Working With the Strategy Master-Dr Michael Silverstein MD, MPH [1945-2024].

New Solutions offers a short memorial statement noting the January 2, 2024, death of Dr Michael Silverstein, an internationally known leader in the field of occupational health and safety. Dr Silverstein spent 53 years specializing in the fields of occupational medicine, public health, and general preventive medicine. He was the Assistant Director for Occupational Health and Safety with the United Automobile Workers Union for 15 years. He served as the Director of Policy for the U.S. Occupational Safety and Health Administration (OSHA) during the Clinton Administration. He later served as Director of the Washington State OSHA program for 10 years and was the Assistant Director for Industrial Safety and Health in the Washington State Department of Labor and Industries. A long-time friend of New Solutions, Dr Silverstein was the journal's first Scientific Solutions editor.

Fortalecimento da Rede Nacional de Atenção Integral à Saúde do Trabalhador pela mobilização social: relato de experiência / Strengthening the National Network for Comprehensive Occupational Healthcare through social mobilization: an experience report

Resumo Introdução: a participação social é o pilar da implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora que estabelece as ações de atenção à Saúde do Trabalhador no Sistema Único de Saúde, a partir da Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Objetivo: descrever a parceria ensino-serviço para fortalecer a atenção à Saúde do Trabalhador em um município, em consonância com os princípios da Renast, a partir da formação e mobilização social em saúde. Métodos: trata-se de um relato do projeto de extensão desenvolvido por demanda da Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora municipal. Foram realizadas três oficinas de trabalho que utilizaram o diálogo em grupos de discussão como método para produção de conhecimento associado a estratégias de ensino-aprendizagem. Resultados: profissionais de saúde, estudantes, trabalhadores e representantes de entidades participaram das oficinas, que versavam sobre: organização da Renast; a epidemiologia e papel dos diversos atores para fortalecimento da Renast; a articulação intra e intersetorial da Renast, suas fragilidades e potencialidades; e a relevância de cada ator no sentido de mobilizá-los para mudança de suas realidades. Conclusão: as oficinas apresentaram-se como estratégia possível de formação e ponto de partida, visando à mobilização social para fortalecer a Renast.

Abstract Introduction: social participation is a cornerstone in implementing the National Policy for Occupational Heath, which establishes care actions for worker's health within the Unified Health System, based on the National Network for Comprehensive Occupational Healthcare (Renast). Objective: to describe the educational-service partnership aimed at strengthening occupational care in a municipality according to Renast principles by education and social mobilization in health. Methods: This experience report focuses on the outreach project developed to answer the demands of the municipal Intersectoral Commission on Occupational Health. Three workshops were conducted using discussion groups as a method for knowledge production associated with teaching and learning strategies. Results: health professionals, students, workers, and representatives of entities participated in the workshops, which addressed Renast organization; epidemiology and the role of various actors in strengthening Renast; Renast intra and intersectoral articulation, its weaknesses and potentialities; and the relevance of each actor in changing their realities. Conclusion: the workshops proved to be a feasible strategy for education and social mobilization aimed at strengthening Renast.

Dez anos da Política Nacional de Saúde do Trabalhador e da Trabalhadora e os desafios da formação para (trans)formação do trabalho / Ten years of the National Occupational Health Policy and the challenges of health education for (trans)formation of work

Resumo O objetivo do artigo, de natureza teórica, é discutir a formação em saúde tomando como referência a Política Nacional de Saúde do Trabalhador e da Trabalhadora (PNSTT), que no ano de 2022 completou dez anos. Essa reflexão crítica está baseada em revisão de literatura e na experiência profissional dos autores em ensino, pesquisa e serviços no campo da Saúde Coletiva/Saúde do Trabalhador. A PNSTT preconiza a capacitação e o desenvolvimento da força de trabalho em saúde de nível médio e superior, com prioridade às equipes de Vigilância em Saúde e da Atenção Primária/Estratégia Saúde da Família. A formação em saúde deve considerar o trabalho em sua função ontogenética enredada no sistema capitalista que o transforma, paradoxalmente, em afirmação e negação do sujeito: pelo trabalho nos tornamos humanos e sob as regras do capital o trabalho se torna arriscado e adoecedor. A formação enseja a construção de modos de trabalho conjunto e diálogo permanente entre trabalhadores e demais atores sociais, desde o planejamento até a efetivação e posterior avaliação dos projetos formativos em saúde, trabalho e ambiente. Atuando de forma democrática, coletiva e organizada, é possível reinventar práticas concretas de educação e trabalho na perspectiva da formação cidadã.

Abstract This theoretical article aims to discuss health training by taking as a reference the National Worker's Health Policy (PNSTT), which celebrated its 10th anniversary in 2022. This critical reflection is based on a literature review and on the authors' professional experience in teaching, research and services in the field of Collective Health/Occupational Health. The PNSTT advocates for the training and development of the mid and higher-level health workforce, with priority given to Health Surveillance and Primary Care/Family Health Strategy teams. Health education must consider work in its ontogenetic function, entangled in the capitalist system that paradoxically transforms it into an affirmation and denial of the subject: through work we become human and under the rules of capital, work becomes risky and unhealthy. Training gives rise to the construction of joint strategies and permanent dialogue between workers and other social actors, from planning to implementation, and the subsequent evaluation of training projects in health, work and environment. Acting in a democratic, collective and organized way, it is possible to reinvent concrete practices of education and work from the perspective of citizen formation.

Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol

Introduction: Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective: To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symptoms, and vocal self-assessment. Methods: Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results: Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee intake (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions: The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.

Introducción: Debido a las exigencias comunicativas inherentes a la profesión, el profesional del derecho se beneficia del seguimiento logopédico para el correcto uso de la voz y para evitar la aparición de trastornos vocales. El desarrollo de instrumentos específicos contribuirá con datos más relevantes para guiar este seguimiento. Objetivo: Verificar la aplicabilidad del Protocolo General de Detección de Riesgo de Disfonía (DRSP-G) y el Protocolo de Detección de Riesgo Específico para Profesionales del Derecho (DRSP-LP) y correlacionar las puntuaciones de ambos con varias variables de interés. Metodología: Participaron 50 profesionales del derecho. Todos completaron el DRSP-G y DRSP-LP y grabaron sus voces para detectar la presencia de alteraciones en la calidad de la voz. Resultados: La mayoría presentó un alto riesgo de disfonía, que fue mayor en los hombres. Se observó alteración en la calidad de la voz en el 34% de los participantes. Los ítems con puntajes más altos en el DRSP-G fueron hablar mucho (76%), ingesta diaria excesiva de café (70%), contacto con fumadores (60%) e hidratación y sueño insuficientes (48%); y en el DRSP-LP, consumo de alcohol (68%) y exposición al aire acondicionado (64%). No hubo correlación entre las puntuaciones de riesgo y el grado de disfonía, ni con la edad o la antigüedad profesional. La puntuación DRSP-G se correlacionó con los signos y síntomas vocales y la autopercepción vocal. Conclusiones: La aplicación conjunta del DRSP-G y el DRSP-LP permitió un análisis cuantitativo y cualitativo de los factores de riesgo de disfonía en profesionales del derecho.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Vigilância em Saúde do Trabalhador na perspectiva de gestores e tomadores de decisão / Workers' Health Surveillance from managers' and decision-makers' perspectives

Resumo Objetivo: analisar as ações de implantação da Vigilância em Saúde do Trabalhador (Visat) na esfera municipal, pela perspectiva de gestores e tomadores de decisão. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado em duas etapas: (1) levantamento documental da legislação relacionada à Saúde do Trabalhador; (2) entrevistas semiestruturadas com 15 gestores e tomadores de decisão na área, que foram gravadas, transcritas e analisadas segundo análise temática. Resultados: a análise documental incluiu seis documentos, sendo três relacionados às ações de Visat e três relacionados às ações que guardam interface com a Saúde do Trabalhador. Sete categorias emergiram na análise temática: Aspectos legais da Saúde do Trabalhador; Implementação das ações de Visat; Fluxos de informação e comunicação da Visat; Papéis e competências relacionados à ST no Sistema Único de Saúde; Articulação entre os setores envolvidos na Visat; Atuação do Centro de Referência em Saúde do Trabalhador regional; Relevância do controle social e participação sindical para implementação da Visat municipal. Conclusão: o estudo evidenciou fragilidades na consolidação da Visat, com desarticulação dos setores envolvidos, ações fragmentadas, ausência de definições de papéis e fluxos de trabalhos e, ainda, desconhecimento dos aspectos relacionados à atenção à saúde dos trabalhadores pelos atores envolvidos em sua consolidação.

Abstract Objective: to analyze the implementation of Workers' Health Surveillance (WHS) at a regional level, from managers' and decision-makers' perspectives. Methods: descriptive-exploratory study with a qualitative approach performed in two steps (1) documental analysis related to Workers' Health legislation; (2) semi-structured interviews with 15 managers and decision-makers, that were recorded, transcribed, and analyzed by thematic analysis. Results: documental analysis found six documents, with three related to WHS and three related to actions interfacing Workers' Health. Seven categories were found in the speeches: Legal aspects of Workers' Health; Implementation of WHS actions; Communication and information flows of WHS; Roles and competencies related to Workers' Health in the Brazilian Unified Health System; Articulation among sectors involved in WHS; Role of the Regional Center of Reference in Workers' Health; and Relevance of social control and union participation for WHS implementation. Conclusion: this study shows flaws in the WHS consolidation, including non-articulation of involved sectors, fragmented actions, lack of defined roles and competencies, and lack of knowledge about Workers' Health care by the actors involved in its consolidation.

Avaliando o absenteísmo por doença nas instituições federais de ensino: análise dos dados de afastamento de servidores por licença médica nas universidades federais de Pelotas e Rio Grande / Evaluating absenteeism due to illness in federal educational institutions: analysis of data on staff leave due to sick leave at the federal universities of Pelotas and Rio Grande

Resumo Objetivo: Analisar as características dos afastamentos por doença entre servidores de duas universidades públicas do extremo sul do Brasil. Método: Foram analisados os afastamentos por doença, concedidos por licença médica ocorridos entre janeiro de 2015 a dezembro de 2019. As universidades possuem características semelhantes no que se refere a localização, contingente de servidores e alunos atendidos. Os indicadores foram baseados no número de licenças apresentadas, número de trabalhadores em licença e dias de trabalho perdidos. Foram analisados os afastamentos por categoria profissional, faixa etária, gênero, local de trabalho e doença que levou ao afastamento. Resultados: Ambas as universidades apresentam perfil semelhante de adoecimento dos servidores, sendo os transtornos psiquiátricos e as doenças osteomusculares as mais prevalentes. As categorias profissionais mais acometidas por doença são os profissionais da área da saúde e educação. O absenteísmo é mais presente entre as mulheres. Conclusão: Os resultados do estudo apontam a necessidade de discutir estratégias que resultem em mudanças na forma de organização do trabalho, promoção à saúde e qualidade de vida dos trabalhadores, visando minimizar os impactos que o adoecimento traz aos trabalhadores e às instituições.

Abstract Resumo: Objetivo: Analisar as características dos afastamentos por doença entre servidores de duas universidades públicas do extremo sul do Brasil. Método: Foram analisados os afastamentos por doença, concedidos por licença médica ocorridos entre janeiro de 2015 a dezembro de 2019. As universidades possuem características semelhantes no que se refere a localização, contingente de servidores e alunos atendidos. Os indicadores foram baseados no número de licenças apresentadas, número de trabalhadores em licença e dias de trabalho perdidos. Foram analisados os afastamentos por categoria profissional, faixa etária, gênero, local de trabalho e doença que levou ao afastamento. Resultados: Ambas as universidades apresentam perfil semelhante de adoecimento dos servidores, sendo os transtornos psiquiátricos e as doenças osteomusculares as mais prevalentes. As categorias profissionais mais acometidas por doença são os profissionais da área da saúde e educação. O absenteísmo é mais presente entre as mulheres. Conclusão: Os resultados do estudo apontam a necessidade de discutir estratégias que resultem em mudanças na forma de organização do trabalho, promoção à saúde e qualidade de vida dos trabalhadores, visando minimizar os impactos que o adoecimento traz aos trabalhadores e às instituições.

Evidence-informed decision about (de-)implementing return-to-work coordination to reduce sick leave: a case study.

BACKGROUND: Coordination of return to work (RtW) is implemented in many countries, but a Cochrane review found no considerable effect on workers' sick leave compared to usual care. The aim of the study is to analyse how the evidence from this review can be used for decisions about (de-)implementing RtW coordination in a country-specific setting, using Finland as an example. METHODS: We conducted a systematic literature search and online survey with two groups of experts to compare interventions included in the Cochrane review to Finnish RtW practice using content analysis methods. We applied the evidence-to-decision (EtD) framework criteria to draw conclusions about (de-)implementing RtW coordination in Finland, including benefits, harms and costs of the intervention compared to usual care. RESULTS: We included seven documents from the literature search and received data from 10 of 42 survey participants. RtW coordination included, both in Finland and in the review, at least one face-to-face meeting between the physician and the worker, a workers' needs assessment, and an individual RtW plan and its implementation. Usual care focuses on medical treatment and may include general RtW advice. RtW coordination would be cost-saving if it decreases sick leave with at least 2 days compared to usual care. The evidence in the Cochrane review was mainly of low certainty, and the effect sizes had relatively wide confidence intervals. Only a new, high-quality and large randomized controlled trial (RCT) can decrease the current uncertainty, but this is unlikely to happen. The EtD framework did not provide arguments for further implementation or for de-implementation of the intervention. CONCLUSIONS: Interventions evaluated in the Cochrane review are similar to RtW coordination and usual care interventions in Finland. Considering all EtD framework criteria, including certainty of the evidence and costs, de-implementation of RtW coordination interventions in Finland seems unnecessary. Better evidence about the costs and stakeholders' values regarding RtW coordination is needed to improve decision-making.

Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression.

OBJECTIVE: To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health. METHOD: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021. RESULTS: A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise. CONCLUSIONS: Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).

Identificación y análisis de factores de riesgo psicosocial según la NOM-035-STPS-2018 en una universidad mexicana / Identification and analysis of psychosocial risk factors according to NOM-035-STPS-2018 in a Mexican university

Antecedentes: Las actividades laborales pueden implicar riesgos para la salud física y emocional, así como para la productividad y satisfacción laboral. En México recientemente se publicó la Norma Oficial Mexicana NOM-035-STPS-2018, que establece que la identificación, análisis y prevención de factores de riesgo psicosocial debe realizarse en todos los centros de trabajo, incluyendo las instituciones universitarias. Método: Esta investigación tuvo como objetivos: a) evaluar el nivel de riesgo psicosocial en un centro universitario y describir las acciones necesarias en el cumplimiento de la Norma y b) explorar el uso de la escala de clima social organizacional y la escala de riesgo psicosocial para profesores universitarios para la evaluación complementaria. Resultados: Participaron 50 trabajadores, el 32% con nivel de riesgo psicosocial medio-alto, los dominios con más trabajadores en riesgo fueron: jornada de trabajo (74%) y falta de control sobre el trabajo (42%). Se encontraron correlaciones entre la mayoría de los factores de los cuestionaros, pero no con el factor Ambiente de trabajo del cuestionario de la NOM-035. Conclusiones: En este estudio, la implementación de la Norma permitió determinar las estrategias de acción potencialmente efectivas para reducir el riesgo psicosocial según las necesidades del centro de trabajo. En general, los instrumentos muestran consistencia, pero algunos factores no se ajustan a lo esperado, por lo que se sugiere corroborar su factibilidad en poblaciones similares.(AU)

Background: The work activities can involve risks to physical and emotional health, as well as productivity and job satisfaction. In México, the Official Mexican Standard NOM-035-STSPS-2018 was recently published, which establishes that the identification, analysis and prevention of psychosocial risk factors must be carried out in all work centers, including the university centers. Method: The objectives of this research were: a) evaluate the level of psychosocial risk in a university center and describe the necessary actions to be taken in complying with the Standard and b) explore the use of the organizational social climate scale and the psychosocial risk scale for university professors for the complementary evaluation. Results: Fifty workers participated, 32% with medium-high psychosocial risk level, the domains with the most workers at risk were: working hours (74%) and lack of control over work (42%). Correlations were found between most of the factors of the questionnaires but none with the work environment factor of the NOM-035 questionnaire. Conclusions: In this study, the implementation of the Standard allowed to determinate the potentially effective action strategies to reduce psychosocial risk according the needs of the workplace. In general, the instruments show consistency, but some factors do not match what is expected, so it is suggested to corroborate their feasibility in similar populations.(AU)

Atenção integral em Saúde do Trabalhador: limitações, avanços e desafios / Comprehensive worker's health care: limitations, advances, and challenges

Resumo Introdução: as políticas públicas e sociais em prol da atenção integral à saúde do trabalhador encontram-se enfraquecidas diante da nova configuração do mundo do trabalho e dos interesses econômicos prevalecentes. Objetivo: refletir sobre temas do campo da Saúde do Trabalhador (ST) que contribuem para a falta de efetividade das suas ações e para o prejuízo da sua atenção integral. Método: ensaio baseado em revisão documental e de literatura. Resultados: foram discutidos os avanços e os desafios para o alcance da atenção integral em ST nos temas: instituições e serviços responsáveis pela ST; Vigilância em Saúde do Trabalhador (VISAT); Sistemas de Informação em Saúde do Trabalhador (SIST) e sistema de proteção social; e formação de recursos humanos no campo da ST. Conclusão: a formulação de novas diretrizes e a implementação de medidas de intervenção são necessárias para o alcance da integralidade em ST, a universalidade dos SIST, uma ação articulada e integral de VISAT e a qualificação de profissionais por meio de uma aproximação teórico-prática.

Abstract Introduction: public and social policies aimed at a comprehensive worker's health care have been weakened in face of the recently changes in the world of work and the prevailing economic interests. Objective: to reflect on themes that have contributed for worker's health care actions becoming less effective and comprehensive. Method: essay based on a documentary research and literature review. Results: we discussed the following themes: institutions/services in charge of the occupational health care; Occupational Health Surveillance; social protection and occupational health information systems; human resources development for occupational health care. Conclusion: in order to reach worker's health comprehensive care, the formulation of new programmatic guidelines and the implementation of intervention measures are necessary.

Health Promotion at Work: A Comparison of Policy and Practice Across Europe.

BACKGROUND: Promoting healthy lifestyles at work should complement workplace safety programs. This study systematically investigates current states of occupational health and safety (OHS) policy as well as practice in the European Union (EU). METHODS: OHS policies of EU member states were categorized as either prevention or health promotion provisions using a manifest content analysis. Policy rankings were then created for each prevention and promotion. Rankings compared eight indicators from the European Survey of Enterprises on New and Emerging Risks-2 data on prevention and promotion practices for each member state using Chi-square and probit regression analyses. RESULTS: Overall, 73.1% of EU establishments take preventive measures against direct physical harm, and about 35.4% take measures to prevent psychosocial risks. Merely 29.5% have measures to promote health. Weak and inconsistent links between OHS policy and practice indicators were identified. CONCLUSION: National OHS policies evidently concentrate on prevention while compliance with health and safety practices is relatively low. Psychosocial risks are often addressed in national policy but not implemented by institutions. Current risk assessment methods are outdated and often lack psychosocial indicators. Health promotion at work is rare in policy and practice, and its interpretation remains preventive. Member states need to adopt policies that actively improve health and well-being at the workplace.

Health as a right and the care of the self: conception of nursing professionals / Salud como derecho y cuidado de sí: concepción de los profesionales de enfermería / Saúde como direito e cuidado de si: concepção dos profissionais de enfermagem

ABSTRACT Objective: To analyze health as a right from the perspective of care of the self, in the conception of nursing professionals. Method: Qualitative study, carried out in a Federal Hospital of the city of Rio de Janeiro, with the participation of 10 nurses and 20 nursing technicians through interviews recorded, transcribed and analyzed in light of the Discursive Textual Analysis. Results: Two categories emerged: Health as the right of professionals and their "non-right" to health; and Care of the self for the health professional: work and torture. Conclusion: There are many challenges to overcome, such as the search for satisfactory public funding, the need to improve the quality of Primary Health Care services, the implementation of a care model compatible with the country's demographic and epidemiological situation; all professionals need an effective endorsement for care of the self, such as their knowledge of the right to health.

RESUMEN Objetivo: Analizar la salud como derecho en la perspectiva del cuidado de sí, en la concepción de los profesionales de enfermería. Método: Estudio cualitativo realizado en un Hospital Federal de la ciudad de Río de Janeiro, con la participación de 10 enfermeros y 20 técnicos en enfermería mediante entrevistas grabadas, transcritas y analizadas a la luz del Análisis Textual Discursivo. Resultados: Se plantearon dos categorías: La salud como derecho del profesional y su "no derecho" a la salud; y El cuidado de sí para el profesional de la salud: trabajo y suplicio. Conclusión: Muchos son los desafíos a superar, tales como la búsqueda de un financiamiento público satisfactorio, la necesidad de mejorar la calidad de los servicios de Atención Primaria de Salud, la implementación de un modelo asistencial compatible con la situación demográfica y epidemiológica del país; todos los profesionales necesitan una efectiva atención para el cuidado de sí, como el conocimiento de sí en la búsqueda del derecho a la salud.

RESUMO Objetivo: Analisar a saúde como direito na perspectiva do cuidado de si, na concepção dos profissionais de enfermagem. Método: Estudo qualitativo realizado em um Hospital Federal da cidade do Rio de Janeiro, com a participação de 10 enfermeiros e 20 técnicos em enfermagem mediante entrevistas gravadas, transcritas e analisadas à luz da Análise Textual Discursiva. Resultados: Emergiram duas categorias: A saúde como direito do profissional e o seu "não direito" à saúde; e O cuidado de si para o profissional de saúde: trabalho e suplício. Conclusão: Muitos são os desafios a superar, tais como a busca de um financiamento público satisfatório, a necessidade de melhorar a qualidade dos serviços de Atenção Primária à Saúde, a implementação de um modelo assistencial compatível com a situação demográfica e epidemiológica do país; todos os profissionais precisam de uma efetiva visada para cuidado de si, como o conhecimento de si na busca pelo direito à saúde.

Health Promotion at Work: A Comparison of Policy and Practice Across Europe

BACKGROUND: Promoting healthy lifestyles at work should complement workplace safety programs. This study systematically investigates current states of occupational health and safety (OHS) policy as well as practice in the European Union (EU). METHODS: OHS policies of EU member states were categorized as either prevention or health promotion provisions using a manifest content analysis. Policy rankings were then created for each prevention and promotion. Rankings compared eight indicators from the European Survey of Enterprises on New and Emerging Risks-2 data on prevention and promotion practices for each member state using Chi-square and probit regression analyses. RESULTS: Overall, 73.1% of EU establishments take preventive measures against direct physical harm, and about 35.4% take measures to prevent psychosocial risks. Merely 29.5% have measures to promote health. Weak and inconsistent links between OHS policy and practice indicators were identified. CONCLUSION: National OHS policies evidently concentrate on prevention while compliance with health and safety practices is relatively low. Psychosocial risks are often addressed in national policy but not implemented by institutions. Current risk assessment methods are outdated and often lack psychosocial indicators. Health promotion at work is rare in policy and practice, and its interpretation remains preventive. Member states need to adopt policies that actively improve health and well-being at the workplace.

A socio-historical approach to policy analysis: the case of the Brazilian Workers' Food Policy / Uma abordagem sócio-histórica à análise de políticas: o caso do Programa de Alimentação do Trabalhador no Brasil / Un enfoque sociohistórico para el análisis de políticas: el caso de la Política Alimentaria de los Trabajadores de Brasil

Abstract: Policy analyses based on traditional or structuralist definitions of the state are important, but they have some limitations for explaining processes related to policymaking, implementation, and results. Bourdieusian sociology links the analysis to objective and subjective dimensions of social practices and can help elucidate these phenomena. This article provides such empirical evidence by analyzing the social genesis of a Brazilian policy that currently serves 18 million workers and was established by the state in 1976 through the Fiscal Incentives Program for Workers' Nutrition (PIFAT/PAT). The study linked the analysis of the trajectory of social agents involved in the policy's formulation to the historical conditions that allowed the policy to exist in the first place. Although the literature treats the policy as a workers' food program (PAT), the current study showed that it actually represented a new model for paying financial subsidies to companies that provided food to their employees, meanwhile upgrading the commercial market for collective meals. The study further showed that the program emerged as an administrative policy, but linked to economic agents. The program became a specific social space in which issues related to workers' nutrition became secondary, but useful for disguising what had been an explicit side of its genesis, namely its essentially fiscal nature.

Resumo: Análises de políticas que partem das concepções clássicas ou estruturalistas do Estado, embora importantes, apresentam algumas limitações na explicação dos processos relacionados com a sua formulação, implementação e resultados. A sociologia Bourdieusiana, ao articular a análise das dimensões objetivas e subjetivas das práticas sociais, pode contribuir para a compreensão desses fenômenos. Este artigo traz evidências empíricas a esse respeito ao analisar a sociogênese de uma política brasileira que atende atualmente a 18 milhões de trabalhadores e que foi instituída pelo Estado em 1976, consubstanciada no Programa de Incentivo Fiscal da Alimentação do Trabalhador (PIFAT/PAT). O trabalho articulou a análise da trajetória dos agentes sociais envolvidos com a sua formulação e o estudo das condições históricas de possibilidade de sua emergência. Embora a literatura a trate como um programa de alimentação do trabalhador (PAT), o presente estudo revelou que, de fato, ela representou um novo modelo de subsídio financeiro às empresas que ofereciam alimentação aos seus empregados, potencializando o mercado de refeições coletivas. Foi ainda constatado que o programa emergiu no interior do campo burocrático, mas em articulação com agentes do campo econômico. Constituiu-se como espaço social específico, em que as questões relacionadas à alimentação se mostraram secundárias, mas úteis na ocultação da face antes explícita em sua gênese: sua natureza essencialmente tributária.

Resumen: Análisis de políticas que parten de concepciones clásicas o estructuralistas del Estado que, pese a que son importantes, presentan algunas limitaciones en la explicación de los procesos relacionados con su formulación, implementación y resultados. La sociología Bourdieusiana, al vincular el análisis de las dimensiones objetivas y subjetivas de las prácticas sociales, puede contribuir a la comprensión de estos fenómenos. Este artículo presenta evidencias empíricas a este respecto, al analizar la sociogénesis de una política brasileña que atiende actualmente a 18 millones de trabajadores, y que fue instituida por el Estado en 1976, consustancial al Programa de Incentivo Fiscal de la Alimentación del Trabajador (PIFAT/PAT). El estudio trata tanto sobre el análisis de la trayectoria de los agentes sociales implicados en su formulación, como sobre el estudio de las condiciones históricas acerca de las posibilidades para su aparición. A pesar de que la literatura lo considere un programa de alimentación del trabajador (PAT), el presente estudio reveló que, de hecho, representó un nuevo modelo de subsidio financiero para las empresas que ofrecían alimentación a sus empleados, potenciando el mercado de comidas colectivas. Se constató incluso que el programa surgió dentro del ámbito burocrático, pero en coordinación con agentes del área económica. Se constituyó como un espacio social específico, donde las cuestiones relacionadas con la alimentación se mostraron secundarias, pero útiles para el ocultar un aspecto antes explícito en su génesis: su naturaleza eminentemente tributaria.

We Have to Be Willing to Say the World Has Changed and Now We Have to Figure Out How to Deal With That: An Interview With Charles Levenstein, About New Solutions.

New Solutions: A Journal of Environmental and Occupational Health Policyhas been published for 25 years. To acknowledge this milestone, Dr. Pia Markkanen interviewed Charles Levenstein, Editor Emeritus of the journal, in August 2015. The purpose of this interview was to review the journal's history: from its earliest roots to the present.New Solutionsbegan in 1990 as a project with the Oil, Chemical and Atomic Workers Union (OCAW). Dr. Charles Levenstein was the founding editor and Tony Mazzocchi was the original publisher. We've tapped Dr. Levenstein's memory to learn the intent of starting the journal and how it developed. The interview presents some of the challenges of sustaining a movement journal with the mission of being a bridge between academics and researchers and workers, environmentalists, as well as advocates and activists.

Health care workers' influenza vaccination: motivations and mandatory mask policy.

BACKGROUND: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. AIMS: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. METHODS: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiary-care university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. RESULTS: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). CONCLUSIONS: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW.

Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence.

There is still a considerable burden of occupational diseases and injuries in the world. It is not well known which interventions can effectively reduce the exposures at work that cause this burden. The objective of this article is to summarize evidence from systematic reviews of interventions to prevent occupational diseases and injuries. We included systematic reviews of interventions to reduce the incidence of work-related cancer, dust-related diseases, occupational asthma, chronic obstructive pulmonary disease, noiseinduced hearing loss, back pain, and occupational injuries. We searched Medline and Embase with predefined search strategies to locate systematic reviews of these interventions. We found 23 systematic reviews of which the results are also applicable to low- and middle income countries. Effective measures to reduce exposure leading to work-related cancer, dust-related diseases, asthma, chronic obstructive pulmonary disease, noise, and injuries are available. However, better implementation of these measures is needed. Regulation, enforcement of regulation, and incentives for employers are effective interventions to achieve this goal. There is evidence that feedback and rewards for workers help in reducing occupational injuries. There is no evidence in many studies that back pain can be prevented. Personal protective equipment technically has the potential to reduce exposure but this is difficult to put into effect. There is no evidence in the studies regarding the effectiveness of education and training, preventive drugs, or health examinations. There is evidence that the implementation of technical measures enforced by regulation can prevent occupational diseases and injuries. For other interventions such as education or health examinations, there is no evidence that supports their effectiveness. More systematic reviews are needed in the area of injury prevention.

Essential Occupational Safety and Health Interventions for Low- and Middle-income Countries: An Overview of the Evidence

There is still a considerable burden of occupational diseases and injuries in the world. It is not well known which interventions can effectively reduce the exposures at work that cause this burden. The objective of this article is to summarize evidence from systematic reviews of interventions to prevent occupational diseases and injuries. We included systematic reviews of interventions to reduce the incidence of work-related cancer, dust-related diseases, occupational asthma, chronic obstructive pulmonary disease, noiseinduced hearing loss, back pain, and occupational injuries. We searched Medline and Embase with predefined search strategies to locate systematic reviews of these interventions. We found 23 systematic reviews of which the results are also applicable to low- and middle income countries. Effective measures to reduce exposure leading to work-related cancer, dust-related diseases, asthma, chronic obstructive pulmonary disease, noise, and injuries are available. However, better implementation of these measures is needed. Regulation, enforcement of regulation, and incentives for employers are effective interventions to achieve this goal. There is evidence that feedback and rewards for workers help in reducing occupational injuries. There is no evidence in many studies that back pain can be prevented. Personal protective equipment technically has the potential to reduce exposure but this is difficult to put into effect. There is no evidence in the studies regarding the effectiveness of education and training, preventive drugs, or health examinations. There is evidence that the implementation of technical measures enforced by regulation can prevent occupational diseases and injuries. For other interventions such as education or health examinations, there is no evidence that supports their effectiveness. More systematic reviews are needed in the area of injury prevention.

Tuberculosis como enfermedad ocupacional / Tuberculosis as occupational disease

Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Perú están normados y reglamentados los derechos laborales inherentes a la tuberculosis como enfermedad ocupacional, como la cobertura por discapacidad temporal o permanente. Sin embargo, estos derechos aún no han sido suficientemente socializados. En este trabajo se presenta información sobre el riesgo de adquirir tuberculosis en el lugar de trabajo, se revisan las evidencias para declarar a la tuberculosis como enfermedad ocupacional en trabajadores de salud y se presenta la legislación peruana vigente al respecto.

There is enough evidence to declare tuberculosis as an occupational disease among healthcare workers. In Peru, there are regulations granting employment rights regarding tuberculosis as an occupational disease, such as healthcare coverage for temporary or permanent disability. However, these rights have not been sufficiently socialized. This study presents information on the risk of acquiring tuberculosis in the workplace, and a review of the evidence to declare tuberculosis as an occupational disease among health care workers, presenting the current Peruvian law related.