Chikungunya in Brazil: An epidemic of high cost for private healthcare, 2017.

OBJECTIVE: We evaluated the impact of direct and indirect medical costs incurred through chikungunya infections in patients treated in Fortaleza, Brazil. METHODS: Cross-sectional study about the cost of illness. The valuation method of medical costs was based on the micro-costing approach (bottom-up). The study was carried out in a large general hospital of the private health network. The study population consisted of patients treated as suspected cases of chikungunya and hospital professionals who applied for sick leave due to chikungunya. RESULTS: In 2017, there were 2683 patients treated at this hospital who incurred an estimated cost of $383,514.40. From this amount, $174,322.91 (45.5%) were expended on emergency care, $194,700.59 (50.8%) on hospitalisations. 123 hospital professionals were infected with chikungunya and sick leave duration ranged between 1 and 19 days. Health professionals generated 746 days of absence and an amount of $14,490.90 due to absenteeism from work related to chikungunya. 31 symptoms were reported, especially arthralgia (91.1%) and fever (79.4%). There was a predominance of females (58.8%) and the age group of 20-39 years (42.1%). CONCLUSION: The average cost of admissions was over $2400. Considering the epidemic potential of chikungunya, our data indicate the huge economic burden of this disease to healthcare units in the presence of epidemics. Economic factors, added to the loss of life and the consequences of chronic chikungunya, make this disease a real scourge for countries with fewer material resources.

Health promotion competencies in the multidisciplinary residency: capacity for change and health advocacy. / Competências em promoção da saúde na residência multiprofissional: capacidade de mudanças e advocacia em saúde.

Health Promotion consists of individual and group strategies to achieve equity and reduce risks related to the Social Determinants of Health. This study aims to analyze the Capacity for Change and Health Advocacy domains of the CompHP in the reality of a Multidisciplinary Residency Program in Family and Community Health. This qualitative exploratory research was conducted with twenty-one participants. Data were interpreted through Discourse Analysis under the lens of Depth Hermeneutics. In the capacity for change, we identified that promoting healthy lifestyles is insufficient to develop autonomous and emancipated individuals in the search for decent living conditions. Concerning health advocacy, residents guide clients on the importance of popular participation in spaces intended for social control in Primary Health Care.

A Promoção da Saúde consiste em estratégias individuais e coletivas, com vistas ao alcance da equidade e redução dos riscos relacionados aos Determinantes Sociais em Saúde. Este estudo objetiva analisar os domínios Capacidade de Mudança e Advocacia em Saúde do CompHP na realidade de uma Residência Multiprofissional em Saúde da Família e Comunidade. Trata-se de uma pesquisa qualitativa, de caráter exploratório. Participaram vinte e um participantes. Os dados foram interpretados através da Análise de Discurso à luz da Hermenêutica de Profundidade. No domínio capacidade de mudanças, foi identificado que promover hábitos de vida saudáveis não é suficiente, sendo necessário desenvolver indivíduos autônomos e emancipados para a busca de condições de vida dignas. Para o domínio advocacia em saúde, os residentes orientam os usuários sobre a importância da participação popular nos espaços destinados ao controle social no âmbito da Atenção Primária em Saúde.

Global burden of mental illness in agents fighting endemics.

Mental disorders are the main cause of the young and economically active population worldwide and in Brazil to live with disabilities, being an important public health problem nowadays. The objective was to estimate the burden of mental disorders among professionals working to combat endemic diseases in a state in northeastern Brazil. Medical records of workers linked to the Brazilian Ministry of Health in Ceará State and fighting endemic diseases were surveyed and, from this, a historical cohort was made. The individual quantification of absenteeism by mental disorders (ICD F-chapter referring to mental disorders) was conducted considering a period of about 35 years, from admission (the 1980s) to December 2017. The global burden of disease was measured by the YLD indicator (years lost to disability). Considering that no deaths due to mental disorders were observed, the YLL indicator (years of life lost) was composed. The high mental disorders burden in this group of workers stands out, whose mood disorders, including depression, conferred a YLD equal to 18.6. This represents just over 18 years of work lived with a disability. Our findings reinforce the need to implement surveillance and health promotion actions in workers to promote effective interventions capable of contributing to the reduction of morbidity in workers and economically active people.

Does Sex-Obesity Intersectionality Play a Role in Labor Inactivity? Results From the Brazilian National Health Survey.

OBJECTIVE: To investigate the association between sex-obesity intersection and labor inactivity and whether education modifies this relationship in a national health survey. METHODS: Cross-sectional study using the database of 43,456 participants from the Brazilian National Health Survey. Logistic Regression analyses were performed. RESULTS: To be women with or without obesity was associated with higher frequency of labor inactivity in comparison to non-obese men. Among men, only those with central obesity had a higher rate of inactivity than non-obese men, especially those with incomplete elementary school. CONCLUSIONS: The double burden of judgment (sexism and fatphobia) suffered by obese women can lead to socioeconomic inequalities which may strength poorness and/or exclusion. Thus, there are urgent measures for empowerment and equity in the labor market.

Exposure to Chemical and Biological Agents at Work and Cardiovascular Disease in Brazil: A Population-Based Study.

OBJECTIVE: Investigating the relationship between exposure to chemical and biological agents at work and the occurrence of cardiovascular diseases in a Brazilian national health survey. METHODS: A cross-sectional study using the database of 36.442 participants from the Brazilian National Health Survey. Logistic Regression analysis was performed for multivariable models. RESULTS: After adjustments for key confounders, we observed that those individuals exposed to chemical agents and biological materials at work had 62% (95% CI: 1.20; 2.20) and 66% (95% CI: 1.03; 2.65), respectively, higher odds of having cardiovascular disease compared to employed individuals who did not report exposure to biological materials/chemical agents at work. CONCLUSION: This study draws attention to the role of chemical and biological risks in the occurrence of cardiovascular diseases. In this sense, it is necessary developing systematic and intersectoral actions for Workers' Health Surveillance to promote health and prevent chronic non-communicable diseases.

Burden and Protection: Heterogeneous Effects of Occupational and Operational Stressors on Burnout Dimensions Among Firefighters.

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.

Parkinson Disease and Occupational and Environmental Exposure to Pesticides in a Region of Intense Agribusiness Activity in Brazil: A Case-Control Study.

OBJECTIVE: To evaluate the relationship between occupational and environmental exposure to pesticides and Parkinson disease in a region of intense agribusiness activity in the state of Mato Grosso/Brazil. METHODS: Case-control study carried out in a referral hospital for chronic neurodegenerative diseases. Non-conditional logistic regression analyses were performed. RESULTS: Having performed direct management of pesticides in the workplace (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.55 to 7.28), having a family history of Parkinson (OR: 3.42; 95% CI: 1.61 to 7.28) and being men (OR: 3.01; 95% CI: 1.66 to 5.45) were all factors that contributed to a greater chance for the development of the disease. CONCLUSION: Our study reinforces the associations between occupational and environmental exposure to pesticides and the occurrence of Parkinson disease in regions of intense agribusiness activity in Brazil.

Prevalence of hypertension and associated factors in female prison correctional officers in a national sample in Brazil.

OBJECTIVES: To estimate hypertension prevalence and associated factors among female correctional officers (FCO) in female Brazilian prisons. METHODS: Cross-sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sampling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer-Assisted Self-Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independent factors were estimated. RESULTS: Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1-44.0). Hypertension was associated with obesity (95% CI = 1.884-9.947), cardiovascular disease (95% CI = 3.348-16.724), and participation in the specific training course for the relevant position (95% CI = 1.413-9.564). CONCLUSIONS: While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to address this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care.

Prevalence and factors associated with respiratory symptoms among civil construction workers: an occupational health surveillance proposal.

BACKGROUND: The civil construction industry is associated with the some of the highest morbidity and mortality rates in Brazil. Despite their epidemiological relevance, occupational health surveillance actions within the primary care setting still exhibit weaknesses. OBJECTIVE: To analyze the prevalence of and factors associated with respiratory symptoms among civil construction workers in Cuiaba, Mato Grosso, Brazil. METHODS: Cross-sectional analytic study conducted with 545 civil construction workers to analyze occupational health surveillance actions. Presence of respiratory symptoms was investigated by means of the British Medical Research Council questionnaire on respiratory symptoms. The Mantel-Haenszel χ 2 test was used for bivariate analysis and Poisson regression for multivariate analysis. The significance level was set to 5%. RESULTS: Most participants were young adults and almost half exhibited respiratory symptoms. The odds to develop cough were higher for the participants exposed to chemicals (PR=1.70; 95%CI 1.22-2.37). The odds to develop wheezing were higher for the participants who had not undergone pre-employment spirometry (PR=1.57; 95%CI 1.17-2.10). CONCLUSION: Biological monitoring of civil construction workers might be useful to improve occupational health surveillance actions within the primary care setting.

INTRODUÇÃO: O setor da construção civil é um dos que mais adoecem e matam trabalhadores no Brasil. Apesar da relevância epidemiológica, ainda são frágeis as ações de vigilância em saúde do trabalhador na Atenção Básica. OBJETIVO: Analisar a prevalência e os fatores associados a sintomas respiratórios em trabalhadores da construção civil de Cuiabá, Mato Grosso. MÉTODOS: Trata-se de um estudo transversal, analítico, realizado com 545 trabalhadores da construção civil, de modo a qualificar as ações de vigilância em saúde do trabalhador. A presença de sintomas respiratórios foi determinada através do instrumento British Medical Research Council. Realizou-se o teste do χ 2 de Mantel Haenszel na análise bivariada e regressão de Poisson na análise multivariada. O nível de significância adotado foi de 5%. RESULTADOS: A maioria dos participantes é de adultos jovens. Quase metade dos participantes foram classificados como sintomático-respiratórios. Trabalhadores expostos a substâncias químicas apresentaram maiores chances para a ocorrência de tosse (RP=1,70; IC95% 1,22­2,37) e expectoração (RP=1,63; IC95% 1,14­2,23). Trabalhadores que não realizaram os testes espirométricos nos exames admissionais obtiveram maiores chances de apresentar sibilos (RP=1,57; IC95% 1,17­2,10). CONCLUSÃO: O monitoramento biológico dos trabalhadores da construção civil pode servir como uma importante ferramenta para a qualificação das ações de vigilância em saúde do trabalhador na Atenção Básica.

Common mental disorders among workers chronically exposed to pesticides: the case of workers involved in fighting endemic diseases.

BACKGROUND: Common mental disorders are a considerable global public health concern and pose a high burden of disease especially in terms of years lived with disability (YLD). OBJECTIVE: To establish the prevalence of common mental disorders among workers involved in fighting endemic diseases in the state of Ceará, Brazil. METHODS: In the present cross-sectional study we administered the Self-Reporting Questionnaire 20, a screening tool for common mental disorders previously validated for use in Brazil. To calculate the sample size we considered the total number of workers involved in fighting endemic diseases in Fortaleza and four metropolitan municipalities. RESULTS: About 33.3% of the participants met the criteria for common mental disorders. The questionnaire section on depressive and anxiety symptoms exhibited the highest frequency of affirmative answers. The prevalence ratio was highest for the participants in Caucaia (PR=2.13). CONCLUSION: The results indicate a previously unknown and considerable morbidity profile. The present was the first study that investigated common mental disorders in this occupational group.

INTRODUÇÃO: Os transtornos mentais comuns correspondem a importantes problemas de saúde pública e conferem alta carga de doença. OBJETIVO: Investigar a prevalência de transtornos mentais comuns nos agentes de combate a endemias no estado do Ceará. MÉTODOS: Foi realizado estudo de corte transversal, com instrumento de rastreio para transtornos mentais comuns validado no Brasil, o Self-Reporting Questionnaire (SRQ-20). Para o cálculo do tamanho da amostra, foi considerado o número total de trabalhadores ocupantes do cargo de agente de combate a endemias lotados em Fortaleza e em quatro municípios da região metropolitana. RESULTADOS: Foi identificado que 33,3% dos trabalhadores apresentaram critérios para transtornos mentais comuns. As respostas mais prevalentes corresponderam ao bloco de perguntas dos componentes humor ansioso e depressivo. Os trabalhadores que labutam no município de Caucaia apresentaram razão de prevalência superior para desenvolver transtornos mentais comuns (razão de prevalência - RP=2,13) quando comparados aos agentes de combate a endemias lotados nos outros municípios. CONCLUSÃO: Os resultados desta pesquisa evidenciaram um perfil de morbidade importante e até então desconhecido. Este estudo é pioneiro na investigação de transtornos mentais comuns no tocante aos trabalhadores da saúde pública expostos a agrotóxicos utilizados nas campanhas de combate a vetores.

Exposure to pesticides and acute intoxication in a region of intense agricultural production in Mato Grosso, Brazil, 2013. / Exposição aos agrotóxicos e intoxicações agudas em região de intensa produção agrícola em Mato Grosso, 2013.

OBJECTIVE: to estimate the prevalence of acute poisoning by pesticides and associated factors in Mato Grosso, Brazil. METHODS: this was a cross-sectional study, the outcome of which was acute intoxication in the month prior to the interview, as diagnosed by a physician; multivariate analysis was performed using Poisson regression. RESULTS: we interviewed 753 individuals; acute intoxication occurred at a rate of 17%; the main associated factors were living near plantations (PR=2.81 - 95%CI 1.79;4.41), having incomplete high school education or less (PR=1.80 - 95%CI 1.22;2.71), living less than 500 meters from maize crops (PR=1.57 - 95%CI 1.05;2.35) and cotton plantations (PR=1.43 - 95%CI 1.02;2.02). CONCLUSION: Individuals living near to corn and cotton plantations reported higher occurrence of acute intoxication.

Competências em promoção da saúde na residência multiprofissional: capacidade de mudanças e advocacia em saúde / Health promotion competencies in the multidisciplinary residency: capacity for change and health advocacy

Resumo A Promoção da Saúde consiste em estratégias individuais e coletivas, com vistas ao alcance da equidade e redução dos riscos relacionados aos Determinantes Sociais em Saúde. Este estudo objetiva analisar os domínios Capacidade de Mudança e Advocacia em Saúde do CompHP na realidade de uma Residência Multiprofissional em Saúde da Família e Comunidade. Trata-se de uma pesquisa qualitativa, de caráter exploratório. Participaram vinte e um participantes. Os dados foram interpretados através da Análise de Discurso à luz da Hermenêutica de Profundidade. No domínio capacidade de mudanças, foi identificado que promover hábitos de vida saudáveis não é suficiente, sendo necessário desenvolver indivíduos autônomos e emancipados para a busca de condições de vida dignas. Para o domínio advocacia em saúde, os residentes orientam os usuários sobre a importância da participação popular nos espaços destinados ao controle social no âmbito da Atenção Primária em Saúde.

Abstract Health Promotion consists of individual and group strategies to achieve equity and reduce risks related to the Social Determinants of Health. This study aims to analyze the Capacity for Change and Health Advocacy domains of the CompHP in the reality of a Multidisciplinary Residency Program in Family and Community Health. This qualitative exploratory research was conducted with twenty-one participants. Data were interpreted through Discourse Analysis under the lens of Depth Hermeneutics. In the capacity for change, we identified that promoting healthy lifestyles is insufficient to develop autonomous and emancipated individuals in the search for decent living conditions. Concerning health advocacy, residents guide clients on the importance of popular participation in spaces intended for social control in Primary Health Care.

Benefícios previdenciários de pescadores artesanais e marisqueiras em comunidade quilombola no Nordeste do Brasil / Social security benefits for small-scale fisherman in a quilombola community in northeastern Brazil

Resumo Introdução: a pesca artesanal e a mariscagem são consideradas atividades especiais, para fins de benefícios, no âmbito do Regime Geral de Previdência Social do Brasil. Objetivo: descrever o acesso aos benefícios previdenciários por uma população quilombola tradicional pesqueira no Nordeste do Brasil, cuja principal atividade ocupacional é a extração e beneficiamento de mariscos. Métodos: estudo transversal, descritivo, em uma comunidade da Ilha da Maré, em Salvador, Bahia, Brasil. Os dados foram coletados por meio de entrevistas, utilizando questionários padronizados. Resultados: participaram 213 pescadores artesanais e marisqueiras, 76,5% do sexo feminino. Dentre os participantes, 62,9% não recebem nenhum tipo de benefício previdenciário. Apesar de se submeter a uma jornada de trabalho exaustiva (90,9%), com exposição a substâncias químicas (83,9%), ruído (69,9%) e radiação solar (88,2%), a maioria não obtém rendimentos que garantam a subsistência familiar (79,6%). Conclusão: há um importante déficit no recebimento de benefícios previdenciários em uma população quilombola tradicional que atende aos critérios de segurados especiais. Sugere-se adequação da legislação, de forma que o acesso aos benefícios se torne mais justo para as comunidades tradicionais.

Abstract Introduction: artisanal fishing and shellfish gathering are considered special activities under the Brazilian general social security system for the purposes of social security benefits. Objective: to describe the access to social security benefits for a traditional fishing quilombola community in northeastern Brazil, whose main occupational activity is shellfish extraction and processing. Methods: a cross-sectional descriptive study conducted in a community from Ilha da Maré, Salvador, Bahia, Brazil. Results: 213 fishermen (76.5% female) participated in the study, of which 62.9% did not receive social benefits. Although most participants undergoing an exhausting working hours (90.9%), with exposure to chemicals (83.9%), noise (69.9%) and solar radiation (88.2%), the majority of them do not earn an income that guarantees their family's subsistence (79.6%). Conclusion: there is an important deficit in social security benefits access for a traditional quilombola population that meets the criteria for special insurance. Legislation must be adapted to ensure fairer access to social benefits for this population.

Competências em Promoção da Saúde na Residência Multiprofissional: Domínios do Diagnóstico, Planejamento, Implementação e Avaliação e Pesquisa / Competencies for health promotion in multiprofessional residency programs: Diagnosis, Planning, Implementation, Evaluation and Research Domains / Competencias en Promoción de la Salud en la Residencia Multiprofesional: Dominios Diagnóstico, Planificación, Implementación y Evaluación e Investigación

Para que as ações de promoção da saúde possam impulsionar mudanças na saúde dos usuários, faz-se necessário o desenvolvimento de competências que auxiliem na sua efetivação. O estudo avaliou os limites e as potencialidades para a incorporação dos domínios Diagnóstico; Planejamento; Implementação; e Avaliação e Pesquisa do Developing Competenciesand Professional Standards for Health Promotion Capacity Building in Europe (CompHP) na realidade de uma residência multiprofissional em Saúde da Família e Comunidade. Pesquisa qualitativa realizada com residentes, tutores e preceptores. Foi utilizada a Hermenêutica de Profundidade, à luz da Análise de Discurso. O desenvolvimento de competências nos domínios do Diagnóstico; Planejamento; Implementação; e Avaliação e Pesquisa foram estratégicos para a formação dos residentes. Elas apresentaram potencial para a implementação e qualificação das ações de promoção da saúde no âmbito da Atenção Primária em Saúde. Por outro lado, lacunas durante o processo formativo dos residentes não possibilitaram uma maior clareza para a aquisição dessas competências.(AU)

For health promotion actions to drive change, health professionals need to develop relevant competencies. This study assessed the limitations and potential for incorporating the domains Diagnosis, Planning, Implementation, Evaluation and Research of the Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe (CompHP) into the reality of a multiprofessional residency program in family and community health. We conducted a qualitative study with residents, tutors, and preceptors using the depth-hermeneutical approach and discourse analysis. The development of competencies in the diagnosis, planning, implementation, evaluation and research domains was key to resident training. The competencies showed potential for implementation and improvement in the quality of health promotion actions in primary care. However, gaps in the training process meant that the residency program did not provide greater clarity for the acquisition of these competencies.(AU)

Para que las acciones de Promoción de la Salud puedan dar impulso a cambios en la salud de los usuarios, es necesario el desarrollo de competencias que ayuden en su realización. l estudio evaluó los límites y las potencialidades para la incorporación de los dominios Diagnóstico, Planificación, Implementación, Evaluación e Investigación del Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe (CompHP) en la realidad de una Residencia Multiprofesional en Salud de la Familia y Comunidad. Investigación cualitativa realizada con residentes, tutores y preceptores. Se utilizó la Hermenéutica de Profundidad a la luz del Análisis de Discurso. El desarrollo de competencias en los dominios Diagnóstico, Planificación, Implementación, Evaluación e Investigación fueron estratégicos para la formación de los residentes. Ellas presentaron potencial para la implementación y calificación de las acciones de promoción de la salud en el ámbito de la Atención Primaria de la Salud. Por otro lado, las brechas durante el proceso formativo de los residentes imposibilitaron una mayor claridad en la adquisición de estas competencias.(AU)

Global burden of mental illness in agents fighting endemics / Carga global da doença mental entre trabalhadores no combate a endemias / Carga global de las enfermedades mentales en agentes sanitarios que luchan contra endemias

Abstract: Mental disorders are the main cause of the young and economically active population worldwide and in Brazil to live with disabilities, being an important public health problem nowadays. The objective was to estimate the burden of mental disorders among professionals working to combat endemic diseases in a state in northeastern Brazil. Medical records of workers linked to the Brazilian Ministry of Health in Ceará State and fighting endemic diseases were surveyed and, from this, a historical cohort was made. The individual quantification of absenteeism by mental disorders (ICD F-chapter referring to mental disorders) was conducted considering a period of about 35 years, from admission (the 1980s) to December 2017. The global burden of disease was measured by the YLD indicator (years lost to disability). Considering that no deaths due to mental disorders were observed, the YLL indicator (years of life lost) was composed. The high mental disorders burden in this group of workers stands out, whose mood disorders, including depression, conferred a YLD equal to 18.6. This represents just over 18 years of work lived with a disability. Our findings reinforce the need to implement surveillance and health promotion actions in workers to promote effective interventions capable of contributing to the reduction of morbidity in workers and economically active people.

Resumo: Os transtornos mentais são a principal causa de anos vividos com incapacidade entre a população jovem e economicamente ativa no mundo e no Brasil. Os impactos representam um problema importante para a saúde pública hoje. O objetivo do estudo foi de estimar a carga de transtornos mentais entre profissionais que trabalham no combate às doenças endêmicas em um estado do Nordeste brasileiro. Foi realizada uma coorte histórica com base na revisão de prontuários médicos dos profissionais que trabalham no combate às doenças endêmicas e vinculados ao Ministério da Saúde no Ceará. Procedemos à quantificação individual do absenteísmo por transtorno mental (CID, capítulo F, sobre transtornos mentais) ao longo de um período de cerca de 35 anos, desde a admissão (anos 1980) até dezembro de 2017. A carga global de doença foi medida pelo indicador anos vividos com incapacidade, considerando que não foram observados óbitos por transtorno mental, que constitui o indicador de anos de vida perdidos por morte prematura. Destaca-se a alta carga de transtorno mental nesse grupo de trabalhadores, cujos transtornos de humor, inclusive depressão, conferiam 18,6 anos vividos com incapacidade, ou seja, mais de 18 anos de trabalho vividos com incapacidade. Nossos achados reforçam a necessidade de implementar medidas de vigilância e promoção da saúde nos trabalhadores para promover intervenções efetivas capazes de contribuir para a redução da morbidade entre trabalhadores e pessoas economicamente ativas.

Resumen: Los desórdenes mentales son la principal causa de años de vida vividos con discapacidad en la población joven y económicamente activa en el mundo y en Brasil. Sus impactos representan un problema importante para la salud pública hoy en día. El objetivo fue estimar la carga de los desórdenes mentales entre profesionales, que trabajan para combatir enfermedades endémicas en un estado del noreste brasileño. Se llevó a cabo con una cohorte histórica procedente de una investigación con registros médicos de trabajadores que luchaban contra enfermedades endémicas, relacionados con el Ministerio de Salud en Ceará. Se procedió a realizar una cuantificación individual del absentismo mediante desórdenes mentales (capítulo ICD F que se refiere a los desórdenes mentales) durante un período de aproximadamente 35 años, desde la admisión (en los años de 1980) hasta diciembre de 2017. Se midió la carga global de la enfermedad mediante el indicador YLD (años perdidos por la discapacidad). Considerando que no se observaron muertes debido a las desórdenes mentales, que conforman el indicador YLL (años de vida perdidos). Destaca la alta carga de desórdenes mentales en este grupo de trabajadores, cuyos trastornos del comportamiento, incluyendo la depresión, confirió un YLD igual a 18,6. Esto representa algo más de 18 años de trabajo vividos con una discapacidad. Nuestros resultados refuerzan la necesidad de implementar acciones de vigilancia y promoción de la salud en los trabajadores, con el fin de promover intervenciones efectivas capaces de contribuir a la reducción de la morbilidad en trabajadores y gente activa económicamente.

Surveillance of occupational accidents by sentinel workers' health centers in the municipality of Fortaleza, Northeast of Brazil. / Vigilância dos acidentes de trabalho em unidades sentinela em saúde do trabalhador no município de Fortaleza, nordeste do Brasil.

This article examines the factors associated with the notification of occupational accidents by sentinel workers' health centers in the municipality of Fortaleza in the northeast of Brazil. An analytical cross-sectional study was conducted of five sentinel workers' health centers for serious and fatal occupational accidents. A total of 354 interviews were conducted with professionals responsible for notifying occupational accidents. Bivariate analysis was conducted using Pearson's chi-square test and/or Fisher's exact test using prevalence ratios and 95% confidence intervals, followed by stratified analysis and multivariate Poisson regression adopting the stepwise forward method. Variables that obtained a p-value of less than or equal to the chosen significance level (0.05) were maintained in the final model. Professionals who had a greater number of years of work experience, had undertaken three training courses, had knowledge of policy directives concerning occupational accidents, were familiar with the SINAN notification form, were aware that occupational accidents are reportable, and discussed the theme of occupational accidents in the workplace were statistically more likely to notify occupational accidents. Education and training helps raise awareness among health professionals.

Resumo O artigo analisa os fatores associados à notificação de Acidentes de Trabalho (AT) em unidades sentinelas do município de Fortaleza, nordeste do Brasil. Estudo transversal, analítico, realizado em cinco unidades sentinela para acidentes de trabalho graves e fatais. Foram aplicados 354 questionários em profissionais responsáveis pelas notificações dos AT. Utilizou-se a Razão de Prevalência, com intervalo de confiança de 95% e os testes de Qui-quadrado de Pearson e/ou exato de Fischer. Após essa etapa, utilizou-se a análise estratificada e análise múltipla através da Regressão de Poisson adotando o método Stepwise Forward. No modelo final, foram mantidas as variáveis que apresentaram nível de significância menor ou igual a 0,05. Foram associados significativamente à maior chance de notificação dos AT as variáveis: tempo de atuação na área, ter participado pelo menos de três cursos, ter conhecimento sobre as portarias e a legislação relacionadas aos AT, sobre a ficha do SINAN, saber que os AT são eventos de notificação compulsória e discutir esse tema com a equipe de trabalho. Ações de capacitação contribuem para a sensibilização dos profissionais.

Symptomatic perception of patients affected by chronic chikungunya: a qualitative perspective / Percepção dos sintomas de pacientes acometidos por chikungunya crônica: um olhar qualitativo

Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.

Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.

[Prevalence and violence-associated factors in the work environment of female prison guards in Brazil]. / Prevalência e fatores associados à violência no ambiente de trabalho em agentes de segurança penitenciária do sexo feminino no Brasil.

This article aims to estimate the prevalence and violence-associated factors in the work environment of female correctional officers in Brazil. A cross-sectional, analytical study was conducted in 15 female correctional facilities in Brazil's five regions. Pearson's chi-square test was performed. The Odds Ratio and Confidence Intervals were estimated for factors that showed a significant association or were confounding factors. The prevalence of having experienced at least one violent occurrence during professional duty as an officer was 28.4%. An interesting factor is fact that agents themselves are identified as the main suspects of robbery (74.6%), moral violence (68.1%) and sexual harassment (66.8%) against their co-workers. Working in more than one correctional facility increased the chance of suffering from violence (OR = 3.23; CI = 1.51 - 6.9). The main associated factors are: working in temporary detention centers, age of admission to the prison system and low social support among co-workers. Violence in the Brazilian prison environment is of great magnitude and considered a complex phenomenon with multiple causes. To combat this, it is necessary to adopt intersectoral actions, capable of intervening both in the prison environment and in society.

Management and use of water resources and the expansion of agribusiness: water for what and for whom?

This article aims to conduct an analysis of the correlation between the management and use of water resources with the expansion of agribusiness and its reflections in environmental and human contamination, pointing toward challenges for SUS in the area of monitoring pesticides in water for human consumption. It is qualitative study with an adopted methodological framework of the case study, applied in an area of agribusiness expansion in the semi-arid region of the state of Ceará. The results demonstrate that there exists an unequal relationship in the management and use of water, in which agribusiness in Ceará is prioritized for access to water at the expense of the great majority of the rural population. As a result, pesticide contamination of surface and ground water brings challenges to surveillance of the control of pesticides in water for human consumption. In this sense, we present alternatives to develop health services with more effective actions in surveillance of health in general, and of Vigiagua in particular, such as: overcoming the fragmentation of vision and intervention regarding health problems; human exposure to multiple pesticides; the lack of laboratories and trained professionals; and enlarging the dissemination of information to the users of water.