesgo de obesidad. En el caso de los ingresos familiares, el factor más relevante fue si la cantidad devengada por la familia era suficiente para garantizar la seguridad alimentaria. Conclusiones: los factores sociales y económicos que tuvieron un rol significativo en la distribución social de la obesidad, fueron aquellos de mayor peso en la desigualdad socialen Colombia: la educación, los ingresos y la calidad de la vivienda y del entorno urbano...(AU) Objective: to establish the social and economic factors associated to obesity in adults of Medellin. Methods: the study was cross-sectional descriptive; sample size was 5556 people aged from 18to 64. The social and economic factors analyzed were family monthly income, educational level, social stratum and occupational activity. Results: we found increased obesity in women andin the age group from 45 to 64. Educational level, social stratum, and family monthly income were associated with an increased risk of obesity. Related to family income, the most decisive fact was whether or not families earn enough to get food security. Conclusions: the social andeconomic factors had a meaningful role in the prevalence of obesity were the same related to social inequalities in Colombia: education, family income and housing and neighborhood quality...(AU) Objetivo: estabelecer os fatores sociais e econômicos associados à obesidade em adultos em Medellín. Métodos: estudo descritivo, transversal. Amostra constituída por 5556 adultos entre 18e 64 anos de idade. Analisaram-se as rendas familiares, nível educativo, atividade ocupacional e estrato social. Resultados: Encontrou-se maior nível de obesidade nas mulheres do que noshomens e no grupo de maior idade. O nível educativo, o estrato social e as rendas familiares associaram-se com um risco maior de obesidade. No caso das rendas familiares, o fator maisrelevante foi se o monto ganho pela família foi suficiente para garantir a segurança alimentar. Conclusões: os fatores sociais e econômicos com um papel significativo na distribuição socialda obesidade foram aqueles com peso maior na desigualdade social na Colômbia: educação, rendas e qualidade da moradia e do entorno urbano...(AU)
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10.

Ingreso y capacitación del personal vinculado a instituciones del tercer nivel de atención en salud - Medellín, Colombia/ Join and training of personnel involved in tertiary institutions in health care - Medellin, Colombia/ Renda e capacitação do pessoal vinculado a instituições do terceiro nível de atenção em saúde - Medellin, Colombia

Arboleda Posada, Gladys Irene
| Idioma(s): Español
Objetivo: describir los ingresos y el acceso a la capacitación en el personal vinculado a instituciones del tercer nivel de atención en salud de Medellín, Colombia. Metodología: estudiodescriptivo transversal utilizando encuestas aplicadas al personal con contrato indefinido en cinco instituciones. Población de 1622 personas y muestra aleatoria final de 242. Resultados: 57% manifestaron que sus ingresos satisfacen sus necesidades; las mujeres tienen salarios mayoresque los hombres, rango de 2-5 SMLMV; refirieron buena asistencia a cursos de capacitación y actualización; pocos integrados a la educación formal; la mayoría señaló que las institucionesno brindan apoyo en tiempo y dinero; algunos no se motivan debido a que estos estudios no garantizan ascensos ni incrementos en la remuneración. Conclusiones: el ingreso promediopercibido es mayor en el sector privado, en comparación con las públicas; la capacitación y el acceso a la educación superior en ambos tipos de instituciones es limitado en apoyo económico y facilidad de tiempo, factor negativo en el desarrollo personal y profesional...(AU) Objective: describe income and access to training, personnel involved in tertiary institutions in health care in Medellin, Colombia. Methods: descriptive cross-sectional surveys administered tostaff with permanent contracts in five institutions. 1622 population of persons, random sample end 242. Results: 57% stated that their income meets their needs; women have higher wagesthan men, SMLMV range of 2-5. They reported good attendance at training courses and updating; few integrated into formal education, noted that most institutions do not provide support intime and money, some are not motivated because these studies do not guarantee promotions or increases in pay. Conclusions: the average income higher perceived private sector compared tothe public, training and access to higher education in both types of institutions is limited financial support and ease of time factor in our personal and professional development...(AU) Objetivo: Descrever ingreso e treinamento do pessoal envolvido nas instituições de saude alta complexidade Medellín, Colombia. Métodos: Estudo transversal utilizando levantamentos administrados ao pessoal com contratos permanentes em cinco instituições. População de 1.622 pessoas, e a amostra final foi aleatória de 242. Resultados: 57% informaram que sua renda atenda às suas necessidades, as mulheres têm salários mais altos do que os homens, faixa de 2-5 eficaz salário mínimo mensal; informou bom atendimento em treinamento e cursos deatualização, poucos integrado na educação formal; observou que a maioria das instituições não prevejam apoio em tempo e dinheiro, alguns não estão motivados porque estes estudosnão garantem promoções ou aumentos salariais. Conclusões: a renda média auferida é maior no setor privado em relação ao treinamento, suporte e acesso do público; formação e acesso aoensino superior, em ambos os tipos de instituições é limitado apoio financeiro e facilidade de tempo, fator negativo no desenvolvimento pessoal e profissional...(AU)
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