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Dengue is the most common arboviral disease in the world. Traditionally, it has affected more adults, but the incidence in children has increased in recent years. Colombia is no stranger to this change; therefore, we aimed to find the differences in signs, symptoms, and clinical, hematological, and hemogram characteristics between children under 12 years old and individuals aged 12 years and older in an endemic region of Colombia in 2020-2022. The analyses were conducted with baseline data, corresponding to a cross-sectional design. Multiple correspondence analysis was used for general, dermatological, and clinical symptom profiles. Discriminant analysis was used for laboratory profiles. Multiple correspondence analysis was applied to nominal categorical data, employing Euclidean distances to analyze age groups. Discriminant analysis was applied to a training sample and validated on a test sample. The overall agreement of the model's discrimination, sensitivity, specificity, and fit indicators was calculated. The results indicated that individuals under 12 years exhibited distinct dermatological and clinical features, including rash, pruritus, hypotension, lymphocyte count, and platelet count, compared with those aged 12 years and older. In contrast, those 12 years and older were profiled for general and clinical symptoms such as pain (back pain, retro-orbital pain, headache), dizziness, chills, hematuria, tachypnea, and elevated/high hematocrit, hemoglobin, and basophil values. These findings are crucial to understanding the high incidence in children; they also facilitate rapid understanding of the disease in clinical care settings and differentiate it from other febrile outbreaks. This will affect disease control, particularly in severe cases, and reduce mortality.
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Dengue , Humanos , Colômbia/epidemiologia , Criança , Dengue/epidemiologia , Dengue/diagnóstico , Adulto , Masculino , Feminino , Adolescente , Estudos Transversais , Pré-Escolar , Doenças Endêmicas , Adulto Jovem , Lactente , Pessoa de Meia-IdadeRESUMO
One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.
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Dengue , Dengue Grave , Humanos , Dengue Grave/genética , América Latina , Dengue/genética , Revisões Sistemáticas como Assunto , Polimorfismo Genético/genéticaRESUMO
Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.
This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.
Assuntos
Análise Multinível , Pesquisa sobre Serviços de Saúde , Viés , BioestatísticaRESUMO
Introduction: Although studies with informal workers have been conducted in Latin America and the Caribbean, there is still scarce evidence on the prevalence of food poisoning among workers with subsistence jobs on the streets and sidewalks of cities and on the factors that influence its presentation. Objectives: To determine sociodemographic, labor, sanitary, and environmental conditions that influence the prevalence of food poisoning in informal workers in downtown Medellín, Colombia. Methods: This is a cross-sectional study using a workers' survey as the primary source. A total of 686 workers aged ≥18 years who had been working for ≥ 5 years were surveyed. An assisted survey was initially applied as a pilot test for training purposes and to obtain informed consent. Results: We identified several associations and explanatory factors of food poisoning using chi-square tests and prevalence ratios, with unadjusted and adjusted 95% confidence intervals (95%CI). A higher prevalence of food poisoning (p < 0.05) was observed in workers with lower frequency of waste collection (PR = 2.09; 95%CI = 1.04-4.19), who left cooked food (PR = 6.40; 95%CI = 2.34-17.8), beverages or chopped fruits uncovered at their workplace (PR = 3.92; 95%CI = 1.40-10.48), with inadequate waste management (PR = 4.84; 95%CI = 2.12-11.06), exposure to polluted water (PR = 3.00; 95%CI = 1.20-7.50) and acceptable water supply (PR = 5.40; 95%CI = 1.60-17.8). The factors that explained higher rates of food poisoning were not having a waste collection service (PRadjusted = 5.58; 95%CI = 3.38-13.10), inadequate waste management (PRadjusted = 6.61; 95%CI = 1.25-34.84), and having sanitary services next to worker's stall (PRadjusted = 14.44; 95%CI = 1.26-165.11). Conclusions: The conditions that are associated with and explain the higher prevalence of food poisoning in this working population can be addressed with health promotion and disease prevention interventions.
Introducción: Aunque se han realizado estudios con trabajadores informales en América Latina y el Caribe, aun es escasa la evidencia con respecto a la prevalencia de intoxicaciones alimentarias en trabajadores con empleos de subsistencia en las calles y aceras de las ciudades y a los factores que influyen en su presentación. Objetivos: Determinar las condiciones sociodemográficas, laborales, sanitarias y ambientales que influyen en la prevalencia de intoxicación alimentaria en trabajadores informales del centro de Medellín. Métodos: Estudio transversal con fuente primaria de información en un censo de 686 trabajadores, ≥18 años y con ≥5 años en su oficio. Se aplicó encuesta asistida previa realización de prueba piloto, estandarización de encuestadores y toma de consentimiento. Resultados: Se identificaron asociaciones y factores explicativos de intoxicación alimentaria, con pruebas del chi-cuadrado y razones de prevalencia (RP), con intervalos de confianza del 95% (IC95%) crudos y ajustados. Mayor prevalencia de intoxicación alimentaria (p < 0,05) en trabajadores con menor frecuencia de recolección de residuos (RP = 2,09; IC95% = 1,04-4,19), en quienes dejaban alimentos preparados (RP = 6,40; IC95% = 2,34-17,8), bebidas o fruta picada descubiertos en el puesto de trabajo (RP = 3,92; IC95% = 1,40-10,48), con inadecuado manejo de residuos (RP = 4,84; IC95% = 2,12-11,06), exposición a agua contaminada (RP = 3,00; IC95% = 1,20-7,50) y de aceptable calidad (RP = 5,40; IC95% = 1,60-17,8). Explicaron mayor intoxicación alimentaria no tener servicio de recolección de residuos (RPajustada = 5,58; IC95% = 3,38-13,10), inadecuado manejo de residuos (RPajustada = 6,61; IC95% = 1,25-34,84), y tener servicios sanitarios al lado del puesto de trabajo (RPajustada = 14,44; IC95% = 1,26-165,11). Conclusiones: Las condiciones que se asocian y explican mayor prevalencia de intoxicación alimentaria en esta población trabajadora, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad.
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Introduction: Although studies about informal work have been carried out, there is still little evidence that explains, from the workers' perspective, what pressures they receive and generate due to the use of public space, and how these pressures affect their health. Objectives: To explore, from the point of view of a group of informal workers from the downtown Medellin, the environmental and social pressures that they receive and generate from the use of the territory, as well as the effects that these pressures may have on their life and health conditions. Methods: Ethnographic tools were used for field work and grounded theory for data analysis. Twelve informal street vendors workers were selected through theoretical sampling, with whom in-depth interviews and focus groups were conducted, after obtaining consent from the verbal and written process. Interviews and focus groups were transcribed verbatim, with the help of janitors and informants. The results were discussed and validated with the workers, and the information was triangulated with the researchers. Open and axial coding was used for data analysis. Results: The environmental and social pressures that these workers receive and generate in the streets and sidewalks of the city led them to experience critical situations in their working conditions, partly derived from the conflict that occurs over the use of the territory with the different actors in the downtown area, a situation that directly affects workers' physical and mental conditions, their life, and their work. Conclusions: The conflicts generated by the use of the territory as a workplace imply that workers have hostile relationships in their daily lives. However, these conflicts could be resolved with actions of the State and the participation of workers.
Introduction: Aunque se han realizado estudios acerca del trabajo informal, aun es escasa la evidencia que explique, desde la mirada de los trabajadores, qué presiones reciben y generan por el uso del espacio público y cómo estas presiones les afectan su salud. Objetivos: Explorar, desde la mirada de un grupo de trabajadores informales del centro de Medellin, las presiones ambientales y sociales que reciben y generan por el uso del territorio, así como los efectos que pueden tener estas presiones en sus condiciones de vida y salud. Métodos: Se utilizaron herramientas etnográficas para el trabajo de campo y de teoria fundamentada para el análisis de datos. Se tomaron mediante muestro teórico a 12 trabajadores informales "venteros", con quienes se realizaron entrevistas en profundidad y grupos focales, previa toma de consentimiento de proceso verbal y escrito. Se transcribieron las entrevistas y grupos focales de manera textual, se contó con porteros e informantes clave. Los resultados fueron discutidos y validados con los trabajadores, y se trianguló la información con los investigadores. Se utilizó codificación abierta y axial para el análisis de datos. Resultados: Las presiones ambientales y sociales que reciben y generan estos trabajadores en las calles y aceras de la ciudad los llevan a vivenciar situaciones críticas en sus condiciones laborales, derivadas, en parte, del conflicto que se da por el uso del territorio con los diferentes actores del centro de la ciudad, situación que afecta directamente las condiciones de salud física y mental de los trabajadores, su vida y su labor. Conclusiones: Los conflictos que se generan por el uso del territorio como lugar de trabajo implican que los trabajadores tengan relaciones hostiles en su cotidianidad. Sin embargo, estos conflictos podrían revertirse con acciones del Estado y la participación de los trabajadores.
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Introduction: Although the informal economy absorbs a considerable portion of the population, there is still little evidence that contributes to identify the lifestyles and eating habits that outline food insecurity in workers with subsistence jobs. Objectives: To determine the profile of food insecurity according to habits and lifestyles in workers with subsistence jobs. Methods: Cross-sectional study with primary sources of information, obtained through an assisted survey, to a census of 686 workers in 2016. The results of the nutritional component of a doctoral thesis approved by the Institutional Ethics Committee of the CES University, Medellín, Colombia, are presented. Results: In this working population, 52.6% were 50 years or old; however, 86.1% reported being the main household provider, and 33.3% did not have a permit to work in public areas. Moreover, 56.8% reported being sedentary/little active, and the highest consumption of alcohol and tobacco was recorded in men, who also ate their food alone. Conversely, women considered that mood affected their appetite, and they consumed their food while serving customers and handling money. In general, less than 50.0% of workers had a set time to consume their food. Food insecurity in workers' households was explained by alcohol consumption (prevalence ratio = 1.62; confidence interval = 1.05;2.38) and having exclusive hours to consume food (prevalence ratio = 1.40; confidence interval = 1.00;1.96). Their food insecurity is defined by not consuming alcoholic beverages, considering that their mood affects their appetite, consuming one or two meals a day, without a defined schedule, not having permission to work, presenting moderate/severe food insecurity, and being a woman. Conclusions: The conditions that explain and outline food insecurity in this working population contribute to their socio-environmental and labor vulnerability, however, these conditions can be reversed.
Introducción: Aunque la economía informal ocupe una gran parte de la población, todavía existen pocas evidencias que ayuden a identificar los estilos de vida y hábitos alimentarios que definen la inseguridad alimentaria entre los trabajadores con empleos de subsistencia. Objetivos: Determinar el perfil de inseguridad alimentaria según hábitos y estilos de vida en trabajadores con empleos de subsistencia. Métodos: Estudio transversal con fuentes primarias de información, realizado a través de encuesta asistida, con un censo de 686 trabajadores en 2016. Los resultados del componente nutricional de una tesis doctoral aprobada por el Comité de Ética Institucional de la Universidad CES, en Medellín, Colombia, son presentados. Resultados: De esta población trabajadora, el 52,6% tenía más de 50 años, sin embargo, el 86,1% reportó ser la persona que más aportaba en el hogar y al 33,3% no se le permitía trabajar en los espacios públicos. El 56,8% refirió ser sedentario/poco activo, registrándose el mayor consumo de bebidas alcohólicas y cigarrillos en los hombres, quienes también comían solos. Por su parte, las mujeres consideraban que el estado de ánimo afectaba al apetito y, cuando comían, simultáneamente atendían a los clientes y manejaban dinero. En general, menos del 50,0% tenía un tiempo definido para consumir sus alimentos. Explicaron inseguridad alimentaria en sus hogares, consumo de bebidas alcohólicas (RP = 1,62. IC = 1,05;2,38) e horarios exclusivos para consumir alimentos (RP = 1,40. IC = 1,00;1,96). Perfilan su inseguridad alimentaria no consumir bebidas alcohólicas, considerar que el estado de ánimo afectaba al apetito, consumir una o dos comidas al día, sin horario definido, no tener permiso para trabajar, presentar inseguridad alimentaria moderada/grave y ser mujer. Conclusiones: Las condiciones que explican y perfilan la inseguridad alimentaria de esta población trabajadora contribuyen a configurar su vulnerabilidad socioambiental y laboral, sin embargo, pueden ser revertidas.
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ABSTRACT One of the main challenges in the clinical management of dengue is the early identification of cases that could progress to severe forms of the disease. A biomarker that may enable this identification is the presence of genetic polymorphisms in genes associated with immune responses. The objective of this study was to perform a systematic review of the Latin American literature on these genes. An electronic literature search was carried out in PubMed, Scopus, Lilacs, and the Virtual Health Library, and reference lists of systematic reviews in the area. Case-control studies conducted in Latin American countries examining at least one form of genetic polymorphism related to immune responses against severe dengue were included. In total, 424 articles were identified and 26 were included in this systematic review. Of the 26 selected articles, 16 reported polymorphisms associated with the risk of developing severe dengue (Risk); Similarly, 16 articles reported polymorphisms associated with a decreased risk of severe dengue (Protective). The final analysis revealed that multiple polymorphisms in immune system genes were early markers of the progression of dengue in Latin Americans and found that polymorphisms of the TNF-alpha gene may have a critical role in dengue pathogenesis.
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Objetivo: Construir un índice que determine la vulnerabilidad sexual de las mujeres trans. Material y Método: Estudio mixto realizado entre los años 2020 y 2021 que en su primera fase utilizó el análisis de contenido para textos que describían los conceptos básicos de vulnerabilidad, vulnerabilidad social y riesgo, apoyado con los relatos obtenidos en grupos focales y entrevistas a 14 mujeres transgénero para generar el constructo teórico de vulnerabilidad sexual de las mujeres transgénero. Para la segunda parte, a partir de la información recolectada de 417 mujeres transgénero de las ciudades de Bogotá y Cali que habían participado del estudio "Vulnerabilidad y Prevalencia de VIH en Mujeres Transgénero en tres ciudades de Colombia: Bogotá, Medellín y Santiago de Cali-2019", se seleccionaron las variables que serían parte de un análisis factorial exploratorio para construir la versión preliminar del índice. Resultados: Se construyó el índice de riesgo de vulnerabilidad sexual de las mujeres transgénero compuesto por 3 factores: apoyo social, prácticas sexuales y cuidado de la salud. El índice consta de 10 preguntas que se evalúan como 0 o 1, donde los puntajes más altos evidencian un mayor riesgo de vulnerabilidad sexual. Conclusiones: La vulnerabilidad sexual es un fenómeno construido por factores propios de la experiencia trans e influenciado por las características del contexto donde la persona habita; el índice construido cuenta con buena consistencia interna (alfa ordinal 0,90). Asimismo, se encontró concordancia entre el modelo teórico de la fase cualitativa y los resultados del análisis factorial exploratorio.
Objective: To construct an index to determine the sexual vulnerability of trans women. Materials and Methods: Mixed study conducted between 2020 and 2021, which in its first phase used content analysis for texts describing the basic concepts of vulnerability, social vulnerability and risk. This was supported by accounts from focus groups and interviews with 14 transgender women to generate the theoretical construct of sexual vulnerability of transgender women. For the second phase, from the information provided by 417 transgender women from the cities of Bogotá and Cali, who participated in the study "Vulnerability and HIV Prevalence in Transgender Women in three cities of Colombia: Bogota, Medellin and Santiago de Cali - 2019", variables were selected to be part of an exploratory factor analysis to construct the preliminary version of the index. Results: The sexual vulnerability risk index of transgender women was based on 3 factors: social support, sexual practices, and health care. The index consisted of 10 questions scored as 0 or 1, with higher scores indicating a higher risk of sexual vulnerability. Conclusions: Sexual vulnerability is a phenomenon based on factors which are specific to the trans experience and it is influenced by the characteristics of the context in which the person lives. The constructed index has good internal consistency (ordinal alpha 0.90) and shows concordance between the theoretical model of the qualitative phase and the results of the exploratory factor analysis.
Objetivo: Construir um índice para determinar a vulnerabilidade sexual de mulheres transgênero. Material e Método: Estudo misto realizado entre 2020 e 2021 que, em sua primeira fase, utilizou a análise de conteúdo para textos que descrevem os conceitos básicos de vulnerabilidade, vulnerabilidade social e risco; apoiado por relatos obtidos em grupos focais e entrevistas com 14 mulheres transgênero para gerar o construto teórico de vulnerabilidade sexual de mulheres transgênero. Para a segunda fase, a partir das informações fornecidas por 417 mulheres transgênero das cidades de Bogotá e Cali que participaram do estudo "Vulnerabilidade e Prevalência de HIV em Mulheres Transgênero em três cidades da Colômbia: Bogotá, Medellín e Santiago de Cali-2019", foram selecionadas variáveis que fizeram parte de uma análise fatorial exploratória para construir a versão preliminar do índice. Resultados: O índice de risco de vulnerabilidade sexual de mulheres transgênero foi construído com base em três fatores: apoio social, práticas sexuais e assistência à saúde. Consiste em 10 perguntas que são avaliadas como 0 ou 1, em que as pontuações mais altas evidenciam um risco maior de vulnerabilidade sexual. Conclusões: A vulnerabilidade sexual é um fenômeno baseado em fatores que são específicos da experiência trans e é influenciado pelas características do contexto em que a pessoa vive. Além disso, o índice construído tem boa consistência interna (alfa ordinal 0,90) e mostra concordância entre o modelo teórico da fase qualitativa e os resultados da análise fatorial exploratória.
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Introducción. El cáncer de mama es el tipo de cáncer que genera más muertes en mujeres en el mundo. Aunque se reconoce el aporte de factores genéticos, hormonales y de estilos de vida como sus principales causas, las hipótesis que señalan que la contaminación del ambiente juega un papel importante en su desarrollo, han tomado mucha fuerza en los últimos años. Estas hipótesis surgen debido a que el aumento en la incidencia del cáncer de mama coincide con procesos de industrialización, además de mayor presencia en regiones urbanas y con altos niveles de contaminación. El objetivo de este artículo fue consolidar información sobre los mecanismos fisiopatológicos que puedan explicar la relación entre cáncer de mama y la contaminación por material particulado. Metodología. Se realizó una búsqueda de literatura en PubMed, Google Académico y Epistemonikos para documentos publicados sobre el tema desde enero de 2016 hasta el 3 de agosto de 2022. Resultados. Se encontró que algunos de los mecanismos que podrían explicar dicha relación incluyen: alteraciones endocrinas que favorecen cambios hormonales, induciendo el crecimiento mamario; cambios en las características histológicas del tejido normal, como involución reducida de unidades lobulares ductales terminales; formación de aductos de hidrocarburos aromáticos policíclicos-ácido desoxirribonucleico (HAP-ADN), con mutación específica del gen TP53; activación de la proliferación en la línea celular MCF-7; y, alteraciones en la metilación del ADN. Conclusión. Si bien órganos distales como la mama no son la primera entrada de los contaminantes ambientales al cuerpo, estos sí pueden verse afectados tras la exposición a largo plazo, a través de diferentes mecanismos de disrupción endocrina y daño al ADN principalmente
Breast cancer is the type of cancer that causes the most deaths in women worldwide. Although the contribution of genetic, hormonal and lifestyle factors are recognized as its main causes, the hypotheses that indicate that environmental pollution has an important role in its development have taken on great strength during the last years. These hypotheses are based on the increase in the incidence of breast cancer that coincides with industrialization processes, in addition to its greater presence in urban regions with high levels of pollution. The aim of this study was to consolidate information on the pathophysiological mechanisms that can explain the relationship between breast cancer and air pollution by particulate matter. Methodology. A literature search was carried out in PubMed, Google Scholar and Epistemonikos for documents published on this topic from January 2016 until August 3rd 2022. Results. Some of the mechanisms that could explain this association include endocrine alterations that favor hormonal changes, inducing breast growth; changes in the histological characteristics of normal tissue such as reduced involution of terminal duct lobular units; formation of polycyclic aromatic hydrocarbons-deoxyribonucleic acid (PAH-DNA) adducts, with specific mutation of the TP53 gene; an increase in cell proliferation in the MCF-7 cell line; and alterations in DNA methylation. Conclusion. Although distal organs such as the breast are not the entry site of environmental pollutants into the body, they can be affected after prolonged exposure, mainly through different mechanisms of endocrine disruption and DNA damage
Assuntos
Humanos , Feminino , Neoplasias da Mama/etiologia , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Neoplasias da Mama/fisiopatologia , Poluição do ArRESUMO
Este artículo pretende explorar el concepto de antifragilidad en el adulto mayor, dado el cambio demográfico en el mundo, con evidencia del aumento de personas mayores, que exige a los profesionales vinculados a su atención implementar modelos de intervención acordes con sus necesidades, relacionadas con su capacidad funcional y promoción de una cultura de antifragilidad. La construcción teórica de lo que significa ser adulto mayor antifrágil, en una sociedad que asimila el envejecimiento con fragilidad, enfermedad y discapacidad, es una oportunidad para presentar una mirada positiva de la salud en la vejez, a partir de las adaptaciones al estrés en diferentes dimensiones que influencian la vida de este grupo poblacional, en el que el capital físico, psicológico y social se integran e influencian, en un proceso que se relaciona con la antifragilidad y el envejecer como un continuo de la vida, con ganancias y pérdidas; el estudio de esta relación permitirá contar con políticas inclusivas adecuadas en cada etapa de la vida.
This article intends to explore the concept of anti-fragility in the elderly, given the demographic change in the world, with evidence of the increase in the number of elderly people, which requires professionals linked to their care, to implement intervention models in accordance with their needs, related to their functional capacity and promotion of a culture of antifragility. The theoretical construction of what it means to be an anti-fragile older adult, in a society that assimilates aging with frailty, illness and disability, is an opportunity to present a positive view of health in old age, based on the adaptations to stress in different dimensions that influence the life of this population group, in which physical, psychological and social capital are integrated and influenced, in a process that is related to anti-fragility and aging as a continuum of life, with gains and losses; the study of this relationship will make it possible to have appropriate inclusive policies at each stage of life.
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RESUMEN Objetivo: Determinar las condiciones laborales y extralaborales relacionadas con los síntomas depresivos de trabajadoras informales del centro de Medellín en 2015-2019. Métodos: Estudio transversal con intención analítica y fuentes primarias de información. Toma de datos con encuesta asistida en una de sus sedes gremiales en 2016, después de prueba piloto y estandarización de encuestadores. Se tomó por censo a 291 trabajadoras y se exploraron sus características laborales y extralaborales. Resultados: Las mujeres tenían una media de edad de 45 arios, escolaridad < 5 años, viviendas en estrato bajo y medio e ingresos inferiores al salario mínimo de 2016. Alrededor del 60,0% tenía inseguridad alimentaria moderada-grave, sin subsidio del Estado; eran fundamentalmente cabezas de familia, con 2 o menos personas a su cargo, y responsables de sus labores en el hogar. Laboraban al menos 8h al día 6 o 7 días a la semana, con padres o parientes venteros, y al menos 20 años en su labor. Alrededor del 60,0% tenía pareja, el 21,6% con disfuncionalidad familiar, y el 15,4% sufría síntomas depresivos moderados-graves (MG). Se asociaron y aportaron a la explicación de síntomas depresivos MG, vivir en cuarto o inquilinato, en estrato socioeconómico bajo y tener disfuncionalidad familiar MG. Conclusiones: Las condiciones extralaborales que se asocian y explican los síntomas depresivos MG de las trabajadoras pueden modificarse con acciones que impacten en los determinantes sociales de la salud.
ABSTRACT Objective: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. Methods: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. Results: The women had an average age of 45 years, <5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8 hours a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. Conclusions: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.
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Resumen Introducción: la hipertensión arterial (HTA) en trabajadores informales, podría explicarse por sus condiciones laborales, ambientales, hábitos y estilos de vida. Objetivo: determinar condiciones laborales, ambientales, hábitos y estilos de vida, que aportan a la explicación de HTA en trabajadores informales del centro de Medellín, Colombia, 2016. Metodología: estudio descriptivo transversal con intención analítica. Fuentes primarias de información, a un censo de 686 trabajadores en 2016, previa toma de consentimiento informado. Se indagaron condiciones laborales, ambientales, hábitos, estilos de vida y autorreporte de HTA. Se realizó análisis univariado, bivariado y multivariado. Pruebas estadísticas con 95 % de confianza y error del 5 %. Un grupo de trabajadores participó en el diseño y ejecución del trabajo de campo. Proyecto aprobado por comité de Ética Institucional de la Universidad CES, Medellín (septiembre 2015). Resultados: el 20,26 % de los trabajadores tenía HTA. Edad 50(±11,76) años y 23,5 años como venteros, 81,5 % trabaja >8 horas diarias. El 17,2 % fumaba cigarrillo, 23,7 % utilizaba salero en la mesa y 28,9 % eran sedentarios. Mayor hipertensión a mayor edad (RP=12,35), mayor antigüedad en el oficio (RP=1,73) y considerarse obeso (RP=2,61), y menor para quienes no consumían licor (RP=0,48). Explica mayor HTA consumir alimentos fritos (PR=3,14. IC=1,64; 6.00), tener entre 30-44 (PR=10,71.CI: 5,00; 22,94) y 45-59 años (PR=2,69. CI: 1,66; 4,37), y menor HTA, considerarse con sobrepeso (PR=0.54. IC=0.34, 0.78). Conclusiones: las condiciones laborales, hábitos y estilos de vida, aportan a la explicación de HTA. Siendo estas, algunas características que aportan a configurar vulnerabilidad laboral, en esta población trabajadora.
Abstract Introduction: High blood pressure (HBP) in informal workers could be explained, by their working and environmental conditions, habits and lifestyles. Objective: To determine working and environmental conditions, habits and lifestyles, which contribute to the explanation of HBP in informal workers in the downtown area in Medellin, Colombia, 2016. Methodology: Cross-sectional descriptive study with analytical intent. Primary source of information: a census of 686 workers in 2016, after obtaining informed consent. Working and environmental conditions, habits, lifestyles and self-report of HBP were investigated. Univariate, bivariate and multivariate analyzes were performed. Statistical tests show 95% confidence and 5% error. A group of workers participated in the design and execution of the fieldwork. Project approved by the Institutional Ethics Committee of Universidad CES, Medellín September 2015. Results: 20,26% of the workers had HBP. Age 50 (±11,76) years old, and 23,5 years as street vendors, 81,5% work>8 hours a day; 17,2% smoked cigarettes, 23,7% used saltshakers at the table and 28,9% were sedentary. Greater hypertension at older age (PR=12.35), greater seniority in the job (PR=1,73) and considered themselves obese (PR=2,61), and lower HBP for those who did not consume liquor (PR=0,48). Greater HBP is explained in people consuming fried foods (PR=3.14.IC=1,64; 6.00), being between 30-44 (PR=10,71. CI:5,00;22,94) and 45 to 59 years old (PR=2,69.CI: 1.66; 4.37), and a lower HBP for those considered as overweight (PR=0,54. IC=0.34; 0.78). Conclusion: working conditions, habits and lifestyles contribute to the explanation of HBP. These are some characteristics that contribute to configure labor vulnerability in this working population.
Resumo Introdução: a hipertensão arterial (HTA) em trabalhadores informais, poderia explicar-se por suas condições laborais, ambientais, hábitos e estilos de vida. Objetivo: determinar condições laborais, ambientais, hábitos e estilos de vida, que aportam à explicação de HTA em trabalhadores informais do centro de Medellín, Colômbia, 2016. Metodologia: estudo descritivo transversal com intenção analítica. Fontes primarias de informação, a um censo de 686 trabalhadores em 2016, previa toma de consentimento informado. Indagaram-se condições laborais, ambientais, hábitos, estilos de vida e auto reporte de HTA. Realizou-se análise uni variado, bivariado e multivariado. Provas estadísticas com 95 % de confiança e erro do 5 %. Um grupo de trabalhadores participou no desenho e execução do trabalho de campo. Projeto aprovado por comité de Ética Institucional da Universidade CES, Medellín (setembro 2015). Resultados: o 20,26 % dos trabalhadores tinha HTA. Idade 50(±11,76) anos e 23,5 anos como camelôs, 81,5 % trabalha >8 horas diárias. O 17,2 % fumava cigarro, 23,7 % utilizava saleiro na mesa e 28,9 % eram sedentários. Maior hipertensão a maior idade (RP=12,35), maior antiguidade no ofício (RP=1,73) e considerar-se obeso (RP=2,61), e menor para quem não consumiam licor (RP=0,48). Explica maior HTA consumir alimentos fritos (PR=3,14. IC=1,64;6.00), ter entre 30-44 (PR=10,71.CI:5,00;22,94) e 45-59 anos (PR=2,69. CI:1,66;4,37), e menor HTA, considerar-se com sobrepeso (PR=0.54. IC=0.34, 0.78). Conclusões: as condições laborais, hábitos e estilos de vida, aportam à explicação de HTA. Sendo estas, algumas características que aportam a configurar vulnerabilidade laboral, nesta população trabalhadora.
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OBJECTIVE: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. METHODS: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. RESULTS: The women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8â¯h a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. CONCLUSIONS: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.
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Depressão , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Depressão/epidemiologia , Escolaridade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms. METHODS: Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α. RESULTS: A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms.
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Salas Cirúrgicas , Segurança do Paciente , Hospitais , Humanos , Cultura Organizacional , Psicometria , Reprodutibilidade dos Testes , Gestão da Segurança/métodos , Inquéritos e QuestionáriosRESUMO
Objetivo: Determinar las condiciones laborales, hábitos y estilos de vida relacionadas con la multimorbilidad de adultos mayores con empleos con subsistencia en el centro de Medellín-Colombia, 2016. Material y Métodos: Estudio transversal con fuentes primarias de información a un censo de 686 trabajadores, encuestados previa toma de consentimiento informado, el año 2016. Para este estudio se tomaron 153 trabajadores con ≥ 60 años. Análisis univariado, bivariado y multivariado, para estudiar su multimorbilidad y factores asociados a su labor. Resultados: 77,0% tenía entre 60-69 años; fundamentalmente hombres, 56,0% ganaba <500.000 pesos colombianos. Tenian >20 años en su oficio. El 62,0% presentó multimorbilidad, fundamentalmente por diabetes; hipertensión; obesidad y sintomatología depresiva. Explicaron mayor prevalencia de multimorbilidad (p<0,05) trabajar cerca de aguas residuales (RPA=3,38. IC=1,27;8,96), no tener horario para el consumo de alimentos (RPA=3,01. IC=1,25;7,27) y consumir alimentos en soledad (RPA=3,28. IC=1,31;8,18). Conclusión: Las condiciones que explican multimorbilidad en estos trabajadores, pueden ser revertidas con acciones de promoción de la salud y prevención de la enfermedad, lideradas por el Estado y con su participación activa (AU)
Objective: To determine the working conditions, habits and lifestyles related to the multimorbidity of older adults with subsistence jobs in the center of Medellín-Colombia, 2016. Material and Methods: Cross-sectional study with primary sources of information to a census of 686 workers, surveyed After obtaining informed consent, in 2016. For this study, 153 workers aged ≥60 years were taken. Univariate, bivariate and multivariate analysis, to study their multimorbidity and factors associated with their work. Results: 77,0% were between 60-69 years old; mainly men, 56,0% earned <500,000 Colombian pesos. They were > 20 years old in their trade. 62,0% presented multimorbidity, mainly due to diabetes; hypertension; obesity and depressive symptoms. They explained a higher prevalence of multimorbidity (p<0,05) working near wastewater (RPA=3,38.CI=1,27; 8,96), not having a schedule for food consumption (RPA=3,01.CI=1,25;7,27) and consuming food alone (RPA=3,28.CI=1,31; 8,18). Conclusion: The conditions that explain multimorbidity in these workers can be reversed with health promotion and disease prevention actions, led by the State and with its active participation (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Multimorbidade , Setor Informal , Estudos Transversais , ColômbiaRESUMO
Resumen El objetivo de este estudio fue analizar mediante el modelo Rasch las evidencias de validez de la medida de funcionalidad familiar obtenida a partir del APGAR-familiar en adultos mayores de Colombia. Se encuestaron 1.514 participantes residentes en Medellín, Barranquilla y Pasto. Se realizaron análisis Rasch de ajuste de categorías de respuesta, ajuste de los ítems y de las personas, funcionamiento diferencial de los ítems, dimensionalidad e independencia local de los ítems y confiabilidad. Los principales resultados indicaron que el formato de respuesta se ajusta a los requerimientos de optimización de función de Linacre, todos los ítems muestran medias cuadráticas Infit y Outfit en el rango esperado, la escala es unidimensional y la confiabilidad de Wright se estimó en 0,962. Se concluye que, en adultos mayores colombianos, el APGAR-familiar proporciona una medida de funcionalidad familiar unidimensional, a nivel de intervalo, confiable e insesgada por edad y sexo, que permite clasificar cinco niveles de funcionalidad familiar con fines de tamizaje.
Abstract The objective of this study was to analyze, using the Rasch model, the evidence of validity of the measure of family functionality obtained from the APGAR-family assessment in older adults in Colombia. A total of 1,514 participants residing in Medellín, Barranquilla and Pasto were surveyed. Rasch analysis of adjustment of response categories, adjustment of items and people, differential functioning of the items, dimensionality and local independence of the items and reliability were carried out. The main results indicated that the response format conforms to the Linacre function optimization requirements. All the items show Infit and Outfit means square in the expected range. The scale is one-dimensional and Wright's reliability was estimated at 0.962. It is concluded that the APGAR-family assessment in Colombian older adults provides a one-dimensional measure of family functionality at the interval level, reliable and unbiased by age and gender, which allows classifying five levels of family functionality for screening purposes.
Resumo O objetivo deste estudo foi analisar através do modelo Rasch as evidencias de validez da medida de funcionalidade familiar obtida a partir do APGAR-familiar em adultos maiores da Colômbia. Entrevistaram-se 1.514 participantes residentes em Medellín, Barranquilla e Pasto. Fizeram-se análises Rasch de ajuste de categorias de resposta, ajuste dos itens e das pessoas, funcionamento diferencial dos itens, dimensionalidade e independência local dos itens e confiabilidade. Os principais resultados indicaram que o formato de resposta se ajusta aos requerimentos de optimização de função de Linacre, todos os itens amostram medias quadráticas Infit e Outfit no rango esperado, a escada é unidimensional e a confiabilidade de Wright se estimou em 0,962. Conclui que, em adultos maiores colombianos, o APGAR-familiar proporciona uma medida de funcionalidade familiar unidimensional, a nível de intervalo, confiável e imparcial por idade e sexo, que permite classificar cinco níveis de funcionalidade familiar com fins de triagem.
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Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.453.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.9821.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.6925.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.
Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.
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Humanos , Hiperplasia Prostática , Bacteriúria , Razão de Chances , Antibioticoprofilaxia , Intervalos de ConfiançaRESUMO
Resumen Introducción: Se hace una correlación entre la osteoatrosis y las condiciones laborales, hábitos y estilos de vida de los trabajadores informales del centro de Medellín, Colombia. Objetivo: Identificar la relación de la osteoartritis y la prevalencia de enfermedades crónicas y degenerativas con las condiciones sociodemográficas, laborales, hábitos y estilos de vida en un grupo de trabajadores informales de Medellín, Colombia. Materiales y métodos: Estudio transversal, con fuente primaria de información de 686 trabajadores informales. Se realizó una encuesta asistida, previa toma de consentimiento. Se seleccionaron 289 trabajadores con diagnóstico de enfermedad crónica o degenerativa, ≥18 años, con ≥5 años en su oficio. Se realizaron análisis exploratorios y de asociación con prueba Chi2, y cálculo de RP con IC del 95%. Resultados: el 79,9% de la población padecía alguna enfermedad crónica. El 3,46% presentaba diagnóstico de osteoartritis, siendo significativamente mayor (p<0,05) en quienes tenían entre 21 y 30 años en su oficio (RP=5,62. IC:1,20;26,34). También fue mayor la prevalencia de osteoartritis en; >45 años (RP=2,26), mujeres (RP:4,44), trabajadores sedentarios (RP=1,71), obesos (RP=3,40), así como en quienes habían sido obreros (RP=1,30), en aquellos que tenían puestos de venta semiestacionaria (RP=2,21), vendían productos de cosecha y perecederos (RP=1,78), en quienes trabajaban >8 horas diarias (RP:2,77), ≤5días a la semana (RP=3,10), no tenían espacio suficiente para moverse (RP=2,08), y en quienes tenían posturas o movimientos forzados (RP=2,72). Conclusión: En la población de vendedores informales del centro de Medellín, los factores sociodemográficos, laborales, hábitos y estilos de vida modificables se relacionan con una mayor prevalencia de osteoartritis.
Abstract Introduction: A correlation is made regarding osteoarthrosis and working conditions and lifestyles of informal workers in Medellin downtown. Objective: To identify the prevalence of chronic and degenerative diseases, and the relationship of osteoarthritis with sociodemographic and work conditions, habits and lifestyles, in a group of informal workers from Medellín, Colombia. Materials and methods: Cross-sectional study, with a primary source of information, with 686 workers. An assisted survey was applied, after obtaining consent. 289 workers with a diagnosis of chronic or degenerative disease, ≥18 years old, with ≥5 years in their profession were included. Exploratory and association analysis with Chi2 test, and calculation of PR with 95% CI. Results: 79.9% of them suffered from a chronic disease. 3.46% had a diagnosis of osteoarthrosis, being significantly higher (p <0.05) in those who had spent between 21 and 30 years performing their profession (PR=5,62.CI:1,20;26,34). The prevalence of osteoarthrosis was also higher in; >45 years (PR=2.26), women (PR=4,44), sedentary workers (PR=1,71), obese (PR=3,40), as well as those who had been brick-layers (PR=1,30), in those who had semi-stationary sales positions (PR=2,21), they sold harvest and perishable products (PR=1,78), in those who worked> 8 hours a day (PR:2,77), ≤ 5 days a week (PR=3,10), they did not have enough space to move (PR = 2.08), and in those who had forced postures or movements (PR=2,72). Conclusion: sociodemographic and work factors, habits and modifiable lifestyles are related to a higher prevalence of osteoarthrosis in this working population.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Osteoartrite , Hábitos , Estilo de Vida , Postura , Trabalho , Doença Crônica , Prevalência , Estudos Transversais , Colômbia , Comércio , Diagnóstico , Categorias de TrabalhadoresRESUMO
INTRODUCTION: Occupational diseases are those that may have a causal relationship with occupational activity or environment. However, this definition does not specify how this disease would be identified and acknowledged for workers with subsistence jobs. OBJECTIVES: To determine sociodemographic, labor and environmental conditions that collaborate to explain the presence of eye and skin irritation among informal vendors in downtown Medellin. METHODS: Descriptive cross-sectional study with analytical intention, primary sources of information, and administration of assisted survey including self-reported eye and skin irritation in 686 workers. RESULTS: Predominantly male population with mean age of 50 (±11.8) years. A total of 23.5 % of workers had worked as vendors for their entire life; 37.5% had worked as vendors for 11 to 20 years as vendors; and 81.5%worked for more than 8 hours a day. According to 69.8% of the sample, poor air quality affected their work, and 80.0% believed that pollution was generated by vehicle fleet. The polluted areas generated unpleasant odors (50.2%) and air pollution (89.4%). The prevalence of eye and skin irritation was 65.4%. Not having working license and having fair, poor, or very poor job tenure significantly reduced the prevalence of eye and skin irritation. Conversely, exposure to polluted water, working in the professional for more than 30 years, male sex, and age older than 60 years were associated with increased prevalence of irritation. CONCLUSIONS: Eye and skin irritation was mainly explained by non-modifiable sociodemographic and labor conditions and by consumption of polluted water; however, implementing public health actions could reduce workers' socio-environmental and labor vulnerability.
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OBJECTIVE: To determine the working and non-working conditions related to depressive symptoms in informal workers in the centre of Medellín in 2015-2019. METHODS: Cross-sectional study with analytical intention and primary sources of information. Data collection with assisted survey in one of its union headquarters in 2016, after a pilot test and standardisation of pollsters. A total of 291 women workers were taken as a census, and their working and non-working conditions were explored. RESULTS: The women had an average age of 45 years, ≤5 years of schooling, low and middle-income housing, and income below the 2016 minimum wage. About 60% suffered moderate-severe food insecurity, and received no state benefits. They were mainly the head of the family, with 1 or 2 dependents, and were responsible for the work at home. They worked at least 8hours a day, 6 or 7 days a week, with parents or relatives selling in the street, and at least 20 years in their work. About 60% had a partner, 21.6% with family dysfunction, and 15.4% moderate-severe depressive symptoms. Living in one room or a slum, with a low socioeconomic status and moderate-severe family dysfunction were associated with, and contributed to the explanation of, moderate-severe depressive symptoms. CONCLUSIONS: The non-working conditions that are associated with and explain the moderate-severe depressive symptoms of female workers can be modified with actions that impact on the social determinants of health.