Utilidad de las estrategias de intervención educativo participativa en la prevención de accidentes laborales / Utility of the educative and participative intervention strategies in the prevention of occupational accidents

Se realiza un análisis de tipo comparativo de dos estudios sobre prevención de accidentes del trabajo que utilizan estrategias de prevención activa, del tipo educativo participativa, con la finalidad de mejorar la identificación de riesgos, el comportamiento en seguridad y, en general, mejorar el clima de seguridad entre los trabajadores de la empresa, de manera que repercuta en una disminución de factores de riesgo de accidentes y lesiones y sus consecuencias: los accidentes del trabajo. El método utilizado en ambos estudios constó de tres etapas fundamentales: 1) identificación de riesgos de accidentes del trabajo en los trabajadores constructores y portuarios (diagnóstico); 2) implementación de la estrategia de intervención correspondiente (intervención educativa); y 3) evaluación de los resultados de las actividades realizadas durante la intervención (evaluación). El resultado en ambos estudios fue positivo, lográndose una mejora en el clima de seguridad entre los trabajadores y una reducción de lesiones, que en el último estudio fue mucho más significativa que en el primero(AU)

SALTRA: a regional program for workers' health and sustainable development in Central America.

In 2003, the university-based Program on Work and Health in Central America, SALTRA, was launched to build national and regional capacities in occupational safety and health with the goal of preventing and reducing poverty in Central America. SALTRA has implemented 20 projects including action projects in priority sectors (e.g., construction, sugarcane, hospitals, migrant coffee workers); strengthening of surveillance (occupational health profiles, carcinogenic exposures, fatal injuries and pesticides); a participatory model for training and risk monitoring by workers; building occupational health capacity for professionals, employers, and workers, with collaborating networks between the countries; strengthening of universities in work, environment, and health; studies of serious occupational and environmental situations; communication channels; and continued efforts to raise political awareness. SALTRA has placed issues of workers' health on political, business, and academic agendas throughout the region and has laid the foundations for achieving substantial future improvements in health conditions of all workers in the region. External evaluators envisioned SALTRA as an innovative development model.

CAREX Nicaragua and Panama: Worker exposures to carcinogenic substances and pesticides.

This study provides data on numbers of workers exposed at work to selected carcinogens and pesticides in Nicaragua (35 substances) and Panama (31), based on a modification of the CAREX data system. Population censuses provided industry- and sex-specific workforce numbers. The activity- and sex-specific proportions of exposed workers were estimated by experts from governmental agencies, workers' organizations, and employers' representatives. Finally, the numbers of those occupied in each activity/sex category were multiplied by the proportions of those exposed in the same categories, yielding numbers of those exposed in these categories for each agent. The study revealed high proportions (> 9%) of occupationally exposed workers in both countries for solar radiation and diesel engine emissions; environmental tobacco smoke in Panama; and some pesticides in Nicaragua. A high proportion of exposed was found for men for lead (12%), silica dust (10%), and hexavalent chromium (10%) in Panama.

Fatal occupational injuries in Nicaragua, 2005.

We attempt to estimate the rate of fatal occupational injuries (FOI) in Nicaragua for 2005, using 10 incomplete data sources. Based on the 173 identified FOIs, the crude empirical FOI rate estimate was 8.3 per 100,000 employed (12.3 men; 1.8 women) and highest in the 25-29 age group (15). The overall rate, corrected by capture-recapture modeling, was 11.6. Manufacturing represented a high rate (11.7); the formal economy rate (12.3) was higher than the informal economy (6); mining (110.3) and electricity (76.2) had the highest industry rates; and the most common agents of FOIs were motor vehicles. With 10 major sources, the extent of FOIs remains grossly underestimated and biased across worker strata. The FOIs among informal and agricultural workers tend to remain invisible, as there is no systematic surveillance by any agency. Changes in legislation and implementation are necessary to correct the situation.

Social determinants of workers' health in Central America.

This communication summarizes the available data on work-related determinants of health in Central America. The Central American working population is young and moving from agriculture toward industry and services. Ethnicity, gender, migration, subemployment and precarious work, informality, rural conditions, low-level educational, poverty, ubiquitous worksite health hazards, insufficient occupational health services, low labor inspection density, and weak unions define the constellation of social determinants of workers' health in Central America. Data are, however, scanty both for hazards and work-related illnesses and injuries. Governments and industries have the responsibility of opening decent work opportunities, especially for those facing multiple inequalities in social determinants of health. A first step would be the ratification and implementation of the ILO Convention (187) on occupational safety and health by the seven national governments of the region.

Registration of fatal occupational injuries in Costa Rica, 2005-2006.

Data on fatal occupational injuries (FOIs) for Latin America are controversial. Costa Rican national rates are inconsistent with estimates extrapolated from other countries. We reviewed the files for all possible FOIs in Costa Rica for 2005-2006 at the National Insurance Institute and at the Center of Forensic Sciences by formality/informality of work, sex, age, economic activity, occupation, and cause of death. The national mortality rate was estimated at 9.5/100,000 person-years (342 deaths). The informal/formal rate ratio was 1.06. Men's rates were over 10 times higher than women's and increased with age. The highest rates were found for transport, storage, and communication (32.1/100,000 person-years), and, by occupation, for messengers and delivery men (91.4). Leading causes of death were traffic injuries and gunshots. Recalculated rates are probably underestimates. Data limitations include the absence of systematic identification and registration among informal sector workers and other groups such as children and farm workers.

A program for the reduction of occupational injuries and changes in safety culture among stevedores at Port of Havana, Cuba.

This study describes the structure, process, and impact of a comprehensive sixteen-month safety enhancement program among stevedores at the Port of Havana, Cuba. Our objective was to reduce occupational injury risk and improve safety conditions by enhancing hazard knowledge and identification as well as improving safety behavior. The target group for the training program consisted of 185 male stevedores in one port terminal. A comparison group of 105 male stevedores was included from another terminal where the program was not implemented. Other personnel were included in the program. The training covered a number of safety procedures and used various training methods. As contrasted with the comparison group, injury incidence decreased in the intervention group, accompanied by significant improvements in safety knowledge and behavior and injury hazard identification. The practices of the program led to safety enhancements in the port and are being considered for adoption in other ports in Cuba.

Condiciones de salud y trabajo en América Central / Work and health in Central America

En este trabajo se presentan las principales características de la población trabajadora centroamericana, así como losproblemas de salud y las políticas de protección y prevención existentes en la actualidad. Para ello, se revisaron documentosy fuentes específi cos de la Región. Se aporta información sobre las transiciones demográfi cas, la pobreza, la distribuciónde la población trabajadora por sectores y actividades económicas, la economía formal e informal, el desempleo, el trabajode la mujer y el trabajo infantil, entre otros temas. Se cuantifi ca los principales riesgos por sectores económicos. Se discutesobre los sistemas de aseguramiento de riesgos profesionales y los registros de exposiciones y efectos sobre la salud disponibles,así como sobre legislación y participación gremial y sindical. Los datos disponibles en materia de salud y trabajo son engeneral escasos, difi cultando la elaboración de políticas adecuadas y coherentes, su evaluación y el establecimiento de prioridades.La baja cobertura de seguros deja a una proporción importante de la población sin protección sanitaria. Se recomiendael desarrollo de sistemas de vigilancia adecuados (registros, encuestas periódicas, etc.) de las condiciones laboralesa nivel nacional y regional que permitan el establecimiento de estrategias de promoción de salud de las personas trabajadoras.También recomendamos el fortalecimiento de las políticas sociales y la divulgación de información sobre riesgos, efectosy legislación existente en la población trabajadora que favorezca la equidad social de la población para mejorar las condicionesde salud y trabajo de sectores menos favorecidos y del conjunto de trabajadores en general (AU)

We discuss the main characteristics of the working population, occupational health issues, and prevention and promotionpolicies in safety and health that currently exist in Central America. Available data and documentation on relatedtopics were reviewed. Demographic transitions, poverty, workforce distributions by sectors and economic activities, informaland formal work, unemployment, female and child labour are discussed, among other issues. Major occupational risks associated with selected economic sectors are presented. We also discuss insurance systems in relation to occupational riskregistries on exposures and health effects, legislation and union participation.Over all data on work and health-related conditions are scarce, limiting the development of accurate and coherent policies,their evaluation and defi nitions of occupational health-related priorities. Low level of insurance coverage results in ahigh proportion of the worker population without health care protection.We recommend the development or effective surveillance systems (registries, periodic surveys, etc.) that allow the monitoringof work and health conditions at the national and regional level and heand targeting of health promotion strategiesfor people at work. We also recommend the strengthening of public policies and the distribution of information regardingrisk factors, their adverse effects and existing legislation among the working population, in order to facilitate social equityand to improve work and health conditions of both disadvantaged sectors and the entire workforce(AU)

Causas y prevención del cáncer ocupacional: [revisión] / Causes and prevention of occupational cancer: [review]

Las neoplasias ocupacionales son altamente prevenibles. Esta comunicación resume los datos de los riesgos cancerígenos ocupacionales, destacando grupos importantes de trabajadores y la prevención. La Agencia Internacional para la Investigación del Cáncer, IARC, ha identificado en el Grupo 1, causa cáncer en humanos, 29 agentes que pueden presentarse en el lugar de trabajo, 26 en el Grupo 2 A, probablemente cancerígeno, y 113 en el Grupo 2B, posiblemente cancerígeno. Los agentes frecuentes en Centroamérica incluyen la radiación solar, Grupo 1, y la radiación ultravioleta, 2A, las emisiones diesel, 2A, los hidrocarburos poliaromáticos, 1-3, el humo de tabaco ambiental, 1, los compuestos de cromo hexavalente, 1, y el benceno, 1. En cuanto a los cánceres de mujeres, estudios de cáncer de mama y ovarios sugieren asociaciones con agentes ocupacionales. Los datos en la economía informal son pocos. Peligros cancerígenos para agricultores y peones agrícolas contemplan la exposición a radiación ultravioleta solar, virus, zoonosis, polvos, aflatoxinas, emisiones de diesel, solventes y plaguicidas. Agentes cancerígenos potenciales presentes en el Sector Salud incluyen: óxido de etileno, formaldehído, humo de tabaco ambiental, tricloroetileno, tetracloroetileno, benceno, asbesto, drogas, hormonas, antibióticos, plaguicidas, virus y desechos y gases cancerígenos. Algunas exposiciones durante el desarrollo y la infancia someten a los niños a riesgos cancerígenos. Prevenir los riesgos para la salud en el lugar de trabajo es responsabilidad del empleador. Se debe actuar con precaución en respuesta a la limitada evidencia plausible y creíble, sobre un peligro probable, y establecer comisiones mixtas de salud y seguridad en lugares de trabajo.

Occupational cancers are highly preventable. This communication summarizes the data on occupational carcinogenic hazards, highlighting important worker groups and prevention. The International Agency for Research on Cancer (IARC) has classified 29 agents that may occur atwork in Group 1 (carcinogenic in humans); 26 in Group 2A (probably carcinogenic); and 113 in Group 2B (possibly carcinogenic). Frequent occupational carcinogens in Central America include solar (Group 1) and ultraviolet (2A) radiation, diesel emissions (2A), polyaromatichydrocarbons (1-3), environmental tobacco smoke (1), hexavalent chromium compounds (1) andbenzene (1). Regarding women, studies on breast and ovarian cancer suggest associations with occupational exposures. The data on carcinogenic risks in the informal economy are scanty. Carcinogenic agents that may be present occur in agriculture include solar radiation, aflatoxins, diesel emissions, viruses, dusts, solvents and pesticides. Carcinogenic agents in the health sector include ethylene oxide; formaldehyde; environmental tobacco smoke; tri- and tetrachloroethylene; benzene; asbestos; carcinogenic drugs, hormones, antibiotics, pesticides, viruses and waste materials; and carcinogenic gases. Environmental exposures during development and infancy may cause childhood cancer. Prevention of health risks at the workplace is the responsibility ofthe employer. The principle of precaution, due to sparse, plausible and credible evidence about probable danger and the establishment of safety and health committees are recommended.

Insecticide residues on hands: assessment and modeling with video observations of determinants of exposure--a study among subsistence farmers in nicaragua.

This investigation quantitatively assessed hand residues of chlorpyrifos and methamidophos in a field setting and sought to explain the residues through application volume and determinants of exposure using application data for 28 subsistence farmers in the Pacific Region of Nicaragua. Hand residues were estimated by recovery of the pesticides by standardized wipe sampling for both hands, analyzed with solvent extraction and gas chromatography with electron capture detector. Application volumes were based on data on individual spraying rates and mixing volumes. Eleven determinants of exposure, related to work practices during mixing and spraying of the pesticides, were assessed for each subject from videotapes. Correlation and regression analyses estimated the associations between hand residues, application volume, pesticide type, and determinants of exposure. Correlations between residues for different hand parts were high (r 0.75-0.98). Total hand residue (sum of residues of parts of both hands) correlated with application volume (r 0.43, p 0.02), not washing hands (r 0.41, p 0.04), spraying nozzle forward (r 0.26, p 0.17), manipulation of hose (r 0.32, p .09), and insecticide type (chlorpyrifos vs. methamidophos; r 0.31, p 0.10). A model that explained total hand residue with these five variables yielded a multiple correlation coefficient of 0.67 (p 0.01). Unmeasured determinants and/or narrow range of the exposure situation probably account for the unexplained variance of the residues.

Determinants of health in seasonal migrants: coffee harvesters in Los Santos, Costa Rica.

In the agroexport zone of Los Santos Zone in Costa Rica, coffee is harvested by migrant labor. Most migrants are from Panama and Nicaragua. We describe migrants' housing- and service-related health determinants, with analyses of ethnicity, nationality and geography. We used interviews, observation-based assessments, and the Geographic Information System to assess a population of 8,783 seasonal migrants and 1,099 temporary dwellings at a total of 520 farms during 2004-2005. We identified determinants of poor health including widespread deficiencies in the quality of grower-provided dwellings, geographical isolation, crowding, lack of radio and television, and deficient toilets and cooking facilities. The indigenous and non-Costa Ricans shared the poorest conditions. Reluctance to use mainstream public health services was widespread, especially among foreign and indigenous migrants and the geographically isolated. Post-study, researchers organized workshops for audiences including workers, coffee producers, public officials and service providers. Topics have included migration, preventive health and hygiene, and child labor. This work was successful in convincing Costa Rican social security authorities to implement reforms that improve access to and quality of health care for the migrants. Special projects on ergonomics, psychosocial health hazards, and water quality, as well as a literacy program, are ongoing.

Estimating the relative risk of pancreatic cancer associated with exposure agents in job title data in a hierarchical Bayesian meta-analysis.

OBJECTIVES: The study demonstrates the application of a hierarchical Bayesian meta-analysis of epidemiologic studies that show an association between pancreatic cancer risk and job titles, using a job-exposure matrix to estimate risks for occupational exposure agents. METHODS: Altogether 261 studies published from 1969 through 1998 on pancreatic cancer and job titles were identified. When proportional studies are excluded, 77 studies were informative for 9 selected occupational agents. These studies included more than 3799 observed pancreatic cancer cases. Hierarchical Bayesian models were used for job titles (lower-level data) and agents (higher-level data), the latter from a Finnish job-exposure matrix. Non-Bayesian random effects models were applied for job titles to check consistency with the Bayesian results. RESULTS: The results suggest that occupational exposures to chlorinated hydrocarbon compounds may increase the risk of pancreatic cancer; the meta-relative risk (MRR) was 2.21 [95% credible interval (CrI) 1.31-3.68]. A suggestive weak excess was found for exposure to insecticides (MRR 1.95, 95% CrI 0.51-7.41). CONCLUSIONS: Hierarchical models are applicable in meta-analyses when studies addressing the agent(s) under study are lacking or are very few, but several studies address job titles with potential exposure to these agents. Hierarchical meta-analytic models involving durations and intensities of exposure to occupational agents from a job-exposure matrix should be developed.

Parental occupational exposure to pesticides and the risk of childhood leukemia in Costa Rica.

OBJECTIVES: Parental exposure to pesticides and the risk of leukemia in offspring were examined in a population-based case-control study in Costa Rica. METHODS: All cases of childhood leukemia (N=334), in 1995-2000, were identified at the Cancer Registry and the Children's Hospital. Population controls (N=579) were drawn from the National Birth Registry. Interviews of parents were conducted using conventional and icon-based calendar forms. An exposure model was constructed for 25 pesticides in five time periods. RESULTS: Mothers' exposures to any pesticides during the year before conception and during the first and second trimesters were associated with the risk [odds ratio (OR) 2.4, 95% confidence interval (95% CI) 1.0-5.9; OR 22, 95% CI 2.8-171.5; OR 4.5, 95% CI 1.4-14.7, respectively] and during anytime (OR 2.2, 95% CI 1.0-4.8). An association was found for fathers' exposures to any pesticides during the second trimester (OR 1.5, 95% CI 1.0-2.3). An increased risk with respect to organophosphates was found for mothers during the first trimester (OR 3.5, 95% CI 1.0-12.2) and for fathers during the year before conception and the first trimester (OR 1.5, 95% CI 1.0-2.2 and OR 1.6, 95% CI 1.0-2.6, respectively), and benzimidazoles during the first, second, and third trimesters of pregnancy (OR 2.2, 95% CI 1.0-4.4; OR 2.2, 95% CI 1.0-5.0; OR 2.2, 95% CI 1.0-5.2, respectively). There was a suggestion of an exposure-response gradient for fathers as regards picloram, benomyl, and paraquat. Age at diagnosis was positively associated with fathers' exposures and inversely associated with mothers' exposures. CONCLUSIONS: The results suggest that parental exposure to certain pesticides may increase the risk of leukemia in offspring.

[Determining exposure history in occupational epidemiology]. / Determinación del historial de exposiciones en la epidemiolgía ocupacional.

In epidemiology, it is necessary that exposure indicators have good validity in order to obtain valid results when measuring the risks associated with occupational exposure to environmental noxious agents. However, ensuring the validity of past exposure data is no easy task. Because there are no environmental hygiene measures or representative levels of bioindicators signaling past exposure, self-reports have been used as a source of indirect exposure data. Unfortunately, data on specific agents are commonly poor and need to be complemented with data on the determinants of exposure. The validity of self-reports improves when certain techniques, such as control lists and icons, are employed, and the quality of individual exposure data improves when secondary data on exposure and its conditioning or determining factors are incorporated. Exposure can be determined by means of exposure matrices, assessment by experts, and exposure models, and by using a combination of primary and secondary data on exposure and its conditioning factors. Matrices contain pooled data and can thus lead to errors in classifying individual exposure and to biased risk estimates. Assessment by experts is probably the method with the highest validity, but it can become expensive when studies are large. It is also feasible to use a formal model for assessing perceivable exposures, complemented with expert assessments whenever the results of the model appear to deviate from reality.

Polycyclic aromatic hydrocarbons and fatal ischemic heart disease.

BACKGROUND: Several toxicologic and epidemiologic studies have produced evidence that occupational exposure to polycyclic aromatic hydrocarbons (PAH) is a risk factor for ischemic heart disease (IHD). However, a clear exposure-response relation has not been demonstrated. METHODS: We studied a relation between exposure to PAH and mortality from IHD (418 cases) in a cohort of 12,367 male asphalt workers from Denmark, Finland, France, Germany, Israel, The Netherlands and Norway. The earliest follow up (country-specific) started in 1953 and the latest ended in 2000, averaging 17 years. Exposures to benzo(a)pyrene were assessed quantitatively using measurement-driven exposure models. Exposure to coal tar was assessed in a semiquantitative manner on the basis of information supplied by company representatives. We carried out sensitivity analyses to assess potential confounding by tobacco smoking. RESULTS: Both cumulative and average exposure indices for benzo(a)pyrene were positively associated with mortality from IHD. The highest relative risk for fatal IHD was observed for average benzo(a)pyrene exposures of 273 ng/m or higher, for which the relative risk was 1.64 (95% confidence interval=1.13-2.38). Similar results were obtained for coal tar exposure. Sensitivity analysis indicated that even in a realistic scenario of confounding by smoking, we would observe approximately 20% to 40% excess risk in IHD in the highest PAH-exposure categories. CONCLUSIONS: Our results lend support to the hypothesis that occupational PAH exposure causes fatal IHD and demonstrate a consistent exposure-response relation for this association.

Perspectives for workplace health promotion in Latin America and the Caribbean.

The Latin American and Caribbean region is witnessing the emergence of discussion on workplace health promotion (WHP). The authors propose WHP as an equitable collective action targeting primarily work hazards and their determinants. It has its economic-political "macro" level and a downstream "micro" level. On the macro level, neoliberalism, privatization, and deregulation threaten equitable health and labor issues. Effective labor and health legislation and a fair degree of social redistribution of resources support WHP. Micro-scale WHP is important for contextual reasons and social diffusion, and can literally save lives. Worker involvement, free association of workers, public health affiliation, the precautionary principle, sensitization and training, employer responsibility for healthy working conditions, coalitions between workers and health professionals, and preference for reduction of direct work hazards over modification of personal lifestyles are basic tenets of WHP.

Determinación del historial de exposiciones en la epidemiolgía ocupacional / Determining exposure history in occupational epidemiology

La validez de los indicadores de exposición es una condición necesaria en epidemiología si se han de obtener resultados válidos en la medición de los riesgos asociados con la exposición a agentes nocivos en el entorno laboral. Sin embargo, llevar a cabo la validación de estos indicadores de exposiciones pasadas no es tarea fácil. Debido a la falta de mediciones de referencia en el ámbito de la higiene industrial y de concentraciones representativas de bioindicadores que reflejen las exposiciones pasadas, el método de los autoinformes se ha utilizado para recoger datos de exposición indirectos. No obstante, los datos acerca de agentes nocivos específicos son a menudo deficientes y deben completarse con otros sobre los factores condicionantes de la exposición. La validez de los autoinformes mejora cuando se utilizan listas de verificación e iconos ilustrativos, mientras que la calidad de la información sobre las exposiciones personales mejora cuando se incorporan datos secundarios acerca de las exposiciones y de los factores que las condicionan o determinan. La exposición se puede determinar mediante matrices de exposición, evaluación por expertos y modelos de exposición, integrando datos primarios y secundarios acerca de las exposiciones y sus factores condicionantes. Las matrices contienen datos agrupados y, por consiguiente, pueden llevar a errores a la hora de clasificar las exposiciones individuales e introducir sesgos en la estimación de los riesgos. La evaluación por expertos es probablemente el método con el índice de validez más alto, pero puede entrañar costos muy altos en el caso de estudios de cierta magnitud. Otra posibilidad con buenas perspectivas es la de utilizar un modelo formal para evaluar las exposiciones patentes y mejorarlo mediante la evaluación por expertos en situaciones en las cuales los resultados del modelo parezcan alejarse de la realidad.

Assessment of pesticide exposure in the agricultural population of Costa Rica.

We describe a model for the retrospective assessment of parental exposure to 26 pesticides, selected by toxicity-based prioritization, in a population-based case-control study of childhood leukaemia in Costa Rica (301 cases, 582 controls). The model was applied to a subset of 227 parents who had been employed or self-employed in agriculture or livestock breeding. It combines external data on pesticide use for 14 crops, 21 calendar years and 14 regions, and individual interview data on determinants (task and technology, personal protective equipment, field reentry, storing of pesticides, personal hygiene) of exposure. Recall was enhanced by use of checklists of pesticides in the interview. An external database provided information on the application rate (proxy for intensity of potential exposure) for each pesticide. The calendar time was individually converted to five time windows (year before conception, first, second and third trimester, and first year of the child). Time-windowed individual data on determinants of exposure and their expert-based general weights and their category-specific hazard values jointly provided an individual determinant score. This score was multiplied by the application rate to obtain an individual index of exposure intensity during application. Finally, average exposure intensity during entire time windows was estimated by incorporating in the model the individual time fraction of exposure during application. Estimates of exposure intensities were proxies assumed to be proportional to dermal exposure intensity, which represents the major pathway of occupational exposure to pesticides. A simulated sensitivity analysis resulted in a correlation coefficient of 0.91 between two sets of 10 000 values of individual exposure indices, based on two different but realistic sets expert-assigned weights. Lack of measurement data on concurrent exposures in comparable circumstances precluded direct validation of the model.