Contaminação pelo Covid-19 em profissionais de hospital de referência no Pará / Contamination by Covid-19 in professionals of a reference hospital in Para's state / Contaminación por Covid-19 en profesionales de un hospital de referencia del estado de Pará

A pandemia do novo coronavírus colocou em alerta os sistemas de saúde, estabelecendo sentimentos de instabilidade e de medo. O trabalho é e importante pilar para o traçado de políticas públicas. Objetivo: analisar a contaminação pelo COVID-19 em profissionais de hospital de referência no Pará. Metodologia: Trata-se de estudo retrospectivo, quantitativo, observacional, com aplicação de série temporal no período de março de 2020 a março de 2022. Foram incluídos todos os servidores atuantes durante a pandemia, que apresentaram atestados médicos com diagnóstico de COVID, e/ou testagem positiva, ou atestados por suspeita de contaminação. O perfil de servidores foi analisado, explorando as variáveis sexo, idade, convivência ou não com parceiros, grau de escolaridade, cargo e setor; juntamente com a incidência de casos confirmados e incidência total (suspeitos e confirmados). Resultados: O total de afastamentos do trabalho devido ao diagnóstico de COVID-19 foi de 1.420 casos, mais 839 casos suspeitos; sendo que 173 trabalhadores apresentaram reincidência. A incidência foi maior nos meses de maio de 2020, março de 2021 e janeiro de 2022. Houve predominância do sexo feminino e da categoria de enfermagem. Setores administrativos e financeiros apresentaram maior porcentagem de contaminados durante a pandemia (73,40%), proporcionalmente ao quantitativo de servidores atuantes na lotação. Entretanto, foram servidores da assistência direta ao paciente que apresentaram maior porcentagem de reinfecção. Conclusão: Foi possível visualizar três ondas na distribuição temporal dos casos de COVID-19, com destaque para elevação nos primeiros meses de 2022. O declínio no diagnóstico de casos novos no hospital estudado após dois anos de pandemia pode representar esforços individuais e coletivos em resistir às dificuldades da conjuntura. É importante observar o comportamento da pandemia em distintas regiões do Brasil para atualização de estratégias de enfrentamento como um todo.

The new coronavirus pandemic has put health systems on alert, establishing feelings of instability and fear. Working is an important pillar for the design of public policies. Objective: to analyze the contamination by COVID-19 in professionals of a reference hospital in Para's State. Methodology: This is a retrospective, quantitative, observational study, with the application of a time series from March 2020 to March 2022. All civil servants working during the pandemic, who presented medical certificates with a diagnosis of COVID, and/or or positive test, or attestations for suspected contamination. The servants' profile was analyzed, exploring the variables sex, age, living or not with partners, education level, position and sector; along with the incidence of confirmed cases and total incidence (suspected and confirmed). Results: The total number of absences from work due to the diagnosis of COVID-19 was 1,420 cases, plus 839 suspected cases; 173 workers presented recurrence. The incidence was higher in the months of May 2020, March 2021 and January 2022. There was a predominance of females and the nursing category. Administrative and financial sectors had a higher percentage of people infected during the pandemic (73.40%), proportionally to the number of servers working in the capacity. However, it was direct patient care workers who had the highest percentage of reinfection. Conclusion: It was possible to visualize three waves in the temporal distribution of COVID-19 cases, with emphasis on an increase in the first months of 2022. The decline in the diagnosis of new cases in the hospital studied after two years of the pandemic may represent individual and collective efforts to resist to the difficulties of the situation. It is important to observe the behavior of the pandemic in different regions of Brazil to update coping strategies in a general scenery.

La nueva pandemia de coronavirus ha puesto en alerta a los sistemas de salud, estableciendo sentimientos de inestabilidad y miedo. El trabajo es un pilar importante para el diseño de políticas públicas. Objetivo: analizar la contaminación por COVID-19 en profesionales de un hospital de referencia en el Estado de Pará. Metodología: Se trata de un estudio retrospectivo, cuantitativo, observacional, con la aplicación de una serie de tiempo de marzo de 2020 a marzo de 2022. Todos los funcionarios que trabajaron durante la pandemia, que presentaron certificados médicos con diagnóstico de COVID, y/o o test positivo, o atestados por sospecha de contaminación. Se analizó el perfil de los funcionarios, explorando las variables sexo, edad, convivencia o no con la pareja, nivel de escolaridad, cargo y sector; junto con la incidencia de casos confirmados y la incidencia total (sospechosos y confirmados). Resultados: El número total de bajas laborales por diagnóstico de COVID-19 fue de 1.420 casos, más 839 casos sospechosos; 173 trabajadores presentaron recurrencia. La incidencia fue mayor en los meses de mayo de 2020, marzo de 2021 y enero de 2022. Hubo predominio del sexo femenino y de la categoría de enfermería. Los sectores administrativo y financiero presentaron mayor porcentaje de infectados durante la pandemia (73,40%), proporcionalmente al número de servidores que trabajaban en esa función. Sin embargo, fueron los trabajadores de atención directa al paciente los que presentaron el mayor porcentaje de reinfección. Conclusiones: Fue posible visualizar tres olas en la distribución temporal de los casos de COVID-19, destacándose un aumento en los primeros meses de 2022. La disminución en el diagnóstico de nuevos casos en el hospital estudiado después de dos años de pandemia puede representar esfuerzos individuales y colectivos para resistir a las dificultades de la situación. Es importante observar el comportamiento de la pandemia en diferentes regiones de Brasil para actualizar las estrategias de afrontamiento en un escenario general.

Saúde Integral: Tai Chi Chuan

O Saúde Integral mostra na reportagem uma tradição milenar oriental que surgiu nas lutas e combates do passado, mas que hoje é usada como um complemento a saúde. É o Tai Chi Chuan, com todos os seus movimentos calmos e bem relaxante. As aulas de Tai Chi Chuan acontecem junto aos corredores do Hospital do Servidor Público Municipal, na zona sul da capital. O estilo ensinado aqui é o da família Yang. O Hospital do Servidor Público está localizado na rua Castro Alves, número 60.

Isolation of Mouse Neutrophils.

Neutrophils represent the first line of defense against bacterial and fungal pathogens. Indeed, patients with inherited or acquired qualitative and quantitative neutrophil defects are at high risk for developing bacterial and fungal infections and suffering adverse outcomes from these infections. Therefore, research aiming at defining the molecular factors that modulate neutrophil effector function under homeostatic conditions and during infection is essential for devising strategies to augment neutrophil function and improve the outcomes of infected individuals. This article describes reproducible density-gradient-centrifugation-based as well as positive and negative immunomagnetic selection protocols that can be applied in any laboratory to harvest large numbers of highly enriched and highly viable neutrophils from the bone marrow of mice. In another protocol, we also present a method that combines gentle enzymatic tissue digestion with a positive immunomagnetic selection technique or fluorescence-activated cell sorting (FACS) to harvest highly pure and highly viable preparations of neutrophils directly from mouse tissues such as the kidney, the liver, or the spleen. Mouse neutrophils isolated by these protocols can be used to examine several aspects of cellular function ex vivo, including pathogen binding, phagocytosis, and killing, neutrophil chemotaxis, oxidative burst, degranulation, and cytokine production, and for performing neutrophil adoptive transfer experiments. © 2023 Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. Basic Protocol 1: Isolation of Neutrophils from Mouse Bone Marrow Using Positive Immunomagnetic Separation Alternate Protocol 1: Purification of Neutrophils from Bone Marrow Using Negative Immunomagnetic Separation Alternate Protocol 2: Purification of Neutrophils from Bone Marrow Using Histopaque-Based Density Gradient Centrifugation Basic Protocol 2: Isolation of Neutrophils from Mouse Tissues Using Positive Immunomagnetic Separation Alternate Protocol 3: Isolation of Neutrophils from Mouse Tissues Using FACS.

Naming and shaming as a strategy for enforcing the Paris Agreement: The role of political institutions and public concern.

Enforcement is a challenge for effective international cooperation. In human rights and environmental law, along with many other domains of international cooperation, "naming and shaming" is often used as an enforcement mechanism in the absence of stronger alternatives. Naming and shaming hinges on the ability to identify countries whose efforts are inadequate and effectively shame them toward better behavior. Research on this approach has struggled to identify factors that explain when it influences state behavior in ways that lead to more cooperation. Via survey of a large (N = 910) novel sample of experienced diplomats involved in the design of the Paris Agreement, we find support for the proposition that naming and shaming is most accepted and effective in influencing the behavior of countries that have high-quality political institutions, strong internal concern about climate change, and ambitious and credible international climate commitments. Naming and shaming appears less effective in other countries, so further enforcement mechanisms will be needed for truly global cooperation. We also find that the climate diplomacy experts favor a process of naming and shaming that relies on official intergovernmental actors, in contrast with studies suggesting that NGOs, media, and other private actors are more effective at naming and shaming. We suggest that these tensions-the inability for naming and shaming to work effectively within the countries least motivated for climate action and the preference for namers and shamers that seem least likely to be effective-will become central policy debates around making cooperation on climate change more enforceable.

Exposure to ambient air pollutants is associated with an increased incidence of hyperuricemia: A longitudinal cohort study among Chinese government employees.

BACKGROUND: It is widely recognized that ambient air pollution can induce various detrimental health outcomes. However, evidence linking ambient air pollutants and hyperuricemia incidence is scarce. OBJECTIVES: To assess the association between long-term air pollution exposure and the risk of hyperuricemia. METHODS: In this study, a total of 5854 government employees without hyperuricemia were recruited and followed up from January 2018 to June 2021 in Hunan Province, China. Hyperuricemia was defined as serum uric acid (SUA) level of >420 µmol/L for men and >360 µmol/L for women or use of SUA-lowering medication or diagnosed as hyperuricemia during follow-up. Data from local air quality monitoring stations were used to calculate individual exposure levels of PM10, PM2.5, SO2 and NO2 by inverse distance weightingn (IDW) method. Cox proportional hazard model was applied to evaluate the causal relationships between air pollutant exposures and the risk of hyperuricemia occurrence after adjustment for potential confounders and meanwhile, restricted cubic spline was used to explore the dose-response relationships. RESULTS: The results indicated that exposures to PM10 (hazard ratio, HR = 1.042, 95% conficence interal, 95% CI: 1.028, 1.057), PM2.5 (HR = 1.204, 95% CI: 1.141, 1.271) and NO2 (HR = 1.178, 95% CI: 1.125,1.233) were associated with an increased HR of hyperuricemia. In addition, a nonlinear dose-response relationship was found between PM10 exposure level and the HR of hyperuricemia (p for nonlinearity = 0.158) with a potential threshold of 50.11 µg/m3. Subgroup analysis demonstrated that participants usually waking up at night and using natural ventilation were more vulnerable to the exposures of PM10, PM2.5, NO2, and SO2. CONCLUSION: Long-term exposures to ambient PM10, PM2.5 and NO2 are associated with an increased incidence of hyperuricemia among Chinese government employees.

Stressful Life Events, Unhealthy Eating Behaviors and Obesity among Chinese Government Employees: A Follow-Up Study.

Background: The underlying mechanisms of the relationship between stressful life events and obesity among Chinese workers are unclear. Objective: This study aimed to understand the processes and mechanisms involved in stressful life events, unhealthy eating behavior, and obesity among Chinese workers. Methods: From January 2018 to December 2019, a total of 15,921 government employees were included at baseline and they were followed-up until May 2021. Stressful life events were assessed using the Life Events Scale, and unhealthy eating behavior was assessed using four items. BMI was calculated as weight (kg) divided by height (m2) using physically measured data. Results: Overeating at each mealtime (OR = 2.21, 95%CI: 1.78-2.71) at baseline led to reports of higher risk of obesity at follow up. Eating before going to bed at night sometimes (OR = 1.51, 95%CI: 1.31-1.73) or often (OR = 3.04, 95%CI: 2.28-4.05) at baseline led to reports of higher risk of obesity at follow-up. Eating out sometimes (OR = 1.74, 95%CI: 1.47-2.07) or often (OR = 1.59, 95%CI: 1.07-2.36) at baseline led to reports of higher risk of obesity at follow-up. Stressful life events were not directly associated with obesity, but unhealthy eating behaviors, including overeating at each mealtime (ß = 0.010, 95%CI: 0.007-0.014; ß = 0.002, 95%CI: 0.001-0.004, respectively) and irregular meal timing (ß = -0.011, 95%CI: -0.015--0.008; ß = -0.004, 95%CI: -0.006--0.001, respectively), significantly mediated the associations between stressful life events at baseline and obesity at both baseline and follow-up. Conclusions: Unhealthy eating behaviors mediated the relationship between stressful life events and obesity. Interventions should be provided to workers who have experienced stressful life events and unhealthy eating behaviors.

339ª Reunião do Conselho Nacional de Saúde - 15 feb. 2023

Diplomatic response to global health challenges in recognizing patient needs: A qualitative interview study.

Background: Global health diplomacy is the applied practice of foreign affairs to further national goals that focus on health issues requiring international cooperation and collective action. We aimed to determine how international diplomats and health policy-related professionals in the EU understand the concept of health diplomacy, which impacts both diplomatic relations as well as patients' rights. Methods: In a qualitative interview study, we used a heterogeneous stratified purposeful sampling to reach participants from different countries and different practitioners from the Pyramid of Health Diplomacy: core, multi-stakeholder, and informal. Reflexive thematic analysis was used to identify the main themes. Findings: We contacted 131 practitioners of GHD, of which 37 responded, and nine agreed to be interviewed. From 11 interview questions, four main themes emerged from the analysis of the individual interview. The participants reported limited knowledge about the definition of GHD but also that they engaged in daily activities and decisions of inter-governmental bodies. They were not aware of existing special education and training for health attachés and made suggestions for improving the field and practice of GHD. They were not fully familiar with the European Charter of Patients' Rights. There was a consensus from all participants that patient rights need to improve as a fundamental right. They stressed the fact that the hospital lockdown and the right access to healthcare were impaired during the COVID pandemic. Interpretation: The role of health diplomacy in linking public health and foreign affairs is key to respecting patients' rights. Health over other interests is becoming an increasingly critical element in foreign policy. Establishing a clear career path for health attachés is necessary to foster effective global health agreements and coordination across countries.

Associations of polysocial risk score with incident rosacea: a prospective cohort study of government employees in China.

Background: The associations between single risk factors and incident rosacea have been reported, but the effects of social risk factors from multiple domains coupled remain less studied. Objectives: To quantify the influence of social determinants on rosacea comprehensively and investigate associations between the polysocial risk score (PsRS) with the risks of incident rosacea. Methods: This was a prospective cohort study of government employees undertaken from January 2018 to December 2021 among participants aged >20 from five cities in Hunan province of China. At baseline, information was collected by a questionnaire and participants were involved in an examination of the skin. Dermatologists with certification confirmed the diagnosis of rosacea. The skin health status of participants was reassessed every year since the enrolment of study during the follow-up period. The PsRS was determined using the nine social determinants of health from three social risk domains (namely socioeconomic status, psychosocial factors, and living environment). Incident rosacea was estimated using binary logistic regression models adjusted for possible confounding variables. Results: Among the 3,773 participants who completed at least two consecutive skin examinations, there were 2,993 participants included in the primary analyses. With 7,457 person-years of total follow-up, we detected 69 incident rosacea cases. After adjustment for major confounders, participants in the group with high social risk had significantly raised risks of incident rosacea with the adjusted odds ratio (aOR) being 2.42 (95% CI 1.06, 5.55), compared to those in low social risk group. Conclusion: Our findings suggest that a higher PsRS was associated with an elevated risk of incident rosacea in our study population.

Associations of levels of peripheral blood leukocyte and subtypes with type 2 diabetes: A longitudinal study of Chinese government employees.

Objectives: Available evidence suggests that type 2 diabetes (T2D) may be associated with inflammation and that leukocytes are a topical clinical, biological indicator of inflammation. This study investigates the associations between peripheral blood leukocyte and subtypes levels with T2D. Methods: A total of 5,475 individuals were included in the baseline examination from January 2018 to April 2020, with incidence data updated to April 30, 2021, and follow-up to 5,362 individuals. T2D was defined according to the Chinese guidelines for preventing and treating type 2 diabetes. Physiological and biochemical indicators, including leukocyte and subtypes, were obtained from the physical examination results of the tertiary care hospitals relied on at the cohort sites. Covariates such as demographic characteristics and lifestyle were collected by questionnaire. Binary logistic regression and Cox proportional hazard models were used to explore the correlations. Receiver Operating Characteristic (ROC) curves and time-dependent ROC curves were used to estimate the predictive diagnosis of T2D across the subtype of leukocytes. Results: The mean follow-up time was 12 months, and the cumulative incidence density of T2D was 4.0/1000 person-years. Cross-sectional results at baseline showed that the levels of peripheral blood leukocyte and its subtypes were higher in the T2D group than in the non-T2D group. Total leukocyte count and subtypes levels were grouped by quintile. After adjusting for age, sex, family history of diabetes, lifestyle score, and triglyceride levels, all were compared with the lowest quintile of each group. Logistic regression model results showed that the corrected OR for those with the highest quintile level of leukocyte was 2.01 (95% CI: 1.02-3.98). The longitudinal analysis showed that the adjusted HR was 8.43 (95%CI: 1.06-66.92) for those with the highest quintile level of leukocytes at baseline after controlling for the effects of the above covariates. For those with the highest quintile level of neutrophils at baseline, the adjusted HR was 5.05 (95%CI: 1.01-25.29). The leukocyte and subtypes had predictive values for T2D. Conclusion: Patients with T2D have a higher level of peripheral blood leukocyte and subtypes than those without the disease. Elevated leukocyte and neutrophil counts may link to a higher risk of T2D.

A "willingness to be orchestrated": Why are UK diplomats working with tobacco companies?

Background: The tobacco epidemic is global and addressing it requires global collaboration. International and national policies have been adopted to promote collaboration for tobacco control, including an obligation on diplomatic missions to protect public health from the vested interests of the tobacco industry. However, incidents of diplomats engaging with the tobacco industry are still occurring despite these regulations. This paper presents a case study of a British ambassador actions, and it points to some of the challenges researchers face in monitoring such incidents. Methods: The incident studied in this paper was first identified through regular media monitoring conducted by the Tobacco Control Research Group at the University of Bath. The incident was further investigated by using the tools made available by the United Kingdom (UK) Freedom of Information Act, including submitting a request, asking for internal review, and submitting a complaint to the Information Commissioner's Office. Results: We identified clear evidence of the UK ambassador to Yemen opening a cigarette factory, part owned by British American Tobacco (BAT), in Jordan. Our investigation revealed a lack of documentation of this and similar incidents of interaction between diplomats and the tobacco industry. We raise concerns about the actions of diplomats which contravene both national and international policies. Discussion: Monitoring and reporting such activities produces several challenges. Diplomats' interactions with the tobacco industry represent a major concern for public health as such interactions seem to be systematically repeated. This paper calls for action to better implement national and international policies to protect the public health including in low- and middle-income countries (LMICs).

Mental health of diplomatic personnel: scoping review.

BACKGROUND: Diplomatic personnel frequently relocate as part of their roles, requiring them to adapt to various cultural and political conditions; many are also at risk of experiencing trauma from being deployed to high-threat postings. With diplomatic personnel having to balance the usual pressures of their work with the uncertainties of COVID-19 in recent years, it is particularly important now to understand how to protect their mental health. AIMS: To synthesize existing literature on the well-being of diplomatic personnel to improve understanding of how to protect their mental health. METHODS: A scoping review was carried out to explore what is already known about the well-being of staff working in diplomatic roles. Four databases were searched and reference lists, as well as one key journal, were hand-searched. RESULTS: Fifteen relevant publications were included. There was little consensus as to how the psychological well-being of diplomatic personnel compares to other populations or which factors predict well-being. Diplomats' psychological responses to traumatic experiences appeared similar to those of other trauma-exposed occupational groups. CONCLUSIONS: Further research is needed to better understand the well-being of diplomatic personnel, particularly those not deployed to high-threat posts.

Factors associated with contact tracing compliance among communities of color in the first year of the COVID-19 pandemic.

RATIONALE: The disproportionate impact of COVID-19 on communities of color has raised questions about the unique experiences within these communities not only in terms of becoming infected with COVID-19 but also mitigating its spread. The utility of contact tracing for managing community spread and supporting economic reopening is contingent upon, in part, compliance with contact tracer requests. OBJECTIVE: We investigated how trust in and knowledge of contact tracers influence intentions to comply with tracing requests and whether or not these relationships and associated antecedent factors differ between communities of color. METHOD: Data were collected from a U.S. sample of 533 survey respondents from Fall (2020) to Spring 2021. Multi-group SEM tested quantitative study hypotheses separately for Black, AAPI, Latinx, and White sub-samples. Qualitative data were collected via open-ended questions to inform the roles of trust and knowledge in contact tracing compliance. RESULTS: Trust in contact tracers was associated with increased intentions to comply with tracing requests and significantly mediated the positive relationship between trust in healthcare professionals and government health officials with compliance intentions. Yet, the indirect effects of trust in government health officials on compliance intentions were significantly weaker for the Black, Latinx, and AAPI samples compared to Whites, suggesting this strategy for increasing compliance may not be as effective among communities of color. Health literacy and contact tracing knowledge played a more limited role in predicting compliance intentions directly or indirectly, and one that was inconsistent across racial groups. Qualitative results reinforce the importance of trust relative to knowledge for increasing tracing compliance intentions. CONCLUSIONS: Building trust in contact tracers, more so than increasing knowledge, may be key to encouraging contact tracing compliance. Differences among communities of color and between these communities and Whites inform the policy recommendations provided for improving contact tracing success.

Association of Healthy Lifestyles with Non-Alcoholic Fatty Liver Disease: A Prospective Cohort Study in Chinese Government Employees.

BACKGROUND: Evidence indicates that certain healthy lifestyle factors are associated with non-alcoholic fatty liver disease (NAFLD). However, little is known about the effect of combined healthy lifestyle factors. OBJECTIVE: To assess the association of combined healthy lifestyle factors with the incidence of NAFLD. METHODS: This cohort study was conducted in Changsha, Hunan Province, China. The healthy lifestyles factors studied were not being a current smoker, having a healthy diet, engaging in physical activity, having a normal body mass index (BMI) and engaging in non-sedentary behavior. NAFLD was diagnosed based on abdominal ultrasonography. Logistic regression models were conducted to investigate the associations being studied. RESULTS: Of the 5411 participants, 1280 participants had NAFLD, with a prevalence of 23.7% at baseline. The incidence of NAFLD among participants without NAFLD at baseline was found to be 7.2% over a mean follow-up of 1.1 years. Compared with participants with 0-1 low-risk factors, the OR of NAFLD was 0.50 (95% CI: 0.29-0.82, p = 0.008) for those with at least 4 low-risk factors. Similar associations were observed in subgroup analyses and sensitivity analyses. CONCLUSION: This study suggests that a combined healthy lifestyle pattern may considerably decrease the risk of NAFLD in Chinese government employees.

Public engagement in government officials' posts on social media during coronavirus lockdown.

BACKGROUND: Social media has been a common platform to disseminate health information by government officials during the COVID-19 pandemic. However, little is known about the determinants of public engagement in officials' posts on social media, especially during lockdown. OBJECTIVES: This study aims to investigate how the public engages in officials' posts about COVID-19 on social media and to identify factors influencing the levels of engagement. METHODS: A total of 511 adults aged 18 or over completed an online questionnaire during lockdown in Iraq. Levels of engagement in officials' posts on social media, trust in officials and compliance of government instructions were assessed. RESULTS: Fear of COVID-19 and trust in officials were positively associated with compliance of government instructions. Trust in officials was also associated with active engagement in officials' posts on social media, including commenting, posting and sharing of the posts. CONCLUSIONS: Trust in government has been established during the COVID-19 pandemic. Public engagement in officials' posts is crucial to reinforce health policies and disseminate health information.

Ambiente de trabalho seguro e sustentável: como a ergonomia de conscientização e participativa se aplica aos servidores públicos? / Safe, sustainable work environment: how awareness and participatory ergonomics can be applied to public servers? / Un entorno de trabajo seguro y sostenible: ¿cómo aplicar la sensibilización y la ergonomía participativa a los servidores públicos?

Introdução: As práticas ergonômicas de conscientização e de participação assumem importante papel na prevenção das doenças ocupacionais. Entretanto, os métodos utilizados pelos programas de prevenção das instituições e empresas visam a correção dos riscos ergonômicos, não observando o fator humano detentor da execução da tarefa. Objetivo: Analisar a utilização das Ergonomia de Conscientização e Participa- ção como programa de educação visando a prevenção primária e a conscientização dos riscos ergonômicos das lesões por esforço repetitivo (LER) e distúrbios osteomusculares relacionadas ao trabalho (DORT). Metodologia: Revisão crítica de literatura, sintetizando o embasamento teórico pertinente ao tema, com documentação técnica, normas, decretos, portarias e dados estatísticos atualizados de afastamento; formando, assim, à análise documental. Resultados e Discussão: Os dados estatísticos mostram a importância de uma mudança nos hábitos, nos programas e nas intervenções ergonômicas no ambiente laboral do trabalhador, visando minimizar os impactos socioeconômicos dos altos índices de afastamento para organizações, empresas privadas e, principalmente, serviços públicos de ensino superior devido a maior precariedade dos ambientes de trabalho. Práticas ergo- nômicas de conscientização e participação dos trabalhadores podem proporcionar uma melhora nos desconfortos do ambiente laboral. Ressalta-se a escassez de pesquisas que priorizem a relação custo-benefício e a eficácia a longo prazo na área de Ergonomia. Conclusões: Novas análises devem ser observadas para promover melhora da qualidade de vida do trabalhador, diminuição das perdas econômicas, contribuindo para um trabalho seguro, decente e sustentável como preconiza principalmente o Objetivo 8 da Agenda 2030 da Organização das Nações Unidas.

Introduction: Ergonomic awareness and participation practices play an im- portant role in the prevention of occupational diseases. However, the methods used by institutions and companies' prevention programs aim to correct ergonomic risks and do not observe the human factor responsible for carrying out the task. Purpose: To analyze the use of Participation and Awareness Ergonomics as an education program aimed at raising awareness of ergonomic risks for the prevention of repetitive strain injuries (RSI) and work-related musculoskeletal disorders (WRMD). Methodology: Critical literature review, summarizing the theoretical basis relevant to the topic, with technical documen- tation, norms, decrees, ordinances, and updated statistical data on leave; thus forming the documental analysis. Results and discussion: Statistical data show the importance of changing habits, programs, and ergonomic interventions in the work environment of the worker, in order to minimize the socioeconomic impacts of the high removal rates of organizations, private companies, and, mainly, public higher education due to more pre- carious work environments. Ergonomic practices of awareness and participation of work- ers can improve the work environment's discomfort. The lack of research that prioritizes the cost-benefit ratio and long-term effectiveness in Ergonomics is highlighted. Conclu- sions: New studies must promote a significant improvement of the quality of life of work- ers, reduction of economic losses and, thus contribute to a safe environment, decent and sustainable, as advocated by Objective 8 of the United Nations 2030 Agenda.

Introducción: Las prácticas de sensibilización y participación ergonómicas desempeñan un papel importante en la prevención de las enfermedades profesionales. Sin embargo, los métodos utilizados por los programas de prevención de instituciones y em- presas tienen como objetivo corregir los riesgos ergonómicos y no observan el factor hu- mano responsable de la realización de la tarea. Propósito: Analizar el uso de la Ergonomía de Participación y Concienciación como programa educativo dirigido a la concienciación de los riesgos ergonómicos para la prevención de las lesiones por esfuerzos repetitivos (LER) y los trastornos musculoesqueléticos de origen laboral (TME). Metodología: Re- visión lit-eratura crítica, resumiendo la base teórica relevante al tema, con documentación técnica, normas, decretos, ordenanzas, y datos estadísticos actualizados sobre bajas la- borales; conformando así el análisis documental. Resultados y discusión: Los datos es- tadísticos demuestran la importancia del cambio de hábitos, programas e intervenciones ergonómicas en el ambiente de trabajo del trabajador, para minimizar los impactos soci- oeconómicos de los altos índices de desvinculación de organizaciones, empresas privadas y, principalmente, de la enseñanza superior pública, debido a la mayor precariedad de los ambientes de trabajo. Práticas ergonómicas de conscientização e par-ticipação dos tra- balhadores podem melhorar a incomodidade do ambiente de trabalho. Se destaca la falta de re-investigación que priorice la relación costo-beneficio y la eficacia a largo plazo en Ergonomía. Conclusiones: Nuevos estudios deben promover una mejora significativa de la calidad de vida de los trabajadores, la reducción de las pérdidas económicas y, así contribuir a un entorno seguro, digno y sostenible, como propugna el Objetivo 8 de la Agenda 2030 de las Na-ciones Unidas.

Unveiling and addressing implementation barriers of vaccination communication strategy: Perspectives from government officials at national and provincial levels.

Communication strategy is one of the support of primary health care (PHC) that can address demand-side barriers and socio-cultural factors to promote better services. Conversely, communication strategies have not been a distinct emphasis of vaccination research in the country until now. Therefore, this study aimed to find the elements that influence the provision of vaccination communication in Pakistan. Twenty-two semi-structured interviews with key stakeholders in vaccine communication were conducted using qualitative methodologies (Jan 2022-March 2022). The interviews revolved around factors affecting the implementation of communication. Interviews were transcribed and analyzed using thematic analysis. By using the SURE framework, numerous factors that affect vaccination communication were identified under three major themes such as organizational-level, constitutional, and community-level factors. Five subthemes marked the organizational-level factors such as constrained budget, infrastructure deficits, inconsistent comprehensive strategy, health workforce, and inadequate training. Two subthemes are derived regarding constitutional and community-level factors, respectively, such as governance and leadership, health communication interventions not a policymaker's priority, community perceptions and practices, and formal partnership lacking between national and local stakeholders. Additionally, employment of established communication committees, improved money allocation, engagement of traditional and religious institutions, and political backing were identified as solutions for improvement. Communication activities are an important part of immunization programs in order to increase vaccination coverage. To be able to execute communication interventions more successfully, national and provincial stakeholders must work together to identify the elements that affect vaccine provision. Additional rigorous implementation studies could aid in the development of clearer knowledge of the system-wide constraints obstructing the program's efficiency.

The myth of meritocracy: academicism and methodological flaws in Brazilian public recruitment / El mito de la meritocracia: academicismo y fallas metodológicas en las licitaciones públicas brasileñas / O mito da meritocracia: academicismo e falhas metodológicas nos concursos públicos brasileiros

Abstract Is there meritocracy when 58% of administrative assistants and 87% of physicians employed in Brazilian federal higher education institutions (HEI) were selected through public exams based solely on theoretical multiple-choice tests? Is there meritocracy in selection processes that do not assess the candidates' experience or apply discursive or practical exams? This article addresses a historically constructed assumption assimilated as a kind of myth in Brazil: the idea that the current model for filling government positions is meritocratic. The extreme objectivity of these public exams reduces the Brazilian tradition of nepotism but presents serious flaws. One is academicism, which overvalues educational titles and theoretical knowledge at the expense of essential skills for many government positions. Calls for civil service entrance exams to fill administrative and medical positions in federal HEI throughout Brazil were verified using the descriptive statistics method (via frequency analysis), tabulating the evaluation types used in each selection, and generating tables and graphs. The results suggest adopting assessments more broadly connected with the competencies the positions require and prioritizing skills and practical behaviors instead of theoretical knowledge of little or no applicability. The study points out alternatives for a nation with more than 200 million inhabitants, the vast majority of which do not realize the incalculable damage of real academicism and illusory meritocracy.

Resumen Cuando el 58% de los trabajadores administrativos y el 87% de los médicos fueron seleccionados únicamente sobre la base de pruebas teóricas de opción múltiple, ¿existe la meritocracia? Selecciones sin requisito de experiencia, ni evaluaciones discursivas o prácticas. Solo marque una "x"... Este artículo busca responder a un supuesto construido históricamente y asimilado como una especie de mito en Brasil: la idea de que el actual modelo de licitación pública sería meritocrático. La extrema objetividad de estos concursos tiene el mérito de reducir la tradición brasileña de nepotismo, pero el modelo de evaluación tiene serias fallas. Una de las disfunciones es el academicismo, que sobrevalora los títulos educativos y los conocimientos teóricos en detrimento de competencias que son simplemente imprescindibles para muchos cargos públicos. Las convocatorias a concursos públicos para ocupar cargos administrativos y médicos en instituciones federales de educación superior en todo Brasil fueron verificadas utilizando el método de estadística descriptiva (mediante análisis de frecuencia), tabulando los tipos evaluativos utilizados en cada selección y generando tablas y gráficos relacionados. Con base en los resultados, el estudio sugiere la adopción de evaluaciones más ampliamente conectadas con las competencias de los cargos y que, en lugar de privilegiar conocimientos teóricos de poca o nula aplicabilidad, prioricen habilidades y comportamientos prácticos inherentes a los cargos. Esta investigación señala alternativas para una nación de más de 200 millones de habitantes, la gran mayoría de los cuales no se da cuenta del daño incalculable del academicismo real y una meritocracia ilusoria.

Resumo Quando 58% de trabalhadores administrativos e 87% dos médicos foram selecionados apenas com base em provas teóricas de múltipla escolha, existe meritocracia? Seleções sem exigência de experiência, nem avaliações discursivas ou práticas. Basta apenas marcar um "x"... Este artigo busca responder um pressuposto historicamente construído e assimilado como uma espécie de mito no Brasil: a ideia de que o atual modelo de concurso público seria meritocrático. A extrema objetividade dos concursos tem o mérito de reduzir a tradição brasileira de nepotismos e apadrinhamentos, mas o modelo de avaliação apresenta graves falhas. Uma das disfunções é o academicismo, que supervaloriza títulos educacionais e conhecimentos teóricos em detrimento de habilidades simplesmente essenciais de muitos cargos. Foram verificados sob método de estatística descritiva (via análise de frequência) editais de concursos para preenchimento de cargos administrativos e médicos em instituições federais de ensino superior em todo o Brasil, tabulando os tipos avaliativos empregados em cada seleção e gerando tabelas e gráficos conexos. A partir dos resultados, o estudo sugere a adoção de avaliações que se conectem mais amplamente com as competências dos cargos e que, em lugar de privilegiar conhecimentos teóricos de baixa ou nula aplicabilidade, priorizem habilidades e comportamentos práticos inerentes aos cargos. Esta pesquisa aponta alternativas para uma nação com mais de 200 milhões de habitantes, cuja grande maioria não percebe os danos incalculáveis de um academicismo real e de uma meritocracia ilusória.

Unprofessional or Admirable? Determinants of Purchasing Behavior in Government Officials' Livestreamed Shopping.

As a new form of poverty governance, government officials' livestreaming e-commerce of agricultural and sideline products has been booming since the outbreak of the coronavirus disease (COVID-19) in 2019. However, exploring the determinants of consumer purchase intentions in the context of government officials' livestreaming is still limited. Drawing on the stimulus-organism-response (S-O-R) framework, this study develops a research model to examine the effect of platform factor (information quality), user factor (bullet screen mutuality), and streamer factors (streamer trustworthiness, streamer expertise, and streamer responsiveness) on perceived information usefulness and arousal, which in turn affect purchase intention. This study also integrates impulsiveness as a moderator. We use structural equation modeling to analyze 430 samples. Our results show that perceived information usefulness and arousal have a significant positive influence on purchase intention. Moreover, impulsiveness moderates the relationship between perceived information usefulness and purchase intention and between arousal and purchase intention. Livestreaming features and streamer characteristics can activate these two mechanisms. This study provides theoretical contributions to livestreaming and the S-O-R literature, as well as practical insights into livestreaming government officials.

Multi-level change strategies for health: learning from people-centered advocacy in Uganda.

BACKGROUND: The paper analyzes how the Accountability Can Transform Health (ACT Health) program activated bottom-up citizen action to secure government responses and more accountable health services in Uganda. The ACT Health program had two phases-Phase 1 focused on a community-level intervention studied with a randomized control trial, and Phase 2 supported citizen-led advocacy targeting government officials across multiple levels. The focus of this paper is an analysis of Phase 2, when the "people-centered advocacy" approach supported almost 400 community advocates representing 98 health facilities to organize, identify joint advocacy priorities, directly monitor health services, and collaborate on health advocacy campaigns in 18 districts. Most district campaigns focused on the complex, power-laden issue of health worker absenteeism. With a few notable exceptions, iterative cycles of engagement between citizens and the state across multiple levels are infrequently discussed in the formal literature on health accountability. METHODS: This paper is based on a comparative, inductive, practitioner-led analysis of program monitoring data from 18 multi-level health advocacy campaigns. The findings emerge from analysis of a "Heat Map," capturing grounded accounts of government responses to community-led advocacy. RESULTS: Officials in eight out of 18 districts fulfilled or surpassed commitments made to community advocates. Government responses included: increased monitoring, more downward accountability, countering backlash against advocates, applying sanctions for absent health workers, and increased budget allocations. Advocates' bottom-up advocacy worked in part through triggering top-down responses and activating governmental checks and balances. CONCLUSIONS: Methodologically, this article demonstrates the value of analyzing process monitoring and program data to understand outcomes from direct engagement between citizens and the state to improve health services. Survey-based research methods and quantitative analysis may fail to capture signs of government responsiveness and relational outcomes (such as subtle signs of shifting power dynamics) many hope to see from citizen-led accountability efforts. Practitioners' perspectives on how accountability for health emerges in practice are important correctives to much positivist research on accountability, which has a tendency to ignore the complex dynamics and processes of building citizen power.