Vulnerabilidad sociolaboral y riesgo a la salud en mineros de subsistencia en las principales cuencas de Colombia / Combined hydration and effects on the vocal health in speech language pathology students

Objetivos: Evaluar la influencia de las condiciones socio-demográficas y de la existencia de asociaciones entre las condiciones de seguridad laboral y la prevalencia de efectos en la salud. Material y Métodos: Estudio transversal con intensión analítica realizado con fuentes secundarias de variables socio-demográficas, laborales, de condición y efectos sobre la salud asociados a la práctica de la minería aurífera y al uso de mercurio, los registros n=367. La realización de pruebas y estimaciones estadísticas de rigor a un nivel de confianza del 95% (p<0,05). Resultados: Las mujeres en su mayoría, de 45 a 49 años, analfabetos. Los efectos sobre la condición física y la salud asociados a su labor, demuestran la prevalencia de alteraciones como pérdida de: fuerza, visión y cabello. Las regresiones lineales entre las concentraciones orgánicas de Hg (sangre, orina y cabello) y el tiempo de realización de esta labor, apuntan que existen asociaciones proporcionales significativas (p<0,05) Conclusiones: El uso de medidas de seguridad laboral puede incidir significativamente en la reducción de riesgos asociados a la exposición al mercurio, principalmente en segmentos poblacionales con mayor vulnerabilidad. (AU)

Objectives: Develop an assessment of socio-demographic conditions influence as well significant associations among occupational safety conditions and health effects prevalence on gold small-scale miners vulnerability in Colombia. Material and Methods: Cross-sectional study with analytical intent conducted with secondary sources of socio-demographic, labor, condition and health effects variables associated with the practice of gold mining and the use of mercury, records n=367. The performance of tests and statistical estimates of rigor at a confidence level of 95% (p<0.05). Results: Women are mostly illiterate aged 45 to 49. The effects on physical condition and health associated with their work demonstrate the prevalence of alterations such as loss of: strength, vision and hair. The linear regressions between the organic concentrations of Hg (blood, urine and hair) and the time of performance of this work, indicate that there are significant proportional associations (p<0.05). Conclusions: The assessment of occupational safety measures might have a significant impact on potential risks reduction associated with mercury usage and exposure, mainly in population segments with higher vulnerability tendencies. (AU)

Tensiones éticas, causas y consecuencias del síndrome de burnout en el personal de salud en tiempos de la Covid-19: una revisión y análisis desde la bioética

esta es una revisión bibliométrica sobre el síndrome de burnout que afectó a profesionales de la salud en tiempos de la Covid-19, los conflictos éticos que lo preceden y suceden, y las estrategias para combatirlo. Metodología/ enfoque: se hizo una revisión bibliométrica en la que se identificaron, de manera sistemática, artículos de revisión, estudios transversales, metaanálisis y estudios cualitativos de todo el mundo. Una vez aplicados los filtros de selección, se analizaron los resultados con el método deliberativo de Diego Gracia. Resultados: se identificaron cuatro subtemas principales, incidencia del burnout durante la pandemia de la Covid-19, estresores éticos que favorecen al síndrome de burnout, consecuencias de este síndrome y estrategias para prevenirlo y combatirlo. Cada subtema se describe desde los ámbitos individuales, institucionales y sociales. Discusión/conclusiones: se argumenta con la teoría de Diego Gracia y se presenta una jerarquización de principios éticos implicados en el burnout, existen factores que favorecen la aparición de esta enfermedad profesional con un profundo calado bioético, en el que subyacen problemas de reconocimiento moral y económico, equidad, seguridad laboral, deber de cuidar, buena práctica médica y el bienestar del paciente, la familia y la sociedad en general. De igual, forma, las consecuencias del síndrome tienen repercusiones en los ámbitos sociales, institucionales e individuales, por lo que las intervenciones para su prevención y atención deben de igual forma tener un enfoque pluralista y diverso desde lo macro, meso y micro. En este sentido, es necesario fortalecer las estrategias de investigación y educación, para comprender, explicar y abordar el fenómeno de una forma integral.

this is a bibliometric review of the burnout syndrome that affected health professionals during Covid-19, the ethical conflicts that precede and follow it, and the strategies to combat it. Methodology/approach: a bibliometric review was carried out in which review articles, cross-sectional studies, meta-analyses, and qualitative studies from all over the world were systematically identified. Once the selection filters were applied, the results were analyzed using Diego Gracia's deliberative method. Results: four main subthemes were identified: incidence of burnout during the Covid-19 pandemic, ethical stressors that favor burnout syndrome, consequences of this syndrome, and strategies to prevent and combat it. Each subtopic is described from the individual, institutional, and societal levels. Discussion/conclusions: it is argued with Diego Gracia's theory, and a hierarchy of ethical principles involved in burnout is presented; some factors favor the appearance of this professional disease with a deep bioethical significance, in which problems of moral and economic recognition, equity, job security, the duty of care, good medical practice and the welfare of the patient, the family and society in general underlie. Similarly, the consequences of the syndrome have repercussions in the social, institutional, and individual spheres, so interventions for its prevention and care must also have a pluralistic and diverse approach from the macro, meso, and micro levels. In this sense, it is necessary to strengthen research and education strategies to understand, explain, and comprehensively address the phenomenon.

esta é uma revisão bibliométrica sobre a síndrome de burnout que afetou profissionais da saúde em tempos da covid-19, os conflitos éticos que a precedem e sucedem, e as estratégias para combatê-la. Metodologia/abordagem: é feita uma revisão bibliométrica na qual foram identificados, de maneira sistemática, artigos de revisão, estudos transversais, metanálise e estudos qualitativos de todo o mundo. Uma vez aplicados os filtros de seleção, foram analisados os resultados com o método deliberativo de Diego Gracia. Resultados: foram identificados quatro subtemas principais: incidência do burnout durante a pandemia da covid-19, estressores éticos que favorecem a síndrome de burnout, consequências dessa síndrome e estratégias para preveni-lo e combatê-lo. Cada subtema é descrito a partir dos âmbitos individuais, institucionais e sociais. Discussão/conclusões: é argumentada com a teoria de Diego Gracia e é apresentada uma hierarquização de princípios éticos implicados no burnout; existem fatores que favorecem o surgimento dessa doença profissional com um profundo silêncio bioético, no qual subjazem problemas de reconhecimento moral e econômico, equidade, segurança profissional, dever de cuidar, boa prática médica e bem-estar do paciente, da família e da sociedade em geral. Além disso, as consequências da síndrome têm repercussões nos âmbitos sociais, institucionais e individuais, razão pela qual as intervenções para sua prevenção e atenção devem de igual forma ter uma abordagem pluralista e diverso a partir do macro, meso e micro. Nesse sentido, é necessário fortalecer as estratégias de pesquisa e educação, para compreender, explicar e abordar o fenômeno de uma forma integral.

Sanitary and environmental conditions related to food poisoning among informal street vendors in downtown Medellín, Colombia, 2016.

Introduction: Although studies with informal workers have been conducted in Latin America and the Caribbean, there is still scarce evidence on the prevalence of food poisoning among workers with subsistence jobs on the streets and sidewalks of cities and on the factors that influence its presentation. Objectives: To determine sociodemographic, labor, sanitary, and environmental conditions that influence the prevalence of food poisoning in informal workers in downtown Medellín, Colombia. Methods: This is a cross-sectional study using a workers' survey as the primary source. A total of 686 workers aged ≥18 years who had been working for ≥ 5 years were surveyed. An assisted survey was initially applied as a pilot test for training purposes and to obtain informed consent. Results: We identified several associations and explanatory factors of food poisoning using chi-square tests and prevalence ratios, with unadjusted and adjusted 95% confidence intervals (95%CI). A higher prevalence of food poisoning (p < 0.05) was observed in workers with lower frequency of waste collection (PR = 2.09; 95%CI = 1.04-4.19), who left cooked food (PR = 6.40; 95%CI = 2.34-17.8), beverages or chopped fruits uncovered at their workplace (PR = 3.92; 95%CI = 1.40-10.48), with inadequate waste management (PR = 4.84; 95%CI = 2.12-11.06), exposure to polluted water (PR = 3.00; 95%CI = 1.20-7.50) and acceptable water supply (PR = 5.40; 95%CI = 1.60-17.8). The factors that explained higher rates of food poisoning were not having a waste collection service (PRadjusted = 5.58; 95%CI = 3.38-13.10), inadequate waste management (PRadjusted = 6.61; 95%CI = 1.25-34.84), and having sanitary services next to worker's stall (PRadjusted = 14.44; 95%CI = 1.26-165.11). Conclusions: The conditions that are associated with and explain the higher prevalence of food poisoning in this working population can be addressed with health promotion and disease prevention interventions.

Introducción: Aunque se han realizado estudios con trabajadores informales en América Latina y el Caribe, aun es escasa la evidencia con respecto a la prevalencia de intoxicaciones alimentarias en trabajadores con empleos de subsistencia en las calles y aceras de las ciudades y a los factores que influyen en su presentación. Objetivos: Determinar las condiciones sociodemográficas, laborales, sanitarias y ambientales que influyen en la prevalencia de intoxicación alimentaria en trabajadores informales del centro de Medellín. Métodos: Estudio transversal con fuente primaria de información en un censo de 686 trabajadores, ≥18 años y con ≥5 años en su oficio. Se aplicó encuesta asistida previa realización de prueba piloto, estandarización de encuestadores y toma de consentimiento. Resultados: Se identificaron asociaciones y factores explicativos de intoxicación alimentaria, con pruebas del chi-cuadrado y razones de prevalencia (RP), con intervalos de confianza del 95% (IC95%) crudos y ajustados. Mayor prevalencia de intoxicación alimentaria (p < 0,05) en trabajadores con menor frecuencia de recolección de residuos (RP = 2,09; IC95% = 1,04-4,19), en quienes dejaban alimentos preparados (RP = 6,40; IC95% = 2,34-17,8), bebidas o fruta picada descubiertos en el puesto de trabajo (RP = 3,92; IC95% = 1,40-10,48), con inadecuado manejo de residuos (RP = 4,84; IC95% = 2,12-11,06), exposición a agua contaminada (RP = 3,00; IC95% = 1,20-7,50) y de aceptable calidad (RP = 5,40; IC95% = 1,60-17,8). Explicaron mayor intoxicación alimentaria no tener servicio de recolección de residuos (RPajustada = 5,58; IC95% = 3,38-13,10), inadecuado manejo de residuos (RPajustada = 6,61; IC95% = 1,25-34,84), y tener servicios sanitarios al lado del puesto de trabajo (RPajustada = 14,44; IC95% = 1,26-165,11). Conclusiones: Las condiciones que se asocian y explican mayor prevalencia de intoxicación alimentaria en esta población trabajadora, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad.

Qualitative perspectives of isolation experiences due to COVID-19 from a group of bioethicists in training performing interdisciplinary healthcare activities. Medellin, Colombia. September 2020.

Introduction: In Colombia, there is still little information on how health care personnel have lived and coped with isolation due to COVID-19. Objectives: To explore the experiences related to the isolation of health professionals performing interdisciplinary care activities from March to September 2020, in Medellín, Colombia. Methods: Qualitative, exploratory, with a group of bioethicists in training. Data collected through the focus group, after obtaining the consent and approval of the Institutional Ethics Committee. Open and axial coding was performed. Texts are presented in prose, information was triangulated, and results were validated with the participants. Results: Work increased and staff decreased, with high staff turnover, redistribution and reassignment of loads and roles, facilitating physical and emotional overload. Study participants considered that teleworking facilitated their work, although more work was done. They lived in double isolation, had losses, and took work and family overloads. For fear of infecting and being infected, they separated from their loved ones, "this is an absolutely lonely disease, if people does not die from COVID, sadness and loneliness kills them." It affected "the recovery process, specifically, of psychiatric patients was prolonged, worsening their condition." They live in the present, and prioritize what is most important, because "being healthy and having those you love is the best wealth". Conclusion: Isolation increased workload, with reassignment of roles, affecting health care. For fear of becoming infected and infecting, study participants lived a double isolation, with anguish and uncertainty, which is why now they prioritize the most important health and love.

Introducción: En Colombia, todavía hay pocas informaciones sobre cómo los profesionales sanitarios han vivido y afrontado el aislamiento por la COVID-19. Objetivos: Explorar las experiencias relacionadas al aislamiento de profesionales sanitarios con actividad asistencial interdisciplinar, entre marzo y septiembre de 2020, en Medellín, Colombia. Métodos: Se condujo una investigación cualitativa y exploratoria con un grupo de bioeticistas en formación. Datos recolectados a través de un grupo focal, después de obtener el consentimiento y la aprobación del Comité de Ética Institucional. Se realizó codificación abierta y axial. Los textos se presentan en prosa, se hizo triangulación de la información, y se validaron los resultados con los participantes. Resultados: El trabajo aumentó y el personal disminuyó, con alta rotación de personal, reasignación y redistribución de cargas y roles, facilitando la sobrecarga física y emocional. Los participantes consideraron que el teletrabajo facilitó su trabajo, aunque se ha hecho más trabajo. Además, hubo un doble aislamiento, pérdidas y sobrecargas de trabajo y familiares. Por miedo a infectar e infectarse, se separaron de sus seres queridos, "esta es una enfermedad absolutamente solitaria, si uno no muere de la COVID, lo matan la tristeza y la soledad." La pandemia también afectó el proceso de recuperación, específicamente de los pacientes psiquiátricos, que se alargó, empeorando su condición. Los profesionales viven el presente y priorizan lo más importante: "tener salud y a los que amas es la mejor riqueza". Conclusión: El aislamiento aumentó la carga de trabajo, con reasignación de roles, afectando la atención sanitaria. Por miedo a infectarse e infectar, los participantes del estudio vivieron un doble aislamiento, con angustia e incertidumbre, y ahora priorizan la salud y el amor.

Food insecurity profile according to habits and lifestyles in workers with subsistence jobs, Medellín-Colombia 2016.

Introduction: Although the informal economy absorbs a considerable portion of the population, there is still little evidence that contributes to identify the lifestyles and eating habits that outline food insecurity in workers with subsistence jobs. Objectives: To determine the profile of food insecurity according to habits and lifestyles in workers with subsistence jobs. Methods: Cross-sectional study with primary sources of information, obtained through an assisted survey, to a census of 686 workers in 2016. The results of the nutritional component of a doctoral thesis approved by the Institutional Ethics Committee of the CES University, Medellín, Colombia, are presented. Results: In this working population, 52.6% were 50 years or old; however, 86.1% reported being the main household provider, and 33.3% did not have a permit to work in public areas. Moreover, 56.8% reported being sedentary/little active, and the highest consumption of alcohol and tobacco was recorded in men, who also ate their food alone. Conversely, women considered that mood affected their appetite, and they consumed their food while serving customers and handling money. In general, less than 50.0% of workers had a set time to consume their food. Food insecurity in workers' households was explained by alcohol consumption (prevalence ratio = 1.62; confidence interval = 1.05;2.38) and having exclusive hours to consume food (prevalence ratio = 1.40; confidence interval = 1.00;1.96). Their food insecurity is defined by not consuming alcoholic beverages, considering that their mood affects their appetite, consuming one or two meals a day, without a defined schedule, not having permission to work, presenting moderate/severe food insecurity, and being a woman. Conclusions: The conditions that explain and outline food insecurity in this working population contribute to their socio-environmental and labor vulnerability, however, these conditions can be reversed.

Introducción: Aunque la economía informal ocupe una gran parte de la población, todavía existen pocas evidencias que ayuden a identificar los estilos de vida y hábitos alimentarios que definen la inseguridad alimentaria entre los trabajadores con empleos de subsistencia. Objetivos: Determinar el perfil de inseguridad alimentaria según hábitos y estilos de vida en trabajadores con empleos de subsistencia. Métodos: Estudio transversal con fuentes primarias de información, realizado a través de encuesta asistida, con un censo de 686 trabajadores en 2016. Los resultados del componente nutricional de una tesis doctoral aprobada por el Comité de Ética Institucional de la Universidad CES, en Medellín, Colombia, son presentados. Resultados: De esta población trabajadora, el 52,6% tenía más de 50 años, sin embargo, el 86,1% reportó ser la persona que más aportaba en el hogar y al 33,3% no se le permitía trabajar en los espacios públicos. El 56,8% refirió ser sedentario/poco activo, registrándose el mayor consumo de bebidas alcohólicas y cigarrillos en los hombres, quienes también comían solos. Por su parte, las mujeres consideraban que el estado de ánimo afectaba al apetito y, cuando comían, simultáneamente atendían a los clientes y manejaban dinero. En general, menos del 50,0% tenía un tiempo definido para consumir sus alimentos. Explicaron inseguridad alimentaria en sus hogares, consumo de bebidas alcohólicas (RP = 1,62. IC = 1,05;2,38) e horarios exclusivos para consumir alimentos (RP = 1,40. IC = 1,00;1,96). Perfilan su inseguridad alimentaria no consumir bebidas alcohólicas, considerar que el estado de ánimo afectaba al apetito, consumir una o dos comidas al día, sin horario definido, no tener permiso para trabajar, presentar inseguridad alimentaria moderada/grave y ser mujer. Conclusiones: Las condiciones que explican y perfilan la inseguridad alimentaria de esta población trabajadora contribuyen a configurar su vulnerabilidad socioambiental y laboral, sin embargo, pueden ser revertidas.

Condiciones ambientales, laborales, hábitos y estilos de vida relacionados con la hipertensión en trabajadores informales, Medellín / Environmental and working conditions, habits and lifestyles related to hypertension in informal workers, Medellín / Condições ambientais, laborais, hábitos e estilos de vida relacionados com a hipertensão em trabalhadores informais, Medellín

Resumen Introducción: la hipertensión arterial (HTA) en trabajadores informales, podría explicarse por sus condiciones laborales, ambientales, hábitos y estilos de vida. Objetivo: determinar condiciones laborales, ambientales, hábitos y estilos de vida, que aportan a la explicación de HTA en trabajadores informales del centro de Medellín, Colombia, 2016. Metodología: estudio descriptivo transversal con intención analítica. Fuentes primarias de información, a un censo de 686 trabajadores en 2016, previa toma de consentimiento informado. Se indagaron condiciones laborales, ambientales, hábitos, estilos de vida y autorreporte de HTA. Se realizó análisis univariado, bivariado y multivariado. Pruebas estadísticas con 95 % de confianza y error del 5 %. Un grupo de trabajadores participó en el diseño y ejecución del trabajo de campo. Proyecto aprobado por comité de Ética Institucional de la Universidad CES, Medellín (septiembre 2015). Resultados: el 20,26 % de los trabajadores tenía HTA. Edad 50(±11,76) años y 23,5 años como venteros, 81,5 % trabaja >8 horas diarias. El 17,2 % fumaba cigarrillo, 23,7 % utilizaba salero en la mesa y 28,9 % eran sedentarios. Mayor hipertensión a mayor edad (RP=12,35), mayor antigüedad en el oficio (RP=1,73) y considerarse obeso (RP=2,61), y menor para quienes no consumían licor (RP=0,48). Explica mayor HTA consumir alimentos fritos (PR=3,14. IC=1,64; 6.00), tener entre 30-44 (PR=10,71.CI: 5,00; 22,94) y 45-59 años (PR=2,69. CI: 1,66; 4,37), y menor HTA, considerarse con sobrepeso (PR=0.54. IC=0.34, 0.78). Conclusiones: las condiciones laborales, hábitos y estilos de vida, aportan a la explicación de HTA. Siendo estas, algunas características que aportan a configurar vulnerabilidad laboral, en esta población trabajadora.

Abstract Introduction: High blood pressure (HBP) in informal workers could be explained, by their working and environmental conditions, habits and lifestyles. Objective: To determine working and environmental conditions, habits and lifestyles, which contribute to the explanation of HBP in informal workers in the downtown area in Medellin, Colombia, 2016. Methodology: Cross-sectional descriptive study with analytical intent. Primary source of information: a census of 686 workers in 2016, after obtaining informed consent. Working and environmental conditions, habits, lifestyles and self-report of HBP were investigated. Univariate, bivariate and multivariate analyzes were performed. Statistical tests show 95% confidence and 5% error. A group of workers participated in the design and execution of the fieldwork. Project approved by the Institutional Ethics Committee of Universidad CES, Medellín September 2015. Results: 20,26% of the workers had HBP. Age 50 (±11,76) years old, and 23,5 years as street vendors, 81,5% work>8 hours a day; 17,2% smoked cigarettes, 23,7% used saltshakers at the table and 28,9% were sedentary. Greater hypertension at older age (PR=12.35), greater seniority in the job (PR=1,73) and considered themselves obese (PR=2,61), and lower HBP for those who did not consume liquor (PR=0,48). Greater HBP is explained in people consuming fried foods (PR=3.14.IC=1,64; 6.00), being between 30-44 (PR=10,71. CI:5,00;22,94) and 45 to 59 years old (PR=2,69.CI: 1.66; 4.37), and a lower HBP for those considered as overweight (PR=0,54. IC=0.34; 0.78). Conclusion: working conditions, habits and lifestyles contribute to the explanation of HBP. These are some characteristics that contribute to configure labor vulnerability in this working population.

Resumo Introdução: a hipertensão arterial (HTA) em trabalhadores informais, poderia explicar-se por suas condições laborais, ambientais, hábitos e estilos de vida. Objetivo: determinar condições laborais, ambientais, hábitos e estilos de vida, que aportam à explicação de HTA em trabalhadores informais do centro de Medellín, Colômbia, 2016. Metodologia: estudo descritivo transversal com intenção analítica. Fontes primarias de informação, a um censo de 686 trabalhadores em 2016, previa toma de consentimento informado. Indagaram-se condições laborais, ambientais, hábitos, estilos de vida e auto reporte de HTA. Realizou-se análise uni variado, bivariado e multivariado. Provas estadísticas com 95 % de confiança e erro do 5 %. Um grupo de trabalhadores participou no desenho e execução do trabalho de campo. Projeto aprovado por comité de Ética Institucional da Universidade CES, Medellín (setembro 2015). Resultados: o 20,26 % dos trabalhadores tinha HTA. Idade 50(±11,76) anos e 23,5 anos como camelôs, 81,5 % trabalha >8 horas diárias. O 17,2 % fumava cigarro, 23,7 % utilizava saleiro na mesa e 28,9 % eram sedentários. Maior hipertensão a maior idade (RP=12,35), maior antiguidade no ofício (RP=1,73) e considerar-se obeso (RP=2,61), e menor para quem não consumiam licor (RP=0,48). Explica maior HTA consumir alimentos fritos (PR=3,14. IC=1,64;6.00), ter entre 30-44 (PR=10,71.CI:5,00;22,94) e 45-59 anos (PR=2,69. CI:1,66;4,37), e menor HTA, considerar-se com sobrepeso (PR=0.54. IC=0.34, 0.78). Conclusões: as condições laborais, hábitos e estilos de vida, aportam à explicação de HTA. Sendo estas, algumas características que aportam a configurar vulnerabilidade laboral, nesta população trabalhadora.

Condiciones laborales y extralaborales relacionadas con la presencia de síntomas depresivos en mujeres trabajadoras con empleos de subsistencia en el centro de Medellín, 2015-2019 / Working and Non-Working Conditions Related to the Presence of Depressive Symptoms in Women Workers with Subsistence Jobs in the Centre of Medellín, 2015-2019

RESUMEN Objetivo: Determinar las condiciones laborales y extralaborales relacionadas con los síntomas depresivos de trabajadoras informales del centro de Medellín en 2015-2019. Métodos: Estudio transversal con intención analítica y fuentes primarias de información. Toma de datos con encuesta asistida en una de sus sedes gremiales en 2016, después de prueba piloto y estandarización de encuestadores. Se tomó por censo a 291 trabajadoras y se exploraron sus características laborales y extralaborales. Resultados: Las mujeres tenían una media de edad de 45 arios, escolaridad < 5 años, viviendas en estrato bajo y medio e ingresos inferiores al salario mínimo de 2016. Alrededor del 60,0% tenía inseguridad alimentaria moderada-grave, sin subsidio del Estado; eran fundamentalmente cabezas de familia, con 2 o menos personas a su cargo, y responsables de sus labores en el hogar. Laboraban al menos 8h al día 6 o 7 días a la semana, con padres o parientes venteros, y al menos 20 años en su labor. Alrededor del 60,0% tenía pareja, el 21,6% con disfuncionalidad familiar, y el 15,4% sufría síntomas depresivos moderados-graves (MG). Se asociaron y aportaron a la explicación de síntomas depresivos MG, vivir en cuarto o inquilinato, en estrato socioeconómico bajo y tener disfuncionalidad familiar MG. Conclusiones: Las condiciones extralaborales que se asocian y explican los síntomas depresivos MG de las trabajadoras pueden modificarse con acciones que impacten en los determinantes sociales de la salud.

ABSTRACT Objective: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. Methods: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. Results: The women had an average age of 45 years, <5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8 hours a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. Conclusions: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.

Working and non-working conditions related to the presence of depressive symptoms in women workers with subsistence jobs in the centre of Medellín, 2015-2019.

OBJECTIVE: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. METHODS: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. RESULTS: The women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8 h a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. CONCLUSIONS: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.

Sociodemographic and labor conditions and the presence of musculoskeletal symptoms in workers in a market in a Colombian municipality.

Introduction: Although informal employment is increasing, there is still little evidence of musculoskeletal symptoms in workers with precarious jobs in marketplaces and of how these symptoms are related to their labor conditions and risks. Objective: To identify sociodemographic and labor conditions and ergonomic risks associated with musculoskeletal symptoms in workers from a marketplace in a Colombian municipality in 2017. Methods: Cross-sectional study of a 2017 census of 194 workers. A survey was applied, and labor and environmental records were collected. Univariate, bivariate and multivariate analyses were performed, with statistical tests with 95% confidence level. Results: Women (56.7%) and workers older than 30 years (75.4%) predominated; 90.7% of participants worked 8 hours a day or more; 52.8% worked from 1 to 5 days a week; and 33.9% had been working in the profession for > 20 years. Moreover, 86.6% had semi-stationary sales position; 43.8% were overweight, and 18.8% obese. Also, 60.6% presented with some type of musculoskeletal symptom, the most prevalent of which was joint pain (37.7%). Selling meat (PRA = 2.36), merchandise/pots (PRA = 1.40), harvest/perishable products (PRA = 1.26), and working from 8 to 11 hours a day (PRA = 1.76) explained higher prevalence of musculoskeletal symptoms. Conversely, moving (PAA = 0.5) and lifting (PRA = 0.75) heavy objects explained lower prevalence of these symptoms. Conclusions: Greater musculoskeletal symptoms were related to older age, lower schooling, fewer days of work, working from 8 to 11 hours, and selling meat, merchandise/pots, and harvest/perishable products. These conditions, once identified, will facilitate promotion and prevention actions to improve the living and health conditions of marketplace workers.

Experiencias en los servicios de salud de epidemiólogos en formación durante la pandemia COVID-19 / Experiences in the health services of epidemiologists in training during the COVID-19 pandemic

Introducción: Aunque existen numerosas evidencias científica sobre la pandemia, el impacto de la COVID-19 en los servicios de salud desde la perspectiva del personal asistencial ha sido poco explorado. Objetivo: Explorar las experiencias en los servicios de salud de epidemiólogos en formación durante la pandemia COVID-19. Métodos: Estudio exploratorio, cualitativo-descriptivo, con herramientas de investigación etnográfica para la toma de datos como la observación, diario de campo y entrevista grupal; así como teoría fundamentada para la construcción de categorías que permitieron comprender el fenómeno de estudio. Para la conformación del grupo focal, participaron siete epidemiólogos en formación de una universidad colombiana, previo consentimiento informado. Se realizó la introducción de la temática, con la posterior aplicación de los instrumentos guía de grupo focal, carteles de consenso, hojas de respuesta y guía de observación. Resultados: Se generó colapso hospitalario y reestructuración emergente de servicios de salud, promoviendo otras estrategias de atención como la telemedicina. Los participantes del estudio experimentaron temor atendiendo pacientes en jornadas estresantes, con desabastecimiento de insumos y medicamentos; fueron estigmatizados, lo que les generó ansiedad y estrés laboral. Sin embargo, aprendieron a clasificar mejor los casos y con el aumento de los pacientes pudieron percibir inequidades que representaron un desafío profesional y humano. Conclusiones: La pandemia de COVID-19 ha sido válida como proceso de aprendizaje con nuevas perspectivas de formación para poder actuar ante eventos sanitarios de interés mundial, con la necesaria aplicación y manejo de protocolos, lo cual puede cambiar el enfoque de la atención en salud y permitir que la epidemiología avance hacia la educación, promoción y prevención(AU)

Introduction: Although there is ample scientific evidence on the pandemic, the impact of COVID-19 on health services from the perspective of healthcare personnel has been little explored. Objective: To explore the experiences in health services of epidemiologists in training during the COVID-19 pandemic. Methods: Exploratory, qualitative-descriptive study, with ethnographic research tools for data collection such as observation, field diary and group interview; as well as grounded theory for the construction of categories that allowed to understand the studied phenomenon. For the formation of the focus group, seven epidemiologists in training from a Colombian university participated, with prior informed consent. The topic was introduced, with the subsequent application of the focus group guide tools, consensus posters, response sheets and an observation guide. Results: Hospital collapse and emerging restructuring of health services were generated, promoting other care strategies such as telemedicine. Study participants experienced fear attending patients on stressful days, with shortages of supplies and medicines; they were stigmatized, which generated anxiety and work stress. However, they learned to better classify cases and with the increase in patients they were able to perceive inequities that represented a professional and human challenge. Conclusions: The COVID-19 pandemic has been valid as a learning process with new training perspectives to be able to act in the face of health events of global interest, with the necessary application and management of protocols, which can change the focus of health care and allow epidemiology to move towards education, promotion and prevention(AU)

Multimorbilidad en adultos mayores con empleos con subsistencia en las calles y aceras de Medellín, Colombia, 2016 / Multimorbidity in older adults with subsistence jobs on the streets and sidewalks of Medellín, Colombia, 2016

Objetivo: Determinar las condiciones laborales, hábitos y estilos de vida relacionadas con la multimorbilidad de adultos mayores con empleos con subsistencia en el centro de Medellín-Colombia, 2016. Material y Métodos: Estudio transversal con fuentes primarias de información a un censo de 686 trabajadores, encuestados previa toma de consentimiento informado, el año 2016. Para este estudio se tomaron 153 trabajadores con ≥ 60 años. Análisis univariado, bivariado y multivariado, para estudiar su multimorbilidad y factores asociados a su labor. Resultados: 77,0% tenía entre 60-69 años; fundamentalmente hombres, 56,0% ganaba <500.000 pesos colombianos. Tenian >20 años en su oficio. El 62,0% presentó multimorbilidad, fundamentalmente por diabetes; hipertensión; obesidad y sintomatología depresiva. Explicaron mayor prevalencia de multimorbilidad (p<0,05) trabajar cerca de aguas residuales (RPA=3,38. IC=1,27;8,96), no tener horario para el consumo de alimentos (RPA=3,01. IC=1,25;7,27) y consumir alimentos en soledad (RPA=3,28. IC=1,31;8,18). Conclusión: Las condiciones que explican multimorbilidad en estos trabajadores, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad, lideradas por el Estado y con su participación activa (AU)

Objective: To determine the working conditions, habits and lifestyles related to the multimorbidity of older adults with subsistence jobs in the center of Medellín-Colombia, 2016. Material and Methods: Cross-sectional study with primary sources of information to a census of 686 workers, surveyed After obtaining informed consent, in 2016. For this study, 153 workers aged ≥60 years were taken. Univariate, bivariate and multivariate analysis, to study their multimorbidity and factors associated with their work. Results: 77,0% were between 60-69 years old; mainly men, 56,0% earned <500,000 Colombian pesos. They were > 20 years old in their trade. 62,0% presented multimorbidity, mainly due to diabetes; hypertension; obesity and depressive symptoms. They explained a higher prevalence of multimorbidity (p<0,05) working near wastewater (RPA=3,38.CI=1,27; 8,96), not having a schedule for food consumption (RPA=3,01.CI=1,25;7,27) and consuming food alone (RPA=3,28.CI=1,31; 8,18). Conclusion: The conditions that explain multimorbidity in these workers can be reversed with health promotion and disease prevention actions, led by the State and with its active participation (AU)

Factores relacionados con osteoartritis en trabajadores informales del centro de Medellín, Colombia / Related factors with Osteoarthritis in informal workers in Medellin downtown, Colombia

Resumen Introducción: Se hace una correlación entre la osteoatrosis y las condiciones laborales, hábitos y estilos de vida de los trabajadores informales del centro de Medellín, Colombia. Objetivo: Identificar la relación de la osteoartritis y la prevalencia de enfermedades crónicas y degenerativas con las condiciones sociodemográficas, laborales, hábitos y estilos de vida en un grupo de trabajadores informales de Medellín, Colombia. Materiales y métodos: Estudio transversal, con fuente primaria de información de 686 trabajadores informales. Se realizó una encuesta asistida, previa toma de consentimiento. Se seleccionaron 289 trabajadores con diagnóstico de enfermedad crónica o degenerativa, ≥18 años, con ≥5 años en su oficio. Se realizaron análisis exploratorios y de asociación con prueba Chi2, y cálculo de RP con IC del 95%. Resultados: el 79,9% de la población padecía alguna enfermedad crónica. El 3,46% presentaba diagnóstico de osteoartritis, siendo significativamente mayor (p<0,05) en quienes tenían entre 21 y 30 años en su oficio (RP=5,62. IC:1,20;26,34). También fue mayor la prevalencia de osteoartritis en; >45 años (RP=2,26), mujeres (RP:4,44), trabajadores sedentarios (RP=1,71), obesos (RP=3,40), así como en quienes habían sido obreros (RP=1,30), en aquellos que tenían puestos de venta semiestacionaria (RP=2,21), vendían productos de cosecha y perecederos (RP=1,78), en quienes trabajaban >8 horas diarias (RP:2,77), ≤5días a la semana (RP=3,10), no tenían espacio suficiente para moverse (RP=2,08), y en quienes tenían posturas o movimientos forzados (RP=2,72). Conclusión: En la población de vendedores informales del centro de Medellín, los factores sociodemográficos, laborales, hábitos y estilos de vida modificables se relacionan con una mayor prevalencia de osteoartritis.

Abstract Introduction: A correlation is made regarding osteoarthrosis and working conditions and lifestyles of informal workers in Medellin downtown. Objective: To identify the prevalence of chronic and degenerative diseases, and the relationship of osteoarthritis with sociodemographic and work conditions, habits and lifestyles, in a group of informal workers from Medellín, Colombia. Materials and methods: Cross-sectional study, with a primary source of information, with 686 workers. An assisted survey was applied, after obtaining consent. 289 workers with a diagnosis of chronic or degenerative disease, ≥18 years old, with ≥5 years in their profession were included. Exploratory and association analysis with Chi2 test, and calculation of PR with 95% CI. Results: 79.9% of them suffered from a chronic disease. 3.46% had a diagnosis of osteoarthrosis, being significantly higher (p <0.05) in those who had spent between 21 and 30 years performing their profession (PR=5,62.CI:1,20;26,34). The prevalence of osteoarthrosis was also higher in; >45 years (PR=2.26), women (PR=4,44), sedentary workers (PR=1,71), obese (PR=3,40), as well as those who had been brick-layers (PR=1,30), in those who had semi-stationary sales positions (PR=2,21), they sold harvest and perishable products (PR=1,78), in those who worked> 8 hours a day (PR:2,77), ≤ 5 days a week (PR=3,10), they did not have enough space to move (PR = 2.08), and in those who had forced postures or movements (PR=2,72). Conclusion: sociodemographic and work factors, habits and modifiable lifestyles are related to a higher prevalence of osteoarthrosis in this working population.

Sociodemographic, environmental and labor conditions related to the presence of conjunctivitis and skin irritation in a group of informal street vendors in downtown Medellin, 2015-2019.

INTRODUCTION: Occupational diseases are those that may have a causal relationship with occupational activity or environment. However, this definition does not specify how this disease would be identified and acknowledged for workers with subsistence jobs. OBJECTIVES: To determine sociodemographic, labor and environmental conditions that collaborate to explain the presence of eye and skin irritation among informal vendors in downtown Medellin. METHODS: Descriptive cross-sectional study with analytical intention, primary sources of information, and administration of assisted survey including self-reported eye and skin irritation in 686 workers. RESULTS: Predominantly male population with mean age of 50 (±11.8) years. A total of 23.5 % of workers had worked as vendors for their entire life; 37.5% had worked as vendors for 11 to 20 years as vendors; and 81.5%worked for more than 8 hours a day. According to 69.8% of the sample, poor air quality affected their work, and 80.0% believed that pollution was generated by vehicle fleet. The polluted areas generated unpleasant odors (50.2%) and air pollution (89.4%). The prevalence of eye and skin irritation was 65.4%. Not having working license and having fair, poor, or very poor job tenure significantly reduced the prevalence of eye and skin irritation. Conversely, exposure to polluted water, working in the professional for more than 30 years, male sex, and age older than 60 years were associated with increased prevalence of irritation. CONCLUSIONS: Eye and skin irritation was mainly explained by non-modifiable sociodemographic and labor conditions and by consumption of polluted water; however, implementing public health actions could reduce workers' socio-environmental and labor vulnerability.

Working and Non-Working Conditions Related to the Presence of Depressive Symptoms in Women Workers with Subsistence Jobs in the Centre of Medellín, 2015-2019. / Condiciones laborales y extralaborales relacionadas con la presencia de síntomas depresivos en mujeres trabajadoras con empleos de subsistencia en el centro de Medellín, 2015-2019.

OBJECTIVE: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. METHODS: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. RESULTS: The women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8hours a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. CONCLUSIONS: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.

Sociodemographic, labor conditions, habits, lifestyles and diabetes mellitus in workers with subsistence jobs, Medellín-Colombia.

INTRODUCTION: According to American Diabetes Association, diabetes is a metabolic change characterized by the presence de hyperglycemia caused by a deficiency and/or malfunctioning of insulin secretion. OBJECTIVES: To determine sociodemographic and labor conditions, habits and lifestyles that explain diabetes in a group of informal street workers in downtown Medellín, Colombia. METHODS: This is a cross-sectional study with analytical intent based on primary sources information and on a survey with a sample of 686 workers in 2016, after obtaining informed consent. Study variables included sociodemographic and labor conditions, habits, lifestyles, and diagnosis of diabetes. Univariate, bivariate and multivariate analyses were performed. RESULTS: Workers with 50 years, 57.6% men, with a partner (56.8%), and more than 20 years in their profession. Higher prevalence of diabetes in those aged 18 to 44 and 45 to 59 years of age, lower schooling, consumed mid-morning, mid-afternoon, and evening snacks, and of households with food insecurity. Higher prevalence of diabetes was explained by: lower age, higher education, consumption of sugars, sweets, and desserts; and lower prevalence by consumption of mid-morning snacks, and household food insecurity. CONCLUSIONS: This disease of public health concern is explained by modifiable factors that can be controlled and avoided to improve the living and health conditions of this workers' population.

Rasch analysis of the Katz index of independence in activities of daily living in senior citizens from Antioquia, Colombia / Análisis de Rasch del índice de independencia de Katz en actividades de la vida diaria en adultos mayores de Antioquia, Colombia / Análise Rasch do índice de independência de Katz em atividades da vida diária em idosos de Antioquia, Colômbia

Abstract Improving Katz index interpretability contributes to a better understanding of its results facilitating decision making and intervention planning. Objective: To evaluate the validity of the Katz geriatric scale in senior citizens from a Rasch model perspective. Methodology: Secondary data analysis of a population-based, cross-sectional study of health status in 4,023 senior citizens conducted in Antioquia, Colombia, in 2012. Item fit, differential item functioning, unidimensionality, reliability and item-person map analyses were performed. Results: All items adjusted to the model. Transferring and Continence showed high differential item functioning with a considerable, but statistically non-significant impact on the overall estimation. Person and Item reliability were 0.80 and 0.90 respectively. The Rasch measurement explained 61.6% of variance. Conclusion: A unidimensional interval level measure can be obtained from the Katz instrument. It is important to do more research on differential functioning of Katz's items in a way in which validity arguments on its generalization to various subpopulations could be strengthened and score interpretability could be improved.

Resumen Mejorar la interpretabilidad del índice de Katz contribuye a una mejor comprensión de sus resultados, lo que facilita la toma de decisiones y la planificación de intervenciones. Objetivo: Evaluar la validez de la escala geriátrica de Katz en adultos mayores desde una perspectiva del modelo de Rasch. Metodología: Análisis de datos secundarios de un estudio poblacional transversal sobre el estado de salud de 4,023 adultos mayores realizado en Antioquia, Colombia, en 2012. Se realizaron análisis de ajuste del ítem, funcionamiento diferencial del ítem, unidimensionalidad, confiabilidad y mapa ítem-persona. Resultados: Todos los ítems se ajustaron al modelo. La transferencia y la continencia mostraron un alto funcionamiento diferencial del ítem con un impacto considerable (pero no estadísticamente significativo) en la estimación general. La confiabilidad para persona e ítem fue de 0.80 y 0.90 respectivamente. La medición de Rasch explicó el 61.6% de la varianza. Conclusión: Se puede obtener una medida de nivel de intervalo unidimensional del instrumento Katz. Es importante investigar más acerca del funcionamiento diferencial de los ítems de Katz de manera que los argumentos de validez sobre su generalización a varias subpoblaciones puedan fortalecerse y se pueda mejorar la interpretabilidad de los resultados.

Resumo Melhorar a interpretabilidade do índice de Katz contribui para uma melhor compreensão de seus resultados, o que facilita a tomada de decisões e o planejamento de intervenções. Objetivo: Avaliar a validade da escala geriátrica de Katz em idosos da perspectiva do modelo de Rasch. Metodologia: Análise de dados secundários de um estudo populacional transversal sobre o estado de saúde de 4.023 adultos idosos realizado em Antioquia, Colômbia, em 2012. Análise de ajuste de itens, função diferencial de item, unidimensionalidade, confiabilidade e mapa item-pessoa foram realizados. Resultados: Todos os itens foram ajustados ao modelo. A transferência e a continência mostraram um desempenho diferencial elevado do item com um impacto considerável (mas não estatisticamente significativo) na estimativa global. A confiabilidade para pessoa e item foi de 0,80 e 0,90, respectivamente. A medida de Rasch explicou 61,6% da variância. Conclusão: Uma medição de nível de intervalo unidimensional do instrumento Katz pode ser obtida. É importante investigar mais sobre o funcionamento diferencial dos itens de Katz, de modo que os argumentos de validade sobre sua generalização para várias subpopulações possam ser fortalecidos e a interpretabilidade dos resultados possa ser melhorada.

Multimorbilidad auto-reportada por el adulto mayor del departamento de Antioquia: prevalência y factores asociados / Self-reported multimorbidity by the elderly in the department of Antioquia: prevalence and associated factors

Resumen Introducción: La multimorbilidad consiste en presentar más de una enfermedad crónica simultáneamente, un fenómeno favorecido por la exposición acumulada a factores de riesgo. Métodos: Estudio observacional, descriptivo, de corte transversal y un modelo de regresión logística binaria de tipo explicativo. Se analizaron 4 248 registros de adultos mayores de 60 años, de una fuente secundaria, con auto-reporte de 17 problemas de salud. Resultados: La edad osciló entre 60 y 112 años, 51,5 % tenía entre 60 y 69 años, el 72,8 % fueron mujeres, el 57,8 % tenía escolaridad primaria y el 15 % no tenía escolaridad. Se encontró auto-reporte desde cero hasta 11 enfermedades, siendo la hipertensión arterial la más frecuente (53,5 %), que junto a diabetes (7,0 %), problemas óseos (4,4 %) y cardíacos (4,2 %) constituyeron las principales combinaciones. El 83,5 % tenía riesgo nutricional y 18,4 % riesgo de dependencia funcional. La prevalencia de multimorbilidad auto-reportada fue 54,8 % (IC 95% 54,7-54,9). Los principales factores asociados correspondieron a mayor edad (Odds ratio -OR- 1,70; IC95% 1,32-2,21), sexo femenino OR= 1,53 (IC95% 1,30-1,82), riesgo de dependencia funcional OR= 1,35 (IC95% 1,02-1,80) y riesgo nutricional OR= 2,34 (IC95% 1,82-3,02). Conclusiones: La prevalencia de multimorbilidad en Antioquia es alta, siendo la hipertensión arterial su principal aportante y está fuertemente relacionada con el riesgo de dependencia funcional y el riesgo nutricional.

Abstract Introduction: Multimorbidity consists of presenting more than one chronic disease simultaneously, a phenomenon favored by cumulative exposure to risk factors. Methods: Observational, descriptive, cross-sectional study and an explanatory binary logistic regression model. We analyzed 4 248 records of adults over 60 years of age, from a secondary source, with self-report of 17 health problems. Results: The age ranged between 60 and 112 years, 51.5% were between 60 and 69 years old, 72.8% were women, 57.8% had primary schooling and 15% had no schooling. Self-report was found from zero to 11 diseases, with arterial hypertension being the most frequent (53.5%), which together with diabetes (7.0%), bone (4.4%) and cardiac problems (4.2%) constituted the main combinations. 83.5% had nutritional risk and 18.4% risk of functional dependence. The prevalence of self-reported multimorbidity was 54.8% (CI 95% 54.7-54.9). The main associated factors corresponded to older age (Odds ratio -OR- 1.70 IC95% 1.32-2.21), female sex (OR = 1.53 IC95% 1.30-1.82), risk of dependence functional (OR = 1.35 IC95% 1.02-1.80) and nutritional risk (OR = 2.34 IC95% 1.82-3.02). Conclusions: The prevalence of multimorbidity in Antioquia is high, with hypertension being its main contributor and is strongly related to the risk of functional dependence and nutritional risk.

Informality and employment vulnerability: application in sellers with subsistence work.

OBJECTIVE: To describe the origin, evolution, and application of the concept of employment vulnerability in workers who subsist on street sales. METHODS: We have carried out an analysis of the literature in database in Spanish, Portuguese, and English, without restriction by country. This is a review of the gray literature of government reports, articles, and documents from Latin America and the Caribbean. We have analyzed information on the informal economy, social-employment vulnerability, and subsistence workers. RESULTS AND CONCLUSIONS: The concept of informal economy is dispersed and suggested as synonymous with employment vulnerability. As a polysemic term, it generates confusion and difficulty in identifying defined profiles of employment vulnerability in informal subsistence workers, who sell their products on the streets and sidewalks of cities. The lack of a clear concept and profile of employment vulnerability for this type of workers generates a restriction on defined actions to reduce employment vulnerability. The profiles could facilitate access to the acquisition of assets that support their structure of opportunities, facilitating and mediating in the passage from vulnerability to social mobility with opportunities. We propose as a concept of employment vulnerability for subsistence workers in the informal sector, the condition of those who must work by day to eat at night, who have little or no ownership of assets, and who have a minimum structure of opportunities to prevent, face, and resist the critical situations that occur daily, putting at risk their subsistence and that of the persons who are their responsibility, thus making the connection between social and employment vulnerability.

Informality and employment vulnerability: application in sellers with subsistence work / Informalidad y vulnerabilidad laboral: aplicación en vendedores con empleos de subsistencia

ABSTRACT OBJECTIVE To describe the origin, evolution, and application of the concept of employment vulnerability in workers who subsist on street sales. METHODS We have carried out an analysis of the literature in database in Spanish, Portuguese, and English, without restriction by country. This is a review of the gray literature of government reports, articles, and documents from Latin America and the Caribbean. We have analyzed information on the informal economy, social-employment vulnerability, and subsistence workers. RESULTS AND CONCLUSIONS The concept of informal economy is dispersed and suggested as synonymous with employment vulnerability. As a polysemic term, it generates confusion and difficulty in identifying defined profiles of employment vulnerability in informal subsistence workers, who sell their products on the streets and sidewalks of cities. The lack of a clear concept and profile of employment vulnerability for this type of workers generates a restriction on defined actions to reduce employment vulnerability. The profiles could facilitate access to the acquisition of assets that support their structure of opportunities, facilitating and mediating in the passage from vulnerability to social mobility with opportunities. We propose as a concept of employment vulnerability for subsistence workers in the informal sector, the condition of those who must work by day to eat at night, who have little or no ownership of assets, and who have a minimum structure of opportunities to prevent, face, and resist the critical situations that occur daily, putting at risk their subsistence and that of the persons who are their responsibility, thus making the connection between social and employment vulnerability.

RESUMEN OBJETIVO Describir el origen, evolución y aplicación del concepto de vulnerabilidad laboral en trabajadores con empleos de subsistencia en las ventas callejeras. MÉTODOS Análisis de la literatura en bases de datos en idioma español, portugués e inglés, sin restricción por país. Revisión de literatura gris de informes gubernamentales, artículos y documentos de América Latina y el Caribe. Se analizó información de economía informal, vulnerabilidad sociolaboral y trabajadores con empleos de subsistencia. RESULTADOS Y CONCLUSIONES El concepto de economía informal es disperso y se sugiere como sinónimo de vulnerabilidad laboral. Como término polisémico, genera confusión y dificultad para identificar perfiles concretos de vulnerabilidad laboral en trabajadores informales con empleos de subsistencia, que venden sus productos en las calles y aceras de las ciudades. No disponer de un concepto claro y un perfil de vulnerabilidad laboral para este tipo de trabajadores genera restricción en acciones concretas, para reducir la vulnerabilidad laboral. Los perfiles podrían facilitar el acceso a la adquisición de activos que apoyen su estructura de oportunidades, facilitando y mediando en el paso de la vulnerabilidad a la movilidad social, con oportunidades. Se propone como concepto de vulnerabilidad laboral para trabajadores del sector informal con empleos de subsistencia, la condición de aquellos que deben trabajar de día para comer de noche, que presentan una escasa o inexistente posesión de activos y una mínima estructura de oportunidades para prevenir, hacer frente y resistir las situaciones críticas que se les presentan cotidianamente, poniendo en riesgo su subsistencia y la de las personas que tienen a su cargo, conectándose así vulnerabilidad social y laboral.

Características sociodemográficas, económicas, ocupacionales y de percepción de salud que explican la disfuncionalidad familiar de trabajadores informales "vendedores" del centro de Medellín / Sociodemographic, economic, occupational and health perception characteristics which explain the dysfunctional family of informal "sellers" who work of the center of Medellín

Objetivo: Identificar características sociodemográficas, económicas, ocupacionales y de percepción de salud que expliquen la disfuncionalidad familiar de trabajadores informales "vendedores" del centro de Medellín. Materiales y métodos: Estudio descriptivo transversal con fuentes primarias de información, muestra de 170 trabajadores en el año 2009 con encuesta que incluía el SF-36 y el APGAR familiar. Resultados: El 35% presentó riesgo de disfunción familiar leve o severa, siendo menor la prevalencia para quienes no eran cabeza de familia (RP: 0,59. IC95%:0,38;94) y vendían bebidas-picadura y dulce (RP:0,29. IC-95%: 0,11;0,77), fue mayor para quienes percibían menos ingresos mes (Me: $300.000; Rq: 242,000), tenían menor número de personas a su cargo (Me:2; Rq: 2) y eran del estrato socioeconómico bajo (RP:2,82. IC-95%:1,40;5,67). Se observaron diferencias para siete de los ocho dominios del SF-36. Conclusiones: Factores laborales y extra laborales en esta población trabajadora aportan a la explicación de la prevalencia de riesgo de disfuncionalidad familiar, ayudando a configurar su condición de vulnerabilidad laboral.

Objective: Identify socio-demographic, economic, occupational and health perception characteristics which explain the dysfunctional family of informal "sellers" who work in the center of Medellín. Materials and methods: A descriptive observational cross-sectional study was performed using primary sources of information to a sample of 170 workers in the year 2009 with a survey that included the SF-36 and the family APGAR. Results: The 35% of those polled presented risk of mild or severe dysfunction family, being less the prevalence for those who were not householders (RP: 0.59.) CI95%:0, 38; 94) and sold drinks - bite and sweet (RP: 0, 29. CI-95%: 0.11; 0.77), it was greater for those who perceived less income in the month (Me: $300,000; RQ: 242,000), had fewer dependants (Me:2; Rq: 2) and belonged to a low socio-economic strata (RP: 2, 82. CI - 95%:1, 40; 5.67). The differences for seven of the eight domains of the SF-36 were observed. Conclusions: The labor and extra labor factors in this working population provide information to the explanation of the prevalence of risk of dysfunctional family, helping to configure their condition of labor vulnerability.