Indicadores de desigualdad y mortalidad por enfermedades cardiometabólicas en Guatemala / Inequality indicators and cardiometabolic diseases mortality in Guatemalahttps

La medición de las desigualdades en salud al interior de los países de ingresos bajos y medios es necesaria para la planificación, monitoreo y evaluación de intervenciones de salud pública, especialmente para problemas que contribuyen altamente a la carga de enfermedad, como las enfermedades cardiometabólicas. El objetivo de este estudio fue caracterizar los patrones de desigualdad de las tasas de mortalidad para las principales causas cardiometabólicas en Guatemala. Se usó datos del Censo Nacional de Población, y estadísticas oficiales de de-función de 2018 para calcular tasas crudas de mortalidad para diabetes (DM), infarto agudo de miocardio (IAM), y accidente cerebrovascular (ACV). Se calcularon indicadores simples y complejos de desigualdad absoluta y relativa (diferencia, razón, índice de pendiente, índice de concentración, distancia de la media, índice de Theil, riesgo atribuible poblacional, y porcentaje de riesgo atribuible poblacional) para seis dimensiones de desigualdad: sexo, pueblo de pertenencia, nivel educativo, tipo de ocupación, departamento y municipio. Se documentaron 6,445 muertes por DM, 5,761 por IAM, y 3,218 por ACV. Los indicadores mostraron marcadas desigualdades para las seis dimensiones estudiadas. El patrón de desigualdad predominante para sexo, pueblo de pertenencia y departamento fue de privación masiva. Para nivel educativo y ocupación predominó un patrón de incrementos escalonados. Se identificó exclusión marginal superpuesta en nivel educativo, ocupación y municipio. Se concluye que los patrones de desigualdad de las tasas de mortalidad para estas tres enfermedades sugieren la superposición de patrones de privación masiva, incrementos escalonados, y exclusión marginal.

Measuring health inequalities within low- and middle-income countries is needed for planning, monitoring, and evaluation of public health interventions, especially for problems that represent a high burden of disease, like cardio metabolic diseases. The goal of this study was to characterize inequality patterns in mortality rates from cardio metabolic causes in Guatemala. Data from the 2018 National Population Census, and official vital statistics were used to estimate crude mortality rates for diabetes (DM), acute myocardial infarction (IAM), and stroke (ACV). Simple and complex indicators of absolute and relative inequality (difference, ratio, slope index, concentration index, distance from the mean, Theil index, population attributable risk, and percentage of popula-tion attributable risk) were calculated for six dimensions of inequality: sex, race/ethnicity, education level, type of occupation, department, and municipality. A total of 6,445 DM deaths, 5,761 IAM deaths, and 3,218 ACV deaths were documented. Indicators showed marked inequalities for the six dimensions studied. Massive deprivation was the predominant inequality pattern for sex, race/ethnicity, and department. Staggered increments were iden-tified for education level and type of occupation. Overlapping marginal exclusion was found for education level, occupation, and municipality. We conclude that inequality patterns found for the three causes of death suggest overlapping patterns of mass deprivation, staggered increments, and marginal exclusion.

Psychiatric legal investigation for sickness benefits due to disability at the Brazilian Federal Social Security Special Court in Florianópolis, capital city of the State of Santa Catarina, southern Brazil / Perícias judiciais psiquiátricas em benefícios por incapacidade no Juizado Especial Federal Previdenciário de Florianópolis, capital do estado de Santa Catarina, sul do Brasil

Objective: To describe the profile of insured individuals that filed claims for sickness benefits and compare the results of the administrative and legal investigations. Method: This case series included 114 insured persons that filed lawsuits against the Brazilian National Institute of Social Security (Instituto Nacional de Seguridade Social, INSS). They underwent psychiatric examinations required by the Brazilian Federal Social Security Special Court in Florianópolis from August to December 2010. Results: Mean age was 47 years, and participant age ranged from 24 to 64 years. Most insured individuals were women (79%), and most were employed (67.5%) and self-employed (26.5%) workers. Mean contribution time was 99.9 months, ranging from 8 to 352 months. Mean benefit duration was 20.4 months, ranging from 2 to 97 months. The most prevalent category of workers was service workers, store and supermarket salespeople (54.4%), followed by administrative workers (19.3%). Conclusions: Only 17 participants were found to be unable to work after benefit cessation, a 14.9% mismatch between administrative and legal investigations. The most frequent diagnoses were mood disorders (59.6%) and anxiety disorders (17.5%). .

Objetivo: Descrever o perfil dos segurados que requerem benefícios por incapacidade e comparar os resultados das perícias administrativas e judiciais. Método: Esta série de casos incluiu 114 segurados que buscaram a justiça contra o Instituto Nacional de Seguridade Social (INSS). Os participantes foram submetidos a perícia psiquiátrica exigida pelo Juizado Especial Federal em Florianópolis, entre agosto e dezembro de 2010. Resultados: A idade média dos participantes foi de 47 anos, variando de 24 a 64 anos. A maioria dos segurados era do sexo feminino (79%) e era empregada (67,5%) ou autônoma (26,5%). O tempo médio de contribuição foi de 99,9 meses, variando de 8 até 352 meses. A duração média dos benefícios foi de 20,4 meses, com mínimo de 2 e máximo de 97 meses. A categoria mais prevalente foi de trabalhadores no setor de serviços e vendedores de lojas e supermercados (54,4%), seguida por trabalhadores em atividades administrativas (19,3%). Conclusão: Apenas 17 participantes foram considerados incapazes de trabalhar após o término do benefício, uma diferença de 14,9% entre as perícias administrativa e judicial. Os diagnósticos mais frequentes foram transtornos de humor (59,6%) e transtornos de ansiedade (17,5%). .

Profesionalización, vocación y ética de enfermería / Professionalism, dedication and motivation, and ethics in nursing

La profesionalización, en enfermería, es un proceso social complejo; proviene del latín professio; significa profesar, es decir, ejercer una ciencia o un arte de forma voluntaria; se refiere también a una ideología o actividad asociada que se encuentra en diversos grupos de profesionales en los que sus integrantes aspiran a un estatus social. El estatus facilita el desarrollo, el crecimiento y la evolución de la profesión, consolidando el concepto de profesionalización o de ocupación, según cada contexto. El crecimiento de la enfermería, en este proceso, presenta factores económicos, políticos y culturales, en los que existe un nivel de crecimiento de acuerdo a criterios generales como el estatus, la vocación y la ética de cada profesional de enfermería.

Professionalisation in nursing, is a complex social process ; It comes from the Latin professio ; means profess , that is, exercise science or an art voluntarily ; also it refers to an ideology or associated activity found in various professional groups in which its members aspire to a social status. The status facilitates the development , growth and evolution of the profession , consolidating the concept of professional or occupation , depending on the context. The growth of nursing, in this process, has economic, political and cultural factors , in which there is a level of growth according to general criteria such as status , vocation and ethics of each nurse .

Mudanças recentes no perfil da distribuição ocupacional da população brasileira / Recent changes in the profile of occupational distribution of the Brazilian population

Este estudo visou contribuir com subsídios para a análise das transformações recentes no perfil da estruturação do trabalhador brasileiro, segundo a segmentação setorial e em grupos específicos de ocupações, particularmente na década de 90. Foram examinadas inicialmente questões teóricas sobre as causas da segmentação do mercado de trabalho na atualidade. Em seqüência, analisaram-se aspectos empíricos relacionados às mudanças estruturais da distribuição no mercado de trabalho em economias mundiais, procurando situar o Brasil neste contexto internacional. Para o Brasil, foram elaborados índices de Estruturação Ocupacional e de Quocientes de Diferenciação Regional. Os resultados da análise mostram que, apesar de transformações ocupacionais significativas constatadas, as mudanças estruturais foram intra e não inter-regionais.

This article analyzes recent changes in the profile of the Brazilian labor structure, according to sector segmentation and specific occupational groups, especially during the 1990s. Theoretical aspects on the causes of the segmentation of the labor market are first examined. Empirical information related to structural changes in labor markets in the worldwide economy are then discussed, in order to locate Brazil in this context. Specifically, Indexes of Occupational Structure and Regional Difference Quotients for Brazil were drawn up. The results show that, besides significant occupational transformations, structural changes occurred in the regions, but not among them.

Crescimento populacional, ocupação e desemprego dos jovens: a experiência recente da Região Metropolitana de Porto Alegre / Population growth, labor by youth and unemployment: the recent experience of the Metropolitan Area of Porto Alegre, Brazil

Este artigo investiga o quanto o tamanho relativo da população juvenil na Região Metropolitana de Porto Alegre (RMPA) afetou a ocupação e o desemprego desse segmento no período 1993-2004. Esta questão ganha relevância no presente tanto pelo fato de que diversos estudos têm apontado a ocorrência do fenômeno de uma onda jovem nas principais regiões metropolitanas do país, nos anos 90, quanto pela correlata observação de uma tendência à elevação do desemprego entre os jovens no período. Assim, primeiramente, é feita uma síntese dos argumentos a respeito dos efeitos do tamanho relativo da coorte juvenil sobre a situação deste grupo populacional no mercado de trabalho. Em seguida, identificam-se as principais tendências da população e da força de trabalho juvenil no mercado de trabalho da RMPA, bem como se estimam os efeitos do tamanho relativo da coorte juvenil sobre a ocupação e o desemprego desse grupo populacional.

This article studies to what extent the relative size of the young population in the Metropolitan Area of Porto Alegre (RMPA) affected employment and unemployment of this group between 1993 and 2004. This question has taken on considerable importance, based on two different factors. The first is the fact that a number of studies have indicated the occurrence of the phenomenon of a wave of youth in the largest metropolitan areas in the country during the 1990s. Secondly, the concomitant trend toward higher unemployment among youth during this same period. The article is organized in the following way: after the Introduction, Section 2 presents a synthesis of the arguments regarding the effects of the relative size of the cohort of youth on the situation of this group in the labor market. Section 3 identifies the main trends of the younger population within the labor market in the RMPA and estimates the effects of the relative size of this cohort on the employment and unemployment of this population group. Finally, the main conclusions of the study are presented.

Coping with ill health in a rickshaw puller's household in Chittagong, Bangladesh.

The correlation between poverty and ill-health is undeniably strong. Ill-health reduces the earning capacity, and increases the risk of families with ill members to drift down the social and economic ladder. In this article, we present a simulation model of how a poor rickshaw puller in Bangladesh copes with illness, in particular tuberculosis (TB). We first analyze the various coping mechanisms that are set in motion when he starts to suffer from tuberculosis; the impact on household assets, income and food intake will be studied. The simulation model is then used to analyse the effects on his household of a specific health intervention, namely the Directly Observer Treatment Short Course (DOTS) treatment. It shows that DOTS offers positive improvements of the overall well-being of the household by restoring the working capacity of the rickshaw puller in one treatment course and minimizing lost income. Assets and food consumption would be preserved significantly more in the presence of DOTS, rendering the household both financially and physically less vulnerable. The probability of death of the sick rickshaw puller is also significantly reduced, improving household's welfare over the long run.