Asbestos Disease in Brazil and the Building of Counter-Powers: A study of Health, Work and Gender

This research reveals the problems associated with the risks to workers and to the population of Brazil who are exposed to asbestos. Document in PDF, requiring Adobe Acrobat.

Contracting and subcontracting by the French nuclear power industry.

The French nuclear power industry contracts out 80% of the maintenance work in its plants to independent companies. The workers in these companies are seldom protected by unions or by government regulations. The average dose of radiation received by such a worker is four times that received by a permanent employee of the contracting entity. As the contract worker approaches a specified dose limit, he is laid off, with no support other than welfare and no compensation for medical expenses that may arise as a result of the radiation exposure or occupational stress. There is a danger that this pattern of worker exploitation will spread as nuclear power plants proliferate around the world.

Principles of efficiency and occupational health: the case of the nuclear industry.

Reducing risks in the nuclear industry necessarily exposes maintenance workers to ionizing radiation. In the early 1980s, the French industry started outsourcing certain work operations, including nearly all maintenance. The goal was seen as one of reducing costs. But an important result is a shift in the category of workers receiving radiation doses. External workers receive 80 percent of annual collective doses recorded at nuclear sites, with average individual monthly dosages in an irradiated area eleven to fifteen times more elevated than those of workers in the French electric company. Nuclear producers strictly observe regulatory exposure limits by managing jobs by doses and externalizing the problem. An employee who reaches the dosage limit is banned from the plant. Qualified permanent employees do not do the work that is most costly in dosage. Outsourcing the risky work prevents challenges from unions and public officials, and firms can claim that radiation exposures are controlled and do not endanger workers' health. The problem, a terrible contradiction at the heart of the industry, has been socially constructed to be invisible.

Occupational Exposures to Asbestos in Brazil.

European and Canadian asbestos companies have long taken advantage of the lack of regulation of the asbestos industry in developing countries. Their activities exploit vulnerable workers whose lack of medical care may result in a silent epidemic of asbestos-related diseases. At this time, virtually all cases of asbestosis and asbestos-related cancers are not identified, reported, or compensated in developing countries. Brazil provides a compelling example of this growing problem. To stem the epidemic of asbestos-related diseases, Brazil, and many other countries, must adopt the total ban on asbestos use now in effect in more developed countries. Obstacles to accomplishing this in developing countries are daunting.

[Food consumption: in search of a multidisciplinary approach]. / Estudo do consumo alimentar: em busca de uma abordagem multidisciplinar.

Changes in eating habits have been observed in many countries in recent decades revealing the complexity of consumption models and their determining factors. Thus it is that the adoption of a multidisciplinary and comparative approach by which the various aspects of eating habits (economic, social, cultural and nutritional) may be assessed so as to permit the elucidation of the mechanisms responsible for these changes and their consequences in different socio-economic contexts, becomes even more necessary. The contributions of the various areas of knowledge to the study of the nutritional situation are here analysed and the approach to this theme in countries of the North and the South is discussed, as is, specifically, the situation in Brazil. Finally, the analysis of the consumption of food-stuffs on the basis of the notion of "food systems", within a historical perspective, is proposed. The various social agents (producers, distributors, consumers, State), their systems of logic, their strategies and the relationships which they establish among themselves over time are taken into account in such a way as to make possible an understanding of the process by which eating habits are constructed and developed.

[Occupational cancers: notification, compensation and prevention]. / Cancers professionnels: connaissance, réparation et prévention.

Less than 140 occupational cancers (OC) are compensated every year in France although the incidence is estimated for at least 6,000 new cases, as estimated by the epidemiologists (4% of the mortality by cancers). This situation can be explained by different factors: few compensation claims by the patients or families, frequent lack of interest from medical doctors for relation between cancer and work, occurrence of the OC after retirement, difficulty to distinguish the role of occupational factors from individual comportmental factors in many OC (for ex. a lung cancer hitting a smoker). The consequences of such a situation are multiple: no compensation for more than 95% of patients or relatives, taking for granted that OC is a minor problem, insufficient prevention of the carcinogenic factors on the work place, prevention of cancers restricted to individual comportmental changes. Physicians working in cancerology units have to incite their patients in notifying the OC and help them in compensation claims. They have also to ask for epidemiologic and toxicologic research when clusters of OC are identified in a plant, in order to get better prevention, compensation and regulations.

[Doctors and injectable contraception. Analysis of the logistics of prescribing in accordance with the views expressed by doctors]. / Médecins et contraception injectable. Analyse des logiques de prescription à partir des discours de médecins.

Injectable contraception (IC) using medroxyprogesterone acetate (Depoprovera) and norethisterone enanthate (Noristerat) has been discussed in numbers of publications since the Food and Drug Administration (FDA) of the USA have refused to authorize the use of Depoprovera as a contraceptive in America. This has provoked a large number of publications in the international literature. The refusal was based on the potential oncogenic risk of the molecule. The distribution of this product as a contraceptive in developing countries and its restricted authorisation in many industrialised countries including France has brought about contradictory debates about the assessment of this method (secondary effects, risks of developing cancer and teratogenesis). In 1986 we started a research using close collaboration between the health teams of Seine-Saint-Denis (which control clinics, family planning clinics and hospitals) in order to try to find some solution to this problem "for or against IC". The object of this research was to find out how acceptable this method was as compared with other contraceptive methods. The fact that many disciplines were involved (gynaecologists, sociologists, epidemiologists and pharmacologists) in this work made it possible first to find out the conditions under which IC was prescribed (by sociological analysis and discussions with doctors). And the socio-cultural features in which the doctors who prescribed this method of contraception were situated also came into play. The criteria under which ICs are prescribed are not mainly medical but are narrowly linked to socio-cultural factors and the socio-economic factors of the women for whom it is prescribed: and this is in comparison with other methods of contraception. Prescribing this substance has a degree of urgency about it.

[Respiratory tuberculosis in Seine-Saint-Denis. Results of treatment]. / Tuberculose respiratoire en Seine-Saint-Denis. Les résultats du traitement.

A study was carried out in 1984-1986 in Seine-Saint-Denis on the clinical management of tuberculous cases. It was possible to observe in routine practice the nature, duration and results of treatment in 336 adult cases suffering for the first time from respiratory tuberculosis. The recommendations of the French Society of Pneumology were taken as a reference. A minority of patients (22%) were treated entirely at home. The others were admitted to hospital then treated at home (33%) or had a stay in a sanatorium (45%). The mean duration of stay in institutions was five months for those patients staying in a sanatorium. The most common therapeutic regime in the initial phase consisted of rifampicin and isoniazid, with additional ethambutol alone (60%) or ethambutol in combination with pyrazinamide (15%). The mean duration of treatment was 10.5 months, without any difference between those regimes consisting of three or four drugs. At the end of the period of treatment 85% of patients were considered to be cured; 16 patients (or 5%) had died and 18 patients (6%) were lost to follow up before the end of treatment. There were 15 patients (or 4%) who showed no significant change between the beginning and the end of the study.

[Health care channels for new cases of respiratory tuberculosis in Seine Saint-Denis in 1984-1986]. / Les filières de soins des nouveaux cas de tuberculose respiratoire en Seine Saint-Denis en 1984-1986.

The purpose of this study was to observe routine practice in the care of tuberculosis cases treated in the Seine Saint-Denis department in 1984, with reference to the recent recommendations of the French Pneumology Society. The pathway of each patient through the care network was established for 336 adult cases being treated for respiratory tuberculosis for the first time. The social and economic cost of each pathway was evaluated. The results show the multiplicity of health services intervening in the care of these patients, the persistence of hospitalization, sanatorium care, and long sick-leaves from work, together with major differences in the care pathways according to the nationality, sex, and socio-economic group of the patients. The cost of tuberculosis treatment is shown to be high for both patients and the community.

[Tuberculosis in the Department of Seine-Saint Denis. I. Cases under treatment in 1984]. / La tuberculose dans la Seine-Saint-Denis. I. Les cas mis au traitement en 1984.

A prospective study of notified cases of tuberculosis started on treatment during 1984 in the department of Seine-Saint-Denis situated in the northern suburb of Paris was undertaken with the help of the Ministry of Health, and the National Committee for the Prevention of Tuberculosis. Fifty-seven hospitals were involved as were 42 sanatoria, 19 clinics and private hospitals and 157 doctors enabled 578 cases of tuberculosis to be registered. For these 578 cases there were 884 notifications coming principally from the control services of the Social Security and public hospitals. Although several sources of notification had declared the same patient, no source had registered all the patients of whom they had knowledge. The notifications made on 12 different forms were often incomplete and sometimes erroneous. Of the 578 patients declared there were 34 different nationalities, of whom 190 were French, approximately 33%; 87 were Algerian, or 15%; 83 came from Mali, or 14%. The study compared the level of notification of tuberculosis in the French, Algerians and those from Mali and has shown that they are six times higher amongst Algerians than the French population and 39 times higher in those from Mali than in the French population. The proportion of patients already treated were 11% and those patients suffering from exclusively extra-respiratory tuberculosis was 16%. A bacteriological and/or histological confirmation was obtained in 70% of cases. The study of the socio-demographic characteristics of the patients has enabled a portrayal of the representation of unskilled workers and the unemployed in comparison to the general population of the department.(ABSTRACT TRUNCATED AT 250 WORDS)