Enfermedad renal crónica de causa desconocida: investigaciones en Guatemala y oportunidades para su prevención / Chronic kidney disease of unknown cause: investigations in Guatemala and opportunities for its prevention

El Centro para la Salud, el Trabajo y el Ambiente (CHWE por sus siglas en inglés) inició un proyecto de colaboración con Pantaleon, una empresa agrícola de caña de azúcar en Guatemala, para hacer frente a una epidemia de enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) que afecta a las comunidades agrícolas en Centroamérica y otros lugares. Este artículo describe el conocimiento actual de la epidemia en Centroamérica, las manifestaciones clínicas, el tratamiento y el manejo; las hipótesis actuales de su etiología, la colaboración y el enfoque de CHWE-Pantaleon. Nuestro enfoque de Total Worker Health® (TWH) para abordar la salud renal en Guatemala incluye múltiples estudios de investigación con trabajadores de caña de azúcar, para evaluar la prevalencia, incidencia y factores de riesgo de la lesión renal aguda y la ERC; se incluye también el desarrollo e implementación de medidas de prevención mejoradas e intervenciones para proteger a los trabajadores abordando los factores de riesgo ya conocidos. Se examinan también las necesidades futuras de investigación y las implicaciones globales de la ERCnT, al igual que la producción de bienes y la economía, así como las recomendaciones actuales para las estrategias de prevención ocupacional y comunitaria.

The Center for Health, Work and Environment (CHWE) began a collaborative project with Pantaleon, a Guatemalan sugarcane agribusiness, to address an epidemic of chronic kidney disease of unknown cause (CKDu) that affects agricultural communities in Central America and elsewhere. This paper describes the current knowledge of the epidemic in Central America including clinical manifestations, course, and management, current etiology hypotheses, and the CHWE-Pantaleon collaboration and approach. Our Total Worker Health® (TWH) approach to addressing kidney health in Guatemala has included multiple research studies with sugarcane workers to assess prevalence, incidence and risk factors for acute kidney injury and chronic kidney disease, as well as development and implementation of enhanced prevention measures and interventions to protect workers by addressing known risk factors. Future research needs and the global implications of CKDu including for economy and commodity production are discussed, as well as current recommendations for occupational and community prevention strategies.

Costo de los exámenes médicos preventivos en trabajadores / Cost of preventive medical exams performed in workers

Introducción: los exámenes médicos periódicos en sus diferentes modalidades son un componente importante de la atención a la salud de los trabajadores y su concepción y realización se deben corresponder con la necesaria racionalidad y eficiencia. Objetivo: calcular los costos por trabajador y por investigación realizada en los exámenes médicos periódicos en trabajadores. Métodos: investigación descriptiva de corte transversal realizada en el Instituto Nacional de Salud de los Trabajadores. Se utilizaron dos sistemas para calcular los costos, el método ABC y el método paciente/enfermedad, vigente este último en la salud pública cubana. La información se obtuvo mediante revisión documental que incluyó las historias clínicas de los pacientes examinados en el centro. Se confeccionó una base de datos con 3 474 trabajadores que asistieron a los servicios del Instituto durante el período 2008-2013. Resultados: los costos de los exámenes médicos, tanto los realizados en las diferentes especialidades como por trabajador, tuvieron diferencias significativas; su contrastación es difícil pues los exámenes médicos están poco estandarizados en el Instituto. Conclusiones: los costos se obtuvieron con precisión pero es necesario continuar su estudio en las actividades preventivas en salud ocupacional. El método con que se calculen los costos puede influir en la valoración económica de los mismos(AU)

Introduction: the systematic medical examinations in its variants are an important element of the health care of workers and their conception and performance should comply with the required rationality and efficiency. Objetive: to estimate the costs per worker and per research study of systematic medical examinations performed in workers. Methods: the research work was conducted at the National Institute of Occupational Health. Two systems were used to estimate costs, that is, the ABC method and the disease/patient estimation method used in the Cuban public health system. The information was collected from documentary review including the medical histories of patients tested in the center. One database was created with 3 474 workers who went to the Institute services in the 2008-2013 period. Results: the costs of medical examinations, both the ones conducted in the different specialties and those performed per worker, showed significant differences; their comparison is difficult since the medical examinations are poorly standardized in the Institute. Conclusions: the costs were accurately estimated, but it is required to continue studying them in the preventive activities of the occupational health. The method used to estimate costs may influence their economic assessment(AU)

Presenteísmo e saúde bucal em trabalhadores da indústria de transformação e construção civil / Presentismo and oral health in workers of the transformation and construction industry

O adoecimento e sua relação com a falta de assiduidade ou produtividade no trabalho têm sido alvo de diversos estudos. Com os crescentes desafios impostos pela economia mundial, os empregadores estão em busca de uma maior eficiência e um consequente aumento da sua produtividade. O absenteísmo e o presenteísmo representam altos custos para as instituições tanto públicas quanto privadas e principalmente para o trabalhador. Neste sentido, observa-se que trabalho e saúde são variáveis que influenciam o processo produtivo e são importantes para a qualidade de vida, que, por sua vez, coloca sua centralidade na capacidade de viver sem doenças ou de superar as dificuldades dos estados ou condições de morbidade. Várias comorbidades estão associadas com a ausência ao serviço (absenteísmo) ou com o baixo rendimento no ambiente de trabalho (presenteísmo), dentre elas destacam-se os problemas de ordem circulatória, dores de cabeça e os distúrbios de origem bucal. O artigo aqui apresentado e intitulado "Presenteismo e saúde bucal em trabalhadores da indústria de transformação e construção civil" objetivou analisar o presentísmo relacionado às condições de saúde bucal dos trabalhadores da Indústria do Estado de Pernambuco enfocando problemas como a cárie dentária e doença periodontal através da análise de um banco de dados originidado de um estudo transversal, de base populacional.(AU)

The disease and its relationship to absenteeism or productivity at work have been the subject of several studies. With the increasing challenges posed by the global economy, Absenteeism and presenteeism represent high costs for both public and private, and institutions primarily for the worker. In this sense, it is observed that work and health are variables that influence the production process and are important for quality of life, which, in turn, puts its centrality in the ability to live without disease or overcome the difficulties of states or conditions of morbidity. Several comorbidities are associated with the absence of the service (absenteeism) or to the low yield in the workplace (presenteeism), among which stand out the order circulatory problems, headaches and disorders of oral origin. The article presented here, entitled "presenteeism and oral health workers in the manufacturing and construction industry" aimed to analyze the presenteeism related to oral health status of workers in the State of Pernambuco Industry focusing on problems such as tooth decay and periodontal disease through analysis of a database originidado data from a cross-sectional study, a population-based.(AU)

Compensation for Occupational Injuries and Diseases in Special Populations: Farmers and Soldiers

Some types of workers such as farmers and soldiers are at a higher risk of work-related injury and illness than workers from other occupations. Despite this fact, they are not covered under the Industrial Safety Health (ISH) Act or the Industrial Accident Compensation Insurance (IACI) Act. The Safety Aid System for Farmers (SASF) is a voluntary insurance scheme, and it is the only public compensation plan for self-employed farmers. Fifty percent of SASF premiums are subsidized by the Korean government. Soldiers are compensated by the Veterans' Pension (VP) Act. The approval standard of and procedure for the VP Act are provided in the Decree of VP Act, and the Council for VP Benefits determines work-relatedness in the claimed cases. Meanwhile, SASF applies the insurance clause automatically without any expert advice or additional procedures. Furthermore, compared with IACI, these programs pay fewer benefits to workers. Thus, a stronger institutional strategy is needed to maintain a safe work environment, to protect workers' health in unavoidably hazardous environments, and to compensate for work-related injuries and diseases.

Investigation of postural edema in the lower extremities of traffic control workers / Investigacao de edema postural de membros inferiores em agentes de transito

OBJECTIVE: Determine the prevalence of postural edema and investigate whether working posture - sitting down or standing up - affect its frequency. METHODS: Sixteen traffic control agents were assessed by water displacement volumetry and the results were analyzed in two groups, depending on working posture. Those who worked standing up for more than 4 hours were allocated to the SU group and those who worked sitting down for more than 4 hours were allocated to the SD group. Each worker was assessed before and after their working shift for three consecutive days. Data were analyzed using ANOVA and the test of equality of two proportions. The significance level was set at p ≤ 0.05. The assessment showed that members of both groups had postural edema of the lower extremities (p ≤ 0.001). RESULTS: When the frequency of postural edema was compared across groups, a trend was observed for greater edema formation in the SU group than in the SD group, although without statistically significant difference. CONCLUSION: It was concluded that traffic control agents suffer postural edema after 4 hours working in either of the postures investigated although with a predominance of edema formation among those who work standing up. .

OBJETIVO: Avaliar a ocorrência de edema postural (EP) e verificar se há diferença na sua formação entre as duas posturas de trabalho adotadas - em pé e sentada. MÉTODOS: Foram avaliados 16 trabalhadores agentes de trânsito por meio da volumetria por deslocamento de água, divididos em dois grupos de acordo com a posição de trabalho adotada. No Grupo em Pé (GP), foram alocados aqueles que trabalhavam em pé e, no Grupo Sentado (GS), aqueles que adotavam a posição sentada, ambos por mais de quatro horas consecutivas. Os dados foram coletados antes e após a jornada de trabalho por três dias consecutivos e tratados com os testes estatísticos ANOVA e Igualdade de duas proporções. O nível de significância adotado foi p ≤ 0,05. A avaliação revelou presença de edema postural de membros inferiores nas duas condições avaliadas (p ≤ 0,001). RESULTADOS: Na análise da diferença na formação de EP entre os grupos, observou-se tendência a maior formação no GP em comparação ao GS, contudo sem diferença estatisticamente significante. CONCLUSÃO: Concluiu-se que existiu EP em agentes de trânsito após quatro horas de trabalho nas duas condições avaliadas com predomínio na formação de edema na postura em pé. .

¿Salud y productividad?: sobre la formación de una analítica "económica" de la relación salud-trabajo (Argentina, 1900-1955) / Health and productivity?: On the development of an "economic" analytics of the relationship between work and health (Argentina, 1900-1955)

Este artículo está dedicado a mostrar que la racionalización económica de la salud que caracteriza el presente, aun reconociendo rasgos singulares, se inscribe en un proceso histórico de mayor duración. Así, entre los años 1900 y 1955 se constituyó en la Argentina una "analítica económica" de la relación salud-trabajo, estructurada en torno a los siguientes focos: la reflexión acerca del "precio del hombre"; el pensamiento que inscribía la medicina social en el programa de la "economía humana"; el discurso acerca de la vida sana y eficiente; los cálculos de los médicos de fábrica y la conformación de un discurso económico-utilitario al interior de la medicina del trabajo y, finalmente, los debates acerca de la productividad. Esos cinco ejes definen la emergencia de una problematización particular de la salud de los trabajadores y, a la vez, dejan planteado el interrogante concerniente a la relación que mantienen, en las sociedades occidentales, el capitalismo, el liberalismo y el biopoder.

This article seeks to demonstrate that the economic rationalization in health that characterizes the present, although possessing unique features, is inscribed within a longer historical process. Between 1900 and 1955, an "economic analytics" of the relationship between health and work was developed in Argentina, structured around the following focal points: reflections on the "price of a man"; thought that framed social medicine within the "human economy" program; the discourse of healthful and efficient living; the calculations of factory doctors and the conformation of an economic and utilitarian discourse within occupational medicine; and, finally, debates on productivity. These five central concepts define the emergence of a particular problematization regarding worker health and, in turn, raise questions about the relationship between capitalism, liberalism and biopower in occidental societies.

Prevalência e duração dos benefícios auxílio-doença decorrentes de asma no Brasil em 2008 / Prevalence and duration of social security benefits allowed to workers with asthma in Brazil in 2008

OBJETIVO: Determinar a prevalência e a duração dos benefícios auxílio-doença (BAD) decorrentes de asma concedidos pelo Instituto Nacional de Seguro Social aos empregados no Brasil em 2008. MÉTODOS: Estudo descritivo e retrospectivo a partir do banco de dados do Sistema Único de Benefícios sobre os BAD decorrentes de asma concedidos em 2008. A população de referência consistiu da média mensal dos empregados registrados no Cadastro Nacional de Informações Sociais em 2008. Foram estudadas as variáveis ramo de atividade econômica, sexo, idade, tipo e duração dos BAD. A relação trabalho-doença foi avaliada por razão de prevalência (RP) entre BAD acidentários e previdenciários. RESULTADOS: Em 2008, foram concedidos 2.483 BAD por asma, com prevalência de 7,5 BAD por 100.000 empregados. A prevalência foi maior em mulheres que em homens (RP = 2,1 entre os sexos). Empregados com > 40 anos tinham 2,5 vezes maior probabilidade de receber BAD por asma do que aqueles com < 40 anos. Os ramos esgoto e atividades relacionadas, fabricação de produtos de madeira e fabricação de móveis tiveram as maiores prevalências (78,8; 22,4; e 22,2 BAD/100.000 empregados, respectivamente). A mediana (intervalo interquartílico) da duração dos BAD foi de 49 (28-87) dias. CONCLUSÕES: A asma é uma importante causa de afastamento do trabalho com forte componente ocupacional na sua etiologia, resultando em grande impacto para empregadores, empregados e previdência social. Ser mulher, ter > 40 anos e trabalhar nos segmentos de esgoto, fabricação de produtos de madeira e de fabricação de móveis aumentam a probabilidade de afastamento do trabalho por asma.

OBJECTIVE: To determine the prevalence and duration of social security benefits (SSBs) claims to registered workers with asthma in Brazil by the Brazilian National Institute of Social Security in 2008. METHODS: This was a retrospective, descriptive study, based on information obtained from the Brazilian Unified Benefit System database, on the number of SSB claims granted to registered workers with asthma in 2008. The reference population was the monthly mean number of workers registered in the Brazilian Social Registry Database in 2008. The variables studied were type of economic activity, gender, age, and type/duration of the SSB claim. The relationship between work and asthma was evaluated by the prevalence ratio (PR) between work-related and non-work-related SSB claims for asthma. RESULTS: In 2008, 2,483 SSB claims were granted for asthma, with a prevalence of 7.5 allowances per 100,000 registered workers. The prevalence was higher among females than among males (PR = 2.1 between the sexes). Workers > 40 years of age were 2.5 times more likely to be granted an SSB claim for asthma than were younger workers. The prevalence was highest among workers engaged in the following types of economic activity: sewage, wood and wood product manufacturing, and furniture manufacturing (78.8, 22.4, and 22.2 claims/100,000 registered workers, respectively). The median (interquartile range) duration of SSB claims for asthma was 49 (28-87) days. CONCLUSIONS: Asthma is a major cause of sick leave, and its etiology has a strong occupational component. This has a major impact on employers, employees, and the social security system. Being female, being > 40 years of age, and working in the areas of urban sanitation/sewage, wood and wood product manufacturing, and furniture manufacturing increase the chance of sick leave due to asthma.

A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension / Un programa de actividad física en el lugar de trabajo en una universidad pública de México puede reducir los costos médicos asociados a la diabetes tipo 2 e hipertensión

OBJECTIVE: To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. MATERIAL AND METHODS: We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. RESULTS: If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. CONCLUSIONS: This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.

OBJETIVO: Evaluar el impacto de un programa de actividad física en el lugar de trabajo sobre la reducción de costos médicos directos relacionados con la diabetes tipo 2 y la hipertensión. MATERIAL Y MÉTODOS: Calculamos el potencial de la actividad física para reducir costos médicos, multiplicando los gastos médicos anuales que realizan diabéticos e hipertensos, multiplicados por la fracción atribuible poblacional asociada a un nivel de actividad física insuficiente. La factibilidad de ejecutar el programa fue evaluada en 425 trabajadores de una universidad pública en México. RESULTADOS: Si 400 trabajadores sedentarios participaran en un programa de actividad física recreativa para reducir su riesgo de diabetes e hipertensión, los costos médicos anuales reducirían en 138880 dólares. Cada dólar invertido en actividad física podría reducir 5.3 dólares en el tratamiento de ambas enfermedades. CONCLUSIONES: Esta investigación evidencia la utilidad de los estudios costoeconómicos en salud para optimizar los recursos financieros en este sector.

Sistema de salud de Uruguay / The health system of Uruguay

En este trabajo se describe el sistema uruguayo de salud: su estructura y cobertura, sus fuentes de financiamiento, el nivel y distribución del gasto en salud, los recursos físicos, materiales y humanos de los que dispone, las actividades de rectoría que en él se desarrollan, las instituciones encargadas de generar la información y la investigación, y el nivel de participación de los ciudadanos en la operación y evaluación del sistema. También se describen las innovaciones más recientes, incluyendo la creación del Sistema Nacional Integral de Salud, el Seguro Nacional de Salud, el Fondo Nacional de Salud y el Programa Integral de Atención a la Salud. Finalmente se discute el impacto que estas innovaciones han tenido en el gasto en salud, en la justicia en el financiamiento del sistema, en los niveles de cobertura y en los principales indicadores de salud.

This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.