Condiciones de salud y trabajo de los recicladores de oficio: revisión de alcance / Health and working conditions of waste pickers: scoping review

RESUMEN El presente artículo busca describir las condiciones de salud y trabajo de los recicladores a nivel mundial, desde el modelo de condiciones de trabajo de la Universidad Nacional de Colombia. Se realizó una búsqueda bibliográfica en PubMed, Taylor and Francis, Science Direct y SAGE de artículos publicados entre los años 1999 al 2019. Para el proceso de depuración de artículos se utilizó el gestor bibliográfico Mendeley. Se obtuvieron 857 registros, de los cuales 88 cumplieron con los criterios de inclusión. La mayoría de los estudios eran de casos y controles, con la aplicación de cuestionarios, entrevistas, encuestas y discusiones de grupos focales. Las condiciones intralaborales de los recicladores se relacionan principalmente con la exposición a agentes químicos y biológicos; las condiciones extralaborales que más influyen en el desempeño laboral están asociadas con su situación económica, familiar, vivienda y relación con el entorno. Las condiciones individuales que más inciden en la salud y el trabajo de los recicladores están asociadas con el sexo, la edad y la escolaridad. Desde el abordaje del modelo de condiciones de trabajo esta revisión de literatura identificó y explicó los agentes de riesgo y los efectos en la salud de recicladores como consecuencia de su exposición a entornos de trabajo inseguros y peligrosos.

ABSTRACT This scoping review article seeks to describe the health and work conditions of waste pickers worldwide from the working conditions model of the Universidad Nacional de Colombia, through a review of scientific articles published between the years 1999 to 2019. The bibliographic search was carried out manually in PubMed, Taylor and Francis, ScienceDirect, and SAGE. For the article screening process, the Mendeley bibliographic manager was used. The methodological quality was based on a rigorous and serious process respecting the established inclusion and exclusion criteria. 857 records were obtained, of which 88 studies met the inclusion criteria. Most of the studies analyzed had a qualitative approach, based on the application of questionnaires, interviews, surveys, and focus group discussions. The intra-work conditions of the waste picker population are mainly related to situations that affect their work environment, while the non-work conditions that most influence the work performance of waste pickers are associated with their economic and family situation, place of residence, and relationship with the environment. The individual conditions that most affect the health and work of waste pickers are associated with sex, age, and education. From the approach to the working conditions model, this literature review identified and explained the different risk agents and effects on the health of waste pickers around the world as a consequence of their exposure to unsafe and dangerous work environments.

[Health and working conditions of waste pickers: scoping review]. / Condiciones de salud y trabajo de los recicladores de oficio: revisión de alcance.

This scoping review article seeks to describe the health and work conditions of waste pickers worldwide from the working conditions model of the Universidad Nacional de Colombia, through a review of scientific articles published between the years 1999 to 2019. The bibliographic search was carried out manually in PubMed, Taylor and Francis, ScienceDirect, and SAGE. For the article screening process, the Mendeley bibliographic manager was used. The methodological quality was based on a rigorous and serious process respecting the established inclusion and exclusion criteria. 857 records were obtained, of which 88 studies met the inclusion criteria. Most of the studies analyzed had a qualitative approach, based on the application of questionnaires, interviews, surveys, and focus group discussions. The intra-work conditions of the waste picker population are mainly related to situations that affect their work environment, while the non-work conditions that most influence the work performance of waste pickers are associated with their economic and family situation, place of residence, and relationship with the environment. The individual conditions that most affect the health and work of waste pickers are associated with sex, age, and education. From the approach to the working conditions model, this literature review identified and explained the different risk agents and effects on the health of waste pickers around the world as a consequence of their exposure to unsafe and dangerous work environments.

El presente artículo busca describir las condiciones de salud y trabajo de los recicladores a nivel mundial, desde el modelo de condiciones de trabajo de la Universidad Nacional de Colombia. Se realizó una búsqueda bibliográfica en PubMed, Taylor and Francis, Science Direct y SAGE de artículos publicados entre los años 1999 al 2019. Para el proceso de depuración de artículos se utilizó el gestor bibliográfico Mendeley. Se obtuvieron 857 registros, de los cuales 88 cumplieron con los criterios de inclusión. La mayoría de los estudios eran de casos y controles, con la aplicación de cuestionarios, entrevistas, encuestas y discusiones de grupos focales. Las condiciones intralaborales de los recicladores se relacionan principalmente con la exposición a agentes químicos y biológicos; las condiciones extralaborales que más influyen en el desempeño laboral están asociadas con su situación económica, familiar, vivienda y relación con el entorno. Las condiciones individuales que más inciden en la salud y el trabajo de los recicladores están asociadas con el sexo, la edad y la escolaridad. Desde el abordaje del modelo de condiciones de trabajo esta revisión de literatura identificó y explicó los agentes de riesgo y los efectos en la salud de recicladores como consecuencia de su exposición a entornos de trabajo inseguros y peligrosos.

Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy.

BACKGROUND: Because of intratendinous ossifications, retrocalcaneal bursitis, or intratendinous necrosis commonly found in insertional tendinosis, it is often necessary to detach the tendon partially or entirely from its tendon-to-bone junction. HYPOTHESIS: Double-row repair for insertional Achilles tendinopathy will generate an increased contact area and demonstrate higher biomechanical stability. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen cadaver Achilles tendons were split longitudinally and detached, exposing the calcaneus; an ostectomy was performed and the tendon was reattached to the calcaneus in 1 of 2 ways: 2 suture anchors (single row) or a 4-anchor (double row) construct. Footprint area measurements over time, displacement after cyclic loading (2000 cycles), and final load to failure were measured. RESULTS: The double-row refixation technique was statistically superior to the single-row technique in footprint area measurement initially and 5 minutes after repair (P = .009 and P = .01, respectively) but not after 24 hours (P = .713). The double-row construct demonstrated significantly improved measures for peak load (433.9 ± 84.3 N vs 212.0 ± 49.7 N; P = .042), load at yield (354.7 ± 106.2 N vs 198.7 ± 39.5 N; P = .01), and slope (51.8 ± 9.9 N/mm vs 66.7 ± 16.2 N/mm; P = .021). Cyclic loading did not demonstrate significant differences between the 2 constructs. CONCLUSION: Double-row construct for reinsertion of a completely detached Achilles tendon using proximal and distal rows resulted in significantly larger contact area initially and 5 minutes after repair and led to significantly higher peak load to failure on destructive testing. CLINICAL RELEVANCE: In treatment for insertional Achilles tendinosis, the tendon often has to be detached and anatomically reattached to its insertion at the calcaneus. To our knowledge there is a lack of biomechanical studies supporting either a number or a pattern of suture anchor fixation. Because the stresses going across the insertion site of the Achilles tendon are significant during rehabilitation and weightbearing activities, it is imperative to have a strong construct that allows satisfactory healing during the early postoperative process.

The effect of medial meniscectomy and meniscal allograft transplantation on knee and anterior cruciate ligament biomechanics.

PURPOSE: Our purpose was to evaluate the effect of meniscectomy and meniscal allograft transplant on anterior cruciate ligament (ACL) and knee biomechanics. METHODS: A differential variable reluctance transducer was placed in the ACL of 10 human cadaveric knees to record strain. Tibial displacement from a neutral reference was recorded relative to the position of the femur. Testing was performed at 30 degrees, 60 degrees, and 90 degrees of knee flexion. Six cycles of anterior-posterior loads were applied to the limit of 150 N. After a testing cycle, a medial meniscectomy was performed and the testing cycle was repeated. A meniscal allograft transplant was performed, and a final testing cycle was conducted. ACL strain and tibial displacement in the meniscectomy and meniscal allograft states were compared with the intact-knee state. RESULTS: Tibial displacement after meniscectomy significantly increased at all angles. The meniscal allograft transplant restored tibial displacement to normal values at 30 degrees and 90 degrees. ACL strain increased significantly after meniscectomy at 60 degrees and 90 degrees of flexion, and meniscal allograft transplant returned the strain values to normal at 60 degrees and 90 degrees. CONCLUSIONS: In most cases medial meniscectomy produced a significant increase in tibial displacement relative to the femur, and meniscal allograft transplantation restored displacement values to normal. Meniscectomy increased ACL strain and meniscal allograft transplant restored strain values to normal in 2 of 3 tested flexion angles. CLINICAL RELEVANCE: The absence of the medial meniscus exposes the ACL to increased strain, whereas meniscal allograft lowered the strain on the native ACL. This could have implications for those patients undergoing ACL reconstruction who have concomitant removal of the medial meniscus.

Biomechanical evaluation of distal biceps reconstruction with cortical button and interference screw fixation.

HYPOTHESIS: Tension slide repair maintains the strength of the standard cortical button repair but reduces gap formation at the repair. Distal biceps tendon repair with a suspensory cortical button has yielded the strongest published repair, despite observed gap formation and tendon pistoning. The tension slide technique (TST) was described to reduce gap formation while maintaining the strength of cortical button repair. This study evaluates the biomechanics of the TST compared with previously described EndoButton (Smith & Nephew, Memphis, TN) repair and the TST with and without an interference screw. MATERIALS AND METHODS: The study used 20 matched specimens: 5 had a standard cortical button repair, and 5 had biceps repair with the TST. An additional 10 specimens underwent a TST, 5 with an interference screw and 5 without. All were cyclically loaded for 3600 cycles. Gap formation and load to failure were measured. RESULTS: The mean (SD) load to failure for standard technique was at 389 (148) N vs 432 (66) N for the TST (P = .28). The mean (SD) gap formation was 2.79 (1.43) mm with the standard repair and 1.26 (0.61) mm with the TST (P = .03). The mean (SD) load to failure with TST repair was 436 (103) N without the interference screw and 439 (94) N (P = 0.48) with the screw. The mean gap formation was 1.63 (1.09) mm without the screw and 1.45 (0.67) mm with the screw (P = .38.) CONCLUSION: This TST maintains the strength of the standard cortical button repair, but significantly reduces gap formation and motion at the repair site. LEVEL OF EVIDENCE: Basic science study.

Cobertura de examen clínico y mamografía de tamización para cáncer de mama en mujeres bogotanas / Breast Cancer Screening Coverage with clinical examination and Mammography Among insured women in Bogota

Objetivo: Determinar la cobertura de examen clínico y mamografía de tamización para cáncer de mama en un grupo de mujeres bogotanas afiliadas a seguros de salud. Métodos: Se realizó una encuesta telefónica a 4.526 mujeres entre 50 y 69 años, residentes en Bogotá y en municipios vecinos, afiliadas a tres compañías de seguros de salud. Se excluyeron las mujeres con antecedente personal de cáncer de mama. La cobertura de tamización se valoró como la proporción de mujeres con antecedente de mamografía y examen clínico de la mama. Se estimó la frecuencia en la vida, en los últimos dos años y en el último año. Se analizaron factores asociados a la práctica de tamización, mediante el cálculo de OR ajustados. Resultados: La frecuencia de vida de uso del examen clínico y mamografía fue de 59,3% y 79,8% respectivamente; el 49,7% y el 65,6% de las mujeres se realizó los exámenes con fines de tamización; el resto, con fines diagnósticos (sintomáticas). El 34,2% tenía examen clínico en el último año, y el 54%, mamografía en los últimos dos años. La educación y el antecedente familiar de cáncer de mama estuvieron asociados a la práctica de tamización. Conclusiones: La cobertura de examen clínico de la mama como método de tamización es baja. Las coberturas de mamografía son superiores a lo exigido por el sistema colombiano, pero inferiores a las coberturas útiles reportadas en países desarrollados.

Objectives: To determine the coverage of clinical breast examination (CBE) and mammography for screening of breast cancer among a group of insured women in Bogotá. Methods: A telephone survey was carried out with 4,526 women between the ages of 50 and 69, residing in Bogotá or its suburbs, who were insured by one of three commercial health plans. Women with a history of breast cancer were excluded. Screening coverage was estimated as the proportion of women who had had a mammography or CBE. Estimates were established for lifetime frequency, two years prior the survey, and one year prior the survey. Factors associated with screening procedures were analyzed with calculations based on adjusted OR. Results: Lifetime frequency of CBE was 59.3% and 79.8% for mammography; and 49.7% and 65.6% of women respectively underwent the tests for screening purposes; the remainder, for diagnostic purposes (breast symptoms). CBE reported a 34.2% one year coverage and mammography reported a 54% two years coverage. Screening was associated to cancer education and family history of breast cancer. Conclusion: Coverage of CBE for screening purposes is low. Mammography coverage is above that required by the Colombian Health Ministry, but below that reported by developed countries.

A biomechanical analysis of capsular plication versus anchor repair of the shoulder: can the labrum be used as a suture anchor?

PURPOSE: To determine the biomechanical strength properties of suture capsulolabral plication to an intact labrum versus glenoid bone anchor fixation. METHODS: Fourteen paired fresh frozen shoulders with intact glenoid labrum and mean age of 43.3 +/- 11.1 were randomized to capsular plication in the anteroinferior and posteroinferior quadrants using either two suture-anchor fixation versus suture fixation to an intact labrum. The construct was then preconditioned at 10 N for 10 cycles (1 Hz), and then loaded to failure at 3 mm per minute. RESULTS: There was no statistical difference in ultimate load to failure between the suture anchor (304.3 +/- 92.8 N) and the intact labrum (285.6 +/- 66.7 N) groups. The suture anchor group demonstrated significantly less mean displacement (2.15 +/- 1.1 mm) than suture plication (3.43 +/- 1.38 mm; P = .007) at failure. There were no statistical differences of labrum strength and stiffness between the anteroinferior and posteroinferior quadrants. CONCLUSIONS: An intact labrum provides similar fixation strength to a glenoid anchor; however, the labrum displacement was higher with plication alone. There were no strength differences between the anteroinferior and posteroinferior labrum. However, displacement of up to 1.5 mm may be expected without the use of glenoid anchors. CLINICAL RELEVANCE: The intact posteroinferior or anteroinferior labrum provides similar fixation strength to a glenoid anchor; however, the labrum displacement is higher versus plication alone.

Intra-articular partial-thickness rotator cuff tears: analysis of injured and repaired strain behavior.

BACKGROUND: There are few biomechanical studies regarding partial-thickness rotator cuff tears and subsequent repair. HYPOTHESIS: Partial-thickness intra-articular supraspinatus tendon tears increase articular-sided tendon strain as they increase in size. Repair of these tears will return strain to the intact state. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty fresh-frozen human cadaveric shoulders were prepared by dissecting to the supraspinatus tendon and leaving the native footprint intact. The tendon footprint was measured with digital calipers and divided into thirds (anterior, middle, and posterior). The middle third was the area where a consistent partial tear was created based on the thickness of the specimens' particular footprint. Created were 25%, 50%, and 75% tears. Image analysis software and differential variable reluctance transducers strain gauges were used to measure strain. A 100 N load at 1 Hz for 30 cycles was conducted for glenohumeral angles of 45 degrees, 60 degrees, and 90 degrees. This was completed for the intact tendon, 25%, 50%, and 75% tears. Shoulders were then repaired using the in situ fixation method. The in situ method consisted of either a parachute anchor or metal corkscrew anchor. Eight shoulders were examined for load-to-failure testing with the Materials Testing System. RESULTS: There was a significant difference (P < .05) in rotator cuff strain between the intact rotator cuff tendon and 50% and 75% partial-thickness tears. The cuff strain was returned to the intact state with repair. This was consistent for 3 different glenohumeral abduction angles and for all 3 intra-articular tendon areas. The bursal strain did not have any significant differences between groups. CONCLUSION: Articular-sided tendon strain increases consistently across the supraspinatus tendon with greater partial tears. Repair returned strain close to the intact state. CLINICAL RELEVANCE: This study may add credence to the clinical practice of repairing intra-articular partial-thickness rotator cuff tears greater than 50%.

Strain pattern comparison of double- and single-bundle anterior cruciate ligament reconstruction techniques with the native anterior cruciate ligament.

PURPOSE: The purpose of this study was to dynamically assess the native strain patterns of the anteromedial bundle (AMB) and posterolateral bundle (PLB) of the anterior cruciate ligament (ACL) and compare these findings with graft bundle strain patterns after double-bundle (DB) ACL reconstruction with tibial fixation under 40 N of tension at 75 degrees knee flexion (AMB) and under 20 N of tension at 20 degrees knee flexion (PLB) and after single-bundle (SB) reconstruction with tibial fixation under 40 N of tension at 20 degrees knee flexion. METHODS: The mean strain pattern of the AMB and PLB of the native ACL of 4 cadaveric knees was measured via differential variable reluctance transducers and 2-dimensional kinematic analysis during passive manual knee flexion-extension under a constant axial compression load. Measurements were repeated after DB and SB ACL reconstruction. Celeration line assessments with a split-middle technique were performed to quantify percent strain/knee flexion-extension angle change at reciprocating bundle function transition points. RESULTS: The DB ACL reconstruction technique displayed reciprocating AMB and PLB strain patterns that more closely replicated those of the native ACL. The SB ACL reconstruction technique tended to replicate AMB strain patterns, suggesting poor bundle function differentiation. CONCLUSIONS: The DB ACL reconstruction with differential AMB and PLB tensioning more closely replicated native ACL strain patterns than the SB ACL reconstruction. The SB ACL reconstruction that we used closely simulated native ACL AMB strain patterns; however, PLB function was not restored. CLINICAL RELEVANCE: The DB ACL reconstruction more closely replicated the AMB and PLB strain patterns of the native ACL.

Tendon and bone responses to a collagen-coated suture material.

Tendon to bone integration after rotator cuff repair is not a reproducible process. During repair, bioabsorbable and nonabsorbable suture material is universally used to facilitate the procedure. Improving the biological architecture of inert suture might aid in overall tendon to bone healing. The objective of our study is to enhance the bone to tendon union by absorbing type I collagen onto high strength nonabsorbable polyester/polyethylene suture commonly used in rotator cuff surgery. Our purpose was to evaluate the tendon and bone cellular response to this novel coated suture compared to uncoated suture. Primary human osteoblasts (HOBs) and tenocytes were plated onto polyester/polyethylene suture that was either uncoated or coated with type I bovine collagen. Cell adhesion to the sutures was assayed at 24 hours. Proliferation was determined at 48 hours by measuring [3H]- Thymidine incorporation in cells attached to the sutures. At 24 and 48 hours, respectively, cells grown on the collagen-coated suture showed a significantly greater response measured by adhesion and proliferation than cells grown on uncoated suture. At five days of culture, alkaline phosphatase activity and protein synthesis was significantly greater on the collagen-coated suture compared to uncoated. Collagen-coated polyester/polyethylene suture appears to stimulate adhesion, proliferation alkaline phosphatase, and protein synthesis more than uncoated sutures, and therefore may aid in the tendon to bone incorporation process critical to rotator cuff repair.