Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in São Paulo, Brazil: need for continuous surveillance and implementation of active strategies

Abstract Introduction: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. Objective: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. Methods: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. Results: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. Conclusions: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.

Quality of the record of data on fatal workplace injuries in Brazil / Qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil

ABSTRACT OBJECTIVE To evaluate the quality of the data on fatal workplace injuries in Brazil, in the Mortality Information System (SIM) and the Information System of Notifiable Diseases (SINAN-AT), analyzing the spatial and temporal distribution between 2007 and 2012. METHODS We identified fields related to fatal workplace injuries, which were examined for completeness and the use of the "ignored" option. From the SIM, we extracted the records of deaths from external causes, which require the completing of the <acidtrab> field about their relation with work. From the SINAN, we analyzed the <evolution> field, which allows us to identify fatal cases among s severe workplace injuries. RESULTS In the SIM, from 469,121 records, the <acidtrab> field was left unfilled or filled as ignored in 84.2% of them; the Brazilian region with the highest proportion was the Northeast (79.1%), from which the state of Alagoas (94.4%) had the highest amount. There was a 5.5% decreasing trend between 2007 (86.6%) and 2012 (81.8%). Among the 251,681 records found in the SINAN-AT, 28.3% had unfilled or ignored responses for <evolution>, varying from 39.7% in 2007 to 23.2% in 2012, a 41.6% decrease. CONCLUSIONS The quality of the records on the fields of interest needed to identify fatal workplace injuries is poor in the SIM, but gradually improving. Recording quality was better for SINAN-AT, which has also been strongly getting better lately.

RESUMO OBJETIVO Avaliar a qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil nos Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação de Agravos de Notificação para acidentes de trabalho grave (Sinan-AT), analisando a distribuição espacial e temporal entre 2007 e 2012. MÉTODOS Identificaram -se os campos relacionados ao acidente de trabalho fatal, que foram examinados para a completude e uso da opção "ignorado". Do SIM, foram extraídos os registros de óbitos por causas externas, para os quais é requerido o preenchimento do campo <acidtrab>, sobre a relação com o trabalho. Do Sinan, analisou-se o campo <evolucao>, que permite a identificação dos casos fatais dentre os acidentes de trabalho graves. RESULTADOS No SIM, dos 469.121 registros, o campo <acidtrab> foi deixado sem preenchimento ou foi preenchido como ignorado em 84,2%, maior na região Nordeste (79,1%) e, em especial, no estado do Alagoas (94,4%). A tendência foi de queda de 5,5% entre 2007 (86,6%) e 2012 (81,8%). Para os 251.681 registros no Sinan-AT, a falta de preenchimento ou o uso de resposta ignorada no campo <evolucao> representaram, juntos, 28,3%, passando de 39,7% em 2007 para 23,2% em 2012, um declínio de 41,6%. CONCLUSÕES A qualidade do preenchimento de campos de interesse para o reconhecimento de casos de acidentes de trabalho fatais é ruim no SIM, mas vem gradualmente melhorando. No Sinan-AT, a qualidade dos registros foi melhor do que no SIM e vem melhorando acentuadamente.

Clase social, factores de riesgo psicosocial en el trabajo y su asociación con la salud autopercibida y mental en Chile / Social class, psychosocial occupational risk factors, and the association with self-rated health and mental health in Chile / Classe social, fatores psicossociais de risco ocupacional e sua associação com saúde autopercebida e mental no Chile

El objetivo fue examinar la relación entre clase social, riesgo psicosocial laboral y la salud autopercibida y mental en Chile. Se trata de un estudio transversal con los datos de la Primera Encuesta Nacional de Condiciones de Empleo, Trabajo, Calidad de Vida y Salud de los Trabajadores y Trabajadoras en Chile (N = 9.503). Las variables dependientes son: salud mental y salud autopercibida. Las variables explicativas son: clase social neo-marxista, factores de riesgo psicosocial y privación material. Se realizaron análisis descriptivos y de regresión logística. Existen desigualdades en la distribución de los factores exposición laboral a riesgos psicosociales, según clase social y sexo. Además, la clase social y los factores de riesgo psicosocial en el trabajo están asociados a una distribución desigual de la salud autopercibida y salud mental entre la población trabajadora en Chile. Las intervenciones en el área de la salud de los trabajadores deben considerar la clase social y los factores de riesgo psicosocial a que están expuestos los trabajadores.

The objective of this study was to analyze the association between social class and psychosocial occupational risk factors and self-rated health and mental health in a Chilean population. A cross-sectional study analyzed data from the First National Survey on Employment, Work, Quality of Life, and Male and Female Workers in Chile (N = 9,503). The dependent variables were self-rated health status and mental health. The independent variables were social class (neo-Marxist), psychosocial occupational risk factors, and material deprivation. Descriptive and logistic regression analyses were performed. There were inequalities in the distribution of psychosocial occupational risk factors by social class and sex. Furthermore, social class and psychosocial occupational risk factors were associated with unequal distribution of self-rated health and mental health among the working population in Chile. Occupational health interventions should consider workers’ exposure to socioeconomic and psychosocial risk factors.

O objetivo foi analisar a associação entre classe social, fatores psicossociais de risco laboral e saúde autopercebida e saúde mental entre a população trabalhadora chilena. Estudo transversal com os dados da Primera Encuesta Nacional de Condiciones de Empleo, Trabajo, Calidad de Vida y Salud de los trabajadores y trabajadoras en Chile (N = 9.503). As variáveis dependentes são: saúde autopercebida e saúde mental. As variáveis explicativas são a classe social (neo-marxista), os fatores psicossociais de risco laboral e privação material. Foram realizadas análises descritivas e de regressão logística. Existem desigualdades na distribuição dos fatores psicossociais de risco laboral segundo classe social e sexo. Além disso, a classe social e os fatores de risco psicossociais no trabalho estão associados a uma distribuição desigual da saúde autopercebida e saúde mental. As intervenções na área da saúde dos trabalhadores devem considerar a classe social e fatores de risco psicossociais a que os trabalhadores estão expostos.

HIV risk practices by female sex workers according to workplace / Práticas de risco ao HIV de mulheres profissionais do sexo

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues. .

OBJETIVO Investigar diferenças nas práticas de risco à infecção pelo HIV segundo local de trabalho das mulheres profissionais do sexo e efeitos de homofilia na estimação da prevalência do HIV. MÉTODOS Foram utilizadas informações de 2.523 mulheres recrutadas por Respondent-Driven Sampling em estudo realizado em 10 cidades brasileiras, 2008-2009. Foram incluídas profissionais com 18 anos ou mais de idade. O questionário foi autopreenchido e incluiu perguntas sobre características da profissão, práticas sexuais, uso de drogas, testes periódicos de HIV e acesso aos serviços de saúde. Utilizaram-se testes rápidos para detecção de HIV. As participantes foram agregadas em dois grupos por local de trabalho: pontos de rua ou locais fechados, e.g., boates, saunas e termas. Foram utilizados testes Qui-quadrado de homogeneidade, levando-se em consideração as probabilidades desiguais de seleção, bem como a dependência entre as observações. Os efeitos de homofilia por local de trabalho foram pesquisados na estimação da prevalência do HIV. RESULTADOS As práticas de maior risco ao HIV associaram-se a: trabalhar em pontos de rua, menor nível socioeconômico, baixa cobertura de exame preventivo de câncer de colo de útero, elevado consumo de crack, maior prevalência de cicatriz sorológica de sífilis e maior prevalência de infecção pelo HIV. O efeito de homofilia foi maior entre as profissionais de locais fechados. Contudo, não afetou a estimativa da prevalência de HIV, mesmo utilizando o procedimento de pós-estratificação por local de trabalho. CONCLUSÕES Os resultados indicaram que as estratégias devem ser dirigidas à ampliação do acesso e à utilização dos serviços ...

Trabajo infantil y salud en un mercado público de Valencia, Venezuela / Child labor and health in a public market, Valencia, Venezuela

Objetivo Determinar condiciones de vida, prácticas de trabajo, efectos a la salud y factores de riesgo asociados en un grupo de menores trabajadores de un mercado público en Valencia, Venezuela. Metodología Se aplicó una encuesta con variables demográficas y de exposición y se realizó análisis descriptivo de los datos, seleccionándose 44 menores. Resultados La jornada de trabajo promedio fue de 9,2 ± 3,2 horas/día. La actividad más desempeñada fue la venta de víveres/frutos (43,2 por ciento). El 22,7 por ciento de los menores presentaba retraso escolar evidente. Los síntomas más reportados fueron cefalea (84 por ciento), estrés (59,1 por ciento) y fatiga (58,2 por ciento). El 11,4 por ciento reportaron haber sufrido accidentes y 2,3 por ciento enfermedad relacionados con la actividad presente. Los factores de riesgo más reportados fueron calor (93,2 por ciento), ruido (88,6 por ciento) y repetitividad en la labor (84,1 por ciento). Se encontró una correlación significativa, inversamente proporcional, entre la edad y el estrés (p=0,04) lo cual es consistente con estudios que indican que el impacto negativo del estrés es más profundo en niños que tienen menos de 10 años de edad. Se determinó significativamente que a menor edad hay una mayor exposición a desechos tóxicos orgánicos (p=0,017) y al trabajo bajo presión (p=0,04). Conclusiones No existen procesos de recolección sistemáticos para evaluar el trabajo infantil en nuestro país aún cuando se identificaron una amplia variedad de factores de riesgo percibidas por los niños trabajadores. Para una evaluación más profunda del problema, se requieren indicadores más sensibles que permitan detectar daños tempranos y la forma de controlar la exposición a los mencionados riesgos.

Objectives This study was aimed at determining the living conditions, work practices, health effects and associated occupational risk factors in children working in a public market in Valencia, Venezuela. MethodologyA questionnaire was administered which included demographic and exposure variables; a descriptive analysis was then made of the data. Forty-four children were selected. Results The average workday lasted 9.2 ± 3.2 hours/day. Children were most frequently employed in selling provisions and fruit (43.2 percent); 22.7 percent of them were evidently backward at school. The symptoms most reported were headache (84 percent), stress (59.1 percent) and fatigue (58.2 percent). Occupational accidents were reported by 11.4 percent of the children and 2.3 percent had suffered an occupational disease related to their present activity. The most frequently occurring occupational risks were discomfort caused by heat (93.2 percent), noise (88.6 percent) and repetitive work (84.1 percent). A significant, indirect correlation was found between age and stress (p=0.04), as in publications showing that the negative impact of stress is more severe in children aged less than 10. It was determined that being a minor had greater significant association with the occupational risk of having greater exposure to organic toxic waste (p=0.017) and working under pressure (p=0.04). Conclusions There is no systematic data collection programme for assessing child labour in Venezuela even though a variety of risk factors have been identified and perceived for children. More sensitive indicators are required for the early identification of effects and how to control exposure to the risks mentioned above so that the problem can be studied in greater depth.

30 años de estudio sobre ausentismo laboral en Chile: una perspectiva por tipos de empresas / Work absenteeism in Chile according to the type of work place

BACKGROUND: The issue of medically justified work absenteeism has a great relevance in Chile at the present moment. AIM: To analyze sick leaves among people working in hospitals, mines, automotive industry and universities. MATERIAL AND METHODS: Analysis of 14 thesis and research papers about absenteeism in Chile. The incapacity rate (number of days with sick leave per worker per year, the frequency rate (number of sick leaves per year per worker) and the severity rate (mean duration of sick leaves) were calculated. The diseases causing the highest rates of absenteeism were also recorded. RESULTS: The mean age of the studied populations was 36 years old and the most common diseases causing absenteeism were respiratory, rheumatologic and trauma. Hospital workers had the highest incapacity rate with 14.3 days of sick leave per worker per year, followed by mining industry with 12 days, automotive industry with 7.1 days and universities with 6 days. CONCLUSIONS: In Chile, respiratory diseases are the main cause of sick leaves and hospital workers have the highest incapacity rate.