Intersectionality and depression symptoms in Mexican adults aged ≥50, MHAS 2001 and 2012.

OBJECTIVE: To analyze, from the perspective of intersectionality, the association of social inequality dimensions (occupation, poverty, and educational level) and socio-demographic and health characteristics with the proportion of depressive symptoms among males and females aged 50 years and older who participated in the 2001 and 2012 waves of the Mexican Health and Aging Study (MHAS). MATERIALS AND METHODS: Descriptive analysis and logistic regression models stratified by sex were performed, including interaction terms between poverty, educational level, and employment conditions on the presence of depressive symptoms. RESULTS: The proportion of females with depressive symptoms was significantly higher than that of males in both waves. A high proportion of older females in poverty, with five years or less of education and manual occupational activities, reported depressive symptoms in the MHAS-2001. The interactions evaluated between occupation, poverty, and educational level were not statistically significant under adjusted models; however, disability and comorbidities were associated with depressive symptoms in both sexes. CONCLUSION: A higher proportion of females have depressive symptoms under conditions of inequality; however, the effect of the intersection between employment and socio-demographic characteristics on depressive symptoms was not observed under adjusted models.

Global health diplomacy in Mexico: insights from key actors in the field.

BACKGROUND: Global health diplomacy (GHD) focuses on the actions taken by diverse stakeholders from different nations -governments, multilateral agents, and civil society- to phenomena that can affect population health and its determinants beyond national borders. Although the literature on conceptual advancements of GHD exists, empirical studies about how health becomes an issue of relevance for foreign policy are scarce. We present an analysis of the entry processes of health into the foreign policy and diplomatic domains in Mexico from the perspective of key informants of three different sectors. METHODS: A purposive sample of high-rank representatives of three sectors involved in GHD was designed: Two from Health Sector (HS), four from Foreign Affairs Sector (FAS), and three from Non-governmental organizations (NGOs). Nine semi-structured interviews were conducted exploring the topics of: (1) Health concerns entering diplomatic and foreign policy; (2) Processes that allow actors to influence foreign policy and negotiation and; (3) Impact of multilateral negotiations on decision-making at the national level. RESULTS: Our analysis suggests that GHD in Mexico is hierarchically driven by the FAS and health concerns only enter foreign policy when they are relevant to national priorities (such as trade or security). HS possesses a lesser degree of influence in GHD, serving as an instance of consultation for the FAS when deciding on health-related issues at global meetings (i.e., World Health Assembly). NGOs resort to lobbying, advocacy, networking, and coalition-working practices with other sectors (academy, think-tanks) to prevent harmful impacts on local health from multilateral decisions and as a mean to compensate its power asymmetry for influencing GHD processes in relation to the government. CONCLUSIONS: GHD in Mexico occurs in a context of asymmetric power relationships where government actors have the strongest influence. However, NGOs' experience in raising awareness of health risks needs to be weighted by government decision-makers. This situation calls for capacity building on intersectoral communication and coordination to create formal mechanisms of GHD practices, including the professionalization and training on GHD among government agencies.

A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research.

BACKGROUND: Despite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action. METHODS: Through a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level. RESULTS: Our model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities. CONCLUSIONS: This type of knowledge can assist researchers and decision-makers to identify any information gaps or barriers to be addressed, and establish new entry points to effectively strengthen these research capacities. This can lead to the production of a stronger evidence base, both locally and globally, which can be used to inform strategic efforts aimed at achieving health equity.

Loss of job-related right to healthcare associated with employment turnover: challenges for the Mexican health system.

BACKGROUND: The Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as experienced by affiliates to the Mexican Institute of Social Security (IMSS) at national level, and of workers with type 2 diabetes (T2DM) in Mexico City. METHODS: Using data from the National Employment and Occupation Survey, 2014, and from IMSS electronic medical records for workers in Mexico City, we estimated annual employment turnover rates to measure the loss of healthcare access due to labour market dynamics. We fitted a binary logistic regression model to analyse the association between sociodemographic variables and employment turnover. Lastly we analysed job-related access to health care in relation to employment turnover events. RESULTS: At national level, 38.3% of IMSS affiliates experienced employment turnover at least once, thus losing the right to access to healthcare. The turnover rate for T2DM patients was 22.5%. Employment turnover was more frequent at ages 20-39 (38.6% national level; 28% T2DM) and among the elderly (62.4% national level; 26% T2DM). At the national level, higher educational levels (upper-middle, OR = 0.761; upper, OR = 0.835) and income (5 minimum wages or more, OR = 0.726) were associated with lower turnover. Being single and younger were associated with higher turnover (OR = 1.413). T2DM patients aged 40-59 (OR = 0.655) and with 5 minimum wages or more (OR = 0.401) experienced less turnover. Being a T2DM male patient increased the risk of experiencing turnover (OR = 1.166). Up to 89% of workers losing IMSS affiliation and moving on to other jobs failed to gain job-related access to health services. Only 9% gained access to the federal workers social security institute (ISSSTE). CONCLUSIONS: Turnover across labour market sectors is frequently experienced by the workforce in Mexico, worsening among the elderly and the young, and affecting patients with chronic diseases. This situation needs to be prospectively addressed by health system policies that aim to expand the financial health protection during an employment turnover event.

Loss of job-related right to healthcare is associated with reduced quality and clinical outcomes of diabetic patients in Mexico.

OBJECTIVES: The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study 2013-2015. SETTING: Six IMSS family medicine clinics (FMC) in Mexico City. PARTICIPANTS: T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. SOURCE OF INFORMATION: IMSS affiliation department database and electronic health records and clinical laboratory databases. MAIN OUTCOME MEASURE(S): Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. RESULTS: The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. CONCLUSION: Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.

Measuring health inequities in low and middle income countries for the development of observatories on inequities and social determinants of health.

BACKGROUND: Almost seven years after the publication of the final report of the World Health Organization's Commission on Social Determinants of Health (CSDH), its third recommendation has not been attended to properly. Measuring health inequities (HI) within countries and globally, in order to develop and evaluate evidence-based policies and actions aimed at the social determinants of health (SDH), is still a pending task in most low and middle income countries (LMIC) in the Latin American region. In this paper we discuss methodological and conceptual issues to measure HI in LMIC and suggest a three-stage methodology for the creation of observatories on health inequities (OHI) and social determinants of health, based on the experience of the Brazilian Observatory on Health Inequities (BOHI) that has been successfully operating since 2010 at the Fundação Oswaldo Cruz (FIOCRUZ). METHODS: A three-stage methodology for the creation of an OHI was developed based on a literature review on the following topics: SDH, HI measurement, and the process of setting-up of health observatories; followed by semi-structured interviews with key informants from the BOHI. We describe the three stages and discuss the replicability of this methodology in other Latin American countries. We also carried out a search of suitable national information systems to feed an OHI in Mexico, along with an outline of the institutional infrastructure to sustain it. RESULTS: When implementing the methodology for an OHI in LMIC such as Mexico, we found that having strong infrastructure of information systems for measuring HI is required, but not sufficient to build an OHI. Adequate funding and intersectoral network collaborations lead by a group of experts is a requirement for the consolidation and sustainability of an OHI in LMIC. CONCLUSION: According to the described methodology, and the available information systems on health, the creation of an OHI in LMIC, particularly in Mexico, is plausible in the near future. However, institutional support (in academic, financial, and policymaking terms) is essential to materialize such needed instance, thus locally contributing to attain health equity.

SDH-NET: a South-North-South collaboration to build sustainable research capacities on social determinants of health in low- and middle-income countries.

BACKGROUND: It is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South-North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice. METHODS: The implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research. RESULTS: The implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open-access learning platform with tools and resources, ethical guidelines for research, policy recommendations, and academic contributions to the global SDH discourse. CONCLUSIONS: The effective triangulation of S-N-S partnerships can be of high value in building sustainable research capacity in LMICs. If designed appropriately, these multicultural, multi-institutional, and multidisciplinary collaborations can enable southern and northern academics to contextualize global research according to their national realities.

[A first analysis of research on social determinants of health in Mexico: 2005-2012]. / Un primer análisis de la investigación en México sobre los determinantes sociales de la salud: 2005-2012.

OBJECTIVE: To examine the research on social determinants of health (SDH) produced in Mexico during the period 2005-2012, based on the characterization of the national health research system and the scientific production on this topic. MATERIALS AND METHODS: Two-stage analyses: Review of Mexican documents and official sources on health research and systematic bibliographic review of the literature on SDH. RESULTS: Although SDH were mentioned in the Specific Action Plan for Health Research 2007-2012, they are not implemented in strategies and goals, as the emphasis is put mostly in infrastructure and administrative aspects of research. In the period studied, 145 articles were published on SDH topics such as health conditions, health systems and nutrition and obesity. CONCLUSIONS: In spite of the availability of research on SDH in Mexico, the operationalization of such findings into health policies has not been possible. The current Sectorial Program on Health 2013-2018 represents a window of opportunity to position research findings that promote health equity policies.

Occupational injuries and their sociodemographic, workplace, and behavioral determinants among large-scale factory workers in Ethiopia: a cross-sectional study.

Workplace injuries constitute a serious and growing public health concern worldwide. Despite work-related injuries being highly common, especially among workers in the manufacturing industry, their growing complexities are not adequately addressed in the current literature. Therefore this study aims to investigate the association between sociodemographic, workplace, and behavioral characteristics with work-related injuries among large-scale factory workers in Ethiopia. A cross-sectional study was conducted from February to April 2020 with 457 workers selected from large-scale factories in Addis Ababa, the capital of Ethiopia. Survey data included sociodemographic characteristics, working and safety conditions, and behavioral factors as predictors of occupational injuries. A logistic regression model was fitted to estimate the probability of injury and identify its associated factors. The 12-month prevalence of work-related injuries was 25%. Most injuries occurred at midnight (8.8%). Factors associated with work-related injury were excessive working hours (OR = 3.26; 95%CI: 1.26-8.41), cigarette smoking (OR = 2.72; 95%CI: 1.22-6.08), and manual handling (OR = 2.30; 95%CI: 1.13-4.72). Use of personal protective equipment reduced the odds of injury (OR = 0.42; 95%CI: 0.21-0.83). Although our estimated prevalence of occupational injury was lower than that found in other studies, our findings suggest that actions on modifiable conditions must be taken to reduce the burden of workplace injuries in Ethiopia. The results could inform preparedness and policy efforts aimed at improving worker safety and health.

[Job conditions and precarious work among Mexican physicians: an analysis based on a national survey]. / Condiciones de empleo y precariedad laboral de los médicos de México: análisis basado en una encuesta nacional.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

Non-Migrant Paid Domestic Workers and Depressive Symptoms: A Mixed-Methods Systematic Review.

Health of non-migrant paid domestic workers (PDWs) has seldom been studied. This review examines the relationship between being a non-migrant paid domestic worker and manifesting depressive symptoms (DS). Following a mixed-methods systematic review protocol, we found 10 relevant cross-sectional studies conducted in African, Asian, and Latin American countries. Depressive symptoms prevalence reported in quantitative studies ranged from 28% (CI: 22-35) to 53% (CI: 46-60). Qualitative evidence points towards structural conditions (poverty and intersectional discrimination) as drivers of female job placement in domestic work. Qualitative and quantitative evidence suggest that DS occurs more frequently in PDWs than other workers in the informal labor market. Psychosocial risks, working conditions, and workplace abuse play an intervening role in the development of DS. Future longitudinal research and adequate sampling methods are needed to examine protective factors, perceptions of working conditions, and work-family conflict in PDWs to better assess the development of DS among them.

Global Health Diplomacy (GHD) and the integration of health into foreign policy: Towards a conceptual approach.

Since the end of the Cold War, health has gone from a peripheral concern in foreign policy negotiations to a prominent place on the global political agenda. While the rise of health onto the foreign policy agenda is by now old news, the driving forces behind its expansion into new political spheres remain understudied and undertheorized. This article builds on empirical findings from a four-country study of the integration of health into foreign policy, and proposes a conceptual approach to GHD to improve understanding of the conditions under which health is successfully positioned on the foreign policy agenda. Our approach consists of three dimensions: features of institutions and the interest various actors represent in GHD; the ideational environment in which GHD operates; and issue characteristics of the specific health concern entering foreign policy. Within each dimension, we identify specific variables that, in combination, make up the explanatory power of the proposed approach. The proposed approach does not relate to, or build upon, a single social sciences, public health, or international relations (IR) theory, but can be seen as a heuristic device to identify dimensions and variables that may shape why certain health issues rise onto the foreign policy agenda.

Perinatal Outcomes Among Venezuelan Immigrants in Colombia: A Cross-Sectional Study.

In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national birth registry (1085 births in migrants and 654,829 in Colombians). Logistic and linear regression models were used to identify the association between the demographic, obstetric and neonatal characteristics with premature birth (PB), low birth weight (LBW), 1-min, and 5-min Apgar score. Venezuelan were more likely to have newborns with LBW, lower Apgar scores at 1-min and 5-min in comparison to Colombians. Furthermore, a difference was observed in the low health insurance coverage and antenatal care visits among Venezuelan in comparison to natives. Access to health care services for the migrants is desirable for the improvement of perinatal health conditions.

COVID-19 Response in Latin America.

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.

Occupational injuries and their sociodemographic, workplace, and behavioral determinants among large-scale factory workers in Ethiopia: a cross-sectional study / Accidentes laborales y sus determinantes sociodemográficos, espaciales y conductuales en trabajadores de grandes fábricas de Etiopía: un estudio transversal / Acidentes de trabalho e seus determinantes sociodemográficos, de espaço e comportamentais em trabalhadores de fábricas de grande porte na Etiópia: estudo transversal

Workplace injuries constitute a serious and growing public health concern worldwide. Despite work-related injuries being highly common, especially among workers in the manufacturing industry, their growing complexities are not adequately addressed in the current literature. Therefore this study aims to investigate the association between sociodemographic, workplace, and behavioral characteristics with work-related injuries among large-scale factory workers in Ethiopia. A cross-sectional study was conducted from February to April 2020 with 457 workers selected from large-scale factories in Addis Ababa, the capital of Ethiopia. Survey data included sociodemographic characteristics, working and safety conditions, and behavioral factors as predictors of occupational injuries. A logistic regression model was fitted to estimate the probability of injury and identify its associated factors. The 12-month prevalence of work-related injuries was 25%. Most injuries occurred at midnight (8.8%). Factors associated with work-related injury were excessive working hours (OR = 3.26; 95%CI: 1.26-8.41), cigarette smoking (OR = 2.72; 95%CI: 1.22-6.08), and manual handling (OR = 2.30; 95%CI: 1.13-4.72). Use of personal protective equipment reduced the odds of injury (OR = 0.42; 95%CI: 0.21-0.83). Although our estimated prevalence of occupational injury was lower than that found in other studies, our findings suggest that actions on modifiable conditions must be taken to reduce the burden of workplace injuries in Ethiopia. The results could inform preparedness and policy efforts aimed at improving worker safety and health.

Los accidentes laborales constituyen un grave y creciente problema de salud pública mundial. Aunque este tipo de accidente es frecuente, especialmente entre los trabajadores de las industrias manufactureras, su creciente complejidad no ha sido abordada adecuadamente en la literatura actual. El objetivo de este estudio fue analizar la asociación entre las características sociodemográficas, ambientales y conductuales y los accidentes laborales en trabajadores de grandes fábricas de Etiopía. Se trató de un estudio transversal, realizado de febrero a abril de 2020 con 457 trabajadores de grandes fábricas en Adís Abeba, la capital de Etiopía. Los datos recopilados contenían características sociodemográficas, condiciones de trabajo, de seguridad y factores conductuales como predictores de accidentes laborales. Se utilizó un modelo de regresión logística para estimar la probabilidad de lesión e identificar sus factores asociados. La prevalencia de accidentes laborales en 12 meses fue del 25%. La mayoría de las lesiones se produjeron a medianoche (8,8%). Los factores asociados a los accidentes laborales fueron el exceso de horas de trabajo (OR = 3,26; IC95%: 1,26-8,41), el tabaquismo (OR = 2,72; IC95%: 1,22-6,08) y la manipulación manual (OR = 2,30; IC95%: 1,13-4,72). El uso de equipos de protección individual redujo la probabilidad de lesiones (OR = 0,42; IC95%: 0,21-0,83). Aunque la prevalencia estimada de accidentes laborales fue inferior a la de otros estudios, los resultados apuntan a acciones que deben adoptarse para reducir la carga de accidentes laborales en Etiopía. Los resultados permiten reflexionar sobre los esfuerzos de preparación y las políticas dirigidas a mejorar la seguridad y la salud de los trabajadores.

Acidentes de trabalho são preocupações de saúde pública sérias e crescentes em todo o mundo. Apesar de acidentes de trabalho serem comuns, especialmente entre trabalhadores de indústrias manufatureiras, suas crescentes complexidades não são adequadamente abordadas na literatura atual. O objetivo deste estudo foi investigar a associação de características sociodemográficas, de ambiente e comportamentais com acidentes de trabalho em trabalhadores de fábricas de grande porte na Etiópia. Um estudo transversal foi conduzido de fevereiro a abril de 2020 com 457 trabalhadores selecionados de fábricas de grande escala em Adis Abeba, capital da Etiópia. Os dados da pesquisa incluíram características sociodemográficas, condições de trabalho e segurança e fatores comportamentais como preditores de acidentes de trabalho. Ajustou-se um modelo de regressão logística para estimar a probabilidade de lesão e identificar seus fatores associados. A prevalência de 12 meses de acidentes de trabalho foi de 25%. A maioria das lesões ocorreu à meia-noite (8,8%). Os fatores associados aos acidentes de trabalho foram jornada excessiva (OR = 3,26; IC95%: 1,26-8,41), tabagismo (OR = 2,72; IC95%: 1,22-6,08) e manuseio manual (OR = 2,30; IC95%: 1,13-4,72). O uso de equipamentos de proteção individual diminuiu a chance de lesão (OR = 0,42; IC95%: 0,21-0,83). Embora nossa prevalência estimada de acidentes ocupacionais tenha sido menor em comparação com outros estudos, nossos resultados apontam para ações pendentes sobre condições modificáveis a serem tomadas para reduzir a carga de acidentes de trabalho na Etiópia. Os resultados poderão informar os esforços de preparação e políticas destinados a melhorar a segurança e a saúde dos trabalhadores.

State of Children Environmental Health Research in Latin America.

BACKGROUND: Promotion of biomedical research along with the development of evidence-based prevention policies have been suggested as an effective way to reduce environmental risks for children's health in Latin America. However, there is little information on the current state of childhood environmental health research, which might help identify its strengths and limitations, as well as to design a strategy to improve the future of child environmental health research in the region. OBJECTIVE: To describe the current state of environmental health research on children exposed to environmental pollutants in Latin America. METHODOLOGY: We performed a comprehensive search of published peer-reviewed environmental health articles (1994-2014), dealing with the exposure of Latin American children to chemical compounds. We described the type of studies and their research topics, and identified networks of co-authors. We also analyzed the relationship between research funding sources and the impact factor (IF) of the journal where research was published. RESULTS: The average number of publications was about 20 per year. Mexico and Brazil produced almost 70% of the 409 identified papers. The most studied contaminant was lead, but research on this element has declined since 2005. Retrospective studies were the most frequent, and also showed a decreasing trend. Most studies did not assess health effects. Four groups of leading investigators and two collaboration models for scientific production were identified. Except for Mexico, there was very little collaboration with North American and European countries. Compared to articles that did not report financial support, those that received international funding had on average an IF around 7, and those with national funding reached a mean IF near 3. CONCLUSION: There is a limited number of publications and insufficient collaboration between Latin-American scientists. It is necessary to identify strategies to stimulate South-South-North alliances and strengthen the scarce research on the environmental health of children in the region.

Condiciones de empleo y precariedad laboral de los médicos de México: análisis basado en una encuesta nacional / Job conditions and precarious work among Mexican physicians: an analysis based on a national survey / Condições de emprego e precariedade laboral dos médicos do México: análise baseada em pesquisa nacional

El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

Perspective Piece COVID-19 Response in Latin America

A gestão eficaz de uma pandemia devido a um vírus respiratório requer capacidade de saúde pública para uma resposta coordenada às restrições obrigatórias, testes em grande escala para identificar indivíduos infectados, capacidade de isolar casos infectados e rastrear e testar contatos e serviços de saúde para aqueles infectados que precisam hospitalização. Devido a fatores contextuais e socioeconômicos, tem sido difícil para a América Latina enfrentar esta epidemia. Neste artigo, discutimos o contexto e as respostas iniciais de oito países latino-americanos selecionados, incluindo semelhanças e diferenças nas medidas de saúde pública, econômicas e fiscais, e fornecemos reflexões sobre o que funcionou e o que não funcionou e o que esperar no futuro.