Universal health coverage as a global public health goal: the work of the International Labour Organisation, c. 1925-2018 / Cobertura universal como meta global de saúde pública: o trabalho da Organização Internacional do Trabalho, c. 1925-2018

Abstract We examine the efforts of the International Labour Organisation (ILO) to extend medical care under social security, through international conventions, advocacy and technical assistance. We consider the challenges faced by the ILO in advancing global health coverage through its labourist, social security model. The narrative begins in the interwar period, with the early conventions on sickness insurance, then discusses the rights-based universalistic vision expressed in the Philadelphia Declaration (1944). We characterize the ILO's postwar research and technical assistance as "progressive gradualism" then show how from the late-1970s the ILO became increasingly marginalized, though it retained an advisory role within the now dominant "co-operative pluralistic" model.

Resumo Analisamos os esforços da Organização Internacional do Trabalho (OIT) em ampliar o cuidado médico sob seguridade social, via convenções, amparo e assistência técnica internacionais. Consideramos os desafios da OIT no desenvolvimento da cobertura global de saúde por meio do modelo trabalhista e de seguridade social. A narrativa inicia no período entreguerras, com as primeiras convenções sobre seguro saúde, depois discute a visão universalista baseada em direitos da Declaração da Filadélfia (1944). Classificamos a pesquisa e a assistência da OIT no pós-guerra como "gradualismo progressivo" e mostramos como, a partir do final da década de 1970, a OIT foi marginalizada, embora mantivesse um papel de conselheira dentro do atual modelo "pluralista cooperativo" dominante.

La construcción discursiva del joven trabajador: Un análisis crítico a los informes Tendencias Mundiales de Empleo / The Discursive Construction of the Youth as Workers: A Critical Analysis of Global Employment Trends for Youth

Resumen El presente artículo se propone como objetivo describir las formas en que la Organización Internacional del Trabajo (OIT) construye discursivamente al joven trabajador. Para esto, se realiza un análisis de discurso de los informes Tendencias Mundiales de Empleo (TEM), publicados por la OIT entre 2004-2014. Los resultados obtenidos dan cuenta que en los informes TEM aparecen seis figuras de la subjetividad que construyen al joven trabajador: a) el joven pobre, b) el joven ocioso, c) la generación perdida, d) el joven feliz, e) los desafortunados jóvenes, y f) los jóvenes desconfiados. De acuerdo al análisis basado en el enfoque de la Gubernamentalidad, se puede constatar que estas formas de conceptualizar a la juventud se fundamentan desde una lógica economicista, basada en valores neoliberales. Se discute en torno a cómo estas figuras de la subjetividad corresponden a Tecnologías del Yo, que permiten prescribir formas de conducir la conducta de los jóvenes para su inclusión al mercado del trabajo.

Abstract This article aims to describe the ways in which the International Labour Organization (ILO) discursively constructs the youth as workers. To do this, a discourse analysis of the Global Empoyment Trends for Youth (GET) reports, published by the ILO from 2004 to 2014, was conducted. The results show six figures of subjectivity that construct the young workers in the TEM reports: a) the poor youth, b) the idle youth, c) the lost generation, d) the happy youth, e) the unfortunate youth, f) the distrust youth. According to the Governmentality approach, it can be seen how these ways of conceptualizing young workers correspond to neoliberal values. Its discussed how these figures of subjectivity correspond to Technologies of the Self, that allow conduct the conduct of youth in order to prescribe way of including young people into the labor market.

Patrón de lectura radiológica digital para la clasificación de imágenes compatibles con silicosis / Digital reading radiation pattern for classification of image about silicosis (P0140-2013)

La silicosis es una enfermedad sin tratamiento. El programa de vigilancia de trabajadores expuestos a sílice está diseñado para detectarla lo más precozmente posible mediante una radiografía de tórax. A pesar de su rol fundamental, esta adolece de una gran variabilidad técnica y de interpretación. Para disminuir estos fenómenos, la OIT creó un sistema de clasificación ampliamente usado en Chile y el mundo. Este se basó en la radiografía análoga, la que ha sido reemplazada por el mismo set análogo, digitalizado. Si bien la OIT permite el uso de este nuevo tipo de imagen, indica que el patrón de comparación debe seguir siendo el análogo. Muchos estudios han demostrado que es mejor utilizar patrones de comparación digitales. El objetivo de este trabajo fue generar un set de radiografías digitales que representen las profusiones centrales de opacidades redondas del sistema de clasificación OIT. De un universo de 32.826 radiografías de pacientes expuestos a sílice, se obtuvo 252 radiografías, de las cuales 54 fueron informadas por 3 lectores acreditados, seleccionándose 8 casos que contaban con opacidades redondas puras de diferentes profusiones, las que se proponen como patrón digital para Chile.

Silicosis is a disease without treatment. The surveillance program for workers exposed to silica is designed to detect as early as possible by a chest radiograph. Despite its fundamental role, it suffers from a great technique and interpretation variability. To reduce these phenomena, the ILO created a classification system widely used in Chile and the world. This was based on analog radiography, which has been replaced by the same analog set, digitized. While the ILO permits the use of this new type of image it indicates that the pattern comparison must remain analog. Many studies have shown that it is best to use digital comparison patterns. The objective of this work was to generate a set of digital x-rays representing the central profusion of round opacities of ILO classification system. From a universe of 32,826 x-rays of patients exposed to silica, 252 films, of which 54 were reported for 3 accredited readers, selected 8 cases that had pure round opacities of different profusions was obtained, which are proposed as digital pattern for Chile.

Asbestos and Asbestos-related Diseases in Vietnam: In reference to the International Labor Organization/World Health Organization National Asbestos Profile

This paper describes progress on formulating a national asbestos profile for the country of Vietnam. The Center of Asbestos Resource, Vietnam, formulated a National Profile on Asbestos-related Occupational Health, with due reference to the International Labor Organization/World Health Organization National Asbestos Profile. The Center of Asbestos Resource was established by the Vietnamese Health Environment Management Agency and the National Institute of Labor Protection, with the support of the Australian Agency for International Development, as a coordinating point for asbestos-related issues in Vietnam. Under the National Profile on Asbestos-related Occupational Health framework, the Center of Asbestos Resource succeeded in compiling relevant information for 15 of the 18 designated items outlined in the International Labor Organization/World Health Organization National Asbestos Profile, some overlaps of the information items notwithstanding. Today, Vietnam continues to import and use an average of more than 60,000 metric tons of raw asbestos per year. Information on asbestos-related diseases is limited, but the country has begun to diagnose mesothelioma cases, with the technical cooperation of Japan. As it stands, the National Profile on Asbestos-related Occupational Health needs further work and updating. However, we envisage that the National Profile on Asbestos-related Occupational Health will ultimately facilitate the smooth transition to an asbestos-free Vietnam.

Análise das alterações radiográficas pulmonares durante a terapêutica da paracoccidioidomicose / Review of lung radiographic findings during treatment of patients with chronic paracoccidioidomycosis

OBJETIVO: Foram analisadas as alterações radiográficas pulmonares em pacientes com paracoccidioidomicose crônica de modo evolutivo, verificando-se as diferenças entre os tratados com um novo agente antifúngico triazólico, o voriconazol, em relação aos que utilizaram a atual droga de escolha para o tratamento, o itraconazol. MATERIAIS E MÉTODOS: Realizou-se estudo comparativo, randomizado, com avaliação das radiografias do tórax obtidas antes, durante e após o tratamento de 39 pacientes, divididos em dois grupos: um recebendo o voriconazol e o outro, itraconazol. A avaliação das radiografias teve como parâmetro uma adaptação do método já estabelecido para a análise de outra doença pulmonar difusa, o esquema ILO (International Labour Office) de classificação das pneumoconioses, classificando-se as lesões em pequenas ou grandes opacidades. RESULTADOS: Os resultados obtidos coincidiram com as descrições prévias existentes em relação à apresentação das alterações radiográficas pulmonares, e a evolução destas ao longo do tratamento foi semelhante nos dois grupos. As pequenas opacidades regrediram parcialmente, ao passo que as grandes opacidades mostraram tendência à regressão completa. CONCLUSÃO: O uso da adaptação do modelo ILO de classificação das pneumoconioses revelou-se útil para o acompanhamento dos pacientes com paracoccidioidomicose crônica ao longo do tratamento, do ponto de vista radiográfico.

OBJECTIVE: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). MATERIALS AND METHODS: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. RESULTS: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. CONCLUSION: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.

Development of Standard Digital Images for Pneumoconiosis

We developed the standard digital images (SDIs) to be used in the classification and recognition of pneumoconiosis. From July 3, 2006 through August 31, 2007, 531 retired male workers exposed to inorganic dust were examined by digital (DR) and analog radiography (AR) on the same day, after being approved by our institutional review board and obtaining informed consent from all participants. All images were twice classified according to the International Labour Office (ILO) 2000 guidelines with reference to ILO standard analog radiographs (SARs) by four chest radiologists. After consensus reading on 349 digital images matched with the first selected analog images, 120 digital images were selected as the SDIs that considered the distribution of pneumoconiosis findings. Images with profusion category 0/1, 1, 2, and 3 were 12, 50, 40, and 15, respectively, and a large opacity were in 43 images (A = 20, B = 22, C = 1). Among pleural abnormality, costophrenic angle obliteration, pleural plaque and thickening were in 11 (9.2%), 31 (25.8%), and 9 (7.5%) images, respectively. Twenty-one of 29 symbols were present except cp, ef, ho, id, me, pa, ra, and rp. A set of 120 SDIs had more various pneumoconiosis findings than ILO SARs that were developed from adequate methods. It can be used as digital reference images for the recognition and classification of pneumoconiosis.

Anotações sobre a aplicação da Convenção 169 da OIT sobre povos indígenas por tribunais da América Latina / Notes on the implementation by Latin American countries of the ILO Convention 169 in indigenous peoples / Apuentes sobre la aplicación del Convenio 169 de la OIT sobre pueblos indígenas por los tribunales de América Latina

O artigo apresenta alguns casos emblemáticos da aplicação da Convenção 169 da Organização Internacional do Trabalho sobre Povos Indígenas e Tribais em Países Independentes por tribunais da América Latina. O trabalho discute um número reduzido de casos sobre temas diversos e que representam diferentes países da região; bem como o tribunal regional de direitos humanos - a Corte Interamericana de Direitos Humanos. Os casos selecionados foram aqueles que apresentaram perspectivas particularmente interessantes com relação à temática abordada, inovação em sua interpretação ou relevância de suas consequências. Antes de apresentar os casos, entretanto, exponho alguns esclarecimentos que podem ser úteis para a compreensão do material selecionado e o contexto no qual estes casos estão inseridos.

This article presents some cases that are emblematic of the application of the International Labour Organisation's Convention 169 concerning Indigenous and Tribal Peoples in Independent Countries, by courts of Latin America. It discusses: a limited number of cases that cover various topics and represent the distinct countries of the region; and the regional court of human rights - the Inter-American Court of Human Rights. These cases are highlighted either according to their subject, by the innovative insight they offer, or by the relevance of their consequences. Before outlining these cases, however, some clarifications are presented which might be useful in explaining the material set forth below and the context in which the material should be situated.

Este trabajo presenta algunos casos emblemáticos de aplicación del Convenio 169 de la Organización Internacional del Trabajo sobre Pueblos Indígenas y Tribales en Países Independientes por Tribunales de América Latina. Discute un número reducido de casos que cubren temas diversos, y representan a distintos países de la región, y al tribunal regional de derechos humanos -la Corte Interamericana de Derechos Humanos y se destacan por su temática, por lo novedoso de la interpretación que ofrecen o por la relevancia de sus consecuencias. Antes de reseñar los casos, se efectúan algunas aclaraciones previas que pueden ser útiles para explicar el material que aquí se expone, y el contexto en el que debe situarse.