O futuro do trabalho após a COVID-19: o papel incerto do teletrabalho no domicílio / The future of work after the COVID-19, the uncertain role of teleworking at home / El futuro del trabajo tras la COVID-19: el papel incierto del teletrabajo en el domicilio

Resumo Introdução: o teletrabalho no domicílio, uma das medidas adotadas para controlar a pandemia de COVID-19 e, ao mesmo tempo, manter o emprego, tem aumentado em vários países. Objetivo: refletir sobre o significado, a magnitude e as tendências do teletrabalho no domicílio, antes e durante a pandemia, enfatizando seus potenciais efeitos na saúde do trabalhador. Discussão: a precedente Convenção 177/1996 da Organização Internacional do Trabalho (OIT) sobre trabalho a domicílio e o acordo sobre teletrabalho entre agentes sociais na União Europeia, em 2002, apontam a dificuldade de regulamentar essa nova forma de organização do trabalho e da prevenção de possíveis lesões e doenças associadas, especialmente transtornos mentais e distúrbios musculoesqueléticos. São necessários estudos sobre os efeitos na saude dessa modalidade de trabalho para fornecer evidências científicas que embasarão normas em nível nacional e global. A inclusão de questões específicas e bem definidas, como as que a OIT propõe, em futuros levantamentos sobre as condições de trabalho, emprego e saúde poderá auxiliar tal objetivo e proporcionar uma oportunidade para observar os efeitos do teletrabalho no domicílio na saúde do trabalhador, bem como avaliar o impacto de uma necessária e urgente regulamentação.

Abstract Introduction: teleworking at home, one of the mitigation measures adopted to control the COVID-19 pandemic, while attempting to maintain employment, has increased in many countries. Objective: to reflect on the meaning, magnitude and trends of teleworking at home, before and during the pandemic, focusing on its potential effects on the health of workers. Discussion: the precedent of Convention 177/1996 of the International Labour Organization (ILO) on home work, and the agreement on teleworking between social agents in the European Union of 2002, underscore the difficulties of regulating this new form of work organization, and the prevention of possible injuries and associated diseases, especially mental and musculoskeletal disorders. The investigation of its effects on health is a priority to base its regulation at the national and global level on scientific evidence. The incorporation of specific, well-defined questions, such as those proposed by the ILO, in questionnaires of future surveys on working conditions, employment and health may help in this objective and provide an opportunity to monitor the effects on health of teleworking at home, as well as evaluating the impact of its necessary and urgent regulation.

Resumen Introducción: el teletrabajo en el domicilio, una de las medidas adoptadas para controlar la pandemia de COVID-19, y al mismo tiempo mantener el empleo, se ha incrementado en diversos países. Objetivos: reflexionar sobre el significado, la magnitud y las tendencias del teletrabajo en el domicilio, antes y durante la pandemia, focalizando en sus potenciales efectos sobre la salud de los trabajadores. Discusión: el antecedente del Convenio 177/1996 de la Organización Internacional del Trabajo (OIT) sobre trabajo a domicilio, y el acuerdo sobre teletrabajo entre agentes sociales en la Unión Europea de 2002, muestran la dificultad de regular esta nueva forma de organización del trabajo, y de la prevención de las posibles lesiones y enfermedades asociadas, especialmente los trastornos mentales y musculoesqueléticos. La investigación de sus efectos sobre la salud es una prioridad para fundamentar en evidencias científicas su regulación a nivel nacional y global. La incorporación de preguntas específicas, bien definidas, como las que propone la OIT, en cuestionarios de futuras encuestas sobre condiciones de trabajo, empleo y salud podrán ayudar en este objetivo y propiciar una oportunidad para monitorizar los efectos del teletrabajo en el domicilio sobre la salud, así como evaluar el impacto de su necesaria y urgente regulación.

Evolución de las lesiones por accidentes de trabajo y enfermedades profesionales en la República Argentina, 1997-2015 / Trends in occupational injury and disease in Argentina, 1997-2015

Objetivo: Describir la tendencia temporal de las lesiones por accidentes de trabajo (LAT) y las enfermedades profesionales (EP) en Argentina, entre 1997 y 2015, según gravedad del daño, lugar de ocurrencia, actividad económica y provincia. Métodos: La población de estudio está formada por la población trabajadora asalariada cubierta por el sistema de Riesgos del Trabajo de Argentina, que era de aproximadamente 4 millones en 1997 y de 9.6 millones en 2015. La tasa anual de incidencia de las LAT y EP se calculó según el número de casos notificados dividido por el promedio de trabajadores cubiertos por el sistema en cada año. Para medir el cambio temporal en la incidencia se calculó el porcentaje de cambio general (PCG), como el cociente de la diferencia entre tasa del primer año menos la del último año, dividido por la tasa del último año. Resultados: La incidencia global de LAT y EP disminuyó de manera más pronunciada entre los mortales (PCG = -65,0%) que en los no mortales (PCG = -23,3%). Según el lugar de ocurrencia, se observó un descenso en la incidencia de las LAT no mortales en jornada (PCG = -47,7%) y un incremento de las in itinere (PCG = 123,4%). En relación a las EP, se apreció un aumento en la incidencia de las EP no mortales (PCG=393,0%). Las EP mortales mostraron una tendencia más oscilante. Estas tendencias se reproducen de manera similar tanto para las actividades económicas como para las provincias seleccionadas. Conclusiones: Las tendencias observadas, especialmente en los últimos años, en las LAT y las EP en Argentina muestran un patrón similar al de países europeos, con un descenso de las LAT en jornada, mortales y no mortales, excepto para las LAT in itinere. Sin embargo, en el estudio de las EP no mortales se debe profundizar en el conocimiento más detallado y completo de su tendencia temporal Integración de la prevención de riesgos en el proceso de compra de desinfectantes hospitalarios del Instituto Catalán de la Salud entre los años 2008 y 2017

Objectives: To describe temporal trends in occupational injuries (OI) and occupational diseases (OD) in Argentina, by severity of the injury, place of occurrence, economic activity and selected provinces, in the period 1997 to 2015. Methods: The study population consists of the working population covered by the Argentine Law of Occupational Risks system, roughly 4 million people in 1997 and 9.5 million in 2015. The annual incidence rate of the OI and OD was calculated by using the number of reported cases divided by the mean number of employees covered by the system each year. To measure change in incidence over time, we calculated the overall percentage change (OPC), by dividing the difference between the incidence rate of the first minus the last year by the incidence rate of the last year. Results: The overall incidence of OI and OD showed a greater decline for fatal (OPC=-65%) versus nonfatal injuries (OPC-23,3%). By place of occurrence, we observed a decrease in the incidence of nonfatal occupational injuries at the workplace (OPC =-47,7%), but an increase in occupational commuting OI (OPC =+123,4%). For OD, there was an increase in the incidence of nonfatal OD (OPC =393%), although the tendency showed both increases and declines among fatal occupational diseases. This pattern was consistent among different economic activities as well as in selected provinces. Conclusions: Observed trends are in line with other high-income countries, with decreasing nonfatal workplace OI, and increasing commuting OI and nonfatal OD. Further in-depth research is warranted on temporal trends in non-fatal OD

[TRENDS IN OCCUPATIONAL INJURY AND DISEASE IN ARGENTINA, 1997-2015]. / Evolución de las lesiones por accidentes de trabajo y enfermedades profesionales en la República Argentina, 1997-2015.

OBJECTIVES: To describe temporal trends in occupational injuries (OI) and occupational diseases (OD) in Argentina, by severity of the injury, place of occurrence, economic activity and selected provinces, in the period 1997 to 2015. METHODS: The study population consists of the working population covered by the Argentine Law of Occupational Risks system, roughly 4 million people in 1997 and 9.5 million in 2015. The annual incidence rate of the OI and OD was calculated by using the number of reported cases divided by the mean number of employees covered by the system each year. To measure change in incidence over time, we calculated the overall percentage change (OPC), by dividing the difference between the incidence rate of the first minus the last year by the incidence rate of the last year. RESULTS: The overall incidence of OI and OD showed a greater decline for fatal (OPC=-65%) versus nonfatal injuries (OPC-23,3%). By place of occurrence, we observed a decrease in the incidence of nonfatal occupational injuries at the workplace (OPC =-47,7%), but an increase in occupational commuting OI (OPC =+123,4%). For OD, there was an increase in the incidence of nonfatal OD (OPC =393%), although the tendency showed both increases and declines among fatal occupational diseases. This pattern was consistent among different economic activities as well as in selected provinces. CONCLUSIONS: Observed trends are in line with other high-income countries, with decreasing nonfatal workplace OI, and increasing commuting OI and nonfatal OD. Further in-depth research is warranted on temporal trends in non-fatal OD.

OBJETIVO: Describir la tendencia temporal de las lesiones por accidentes de trabajo (LAT) y las enfermedades profesionales (EP) en Argentina, entre 1997 y 2015, según gravedad del daño, lugar de ocurrencia, actividad económica y provincia. MÉTODOS: La población de estudio está formada por la población trabajadora asalariada cubierta por el sistema de Riesgos del Trabajo de Argentina, que era de aproximadamente 4 millones en 1997 y de 9.6 millones en 2015. La tasa anual de incidencia de las LAT y EP se calculó según el número de casos notificados dividido por el promedio de trabajadores cubiertos por el sistema en cada año. Para medir el cambio temporal en la incidencia se calculó el porcentaje de cambio general (PCG), como el cociente de la diferencia entre tasa del primer año menos la del último año, dividido por la tasa del último año. RESULTADOS: La incidencia global de LAT y EP disminuyó de manera más pronunciada entre los mortales (PCG = -65,0%) que en los no mortales (PCG = -23,3%). Según el lugar de ocurrencia, se observó un descenso en la incidencia de las LAT no mortales en jornada (PCG = -47,7%) y un incremento de las in itinere (PCG = 123,4%). En relación a las EP, se apreció un aumento en la incidencia de las EP no mortales (PCG=393,0%). Las EP mortales mostraron una tendencia más oscilante. Estas tendencias se reproducen de manera similar tanto para las actividades económicas como para las provincias seleccionadas. CONCLUSIONES: Las tendencias observadas, especialmente en los últimos años, en las LAT y las EP en Argentina muestran un patrón similar al de países europeos, con un descenso de las LAT en jornada, mortales y no mortales, excepto para las LAT in itinere. Sin embargo, en el estudio de las EP no mortales se debe profundizar en el conocimiento más detallado y completo de su tendencia temporal.

Propuesta de indicadores para la vigilancia de la salud ocupacional en América Latina y el Caribe

[RESUMEN]. Este artículo propone un conjunto básico y común de indicadores para la vigilancia en salud ocupacional en América Latina y el Caribe e identifica las fuentes de datos disponibles para su medición. Para ello, se llevó a cabo un proceso de consenso de la Red Experta en Encuestas sobre Condiciones de Trabajo, Empleo y Salud (RED ECoTES) en dos etapas. En la primera etapa, se consensuó un primer listado de indicadores, y en la segunda etapa, se identificaron las fuentes de datos y sus características, con el fin de facilitar la comprobación de la factibilidad del cálculo real de cada indicador en 20 países de la Región. La propuesta del conjunto básico de indicadores, y sus definiciones, está conformado por 13 indicadores distribuidos en cuatro dimensiones: condiciones de empleo (tres indicadores), condiciones de trabajo (cuatro indicadores), recursos y actividades preventivas (dos indicadores) y salud (cuatro indicadores). Las principales fuentes disponibles para calcular estos indicadores en la Región fueron las encuestas permanentes de hogares, las encuestas de condiciones de trabajo, empleo y salud, las estadísticas vitales, y los sistemas de notificación de lesiones por accidentes de trabajo. En la Región existen datos para un número relevante de los indicadores propuestos. Sin embargo, un número importante de aquellos orientados a las condiciones de trabajo y actividades preventivas están ausentes en la mayoría de países. La vigilancia efectiva de la salud ocupacional en la Región exige impulsar decididamente las encuestas sobre condiciones de empleo, trabajo y salud en cada uno de los países que la conforman.

[ABSTRACT]. This article proposes a set of common basic indicators for occupational health surveillance in the region of Latin America and the Caribbean and identifies the sources of data that are available for their measurement. To this end, consensus was built among members of the Expert Network on Working, Employment, and Health Conditions Surveys (RED ECoTES) in two stages. In the first stage, a preliminary list of indicators was agreed upon; in the second stage, data sources and their characteristics were identified to help determine the feasibility of measuring the actual value of each indicator in 20 countries of the region. The proposed set of basic indicators, together with their definitions, is composed of 13 indicators in four areas: employment conditions (three indicators), working conditions (four indicators), resources and preventive activities (two indicators), and health (four indicators). The primary sources of data available in the region for calculating these indicators were: permanent household surveys; surveys on conditions of work, employment, and health; vital statistics; and reporting systems for occupational injuries. Data are available in the region for many of the proposed indicators, but a sizable number of those having to do with working conditions and preventive activities are not available in most countries. For effective occupational health surveillance in the region, surveys on conditions of work, employment, and health must be vigorously promoted in each country.

[RESUMO]. Neste artigo é proposto um conjunto básico de indicadores comuns para vigilância em saúde ocupacional na América Latina e Caribe, com a identificação das fontes de dados disponíveis para mensuração destes indicadores. A Rede Latino-Americana de Especialistas em Inquéritos sobre Condições de Trabalho, Emprego e Saúde (REDE ECoTES) conduziu um processo de decisão por consenso em duas etapas. A primeira etapa consistiu da seleção inicial dos indicadores e a segunda etapa compreendeu a identificação das fontes de dados e suas características, com o propósito de facilitar comprovar a viabilidade do cálculo efetivo de cada indicador em 20 países da Região. É proposto um conjunto básico de indicadores e respectivas definições contendo 13 indicadores distribuídos em quatro dimensões: condições de emprego (três indicadores), condições de trabalho (quatro indicadores) e recursos e atividades de prevenção (dois indicadores) e saúde (quatro indicadores). As principais fontes disponíveis na Região para determinar os indicadores são: as pesquisas permanentes de domicílios, as pesquisas sobre as condições de trabalho, emprego e saúde, as estatísticas vitais e os sistemas de notificação de acidentes de trabalho. Existem dados disponíveis para o cálculo de um número relevante dos indicadores propostos. Porém, a maioria dos países não dispõe de dados para calcular um número importante dos indicadores relacionados às condições de trabalho e atividades de prevenção. A vigilância efetiva em saúde ocupacional requer um firme incentivo às pesquisas sobre as condições de emprego, trabalho e saúde em cada país da Região.

[Proposed indicators for occupational health surveillance in Latin America and the CaribbeanProposta de indicadores para vigilância em saúde ocupacional na América Latina e Caribe]. / Propuesta de indicadores para la vigilancia de la salud ocupacional en América Latina y el Caribe.

This article proposes a set of common basic indicators for occupational health surveillance in the region of Latin America and the Caribbean and identifies the sources of data that are available for their measurement. To this end, consensus was built among members of the Expert Network on Working, Employment, and Health Conditions Surveys (RED ECoTES) in two stages. In the first stage, a preliminary list of indicators was agreed upon; in the second stage, data sources and their characteristics were identified to help determine the feasibility of measuring the actual value of each indicator in 20 countries of the region. The proposed set of basic indicators, together with their definitions, is composed of 13 indicators in four areas: employment conditions (three indicators), working conditions (four indicators), resources and preventive activities (two indicators), and health (four indicators). The primary sources of data available in the region for calculating these indicators were: permanent household surveys; surveys on conditions of work, employment, and health; vital statistics; and reporting systems for occupational injuries. Data are available in the region for many of the proposed indicators, but a sizable number of those having to do with working conditions and preventive activities are not available in most countries. For effective occupational health surveillance in the region, surveys on conditions of work, employment, and health must be vigorously promoted in each country.

Neste artigo é proposto um conjunto básico de indicadores comuns para vigilância em saúde ocupacional na América Latina e Caribe, com a identificação das fontes de dados disponíveis para mensuração destes indicadores. A Rede Latino-Americana de Especialistas em Inquéritos sobre Condições de Trabalho, Emprego e Saúde (REDE ECoTES) conduziu um processo de decisão por consenso em duas etapas. A primeira etapa consistiu da seleção inicial dos indicadores e a segunda etapa compreendeu a identificação das fontes de dados e suas características, com o propósito de facilitar comprovar a viabilidade do cálculo efetivo de cada indicador em 20 países da Região. É proposto um conjunto básico de indicadores e respectivas definições contendo 13 indicadores distribuídos em quatro dimensões: condições de emprego (três indicadores), condições de trabalho (quatro indicadores) e recursos e atividades de prevenção (dois indicadores) e saúde (quatro indicadores). As principais fontes disponíveis na Região para determinar os indicadores são: as pesquisas permanentes de domicílios, as pesquisas sobre as condições de trabalho, emprego e saúde, as estatísticas vitais e os sistemas de notificação de acidentes de trabalho. Existem dados disponíveis para o cálculo de um número relevante dos indicadores propostos. Porém, a maioria dos países não dispõe de dados para calcular um número importante dos indicadores relacionados às condições de trabalho e atividades de prevenção. A vigilância efetiva em saúde ocupacional requer um firme incentivo às pesquisas sobre as condições de emprego, trabalho e saúde em cada país da Região.

Propuesta de indicadores para la vigilancia de la salud ocupacional en América Latina y el Caribe / Proposed indicators for occupational health surveillance in Latin America and the Caribbean / Proposta de indicadores para vigilância em saúde ocupacional na América Latina e Caribe

RESUMEN Este artículo propone un conjunto básico y común de indicadores para la vigilancia en salud ocupacional en América Latina y el Caribe e identifica las fuentes de datos disponibles para su medición. Para ello, se llevó a cabo un proceso de consenso de la Red Experta en Encuestas sobre Condiciones de Trabajo, Empleo y Salud (RED ECoTES) en dos etapas. En la primera etapa, se consensuó un primer listado de indicadores, y en la segunda etapa, se identificaron las fuentes de datos y sus características, con el fin de facilitar la comprobación de la factibilidad del cálculo real de cada indicador en 20 países de la Región. La propuesta del conjunto básico de indicadores, y sus definiciones, está conformado por 13 indicadores distribuidos en cuatro dimensiones: condiciones de empleo (tres indicadores), condiciones de trabajo (cuatro indicadores), recursos y actividades preventivas (dos indicadores) y salud (cuatro indicadores). Las principales fuentes disponibles para calcular estos indicadores en la Región fueron las encuestas permanentes de hogares, las encuestas de condiciones de trabajo, empleo y salud, las estadísticas vitales, y los sistemas de notificación de lesiones por accidentes de trabajo. En la Región existen datos para un número relevante de los indicadores propuestos. Sin embargo, un número importante de aquellos orientados a las condiciones de trabajo y actividades preventivas están ausentes en la mayoría de países. La vigilancia efectiva de la salud ocupacional en la Región exige impulsar decididamente las encuestas sobre condiciones de empleo, trabajo y salud en cada uno de los países que la conforman.

ABSTRACT This article proposes a set of common basic indicators for occupational health surveillance in the region of Latin America and the Caribbean and identifies the sources of data that are available for their measurement. To this end, consensus was built among members of the Expert Network on Working, Employment, and Health Conditions Surveys (RED ECoTES) in two stages. In the first stage, a preliminary list of indicators was agreed upon; in the second stage, data sources and their characteristics were identified to help determine the feasibility of measuring the actual value of each indicator in 20 countries of the region. The proposed set of basic indicators, together with their definitions, is composed of 13 indicators in four areas: employment conditions (three indicators), working conditions (four indicators), resources and preventive activities (two indicators), and health (four indicators). The primary sources of data available in the region for calculating these indicators were: permanent household surveys; surveys on conditions of work, employment, and health; vital statistics; and reporting systems for occupational injuries. Data are available in the region for many of the proposed indicators, but a sizable number of those having to do with working conditions and preventive activities are not available in most countries. For effective occupational health surveillance in the region, surveys on conditions of work, employment, and health must be vigorously promoted in each country.

RESUMO Neste artigo é proposto um conjunto básico de indicadores comuns para vigilância em saúde ocupacional na América Latina e Caribe, com a identificação das fontes de dados disponíveis para mensuração destes indicadores. A Rede Latino-Americana de Especialistas em Inquéritos sobre Condições de Trabalho, Emprego e Saúde (REDE ECoTES) conduziu um processo de decisão por consenso em duas etapas. A primeira etapa consistiu da seleção inicial dos indicadores e a segunda etapa compreendeu a identificação das fontes de dados e suas características, com o propósito de facilitar comprovar a viabilidade do cálculo efetivo de cada indicador em 20 países da Região. É proposto um conjunto básico de indicadores e respectivas definições contendo 13 indicadores distribuídos em quatro dimensões: condições de emprego (três indicadores), condições de trabalho (quatro indicadores) e recursos e atividades de prevenção (dois indicadores) e saúde (quatro indicadores). As principais fontes disponíveis na Região para determinar os indicadores são: as pesquisas permanentes de domicílios, as pesquisas sobre as condições de trabalho, emprego e saúde, as estatísticas vitais e os sistemas de notificação de acidentes de trabalho. Existem dados disponíveis para o cálculo de um número relevante dos indicadores propostos. Porém, a maioria dos países não dispõe de dados para calcular um número importante dos indicadores relacionados às condições de trabalho e atividades de prevenção. A vigilância efetiva em saúde ocupacional requer um firme incentivo às pesquisas sobre as condições de emprego, trabalho e saúde em cada país da Região.

Work and health in Latin America: results from the working conditions surveys of Colombia, Argentina, Chile, Central America and Uruguay.

OBJECTIVE: To describe working and employment conditions, and health status between non-agricultural employees with a written contract from Colombia, Argentina, Chile, Central America and Uruguay. METHODS: We compared data from the first working condition surveys (WCS) of Colombia, Argentina, Chile, Central America and Uruguay. For comparative purposes, we selected a subsample of 15 241 non-agricultural employees aged 18-64 years and working with a written contract. We calculated prevalences and 95% CIs for the selected variables on working and employment conditions, and health status, separated by sex. RESULTS: Across all countries, at least 40% of women and 58% of men worked >40 hours a week. The most prevalent exposures were repetitive movements, followed by noise and manual handling, especially among men. Psychosocial exposures were very common among both sexes. Workers in Chile (33.4% of women and 16.6% of men) and Central America (24.3% of women and 19.1% of men) were more likely to report poor self-perceived health and were least likely to do so in Colombia (5.5% of women and 4.2% of men). The percentage of workers reporting occupational injuries was <10% across all countries. CONCLUSIONS: This study provides, for the first time, a broad picture of work and health in different Latin American countries, based on the national WCSs available. This allows for a better understanding of occupational health and could serve as a baseline for future research and surveillance of work and health in the Region. However, greater efforts are needed to improve WCSs comparability.

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean]. / Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe.

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe / Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean / Questionário básico e critérios metodológicos para as Pesquisas sobre Condições de Trabalho, Emprego e Saúde na América Latina e Caribe

Resumen: El objetivo de este trabajo es presentar un cuestionario básico y criterios metodológicos mínimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en América Latina y el Caribe. Para ello, se llevó a cabo un proceso de consenso, tanto virtual como presencial, con la participación de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la región hasta 2013. El cuestionario final incluyó 77 preguntas agrupadas en seis dimensiones: características sociodemográficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y características familiares. Entre los criterios metodológicos mínimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en América Latina y el Caribe, lo que contribuiría a mejorar la información en salud laboral en la región.

Abstract: This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Resumo: O objetivo deste trabalho é apresentar um questionário básico e critérios metodológicos mínimos, para serem considerados em futuras pesquisas sobre Condições de Trabalho, Emprego e Saúde (ECTES) na América Latina e Caribe. Para tal, foi realizado um processo de consenso, tanto virtual como presencial, com a participação de um grupo internacional de expertos que, para definir a proposta, partiram das pesquisas disponíveis na região até 2013. O questionário final incluiu 77 perguntas agrupadas em seis dimensões: características sociodemográficas do trabalhador e a empresa; condições de emprego; condições de trabalho; estado de saúde; recursos e atividades preventivas; assim como características familiares. Entre os critérios metodológicos mínimos destacam-se o domicílio da pessoa entrevistada como lugar da entrevista e os relacionados com a qualidade do trabalho de campo. Estes resultados podem ajudar a melhorar a comparabilidade das futuras ECTES na América Latina e Caribe, o que contribuiria para melhorar a informação sobre saúde do trabalhador na região.

Encuestas de condiciones de trabajo y salud: su utilización en la investigación en salud laboral / Surveys on working conditions and health: their use in occupational health research

Objetivo: Analizar la utilización de las Encuestas de Condiciones de Trabajo y Salud (ECTS) en el ámbito de la investigación en salud laboral. Material y Métodos: Se realizó una revisión bibliográfica sobre ECTS incluyendo artículos originales publicados en revistas indexadas en PubMed y CISDOC 1990-2009. En los artículos seleccionados se identificaron objetivos, temáticas abordadas y vacíos conceptuales, entre otras dimensiones. Resultados: Inicialmente se localizaron 627 publicaciones, tras la selección se analizaron 15. Las temáticas más estudiadas fueron las condiciones de empleo y la salud (14 artículos en ambos). En las condiciones de trabajo se destacaron los riesgos ergonómicos (11 artículos) y psicosociales (10 artículos). Bajo la dimensión de salud 9 estudios analizaron los síntomas psicosomáticos. Sólo 4 estudios incluyeron una perspectiva de género y 3 incorporaron la clase social. Fue escasa la investigación en prevención (2 artículos) y participación de los trabajadores (1 artículo).Conclusiones: La literatura científica producida a partir de las ECTS refleja que ciertos tópicos, como la participación de los trabajadores y las intervenciones preventivas, han sido prácticamente inexplorados. Igualmente, sería de gran interés la introducción de la perspectiva de género, migraciones y clase social ocupacional en los artículos científicos basados en las ECTS (AU)

Objective: To analyse the use of the working and health conditions survey (WHCS) in occupational health research. Method: A literature review about working and health conditions survey (WHCS) was conducted in PubMed and CISDOC in the period 1990-2009 including research articles. In selected papers objectives, main issues and gaps were identified. Results: 627 publications were located and we analysed 15 papers about WHCS. Employment conditions and Health were the most explored issues (n=14). Considering working conditions, ergonomic (n=11) and psychosocial risk factors (n=10) were more described. 9 papers analysed psychosomatic symptoms and 7 papers described self-perceived health status. Only 4 papers included gender perspective and 3 papers incorporated social class within the analysis. Research on workers’ participation (n=1) and prevention (n=2) was scarcely. Conclusions: Scientific literature based on the WHCS show that some topics have been practically unexplored, such as workers participation, preventive interventions, and labour and familiar conciliation. The introduction of a gender perspective, migration and social class in the analysis of the scientific articles would be well acknowledged (AU)

El Sistema de Riesgos del Trabajo en Argentina: salud y seguridad de los trabajadores / Occupational Risks System in Argentina: workers’ health and safety

En el presente informe se trata la salud de los trabajadores en Argentina, describiendo el Sistema de Riesgos del Trabajo,actores, normativas y daños en la salud de los trabajadores. La población argentina, que para 2008 fue superior a 39 millonesde personas, es predominantemente urbana (90%), siendo económicamente activa el 45%. Un 90% de la poblaciónestá ocupada, aunque aproximadamente el 40% es ocupación no registrada. La población trabajadora está alfabetizada casitotalmente considerando que el 93% concluyó sus estudios primarios. El 50% de la población económicamente activa estáafiliada al Sistema de Riesgos del Trabajo. Las principales contingencias relacionadas con el trabajo son las lesiones por accidentede trabajo, infiriéndose un importante subdiagnóstico y subregistro de enfermedades profesionales, poco relevantesal examinar el conjunto de siniestralidad laboral (sólo 2% del total). El sector económico con mayor incidencia es el de laconstrucción, seguido por industrias manufactureras y agricultura, caza y pesca. Respecto a frecuencia y gravedad, el sectorde la construcción encabeza la lista, con el mayor número de trabajadores fallecidos, seguido por agricultura y transporte.En la I Encuesta Nacional de Trabajo, Empleo, Condiciones y Medioambiente Laboral y Salud, realizada en el año 2009,los trabajadores refieren que en el lugar de trabajo existe, en un 30% de los casos, alguna situación ambiental entre regulary mala de los principales riesgos ambientales. En las empresas donde hubo accidentes, en un 39% de las respuestas se atribuíana deficiencias en las condiciones ambientales de trabajo. Los encuestados que perciben que el trabajo les afecta la saludidentifican los factores de riesgo responsables. Las afecciones más prevalentes fueron trastornos musculoesqueléticos,alergias, trastornos cardiovasculares, agotamiento y depresión(AU)

This paper provides an overview of occupational health in Argentina, including information systems, regulations and somework-related injury and illness statistics. In 2008, the population in Argentina was around 39 million, with 90% living in urbanareas and 45% representing the economically active population. Approximately 40% of the workforce is in the informalsector, and 93% have completed at least primary studies. Fifty percent of the economically active population, both urban andrural is covered by a national labor risk insurance system. Legislation exists at the national and provincial levels, and regulatesemployers, workers, and insurance companies, and defines the role of the national labor risk insurance system. Occupationaldiseases are likely both underdiagnosed as well as underreported, representing only 2% of reported illness and injury statistics.The main possible contingencies are work injuries and occupational diseases. The construction sector bears the largest proportionof injury rates, both fatal and non-fatal, and should be a priority for targeted interventions. In a recently concluded nationalsurvey of working conditions, 30% of workers indicated that environmental working conditions are either fairly pooror poor. In companies with high injury rates, 39.4% of respondents attributed these injuries to faulty environmental workingconditions. 20% of workers perceive that their health is affected by their jobs and recognize the origin of risk factors. Themost prevalent adverse health outcomes are musculoskeletal disorders, cardiovascular diseases, allergies, depression and stress(AU)

The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism.

BACKGROUND: Most women with hypothyroidism require an increase in their dose of levothyroxine (LT4) after conception. To minimize fetal and maternal complications of maternal hypothyroidism, it is thought that women should be rapidly restored to the euthyroid state. The objectives of this study was to determine the percentage of hypothyroid women who would need to increase their dose of LT4 dose even if they had a preconception (pre-C) serum thyrotropin (TSH) of <2.5 mIU/L as recommended by the Endocrine Society's guidelines and to ascertain whether there was a relationship between the pre-C TSH value and the need to increase the LT4 dose during pregnancy. METHODS: Fifty-three pregnant women with hypothyroidism on LT4 treatment in whom the pre-C serum TSH was <2.5 mIU/L, but which was within the normal range, within the 6 months before pregnancy were retrospectively studied. An additional selection criterion was that their LT4 dose at the time of their first prenatal visit was the same as that received pre-C. RESULTS: Seventeen patients had to increase their LT4 dose during pregnancy, because their serum TSH was increased at the time of the first prenatal visit (Group 1); and 36 patients did not have to increase their dose of LT4 during pregnancy (Group 2). The pre-C TSH was significantly higher in Group 1 (1.55 ± 0.62 mIU/L) than in Group 2 (0.98 ± 0.67 mIU/L). When pre-C TSH range was 1.2-2.4 mIU/L, 50% of the patients required an increase in the LT4 dose during pregnancy. In contrast, when the pre-C TSH was <1.2 mIU/L, only 17.2% (p< 0.02) had to increase the LT4 dose during pregnancy. CONCLUSIONS: We suggest that in women with hypothyroidism who are planning to become pregnant, serum TSH levels should be in the normal range but should not be greater than about 1.2 mIU/mL.

Asociación de factores de riesgo coronario en la ancianidad: estudio AFRICA / Association of coronary risk factors in old age: AFRICA study

Se diseñó un estudio epidemiológico transversal multicéntrico, en Argentina, con el objetivo de conocer la prevalencia de las conductas y de los factores de riesgo para la enfermedad coronaria en pacientes de 90 años o mayores, así como conocer la posible agregación de estos factores y observar qué hallazgos estarían asociados con la longevidad. Se encuestó a 322 ancianos de 90 años o más, de los que el 47% tenía familiares longevos. La mayoría consumía frutas, lácteos y verduras y aproximadamente la mitad bebía vino tinto. Predominó un índice de masa corporal normal y realizaban actividad física con regularidad. La diabetes mellitus se asoció con la obesidad. La hipertensión arterial se observó a una edad de comienzo muy alta (72 años). Se halló un escaso porcentaje de fumadores. La agregación de dos factores de riesgo fue poco frecuente, y aun menor que se asociaran tres de ellos. En conclusión, la población de edad muy avanzada en nuestro medio presentaba características que indican que hay a la vez un componente genético y factores ambientales favorecedores de longevidad.

[Association of coronary risk factors in old age. AFRICA study]. / Asociación de factores de riesgo coronario en la ancianidad. Estudio AFRICA.

We carried out a multicenter cross-sectional study in Argentina to investigate the prevalence of behavioral and other risk factors for coronary heart disease in patients aged 90 years or more and to study the association between risk factors and longevity. Data were collected on 322 individuals aged 90 years or more, 47% of whom had a family history of longevity. The majority ate meals comprising mainly fruit, milk and vegetables every day and half of the participants drank a moderate amount of red wine. On average, their body mass index was normal and they regularly took some form of physical activity. Generally, diabetes mellitus was associated with obesity. The onset of arterial hypertension occurred at the high average age of 72 years. Few were found to be current smokers. Few individuals had two concurrent risk factors, and even fewer had three concurrent major coronary risk factors. In conclusion, patients aged 90 or more in our series showed characteristics indicating both a genetic trait and environmental factors favouring longevity.

Asociación de factores de riesgo coronario en la ancianidad. Estudio AFRICA / Association of coronary risk factors in old age. AFRICA study

Se diseñó un estudio epidemiológico transversal multicéntrico, en Argentina, con el objetivo de conocer la prevalencia de las conductas y de los factores de riesgo para la enfermedad arterial coronaria en pacientes de 90 años o más, así como conocer la posible agregación de éstos y observar qué hallazgos estarían asociados con la longevidad. Se encuestó a 322 ancianos de 90 años de edad o mayores, de los que el 47% tenía familiares longevos. Una mayoría consumía frutas, lácteos y verduras con regularidad, y aproximadamente la mitad bebía vino tinto. Predominó un índice de masa corporal normal y realizaban actividad física con regularidad. La diabetes mellitus se asociaba con la obesidad. La hipertensión arterial se observó a una edad de comienzo muy avanzada (72 años). Se halló un escaso porcentaje de fumadores. La agregación de 2 factores de riesgo fue poco frecuente, y aún menor cuando se asociaban 3 de ellos. En conclusión, la población de edad muy avanzada en nuestro medio presentaba características que indican que hay a la vez un componente genético y factores ambientales favorecedores de longevidad

We carried out a multicenter cross-sectional study in Argentina to investigate the prevalence of behavioral and other risk factors for coronary heart disease in patients aged 90 years or more and to study the association between risk factors and longevity. Data were collected on 322 individuals aged 90 years or more, 47% of whom had a family history of longevity. The majority ate meals comprising mainly fruit, milk and vegetables every day and half of the participants drank a moderate amount of red wine. On average, their body mass index was normal and they regularly took some form of physical activity. Generally, diabetes mellitus was associated with obesity. The onset of arterial hypertension occurred at the high average age of 72 years. Few were found to be current smokers. Few individuals had two concurrent risk factors, and even fewer had three concurrent major coronary risk factors. In conclusion, patients aged 90 or more in our series showed characteristics indicating both a genetic trait and environmental factors favouring longevity

[Advances in hereditary hemochromatosis]. / Avances en hemocromatosis hereditaria.

Hereditary hemocromatosis (HH) is a genetic disease with a recessive autosomic pattern, in which inadequate iron (Fe) absorption is made by the intestinal cell. As consequence of that process, takes place a progressive accumulation of metal in different organs, predominantly in the liver. This leads to an alteration of liver structure and function: cirrhosis and hepatocarcinoma (1). The gene implied in this pathology was identified (HFE) in 1996. This codes a similar molecule to the mayor histocompatibility complex type 1(MHC-T1 like) that can modulate the transport of PE binding the transferrin receptor. This progress allows a deep understanding of the molecular and cellular biology of the homeostasis of the Fe and its alterations in the NH. The diagnosis of disease by means of a genetic test let to carry out a familiar screening and to detect asymptomatic carriers. This makes possible to begin the appropriate treatment at early stages of the disease in order to avoid its consequences and offering a better quality of life to these patients.

Avances en hemocromatosis hereditaria. / [Advances in hereditary hemochromatosis]

Hereditary hemocromatosis (HH) is a genetic disease with a recessive autosomic pattern, in which inadequate iron (Fe) absorption is made by the intestinal cell. As consequence of that process, takes place a progressive accumulation of metal in different organs, predominantly in the liver. This leads to an alteration of liver structure and function: cirrhosis and hepatocarcinoma (1). The gene implied in this pathology was identified (HFE) in 1996. This codes a similar molecule to the mayor histocompatibility complex type 1(MHC-T1 like) that can modulate the transport of PE binding the transferrin receptor. This progress allows a deep understanding of the molecular and cellular biology of the homeostasis of the Fe and its alterations in the NH. The diagnosis of disease by means of a genetic test let to carry out a familiar screening and to detect asymptomatic carriers. This makes possible to begin the appropriate treatment at early stages of the disease in order to avoid its consequences and offering a better quality of life to these patients.