Amapola, lindísima amapola: de los opiáceos y los opioides, utilidad y riesgos / Poppy, beautiful poppy: opiates and opioids, utility and risks

Resumen El opio y sus derivados, y recientemente los opioides, han acompañado a la humanidad desde las civilizaciones más antiguas hasta la actualidad. Sus efectos analgésicos, hipnóticos y placenteros no pasaron desapercibidos para los antiguos, los consideraron de utilidad médica y beneficiosa para el estado de ánimo. Hoy en día no existe otro tipo de medicamentos que puedan tratar el dolor más intenso tan eficientemente como estos potentes analgésicos. Sin embargo, el uso médico y recreativo de los opiáceos y los opioides conlleva riesgos para la salud, como la tolerancia, la hiperalgesia y la adicción. Actualmente, además de ser indiscutiblemente el tratamiento médico más poderoso para mitigar el sufrimiento ocasionado por el dolor, se ha convertido también en un problema de salud pública debido a la alta cantidad de personas con trastorno por uso de opioides y por las muertes ocasionadas por sobredosis. En esta revisión se hará mención de las bondades de los opiáceos y opioides, y también de los efectos no deseados que estos producen.

Abstract Opium and its derivatives, and recently the opioids have accompanied the humankind since the ancient civilizations to the present day. Its analgesic, hypnotic and pleasant effects did not go unnoticed by ancient people, which considered most of these effects of medical utility and noticed that they had remarkable mood benefits. Currently, there are no other kind of drugs that can palliate intense pain as efficiently as these powerful analgesics. However, the medical and recreational use of opiates and opioids may carry health risks such as tolerance, hyperalgesia, and addiction. Nowadays, in addition to being indisputably the most powerful medical treatment to alleviate the suffering caused by pain, it has also become a public health problem due to the high number of people with opioid use disorder that have facilitated deaths caused by opioids overdose. In this review we will discuss the medical benefits of opiates and opioids, as much as the unwanted effects they produce.

Presenteeism and noise perception at work: a cross-sectional study using association analysis

ABSTRACT BACKGROUND: Presenteeism refers to the presence of a worker at work with reduced performance due to illness, and it is a common public health problem. Exposure to noise during production processes brings risk to workers' health. OBJECTIVE: To analyze the health profile of workers in the automotive industry and identify the association between noise perception and presenteeism among workers in the Brazilian automotive industry. DESIGN AND SETTING: This was a cross-sectional study utilizing a case study design analyzing the automotive industry in the interior of São Paulo state, Brazil. METHODS: This study included 306 workers using the Presenteeism Work Limitations Questionnaire protocol. Multiple logistic regression was used for data analysis. RESULTS: Male workers with reports of headache, tension, and limited well-being at work, having perceived that noise exposure interferes with productivity, showed a positive association with the occurrence of presenteeism. Physical demand had the highest score in terms of interfering with the presenteeism index. CONCLUSION: Workers' perceptions of noise were associated with presenteeism.

Investigation on awareness of radon and health risks in non-uranium miners from 2020 to 2021 / 中华放射医学与防护杂志

Objective:To understand the non-uranium miners′ awareness of radon and health risks in China and analyze the relevant influencing factors, in order to provide research basis for radiological protection institutions and employers to carry out radon health education.Methods:Male miners in 32 typical non-uranium mines from 11 provinces were selected by using cluster random sampling method from June 2020 to December 2021. The awareness of radon and health risks was investigated, and the influencing factors were analyzed by binary logistic regression model.Results:A total of 1 184 non-uranium miners were investigated, and the radon awareness rate of them was 19.17%. 36.56% of the non-uranium miners heard about radon knew the radon health risks accurately, and 18.06% could identify the measures to reduce radon concentration correctly. Univariate analysis showed that the radon awareness rate of non-uranium miners varied with different education levels, labor relations, post categories, and regions ( χ2=55.92, 21.89, 64.31, 11.26, P<0.05 ). The result of logistic regression analysis showed that a bachelor degree or above, regular employee, administrative personnel and technical personnel were influencing factors of the radon awareness level ( χ2=12.81, 6.58, 5.66, 21.44, P<0.05 ). There was no statistically significant difference of radon awareness rate in different ages, working years, regions, and smoke groups ( P>0.05 ). Conclusions:The awareness level of radon and health risks of non-uranium miners was relatively low in China. Radiological protection institutions and employers should strengthen education and training of radon related knowledge in non-uranium miners through mass media, on-duty training, contract notification and workplace publicity board notification, so as to improve their personal protection consciousness.

Antibiotic pollution characteristics and health risk assessment of source water in Yichang City / 公共卫生与预防医学

Objective To investigate the distribution characteristics of antibiotics in source water and their health risks to human body in Yichang City, and to provide a scientific basis for the prevention and control of new types of pollution such as antibiotics in drinking water. Methods Solid phase extraction (SPE) was used for enrichment, and ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was used to detect and analyze the content of five types of antibiotics including sulfonamides, tetracyclines, chloramphenicol, quinolones and β-lactams in the main drinking water sources of Yichang City. The human health risk assessment of these antibiotics was conducted. Results All five types of antibiotics were detected in the source water of Yichang City, and the detection rate was 6.25% to 81.25%. The total detection rate of β-lactam antibiotics was the highest, and the highest detection concentration of norfloxacin was 213.9 ng/L. The health risk assessment of 11 antibiotics detected in the source water showed that these antibiotics would not cause obvious health harm to human body, but the risk entropy (RQH) tended to increase with the younger age. Conclusion The distribution level of antibiotics in source water of Yichang City will not cause obvious health harm to human body.

Calidad de sueño en personas adultas mayores con diabetes mellitus tipo II / Sleep quality in older adults with type II diabetes mellitus

Introducción: el dormir mal podría ser la causa de diabetes mellitus tipo II y otras enfermedades crónicas no transmisibles. Objetivo: conocer la calidad de sueño de las personas con diabetes mellitus tipo II. Material y métodos: se realizó un estudio descriptivo, la muestra 44 adultos con diabetes mellitus. Se aplicó el cuestionario de Índice de Calidad de Sueño de Pittsburgh, 19 reactivos que contiene siete componentes con una escala de 0 a 3. La suma de estos da el índice. Resultados: se evaluó la calidad de sueño en 44 personas con diabetes mellitus tipo II, de abril a agosto 2021. El promedio de edad 67 años, 73 % del sexo femenino. El 39 % tiene una mala calidad de sueño, 27 % tarda en dormir entre 30 y 60 minutos, 18 % duerme <5 horas, 79.5 % no tiene una eficiencia de sueño normal, 48% reporto tener alteraciones del sueño una o dos veces a la semana, 11 % usa medicamentos para dormir menos de una vez a la semana y 11 % tiene una disfunción diurna. En cuanto al índice de calidad de sueño 85 % tiene un índice > 5. Conclusión: las personas diabéticas tienen una mala calidad de sueño lo cual puede afectar su metabolismo, en consecuencia es necesario realizar una intervención para mejorar su calidad de sueño.

Introduction: poor sleep could be the cause of type II diabetes mellitus and other chronic non-communicable diseases. Objective: to know the quality of sleep of people with type II diabetes mellitus. Material and methods: a descriptive study was carried out, the sample consisted of 44 adults with diabetes mellitus. The 19-item Pittsburgh Sleep Quality Index questionnaire was applied, containing seven components with a scale from 0 to 3. The sum of these gives the index. Results: the quality of sleep was evaluated in 44 people with type II diabetes mellitus, from April to August 2021. The average age was 67 years old, 73% are female. 39% have a poor quality of sleep, 27% take between 30 to 60 minutes to sleep, 18% sleep <5 hours, 79.5% do not have a normal sleep efficiency, 48% reported having sleep disturbances one or twice a week, 11% use sleep medications less than once a week and 11% have a daytime dysfunction. Regarding the sleep quality index, 85% have an index> 5 Conclusion: diabetic people have a poor quality of sleep which can affect their metabolism, so it is necessary to carry out an intervention to improve their quality of sleep.

Chlorpyrifos should be banned in agriculture and livestock production in Colombia

Chlorpyrifos (CPF) is a pesticide widely used in Colombia´s agriculture, including crops, farm animals and pets, despite it has been banned for use in the European Union and the United States. Studies demonstrate that even low blood levels of CPF -which do not inhibit blood acetylcholinesterase- can lead to child developmental and neurological disorders such as smaller head circumference and brain alterations, and psychomotor and cognitive deficits related to learning ability, attention and memory. In adults, CPF is an endocrine disruptor and breast carcinogen. High direct and indirect economic costs have been associated with CPF exposure. Not only farmers and their families -who have the highest exposures- but the general population consuming crops sprayed with CPF are also at risk. For these reasons CPF was recently banned by the European Union (2020) and the USA (2021). Pesticide regulation policies vary greatly depending on which and how scientific studies are used to assess health risks. Pesticide evaluations funded by the chemical industry should be rectified to avoid conflicts of interest. Furthermore, political alignment with the interests of the industry should not take precedence over independent scientific evidence. It is discouraging, to say the least, that until stricter health laws are passed in Colombia, CPFs and related pesticides will continue to be imported from those countries that have already banned them. Colombian scientists should raise their voice to challenge blind acceptance of profits over unintended consequences, and efforts to prevent pesticide´s abuse should be encouraged.

El clorpirifos (CPF) es un pesticida ampliamente utilizado en la agricultura de Colombia, incluidos cultivos, animales de granja y mascotas, a pesar de haber sido prohibido en la Unión Europea y Estados Unidos. Los estudios han demostrado que incluso niveles bajos de CPF en sangre -que no inhiben la acetilcolinesterasa sanguínea- pueden provocar trastornos neurológicos y del desarrollo infantil, como menor circunferencia de la cabeza y alteraciones cerebrales, y déficits psicomotores y cognitivos relacionados con la capacidad de aprendizaje, la atención y la memoria. En adultos, el CPF es un disruptor endocrino y causante de cáncer de mama. Altos costos económicos directos e indirectos se han asociado con la exposición al CPF. No solo los trabajadores agrícolas y sus familias, que están más expuestos, sino también la población en general que consume cultivos rociados con CPF también están en riesgo. Por estas razones el CPF fue prohibido recientemente por la Unión Europea (2020) y los EE. UU. (2021). Las políticas de regulación de plaguicidas varían mucho según los estudios científicos escogidos para evaluar los riesgos para la salud. Las evaluaciones de plaguicidas financiadas por la industria química deben rectificarse para evitar conflictos de interés. Además, ante la evidencia científica independiente no debería prevalecer la alineación política con los intereses de dicha industria. Es desalentador, por decir lo menos, que hasta que se aprueben leyes de salud más estrictas en Colombia se seguirán importando CPF y pesticidas relacionados desde aquellos países que ya los han prohibido. Los científicos colombianos deben alzar la voz para desafiar la aceptación ciega de ganancias por encima de las consecuencias no deseadas en salud pública, y se deben alentar los esfuerzos para prevenir el abuso de pesticidas.

Clorpirifós (CPF) é um pesticida registrado amplamente utilizado na agricultura colombiana, incluindo lavouras, animais de fazenda e animais de estimação, apesar de ter sido proibido na União Europeia e nos Estados Unidos. Estudos têm demonstrado que mesmo níveis baixos de CPF no sangue -que não inibem a acetilcolinesterase sanguínea-podem levar a distúrbios neurológicos e de desenvolvimento em crianças, como menor perímetro cefálico e alterações cerebrais, além de déficits psicomotores e cognitivos relacionados à capacidade de aprendizagem, atenção e memoria. Em adultos, o CPF é um desregulador endócrino e cancerígeno da mama. Altos custos econômicos diretos (devido ao tratamento) e indiretos (devido à perda de produtividade) têm sido associados à exposição ao CPF. Não apenas os trabalhadores agrícolas e suas famílias, que têm as maiores exposições, mas a população em geral que consome culturas pulverizadas com CPF também estão em risco. Por essas razões, o CPF foi recentemente proibido pela União Europeia (2020) e pelos EUA (2021). As políticas de regulamentação de pesticidas variam muito, dependendo de quais (e como) os estudos científicos são usados para avaliar os riscos à saúde. As avaliações de pesticidas financiadas pela indústria química devem ser retificadas para evitar conflitos de interesse. Além disso, o alinhamento político com os interesses da indústria não deve ter precedência sobre as evidências científicas independentes. É desanimador - para dizer o mínimo - que até que leis de saúde mais rígidas sejam aprovadas na Colômbia, o CPF e tóxicos relacionados continuarão a ser importados dos países que já os proibiram.

Investigation of arsenic in drinking water and health risk assessment in Urumqi City / 中华地方病学杂志

Objective:To learn about the arsenic status of drinking water in Urumqi City and evaluate its health risk, so as to provide scientific basis for the construction of water improvement projects in Urumqi City.Methods:From 2018 to 2020, 687 water samples were collected at monitoring sites in 7 districts and 1 county of Urumqi City for three consecutive years, and arsenic in drinking water was detected according to "Standard Examination Methods for Drinking Water - Nonmetal Parameters" (GB/T 5750.5-2006), and the arsenic in drinking water was evaluated according to "Standards for Drinking Water" (GB/T 5749-2006). The health risk of arsenic in drinking water in Urumqi City was evaluated by using the health risk assessment model recommended by United States Environmental Protection Agency (USEPA).Results:All of 687 water samples were centralized water supply, the arsenic compliance rates in dry season ( n = 342) and wet season ( n = 345), surface water ( n = 414) and underground water ( n = 273) were 100.0%. In dry season, the carcinogenic risk of arsenic via drinking water was 8.24 × 10 -6/a. In wet season, the carcinogenic risk of arsenic via drinking water was 3.30 × 10 -6/a. Conclusions:Remarkable achievements have been made in the construction of water improvement projects in Urumqi City, and the drinking water arsenic condition is good, the health risk of arsenic via drinking water is small. In the future, we should continue to strengthen the monitoring of drinking water quality, promote the construction of water improvement projects, further improve the drinking water sanitation, and put forward targeted prevention and control measures to ensure drinking water safety.

Gender differences on perceptions of health risks and adaptation of climate change among primary healthcare workers in Guangdong Province / 环境与职业医学

Background Climate change has resulted in long-term impacts on human health. Implementing efficient adaptation strategies among primary healthcare facilities is well determined by whether staff of different genders recognize the health risks related to climate change and are willing to take active measures. Objective To investigate gender differences on perceptions of health risks and attitude towards adaptation strategies among primary healthcare workers in China, and provide relevant suggestions. Methods By adopting a multi-stage cluster sampling method, we selected 21 urban and 10 rural healthcare facilities in Guangdong Province to collect information with a questionnaire. Then chi-square test, Wilcoxon rank sum test, and logistic regression analysis were used to explore the gender differences in climate change-related health risk cognition, knowledge acquisition channels, attitudes towards adaptation strategies, main obstacles, and resource requirements among the healthcare workers. Results Of 733 participants, 38.47% (282 participants) were male and 61.53% (451 participants) were female. The percentages of male healthcare workers who agreed that climate change is happening and recognized the causes of climate change (70.21%, 60.99%) were higher than the percentages of female counterparts (59.87%, 49.00%) (both Ps＜0.05), but no obvious gender differences existed in recognizing health risks of heatwaves and infectious diseases as well as sensitive population identification (all Ps＞0.05). Most of the participants (92.50%) received climate change and health-related information from mass media like TV, radio, and newspapers. Meanwhile less men chose new media channels than women (OR=0.62, 95%CI∶ 0.41-0.94). Only 30.56% of the participants (33.69% of men and 28.60% of women) reported involvement of relevant training and lectures. Most of them (90.96%) agreed to take active measures to deal with the health threats associated with climate change without gender differences for various measures (all Ps＞0.05). The leading obstacles were hard to integrate health adaptation to climate change into main work of institutions (most female agreed, 72.28%) and the lack of funds (most male agreed, 77.66%). Increasing funding for primary health care was regarded as the most needed resource by male (86.88%) and female (89.14%). After controlling the influence of other social factors, more men agreed with the lack of funds than women (OR=1.57, 95%CI∶ 1.10-2.24). Conclusion There are some gender differences in the perceptions of health risks and adaptation strategies of climate change among primary healthcare workers: Male staff are more likely to agree with climate change and regard the lack of funds as the main obstacle, while women prefer to choose new media channels to obtain information. It’s suggested that the government and relevant institutions focus on the learning and training of climate change and health-related knowledge and expand diversified information access, and promote capacity building to cope with health threats at grass-root level, in the light of recognized gender differences among primary healthcare workers.

El desafío de las enfermedades (re)emergentes, los límites de la respuesta biomédica y el nuevo paradigma de salud global / The challenge of (re)emerging diseases, the limits of the biomedical response and the new paradigm of global health

Resumen Las "enfermedades infecciosas emergentes y reemergentes" constituyen una creciente amenaza para la hegemonía de la biomedicina, al suscitar no pocos interrogantes sobre la idoneidad de su discurso y prácticas para afrontar el desafío global que representan. Se analiza el proceso de construcción de esta nueva categoría nosológica, y se examinan ejemplos destacados del impacto de las enfermedades (re)emergentes en la salud pública, la seguridad alimentaria y el desarrollo humano a escala global. Se refiere a prácticas irresponsables de sectores de la industria farmacéutica y agropecuaria, determinantes en su desencadenamiento y diseminación; y a algunos fallos cruciales de enfoque y manejo de los tiempos en las políticas de salud global en relación al VIH/sida con desastrosas consecuencias para el África subsahariana.

Abstract "Emerging and reemerging infectious diseases" pose a growing threat to the hegemony of biomedicine, raising questions about whether its discourse and practices can handle the global challenge they represent. The construction of this new nosological category is analyzed in this article, which examines some notable examples of the impact of (re)emerging diseases on public health, food security and human development on a global scale. It discusses irresponsible practices by sectors of the pharmaceutical and agricultural industries which led to the emergence and spread of these diseases; and points to some crucial failures of approach and time management in global health policies on HIV/AIDS, with disastrous consequences for sub-Saharan Africa.

Prazer e sofrimento no contexto de trabalho de uma unidade de alimentação e nutrição: estudo com abordagem mista / Pleasure and suffering in the work context of a food and nutrition unit: a study with a mixed approach

O trabalho em Unidade de Alimentação e Nutrição, geralmente, coloca o trabalhador frente às constantes situações de exigências de alta produtividade, em tempo limitado e, muitas vezes, expostos às condições laborais desfavoráveis causadas pelo próprio Contexto de Trabalho. Assim, esse estudo objetivou discutir a relação entre o Contexto de Trabalho, o Prazer/Sofrimento psíquico e o risco de adoecimento dos trabalhadores de uma Unidade de Alimentação e Nutrição, à luz da Psicodinâmica do Trabalho de Dejours. Trata-se de um estudo exploratório, por meio de pesquisa de campo, com abordagem mista, sequencial, de mesmo status, com 52 trabalhadores de alimentação coletiva de um Restaurante Universitário público do município de Niterói-RJ. A coleta dos dados ocorreu de abril a junho/2019, com observação direta não participante, entrevista semiestruturada com utilização de um formulário sociodemográfico e profissional e questões abertas que responderam aos objetivos do estudo. Foram também aplicadas as Escalas de Avaliação do Contexto de Trabalho e de Indicadores de Prazer e Sofrimento no Trabalho. As respostas do formulário foram submetidas à análise lexical pelo ALCESTE. Os dados das escalas foram submetidos ao programa Statistical Package for the Social Sciences (SPSS). Os resultados foram apresentados por: quadros, tabelas e gráficos. Evidenciou-se, pelo ALCESTE, as Classes 1 e 2, ambas com o mesmo conteúdo temático, com diferenciação entre elas no predomínio desses conteúdos. Dessas Classes, emergiu uma única Categoria originando cinco SubCategorias, intituladas: Relação interpessoal no trabalho; Dificuldades e necessidades laborais dos trabalhadores; Doenças ocupacionais de trabalhadores de Unidade de Alimentação e Nutrição; Estratégias defensivas e Satisfação no trabalho. Nas escalas, todos os domínios foram considerados críticos quanto a oferecer risco de adoecimento aos trabalhadores, na do Contexto de Trabalho foram pior avaliadas a Organização e as Condições de Trabalho, já os indicadores de Prazer/Sofrimento mais críticos foram: Liberdade de Expressão e Esgotamento Profissional sendo este influenciado, predominantemente, pela organização do trabalho. Nesse estudo, confirmou-se a hipótese de que o Contexto de Trabalho implica em mais sofrimento psíquico dos trabalhadores, comparado com o prazer. Constatou-se precarização do trabalho, consequente da terceirização, da organização e das condições de trabalho. Evidenciou-se que esses trabalhadores encontravam-se em sofrimento social não conseguindo ressignificar o sofrimento, observado pelo conjunto de estratégias defensivas utilizadas por eles, por questão de sobrevivência. Do ponto de vista da subjetividade, o discurso do trabalhador muito defensivo levou a crer que este encontre-se em servidão voluntária patologizado. Concluiu-se que as avaliações críticas de todos os domínios das escalas sinalizaram o sofrimento no trabalho, evidenciando os fatores de risco de adoecimento, possibilitando direcionar medidas de intervenção, por parte dos gestores, em curto e em médio prazo, que protejam os trabalhadores. Concluiu-se ainda que a alta utilização de estratégias defensivas, pelos trabalhadores do Restaurante Universitário, faz-se necessária por uma questão de sobrevivência, à medida que elas alienam e protegem os trabalhadores. Os achados desse estudo poderão auxiliar na reflexão sobre o impacto do trabalho na saúde do trabalhador, considerando que as situações de sofrimento podem interferir na saúde física e psíquica dos trabalhadores.

The work in the Food and Nutrition Unit usually puts the worker in front of the constant situations of high productivity requirements, in limited time and, often, exposed to unfavorable working conditions caused by the Labor Context itself. Thus, this study aimed to discuss the relationship between the Work Context, the Psychic Pleasure/Suffering and the risk of illness of the workers of a Food and Nutrition Unit, in the light of the Psychodynamics of Dejours' Work. This is an exploratory study, through field research, with a mixed, sequential, same status approach, with 52 collective feeding workers from a public University Restaurant in the city of Niterói-RJ. Data collection occurred from April to June/2019, with direct non-participant observation, semi-structured interview using a sociodemographic and professional form and open questions that answered the study objectives. The Scales of Evaluation of the Work Context and Indicators of Pleasure and Suffering at Work were also applied. The form responses were submitted to lexical analysis by ALCESTE. The scale data were submitted to the Statistical Package for the Social Sciences (SPSS) program. The results were presented by: tables, tables and graphs. By ALCESTE, classes 1 and 2 were evidenced, both with the same thematic content, with differentiation between them in the predominance of these contents. From these Classes, a single Category emerged, resulting in five SubCategories, entitled: Interpersonal relationship at work; Difficulties and labor needs of workers; Occupational diseases of workers of the Food and Nutrition Unit; Defensive strategies and job satisfaction. In the scales, all domains were considered critical regarding the risk of illness to workers, in the Work Context, the Organization and Working Conditions were worse evaluated, while the most critical pleasure/suffering indicators were: Freedom of Expression and Professional Exhaustion being predominantly influenced by the work organization. In this study, the hypothesis was confirmed that the Work Context implies more psychological suffering of workers, compared with pleasure. There was precarious work, resulting from outsourcing, organization and working conditions. It was evidenced that these workers were in social distress and could not resignify the suffering, observed by the set of defensive strategies used by them, for the sake of survival. From the point of view of subjectivity, the discourse of the very defensive worker led us to believe that he is in pathologized voluntary servitude. It was concluded that the critical evaluations of all the domains of the scales indicated the suffering at work, evidencing the risk factors of illness, making it possible to direct intervention measures, on the part of managers, in the short and medium term, that protect workers. It was also concluded that the high use of defensive strategies by the workers of the University Restaurant is necessary for the sake of survival, as they alienate and protect the workers. The findings of this study may help to reflect on the impact of work on workers' health, considering that situations of suffering can interfere in the physical and mental health of workers.

El trabajo en la Unidad de Alimentos y Nutrición generalmente pone al trabajador frente a las situaciones constantes de altos requisitos de productividad, en tiempo limitado y, a menudo, expuesto a condiciones de trabajo desfavorables causadas por el propio Contexto Laboral. Así, este estudio tenía como objetivo debatir la relación entre el contexto laboral, el placer psíquico/sufrimiento y el riesgo de enfermedad de los trabajadores de una Unidad de Alimentación y Nutrición, a la luz de la Psicodinámica del Trabajo de Dejours. Se trata de un estudio exploratorio, a través de la investigación de campo, con un enfoque mixto, secuencial, del mismo estatus, con 52 trabajadores de alimentación colectiva de un restaurante universitario público en la ciudad de Niterói-RJ. La recopilación de datos se realizó de abril a junio/2019, con observación directa no participante, entrevista semiestructurada utilizando una forma sociodemográfica y profesional y preguntas abiertas que respondían a los objetivos del estudio. También se aplicaron las escalas de evaluación del contexto de trabajo y los indicadores de placer y sufrimiento en el trabajo. Alceste presentó al análisis léxico las respuestas del formulario. Los datos de escala se presentaron al programa Statistical Package for the Social Sciences (SPSS).Los resultados fueron presentados por: tablas, tablas y gráficos. Por ALCESTE, se evidenciaron las clases 1 y 2, ambas con el mismo contenido temático, con diferenciación entre ellas en el predominio de estos contenidos. De estas clases surgió una sola categoría, originaria de cinco subcategorías, titulada: Relación interpersonal en el trabajo; Dificultades y necesidades laborales de los trabajadores; Enfermedades profesionales de los trabajadores de la Unidad de Alimentación y Nutrición; Estrategias defensivas y satisfacción laboral. En las escalas, todos los ámbitos se consideraban críticos en cuanto al riesgo de enfermedad para los trabajadores, en el contexto laboral, la Organización y las condiciones de trabajo eran peor evaluadas, mientras que los indicadores más críticos de placer/sufrimiento eran: La libertad de expresión y el agotamiento profesional estaban predominantemente influenciados por la organización del trabajo. En este estudio, se confirmó la hipótesis de que el contexto laboral implica más sufrimiento psicológico de los trabajadores, en comparación con el placer. Había un trabajo precario, resultante de la externalización, la organización y las condiciones de trabajo. Se evidencí que estos trabajadores estaban en dificultad social y no podían renunciar al sufrimiento, observado por el conjunto de estrategias defensivas utilizadas por ellos, en aras de la supervivencia. Desde el punto de vista de la subjetividad, el discurso del trabajador defensivo nos llevó a creer que está en servidumbre voluntaria patológica. Se concluyó que las evaluaciones críticas de todos los dominios de las escalas indicaban el sufrimiento en el trabajo, evidenciando los factores de riesgo de enfermedad, lo que permite dirigir medidas de intervención, por parte de los gerentes, a corto y medio plazo, que protejan a los trabajadores. También se concluyó que el alto uso de estrategias defensivas por parte de los trabajadores del Restaurante Universitario es necesario en aras de la supervivencia, ya que alienan y protegen a los trabajadores. Los resultados de este estudio pueden ayudar a reflexionar sobre el impacto del trabajo en la salud de los trabajadores, teniendo en cuenta que las situaciones de sufrimiento pueden interferir en la salud física y mental de los trabajadores.

Distribution level and health risk assessment of disinfection by-products in drinking water in China / 公共卫生与预防医学

Objectives To understand the distribution level and health risk of disinfection by-products of drinking water in cities of China, and to provide references for drinking water safety management. Methods By systematically searching the literatures published from 2009 to 2019, the effective data were extracted and the exposure levels of disinfection by-products of drinking water in China was statistically analyzed. The health risk assessment model recommended by EPA was used to conduct risk assessments on THMs and HAAs disinfection by-products. Results The levels of various disinfection by-products were as follows: trihalomethane > haloacetic acid > haloacetonitrile > chloral hydrate > haloketones > nitrosamines. The main disinfection by-products in drinking water in southern China were higher than those in northern China. The total amount of disinfection by-products produced by liquid chlorine disinfection was higher than other disinfection methods. Conclusion The carcinogenic risk of various disinfection by-products in domestic urban drinking water was higher than the acceptable EPA level (1×10-6 ). Sodium hypochlorite disinfection instead of liquid chlorine disinfection was able to effectively reduce the health risk of disinfection by-products to humans. The health risk of the exposure to pollutants in drinking water was higher in children than in adults, which should be taken into special consideration

Respirable Particulate (PM10) and Its Heavy Metals Concentrations from Bauxite Mining in the Vicinity of Urban Kuantan, Malaysia: Inhalation Health Risk Assessment

@#Introduction: Bauxite ore contain various heavy metals especially aluminum, if exposed excessively is detrimental to the respiratory system. Objective: This study aimed at determining the PM10 and its Al, As, Cd, Cr, Ni and Pb content and assessing the inhalation health risk assessment (HRA) among the community. Method: This cross-sectional study was conducted in Kuantan on 162 randomly selected respondents in three residential areas; Felda Bukit Goh (FBG), Jalan Besar Bukit Goh (JBBG) and Kuantan Port Consortium Flat (KPCF). Questionnaires were used to obtain the background information and health symptoms. PM10 with its heavy metals were subsampled for 24 hours using air sampling pumps in 42 randomly sub-sampled households from the 3 areas. Results: PM10 exceeded 150 µg/m3 and the Al, Cd, As, Cr, Ni and Pb levels exceeded the standard limit. The hazard quotient (HQ) of Cd in JBBG (4.13), Cr in FBG (74.06), JBBG (84.41), KPCF (76.87) and Ni in FBG (60.53), JBBG (66.95) and KPCF (58.81) exceeded the HQ value of 1. The lifetime cancer risk (LCR) exceeded the level of 0.0000001 for Cr in FBG (0.0252), JBBG (0.0288) and KPCF (0.0262), as well as for Ni in the FBG (0.000184), JBBG (0.000204), and KPCF (0.000179) areas. Conclusion: The PM10 levels exceeded the USEPA guidelines while Al, Cd, As, Cr, Ni and Pb exceeded the ATSDR limit. The Cd, Cr and Ni posed non-carcinogenic and carcinogenic health risks. Therefore, health risks from the PM10, Cd, Cr and Ni exposures were found in this study.

Ensayo sobre la pandemencia: cuando los personajes y microbios de la ciencia ficción salen de la película / Essay on Pandementia: when the characters and microbes of science fiction jump off the screen and invade the planet

RESUMEN Este ensayo crítico acerca de las declaraciones sobre la técnica y la vida en el planeta COVID-19 propone una reflexión ético-filosófica de los efectos de la pandemia. Trata de entender, atribuir significados y criticar las referencias a la pandemia, especialmente en Brasil, en momentos especialmente dramáticos, debido a la sinergia entre la grave enfermedad que afecta al país y al planeta, y un gobierno que se destaca por su gigantesca incapacidad para hacer frente a la calamidad. Este texto fue escrito en el periodo de "cuarentena" brasileña, desde mediados de marzo hasta fines de abril de 2020. Es un momento en el que los hechos nos golpean y no dejan de atormentarnos, y se vive a diario bajo el terrible dominio de esta pandemia. Así, este texto se caracteriza por estar elaborado en medio de un contexto social marcado por los esfuerzos de control y atención de la salud de los afectados, a pesar del complejo marco político actual y de las profundas dificultades económicas del país.

ABSTRACT This essay intends to carry out an ethical and philosophical reflection on the effects of the emergency contingencies of the COVID-19 pandemic. With a focus on Brazil, it seeks to understand, critique, and attribute meaning to references to the pandemic, in particularly dramatic moments brought about by the synergy produced between the serious disease affecting the country and the world and a government that stands out for its remarkable unwillingness and inability to deal with this calamity. This text was written during the Brazilian "quarantine," which lasted from mid-March to late April, 2020. During this period, we were bombarded by facts that never ceased to haunt us, and lived each day under the terrible dominion of the pandemic. Therefore, this text was written in the midst of a social context marked by control efforts, with great attention directed at the health of those affected, despite the complex political framework and serious economic difficulties facing the country.

Self-medication with Antimicrobials Perceptions among the Households in Nyalenda Informal Settlement, Kisumu County, Kenya: Post-Community Mobilization Intervention

Self-medication is very common especially in developing countries and is documented to be associated with many health risks including antibiotic resistance.Antibiotic resistance is shrinking the range of effective antibiotics and is currently listed as a global health problem.This study investigated the perceptions of self-medication with antimicrobials (SMWA) after community mobilization intervention amongthe households in Nyalenda B, an informal settlement, within Kisumu County, Kenya.This enabled the study to establish the magnitude of SMWA and the perceptions that persist given such intervention within the region. Data was collected through structured questionnaires administered to 380 households. Focus group discussions (FGDs) were also facilitated and targeted purposively-selected 30 CHVs. Descriptive and binary logistic regression analyses were used to determine the associationbetween socio-demographic characteristics and the perceptions influencing SMWA. The study established that 316 households had used antimicrobials of which 20.9% were self-medicating with antimicrobials.Age (OR=0.647, 95% CI=0.431, 0.973, P=0.037) is significantly related to SMWA, use of NHIF for outpatient services(OR=1.772, 95% CI=0.652, 2.887, P=0.133)and use of Universal Healthcare Services (OR=1.165, 95% CI=0.922, 1.472, P=0.201)may have contributed to SMWA reduction but not significantly as compared to other socio-demographic factors. Likewise, sources of information or advice on self-medication (OR=0.732, 95% CI=0.613, 0.873, P=0.001) and illness or symptoms of illness (OR=1.324, 95% CI=1.129, 1.554, P=0.001) may significantly influence SMWA as compared to other SMWA perceptions. Community mobilization using empowerment as a strategy and implemented through participatory learning and action is a successful method for reduction of SMWA level and development of SMWA perceptions with an experiential value especially when strengthened with structural modification. SMWA is a serious problem in developing countries and so such intervention should be prolonged and continuous to offer sustained changes in public perception and attitudes towards the misuse of antimicrobials

Exercise is more important than Medicines: A Clinical Approach

Promotion, as well as maintenance of health, is directly associated with exercise and good dietary habits. Lack of exercise and good dietary habits adversely affect health, therefore this study was conducted to assess the perception of patients regarding the effectiveness of exercise and medicine in the maintenance of health. Total of 30 patients of different diseases (heart diseases, hypertension, and obesity) was voluntarily taken as a sample of the study. For the collection of data, a questionnaire was developed; collected data were analyzed by applying Student’s t-test using SPSS version 21.0. Heart problems, hypertension, and obesity all are the chronic health problems and the majority of the respondents opined that the impact of performing various kinds of exercise along with medicine for reducing these chronic health problems was significant (p=0.004). On the basis of findings, the researcher concluded that exercise is the sister art of medicine which plays a significant role in preventing different health problems such as heart diseases, hypertension, and obesity.

Public health risks related to food safety issues in the food market: a systematic literature review

BACKGROUND@#Food safety in the food market is one of the key areas of focus in public health, because it affects people of every age, race, gender, and income level around the world. The local and international food marketing continues to have significant impacts on food safety and health of the public. Food supply chains now cross multiple national borders which increase the internationalization of health risks. This systematic review of literature was, therefore, conducted to identify common public health risks related to food safety issues in the food market.@*METHODS@#All published and unpublished quantitative, qualitative, and mixed method studies were searched from electronic databases using a three step searching. Analytical framework was developed using the PICo (population, phenomena of interest, and context) method. The methodological quality of the included studies was assessed using mixed methods appraisal tool (MMAT) version 2018. The included full-text articles were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. We then synthesized each theme by comparing the discussion and conclusion of the included articles. Emergent themes were identified based on meticulous and systematic reading. Coding and interpreting the data were refined during analysis.@*RESULTS@#The analysis of 81 full-text articles resulted in seven common public health risks related with food safety in the food market. Microbial contamination of foods, chemical contamination of foods, food adulteration, misuse of food additives, mislabeling, genetically modified foods (GM foods), and outdated foods or foods past their use-by dates were the identified food safety-related public health risks in the food market.@*CONCLUSION@#This systematic literature review identified common food safety-related public health risks in the food market. The results imply that the local and international food marketing continues to have significant impacts on health of the public. The food market increases internationalization of health risks as the food supply chains cross multiple national borders. Therefore, effective national risk-based food control systems are essential to protect the health and safety of the public. Countries need also assure the safety and quality of their foods entering international trade and ensure that imported foods conform to national requirements.

SUS 30 anos: Vigilância Sanitária / Unified health system 30th birthday: health surveillance

Resumo Este artigo apresenta uma visão geral sobre a natureza, as funções e a trajetória da vigilância sanitária na conformação do SUS. Recorreu-se a fontes bibliográficas e a documentos oficiais, cuja discussão foi enriquecida com referências oriundas da trajetória dos autores, bastante vinculada a esta área. Verdadeiras tragédias ocorridas nos anos 1990 evidenciaram a fragilidade da vigilância sanitária e trouxeram graves problemas ao SUS. A criação da Anvisa e do SNVS e o apoio aos órgãos estaduais e municipais proporcionaram melhoria na estrutura e funcionamento do sistema e também para o reconhecimento da área enquanto tema emergente na pesquisa e no ensino em Saúde Coletiva. Diversos problemas ainda dificultam a efetiva estruturação do SNVS. Postula-se mudança da concepção de promoção da saúde, com responsabilização social das grandes corporações, cujas atividades têm fortes conexões com fatores de risco relacionados à atual epidemia de doenças crônicas, e refere-se um elenco de desafios para melhor estruturação da vigilância sanitária no SUS.

Abstract This article presents an overview of the nature, functions and history of health surveillance in the structure of the Brazilian Unified Health System (SUS). Bibliographical sources and official documents were used, with references from the careers of the authors, who have worked in health surveillance. Extremely serious adverse events in the mid-1990s gave political visibility to the fragility of Brazilian health surveillance, and were reflected in serious problems for the SUS. The creation of Anvisa and the SNVS surveillance system, and the support for bodies in individual states and municipalities, resulted in improvement in the structure and functioning of health surveillance, and improved recognition of the area as an emerging theme in research and education in public health. Several problems hamper the effective structuring of the SNVS. A change in the conception/design of health promotion is postulated, in which the large corporations, whose activities have strong connections with risk factors related to the current epidemic of chronic diseases, would be given a social responsibility. A set of challenges for better structuring of health surveillance in the SUS is also put forward.

Food intake, nutritional and health status of Filipino adults according to occupations based on the 8th National Nutrition Survey 2013

@#Introduction: The health and nutrition of a country's workforce plays an effective role in the social health and economic status of its society. Methods: This study determined the food intake, nutritional and health status of 69,505 Filipino adults and their households according to occupations using the 8th National Nutrition Survey conducted in 2013 by the Food and Nutrition Research Institute. Occupational grouping was based on the 1992 Philippine Standard Occupation Code. Descriptive statistics such as mean and percentages were generated using the survey module (svy) of Stata 12.0. Results: Chronic Energy Deficiency and anaemia were highest among adults with no occupation (12.3% and 14.8% respectively) and lowest among officials (4.3%) and those with special occupations (4.5%). Overweight, hypertension, high fasting blood sugar and high total cholesterol levels were highest among officials and lowest among farmers and professionals. Farmers had the highest percentage of smokers, alcoholic drinkers and with high physical activity level, while adults with no occupation had the lowest physical activity level. Households headed by special occupation groups had the highest energy intake, while farmers had the lowest protein, iron, vitamin A, thiamine, riboflavin, niacin and fat intakes. Crafts and related trade workers had the lowest percentage of households meeting the energy requirement (27.4%). Conclusion: The food intake, nutrition and health status of Filipino workers in certain occupations were poor, in need of improvement. A national policy on addressing the health, nutrition and welfare of workers is recommended.

Diagnóstico participativo socioambiental e de riscos à saúde das comunidades do entorno do Complexo Petroquímico do Rio de Janeiro, Brasil / Participatory environmental diagnosis and of health risks from the surrounding communities the Petrochemical Complex of Rio de Janeiro, Brazil

Resumo O objetivo deste estudo foi diagnosticar os problemas socioambientais prioritários e os riscos à saúde das comunidades do entorno do Complexo Petroquímico do Rio de Janeiro. De abordagem participativa, a pesquisa-ação conduziu a aplicação de entrevistas, grupos focais, reuniões e oficina com atores sociais de Porto das Caixas e Sambaetiba, localizados em Itaboraí/RJ, no período de novembro de 2013 a dezembro de 2014. Uma análise estrutural dos problemas priorizados pelas comunidades (oferta de água, tratamento de esgoto e risco de doenças transmissíveis; risco de poluição do ar e doenças respiratórias; ausência de segurança pública e risco de violência) esquematizou a relação causa-efeito-intervenção, com base no Protocolo para Avaliação Comunitária de Excelência em Saúde Ambiental. O processo revelou ausência de representatividade dos atores sociais das localidades estudadas em espaços decisórios sobre a problemática ambiental. Urgem ações educativas com profissionais e moradores que visem a favorecer a constituição de movimentos coletivos, indispensáveis à garantia dos direitos de mitigação das situações de contaminação do ar e de acesso aos serviços de saneamento e de segurança pública e de condições de menor risco à saúde.

Abstract The aim of this study was to diagnose the priority socio environmental problems and the health risks from the surrounding communities the Petrochemical Complex of Rio de Janeiro. Characterized by a participatory approach, the action research has led to the application of interviews, focal groups, meetings and workshop with social actors of Porto das Caixas and Sambaetiba districts, located in Itaboraí city/RJ from November 2013 to December 2014. A structural analysis of the problems prioritized by the communities (water supply, sewage treatment and risk of transmissible diseases; risk of air pollution and respiratory diseases; absence of public security and risk of violence) sketched out the cause-effect-intervention relationship, on the basis of the Protocol for Assessing Community Excellence in Environmental Health. The process revealed the absence of representativity of the social actors of the studied localities in spaces of decision-making on the environmental issue. Educational actions with professionals and inhabitants that aim to promote the formation of collective movements urge, indispensable to guarantee the rights of mitigation of situations of contamination of air and access to sanitation services and public security and thus of conditions of lower risk to health.

Aportes al debate de legalización del uso medicinal de la marihuana en Colombia / Contributions to the debate on the legalization of marijuana as medicine in Colombia / Contributos ao debate sobre a legalização da maconha para uso medicinal na Colômbia

Resumen Es intenso el debate sobre legalización de la marihuana para usos terapéuticos, que busca minimizar la criminalización del usuario. Paradójicamente, a pesar de la evidencia de efectos nocivos de la marihuana su consumo aumenta, hay altas prevalencias de vida y surgen variedades más potentes y peligrosas de cannabis. Objetivo: Analizar la información disponible sobre marihuana, describiendo la evidencia que existe y, de esta manera, aportar al debate actual sobre la legalización de esta sustancia para usos medicinales en Colombia. Metodología: Revisión sobre componentes de la marihuana, efectos y evidencia terapéutica. Resultados: La planta contiene más de 400 compuestos activos y de la mayoría se desconoce su toxicidad. Contiene, además, unos 66 cannabinoides. Hay alguna evidencia del efecto medicinal de algunos compuestos, pero, falta investigación. Una cosa son cannabinoides sintéticos y derivados de la planta, otra el consumo de la "yerba". Discusión: Componentes benéficos de la planta no pueden, hasta hoy, separarse de los tóxicos. En uso terapéutico o recreativo se ingieren unos y otros. Cannabinoides producen en humanos un síndrome que altera funciones cerebrales como memoria, estado de ánimo, sueño, atención, humor, coordinación, cognición, percepción del tiempo y distorsión de la información, entre otras alteraciones, además de generar dependencia, tolerancia, adicción y síndrome de abstinencia, todas ya probadas. Conclusiones: el desconocimiento de efectos adversos del uso de la planta de marihuana como medicamento, sin conocer muy bien qué se está consumiendo, plantea importantes riesgos para la salud.

Abstract Currently there is an intense debate regarding the legalization of marijuana for therapeutic uses seeking to decrease consumer criminalization. Paradoxically, despite the evidence of hazardous effects of marijuana with high prevalence of life, and new varieties of more powerful and more dangerous cannabis. Objective: To analyze the available information on marijuana describing the evidence that exists and, in this way, contribute to the current debate on the legalization of this substance for medicinal uses in Colombia Methodology: This study is a bibliographical review based on the components of marijuana, adverse effects and evidence of therapeutic effects. Results: The marijuana plant contains more than 400 active components, the toxicity of the majority of these components is unknown, and it also contains approximately 66 cannabinoids. There is scientific evidence of the medicinal effect of some components, yet there is still not enough research. One thing is synthetic cannabinoids from pharmaceutical research and derived from the marijuana plant, and another thing is the use of the plant as "weed". Discussion: Technically up-to-date, the beneficial components of the marijuana plant cannot be separated from the toxic ones, so when it is used for therapeutic or recreational purposes people ingest both. Cannabinoids produce in human beings a syndrome which alters important brain functions like memory, mood, sleep, attention, humor, coordination, cognition, time perception, and distortion of information, among others. This also includes dependence, tolerance, addiction and withdrawal syndromes already proven. Conclusions: A lack of knowledge of the adverse effects of the use of the marijuana plant as such poses a serious health risk when used as medication without knowing exactly what a person is using.

Resumo Atualmente, existe um debate intenso sobre a legalização da maconha para usos terapêuticos, visando minimizar a criminalização do consumidor. Paradoxalmente, apresar da evidência dos efeitos negativos, o consumo e a prevalência da maconha aumentam. Também surgem novas de variedades de cânabis, mais potentes e perigosas. Objetivo : analisar a informação disponível sobre a maconha descrevendo a evidência de que existe e, assim, contribuir para o actual debate sobre a legalização da substância para uso médico na Colômbia Metodologia: Revisão bibliográfica sobre os componentes na maconha, efeitos adversos e evidência de efeitos terapêuticos. Resultados: A planta de maconha tem mais de 400 compostos ativos e a toxicidade da maioria deles é desconhecida. Além disso, contém 66 canabinóides. Existe alguma evidencia científica sobre o efeito medicinal dalguns compostos, mais ainda é preciso pesquisar mais. O consumo da "erva" diferencia-se dos canabinóides sintéticos e dos derivados da planta da maconha produzidos através de pesquisa farmacêutica. Discussão: Neste momento, os componentes benéficos da maconha não podem ser separados tecnicamente dos tóxicos. Por isso, consumi-la para usos terapêuticos ou recreativo implica ingerir tanto uma coisa quanto a outra. Nos humanos, os canabinóides produzem uma síndrome que desvirtua a informação e altera funções cerebrais importantes: a memória, o temperamento, o sonho, a atenção, o humor, a coordenação, a cognição, a percepção do tempo, entre outras. Além da dependência, já se comprovaram a tolerância, a adição e a síndrome de abstinência. Conclusões: poderiam surgir importantes riscos para a saúde derivados do uso da maconha como medicamento, desconhecendo seus efeitos adversos. Não há claridade sobre o que se consume.