Artigos e Materiais de Revistas Científicas - ODS/08
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- Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil(2023) MIRANDA, C. B. de; SILVA-JUNIOR, J. S.; GARCIA, K. K. S.; SOUSA, F. N. E. F. de; FISCHER, F. M.Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12–6.91) or southern region (HR: 2.68; 95% CI 1.04–6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07–6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05–6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation.
- Cancer mortality and premature deaths among hairdressers in Brazil(2024) BURALLI, Rafael; RIBEIRO, Adeylson; CREMONESE, Cleber; VINEIS, Paolo; MEYER, ArmandoHairdresser is an occupation classified by the International Agency for Research on Cancer as probably carcinogenic (Group 2A) for lung and bladder cancer, but evidence is accumulating on its association with other cancer types. To our knowledge, this is the first study aimed to compare the cancer mortality and premature mortality between hairdressers and other workers in Brazil. Methods: In this exploratory study, information on deaths by selected cancers that occurred in Brazil, from 1996 to 2020, among workers aged 20-70y, with identified occupation was gathered from the Brazilian Mortality Information System. Sociodemographic characteristics, sex-specific mortality ratio, and Years of Potential Life Lost (YPLL) were compared between hairdressers, service workers, and general workers. We used logistic regression models to estimate crude (ORC) and adjusted (ORADJ) odds ratios. Models were adjusted by age, educational level, and ethnicity. We also used Poisson regression models to compare the YPLL rates across the occupational groups. Results: From 1996 to 2020, 23 557 deaths occurred among hairdressers, 576 428 among service workers, and 13 332 996 among general workers in Brazil. Higher mortality ORs and YPLL were observed for several types of cancer among hairdressers, compared to service and general workers, especially for women. Hairdressers' mortality was significantly higher among whites, women, younger workers, and those who completed high school. Female hairdressers had significantly higher odds of dying from cancer of the digestive, respiratory, reproductive, urinary, and hematological systems, both in crude and adjusted models. For male hairdressers, higher odds were found only for urinary tract and bladder cancer, while other significant associations indicated lower mortality than the comparison groups. YPLL analyses revealed significant premature deaths among Brazilian hairdressers. In women, this was more evident among those who died of neoplasms of salivary glands, bones and articular cartilages, and acute lymphoid leukemia; in men, tongue, pharynx, and thyroid. Conclusions: Our results suggest that Brazilian female hairdressers are more likely to die from several cancers, with potential consequences on premature deaths. Causal associations to occupational risks, such as exposure to chemicals, should be investigated by observational epidemiologic studies. Meanwhile, it is important to promote public policies, regulations, and Occupational Safety and Health (OSH) strategies to protect hairdressers' health, mitigate occupational risks, and ensure safe workplaces.
- Air Pollution and Health - A Science-Policy Initiative(2019) ANDRADE, Maria de Fatima; ARTAXO, Paulo; MIRAGLIA, Simone Georges El Khouri; GOUVEIA, Nelson; KRUPNICK, Alan J.; KRUTMANN, Jean; LANDRIGAN, Philip J.; LANGERMAN, Kristy; MAKONESE, Tafadzwa; MATHEE, Angela; PIKETH, Stuart; RITZ, Beate; SALDIVA, Paulo H. N.; SAMET, Jonathan; SCHIKOWSKI, Tamara; SCHNEIDER, Alexandra; SMITH, Kirk R.; TRAIDL-HOFFMANN, Claudia; WIEDENSOHLER, Alfred; WRIGHT, Caradee; BOYD, David Richard; FOLTESCU, Valentin; FULLER, Richard; JAROSINSKA, Dorota; MCGLADE, Jacqueline Myriam; SHINDELL, Drew; SCHEUENSTUHL, Marcos Cortesao Barnsley; BORIGHT, John P.; BULANI, Siyavuya; HAMBURG, Margaret; HAPPE, Kathrin; NISSEN, Jan; SCHEER, IsabelAir pollution is a major, preventable and manageable threat to people's health, well-being and the fulfillment of sustainable development. Air pollution is estimated to contribute to at least 5 million premature deaths each year across the world. No one remains unaffected by dirty air, but the adverse impacts of air pollution fall most heavily upon vulnerable populations, such as children, women, and people living in poverty - groups to whom States have special obligations under international human rights law. The National Academies of Sciences and Medicine of South Africa, Brazil, Germany and the United States of America are calling upon government leaders, business and citizens to take urgent action on reducing air pollution throughout the world - to the benefit of human health and well-being, to the benefit of the environment and as a condition towards sustainable development. Air pollution is a cross-cutting aspect of many UN Sustainable Development Goals.
- A concept for integrated care pathways for atopic dermatitis-A GA2LEN ADCARE initiative(2023) ZUBERBIER, Torsten; LATIFF, Amir Abdul; AGGELIDIS, Xenofon; AUGUSTIN, Matthias; BALAN, Radu-Gheorghe; BANGERT, Christine; BECK, Lisa; BIEBER, Thomas; BERNSTEIN, Jonathan A.; COLILLA, Marta Bertolin; BERARDI, Alejandro; SERRA-BALDRICH, Esther; SIEMENS, Kristina; SMITH, Cathrine; STAUBACH, Petra; STEVANOVIC, Katarina; SU-KUCUK, Ozlem; SUSSMAN, Gordon; TAVECCHIO, Simona; MITREVSKA, Natasa Teovska; THACI, Diamant; TOUBI, Elias; TRAIDL-HOFFMANN, Claudia; TREUDLER, Regina; VADASZ, Zahava; HOFMAN, Ingrid van; VENTURA, Maria Teresa; WANG, Zhao; WERFEL, Thomas; WOLLENBERG, Andreas; YANG, Ariana; YEW, Yik Weng; ZHAO, Zuotao; ZWIENER, Ricardo; WORM, Margitta; BEDBROOK, Anna; BINDSLEV-JENSEN, Carsten; BOUSQUET, Jean; BRUIN-WELLER, Marjolein de; BRUSCKY, Dayanne; BUYUKTIRYAKI, Betul; CANONICA, Giorgio Walter; CASTRO, Carla; CHANTURIDZE, Natia; CHONG-NETO, Herberto Jose; CHU, Chia-Yu; CHULAROJANAMONTRI, Leena; CORK, Michael; CRIADO, Roberta F. J.; BARREDO, Laia Curto; CUSTOVIC, Adnan; DARSOW, Ulf; EMURLAI, Arben; PABLO, Ana de; GIACCO, Stefano Del; GIROLOMONI, Giampiero; JOVANOVA, Tanja Deleva; DELEURAN, Mette; DOULADIRIS, Nikolaos; DUARTE, Bruno; DUBAKIENE, Ruta; ELLER, Esben; ENGEL-YEGER, Batya; ENSINA, Luis Felipe; FILHO, Nelson Rosario; FLOHR, Carsten; FOMINA, Daria; FRANCUZIK, Wojciech; GALIMBERTI, Maria Laura; GIMENEZ-ARNAU, Ana M.; GODSE, Kiran; MORTZ, Charlotte Gotthard; GOTUA, Maia; HIDE, Michihiro; HOETZENECKER, Wolfram; HUNZELMANN, Nicolas; IRVINE, Alan; JACK, Carolyn; KANAVAROU, Ioanna; KATOH, Norito; KINACIYAN, Tamar; KOCATUERK, Emek; KULTHANAN, Kanokvalai; LAPEERE, Hilde; LAU, Susanne; NASTRI, Mariana Machado Forti; MAKRIS, Michael; MANSOUR, Eli; MARSLAND, Alexander; FELIX, Mara Morelo Rocha; CASTRO, Ana Paula Moschione; NETTIS, Eustachio; NICOLAS, J. F.; NOSBAUM, Audrey; ODEMYR, Mikaela; PAPAPOSTOLOU, Niki; PARISI, Claudio A. S.; PAUDEL, Sushil; PETER, Jonny; POKHAREL, Prakash; PUIG, Luis; QUINT, Tamara; RAMON, German Dario; REGATEIRO, Frederico; RICCI, Giampaolo; ROSARIO, Cristine; SACKESEN, Cansin; SCHMID-GRENDELMEIER, PeterIntroduction: The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems.Methods: The GA(2)LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL(2)EN ADCARE centres.Results: The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD.Conclusion: The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD.
- COVID-19 infection in nursing staff: A cohort study(2023) NOGUEIRA, Lilia de Souza; POVEDA, Vanessa de Brito; LEMOS, Cassiane de Santana; BRUNA, Camila Quartim de Moraes; MOURA, Bruna Roberta SiqueiraAimThis study aims to identify the working conditions of Brazilian nursing professionals and the risk factors for these professionals to become infected by coronavirus disease. BackgroundUnderstanding the factors that affected nursing professionals during the pandemic can support better nursing management. DesignThis is a quantitative, cross-sectional survey study. MethodsData collection was carried out between February and March 2022 in Brazil. All nursing professionals registered in the national database received by e-mail the study instrument with the data collection variables: professionals' sociodemographic and comorbid, professional and institutional characteristics, and professionals' health conditions and disease-related aspects for COVID-19. ResultsFour thousand eight hundred sixty-two nursing professionals reported a lack of personal protective equipment for patient care, and 4424 were infected by coronavirus disease. The risk factors to become infected were having cardiovascular disease, being under 60 years of age, living in the northern region, using public transportation, working in a hospital, an emergency department or reference institution for COVID-19, living with an infected person and lack of respirators or waterproof aprons. ConclusionMultiple risk factors for infection with SARS-CoV-2 were demonstrated for the nursing professionals during the pandemic, highlighting current and future pandemics factors that are modifiable in a worthwhile time frame to minimize nurses' infection risks, such as inadequate working conditions associated with lack of essential personal protective equipment.
- What happened to health labour markets during COVID-19? Insights from the analysis of cross-sectional survey data on the perceptions of medical doctors in Brazil(2023) RUSSO, Giuliano; OLIVEIRA, Bruno Luciano Carneiro Alves Luciano de; CASSENOTE, Alex J. Flores; SCHEFFER, Mario C.ObjectivesTo examine physicians' perceptions of changing employment opportunities in Brazil, and gain an insight into labour markets in low/middle-income countries (LMICs) during the pandemic. Study designDescriptive and inferential analysis of a quantitative dataset from a representative cross-sectional survey of physicians of two Brazilian states. SettingsSao Paulo and Maranhao states in Brazil. ParticipantsRepresentative sample of 1183 physicians. Outcome measuresWe estimated prevalence and 95% CIs for physicians' perceptions of changes in demand and supply of doctors, as well as changes in prices of medical services for facilities of practice in the two states, stratified by public, private and dual-practice physicians. ResultsMost doctors reported increased job opportunities in the public sector (54.9%, 95% CI 52.0% to 57.7%), particularly in Maranhao state (65.0%, 95% CI 60.9% to 68.9%). For the private sector, increased opportunities were reported only in large private hospitals (46.7%, 95% CI 43.9% to 49.6%) but not in smaller clinics. We recorded perceptions of slight increases in availability of doctors in Maranhao, particularly in the public sector (51.4%, 95% CI 43.2% to 59.5%). Younger doctors recounted increased vacancies in the public sector (64%, 95% CI 58.1% to 68.1%), older doctors only in walk-in clinics in Maranhao (47.5%, 95% CI 39.9% to 55.1%). Those working directly with patients with COVID-19 saw opportunities in public hospitals (65%, 95% CI 62.3% to 68.4%) and in large private ones (55%, 95% CI 51.8% to 59.1%). ConclusionsOur findings hint that health labour markets in LMICs may not necessarily shrink during epidemics, and that impacts will depend on the balance of public and private services in national health systems.
- Children and adolescents continue to be exposed to early work in Brazil(2023) JR, Cassio de Mattos Dziabas; DIONIZIO, Barbara Silveira; VIANA, Ana Maiara; DELMONDES, Gyllyandeson de Araujo; AMORIM, Daniel Machado de; JR, Jose Oliveira de Amorim; LEITE, Loyze Petronio; NOGUEIRA, Matheus Figueiredo; MACEDO, Luis Fernando Reis; NETO, Modesto Leite Rolim2 million children and adolescents between 11 and 19 years old have not yet finished basic education and had left school. The current Brazilian scenario reflects the reality in which these children and adolescents are inserted, without sufficient resources for the continuity of basic or elementary education, and often the parents' lack of income leads these young people to seek work, as can be seen in several capitals and inland cities: children selling food at traffic lights, bars, restaurants, and similar situations5. According to a study carried out by Abrinq Foundation (Fundacao Abrinq), in the last quarter of 2021, there were about 2.36 million adolescents aged between 14 and 17 years old in the labor market or looking for a job, of which 1.2 million were in child labor in disagreement with Brazilian legislation, including work similar to slavery, and activities harmful to health, development, and morality. & COPY; 2022 Published by Elsevier Inc.
- Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study(2023) GAMEIRO, Gustavo Rosa; GAMEIRO, Giovana Rosa; MIOTTO, Bruno Alonso; GUILLOUX, Aline Gil Alves; CASSENOTE, Alex Jones Flores; SCHEFFER, Mario CesarOBJECTIVE: The objective of this study was to evaluate fresh medical graduates' perceptions regarding the general aspects of ethics teaching in Brazilian medical schools.METHODS: A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages.RESULTS: A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients' families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants' medical training. Statistically significant differences were found between the answers of public and private school graduates.CONCLUSION: Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.
- Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019(2023) LI, Chuanxi; WANG, Zhendong; YAN, Yu; QU, Yinan; HOU, Liangyu; LI, Yijie; CHU, Cordia; WOODWARD, Alistair; SCHIKOWSKI, Tamara; SALDIVA, Paulo Hilario Nascimento; LIU, Qiyong; ZHAO, Qi; MA, WeiIMPORTANCE Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear. OBJECTIVE To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022. EXPOSURES City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019. MAIN OUTCOMES AND MEASURES The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development. RESULTS Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60). CONCLUSIONS AND RELEVANCE Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.
- Productivity-adjusted life years lost due to non-optimum temperatures in Brazil: A nationwide time-series study(2023) WEN, Bo; ADEMI, Zanfina; WU, Yao; XU, Rongbin; YU, Pei; YE, Tingting; COELHO, Micheline de Sousa Zanotti Stagliorio; SALDIVA, Paulo Hilario Nascimento; GUO, Yuming; LI, ShanshanNon-optimal temperatures are associated with premature deaths globally. However, the evidence is limited in low-and middle-income countries, and the productivity losses due to non-optimal temperatures have not been quantified. We aimed to estimate the work-related impacts and economic losses attributable to non-optimal temperatures in Brazil. We col-lected daily mortality data from 510 immediate regions in Brazil during 2000 and 2019. A two-stage time-series analysis was applied to evaluate the association between non-optimum temperatures and the Productivity-Adjusted Life-Years (PALYs) lost. The temperature-PALYs association was fitted for each location in the first stage and then we applied meta -analyses to obtain the national estimations. The attributable fraction (AF) of PALY lost due to ambient temperatures and the corresponding economic costs were calculated for different subgroups of the working-age population. A total of 3,629,661 of PALYs lost were attributed to non-optimal temperatures during 2000-2019 in Brazil, corresponding to 2.90 % (95 % CI: 1.82 %, 3.95 %) of the total PALYs lost. Non-optimal temperatures have led to US$104.86 billion (95 % CI: 65.95, 142.70) of economic costs related to PALYs lost and the economic burden was more substantial in males and the population aged 15-44 years. Higher risks of extreme cold temperatures were observed in the South region in Brazil while extreme hot temperatures were observed in the Central West and Northeast regions. In conclusion, non -optimal temperatures are associated with considerable labour losses as well as economic costs in Brazil. Tailored policies and adaptation strategies should be proposed to mitigate the impacts of non-optimal temperatures on the labour supply in a changing climate.
- Incor Residency Program in Adult Cardiology in 2022: 40 Years Preparing Cardiologists for the Demands in Brazil(2022) LOTTENBERG, Marcos Pita; BICHUETTE, Luciana Dornfeld; BORTOLOTTO, Luiz Aparecido; GOWDAK, Luis Henrique Wolff; DARRIEUX, Francisco Carlos da Costa; BINOTTO, Maria Angelica; KALIL FILHO, Roberto; CARAMELLI, BrunoBackground: Considering demographic data related to the cardiologist's fields of work in Brazil, the administrative board of the InCor medical residency program decided for an update of its curriculum content, to adapt the educational process to the cardiologist's work reality. Objective: This article aimed to describe the recent updates applied to the InCor medical residency program. Methods: In the article, we described the recent updates on the InCor residency program, and compared the current curriculum track with the previous one. We also presented the rationale for these changes, based on the literature on the participation of cardiologists in the labor market. Results: There was a reduction in the working hours of residents in training in the intensive care unit, and an increase in the outpatient activities of primary and secondary prevention. Also, the didactic content was reformulated and became organized by the corresponding division. Conclusion: The update of the curriculum track of the InCor medical residency program was required in order to adapt it to the Brazilian labor market. The commission in charge of this update is aware that this is a dynamic process that may need changes over time.
- Economic burden of sickle cell disease in Brazil(2022) SILVA-PINTO, Ana Cristina; COSTA, Fernando F.; GUALANDRO, Sandra Fatima Menosi; FONSECA, Patricia Belintani Blum; GRINDLER, Carmela Maggiuzzu; SOUZA FILHO, Homero C. R.; BUENO, Carolina Tosin; CANCADO, Rodolfo D.Background Sickle cell disease (SCD) may cause several impacts to patients and the whole society. About 4% of the population has the sickle cell trait in Brazil, and 60,000 to 100,000 have SCD. However, despite recognizing the significant burden of disease, little is known about SCD costs. Objective To estimate SCD societal costs based on disease burden modelling, under Brazilian societal perspective. Methods A disease burden model was built considering the societal perspective and a one-year time horizon, including direct medical and indirect costs (morbidity and mortality). The sum of life lost and disability years was considered to estimate disability-adjusted life years (DALYs). Data from a public database (DATASUS) and the prevalence obtained from literature or medical experts were used to define complications prevalence and duration. Costs were defined using data from the Brazilian public healthcare system table of procedures and medications (SIGTAP) and the human capital method. Results Annual SCD cost was 413,639,180 USD. Indirect cost accounted for the majority of burden (70.1% of the total; 290,158,365 USD vs 123,480,816 USD). Standard of care and chronic complications were the main source of direct costs among adults, while acute conditions were the main source among children. Vaso-occlusive crisis represented the complication with the highest total cost per year in both populations, 11,400,410 USD among adults and 11,510,960 USD among children. Conclusions SCD management may impose an important economic burden on Brazilian society that may reach more than 400 million USD per year.
- The Impact of the COVID-19 Pandemic on Physicians' Working Hours and Earnings in Sao Paulo and Maranhao States, Brazil(2022) OLIVEIRA, Bruno Luciano Carneiro Alves de; ANDRIETTA, Lucas Salvador; REIS, Regimarina Soares; CARVALHO, Ruth Helena de Souza Britto Ferreira de; ALVES, Maria Teresa Seabra Soares e; SCHEFFER, Mario Cesar; RUSSO, GiulianoEvidence exists on the health impacts of the current COVID-19 pandemic on health workers, but less is known about its impact on their work dynamics and livelihoods. This matters, as health workers-and physicians in particular-are a scarce and expensive resource in low- and middle-income countries (LMICs). Our cross-sectional survey set out to explore changes in working hours and earnings during the second year of the pandemic in a representative sample of 1183 physicians in Brazil's Sao Paulo (SP) and Maranhao (MA) states. Descriptive analysis and inferential statistics were employed to explore differences in working hours and earnings among public and private sector physicians across the two locations. The workloads and earnings of doctors working exclusively in the public sector increased the most in the second year of the epidemic, particularly in MA. Conversely, the largest proportion of private-only doctors in our sample saw a decrease in their working hours (48.4%, 95% CI 41.8-55.0), whereas the largest proportion of public-only doctors in MA saw an increase in their working hours (44.4%, 95% CI 38.0-50.8). Although earnings remained broadly stable in the public sector, a third of public sector-only physicians in MA saw an increase in their earnings (95% CI 24.4-36.2). More than half of private-only doctors across both states saw a decrease in their earnings (52.2%, 95% CI 45.6-58.8). The largest proportion of dual practitioners (the majority in Brazil and in our sample) maintained their pre-pandemic levels of income (38.8%, 95% CI 35.3-42.3). As public-sector doctors have been key in the fight against the pandemic, it is critical to invest in these cadres in order to develop epidemic preparedness in LMICs, and to find new ways to harness for-profit actors to deliver social benefits.
- Occupational Safety and Health Staging Framework for Decent Work(2022) SCHULTE, Paul A.; IAVICOLI, Ivo; FONTANA, Luca; LEKA, Stavroula; DOLLARD, Maureen F.; SALMEN-NAVARRO, Acran; SALLES, Fernanda J.; OLYMPIO, Kelly P. K.; LUCCHINI, Roberto; FINGERHUT, Marilyn; VIOLANTE, Francesco S.; SENEVIRATNE, Mahinda; OAKMAN, Jodi; LO, Olivier; ALFREDO, Camila H.; BANDINI, Marcia; SILVA-JUNIOR, Joao S.; MARTINEZ, Maria C.; COTRIM, Teresa; OMOKHODION, Folashade; FISCHER, Frida M.The 2030 United Nations Goal 8 for sustainable development focuses on decent work. There is utility in identifying the occupational safety and health aspects of Goal 8, as they pertain to the four pillars of decent work: job creation, social protection, rights of workers, and social dialogue. A workgroup of the International Commission on Occupational Health and collaborators addressed the issue of decent work and occupational safety and health (OSH) with the objective of elaborating a framework for guidance for practitioners, researchers, employers, workers, and authorities. This article presents that framework, which is based on an examination of the literature and the perspectives of the workgroup. The framework encompasses the intersection of the pillars of decent (employment creation, social protection, rights of workers, and social dialogue) work with new and emerging hazards and risks related to various selected determinants: new technologies and new forms of work; demographics (aging and gender); globalization; informal work; migration; pandemics; and OSH policies and climate change. The OSH field will need an expanded focus to address the future of decent work. This focus should incorporate the needs of workers and workforces in terms of their well-being. The framework identifies a starting point for the OSH community to begin to promote decent work.
- Personal protective equipment implementation in healthcare: A scoping review(2022) CORDEIRO, Luciana; GNATTA, Juliana Rizzo; CIOFI-SILVA, Caroline Lopes; PRICE, Amy; OLIVEIRA, Naila Albertina de; ALMEIDA, Rodrigo M. A.; MAINARDI, Giulia M.; SRINIVAS, Shrinidhy; CHAN, Whitney; LEVIN, Anna Sara S.; PADOVEZE, Maria ClaraBackground: Adherence to infection prevention and control (IPC) measures, including the proper use of pro-tective personal equipment (PPE), in health care is complex and is influenced by many factors. Isolated inter-ventions do not have the potential to achieve optimal PPE adherence and appropriate provision, leading to incomplete PPE implementation.Objective: To map PPE implementation in health care with a focus on its barriers and facilitators.Methods: A scoping review was conducted across 14 electronic databases using the Joanna Briggs Institute methodology.Results: Seventy-four papers were included in the review. Findings were analyzed and synthesized into categories to match the Consolidated Framework for Implementation Research domains. The content was then synthesized into barriers for PPE implementation and interventions to address them. The main barriers were discomfort in clinical work; shortage, supply and logistics problems; inadequacies in facili-ties infrastructure, weakness in policies and communication procedures; and health workers' (HW) psychological issues and lack of preparedness. Implementation interventions reported were related to HW wellbeing assurance; work reorganization; IPC protocols; adoption of strategies to improve commu-nication and HW training; and adoption of structural and organizational changes to improve PPE adherence.Conclusions: PPE implementation, which is critical IPC programs, involves multilevel transdisciplinary com-plexity. It relies on the development of context-driven implementation strategies to inform and harmonize IPC policy in collaboration with local and international health bodies.(c) 2022 Association for Professionals in Infection Control and Epidemiology, Inc.
- Adherence to non-pharmacological preventive measures among healthcare workers in a middle-income country during the first year of the COVID-19 pandemic: Hospital and community setting(2022) COSTA, Silvia Figueiredo; VERNAL, Sebastian; GIAVINA-BIANCHI, Pedro; PERES, Carlos Henrique Mesquita; SANTOS, Lanuse G. D. dos; SANTOS, Roseli E. B.; SANTOS, Rita C. C.; FRANCISCO, Maria Cristina P. B.; SATIE, Fatima M.; SECCO, Ligia M. dal; CORA, Aline Pivetta; SANTOS, Carolina Lazari dos; DUARTE, Alberto Jose da Silva; BONFA, Eloisa Silva Dutra de Oliveira; PERREIRA, Antonio Jose; SABINO, Ester Cedeira; SEGURADO, Aluisio Cotrin; LEVIN, Anna SaraThis study assessed, using a self-reported questionnaire, the adherence to PPE (mask, gowns, and gloves) at the workplace, as well as to non-pharmacological preventive measures (NPPM) (physical distance defined as hardly ever and/or never approaches other people within 1.5 meters, social isolation as leaving home less than once a week, hand hygiene was defined as performing hand hygiene >= 6 times per period, and adherence to the use of a mask outside of the workplace was defined as on all outings and hardly ever and/or never removes the mask) outside of the workplace among 1,296 health care workers (HCWs), including if NPPM adherence was associated with COVID-19 in HCWs. High adherence to PPE was independently associated with younger age, professional category, work in an area of direct patient assistance; use of public transportation, or adherence to NPPM outside of the workplace.
- Estimating the cost of training an ophthalmologist in Brazil(2022) KARA JÚNIOR, Newton; SCHERER, RafaelABSTRACT Introduction: It is estimated that 23% of the Brazilian population does not have access to an ophthalmologist, mainly because of the irregular geographical distribution of experts. It may be expensive to train ophthalmologists in Brazil. Objective: To estimate the cost of training an ophthalmologist and the labor market conditions so that the provider recovers the investment. Methods: Epidemiological study in databases from governmental sources and institutions related to the eye health system regulation. Results: The cost for training an ophthalmologist would be equal to R$ 592.272,00. After specialization, if the provider pledged all his/her income to recover the amount spent on training, it would take 5.2 years to reach the point of equilibrium. Conclusion: Young doctors from families unable to afford the cost of their education and support for at least 14 years after the beginning of the undergraduate course will hardly be able to specialize in Ophthalmology if they are unable to carry out their studies in public educational institutions. And those who can specialize are likely to choose to practice their profession in large urban centers, where most of the job opportunities are available, to at least recover the financial investment in training in the medium term.
- Doenças raras, drogas órfãs e as políticas para avaliação e incorporação de tecnologias nos sistemas de saúde(2019) NOVAES, Hillegonda Maria Dutilh; SOÁREZ, Patrícia Coelho deAbstract This work discusses the problem of rare diseases and orphan drugs in the context of the medical science and practice, especially regarding the technological development, innovation, evaluation and incorporation of technologies in health systems and their impacts on theory, practices and policies on Health Technology Assessment (HTA). A thematic review of scientific literature was conducted involving the areas of Medicine, Sociology of Medicine, Health Science and Technology and Public Health, in order to provide an interdisciplinary approach to the issue. The study focuses on rare diseases caused by genetic mutations, as they are paradigmatic for understanding the challenges posed to the medical field. Since the 1970s, changes have occurred in Medicine, in the ways of diagnosing, classifying and studying such diseases, from clinical, laboratorial and epidemiological perspectives, as well as in the development of technologies for prevention and intervention. As of 1970, HTA has developed as an area of knowledge and practice aimed at contributing to the scientific and institutional foundations of innovation policies in health systems. Countries have been facing challenges to the sustainability of their health systems, which stem from scientific and technological development and medical innovations, economic and political power of corporations, increased expectations, aging populations and political and social inequalities. Discourses carrying disparate scientific, technological and political views on medicine and health policies coexist, posing difficulties to dialogue. Meanwhile, society, marginalized from the world of specialists, faces many problems in understanding such discourses, being heard and participating in the construction of new perspectives on health and disease that offer answers to their problems.
- Evaluation of IFN-gamma secretion after stimulation with C. neoformans and C. gattii antigens in individuals with frequent exposure to the fungus(2022) MACIEL, Isabel Feitosa; FREITAS-XAVIER, Roseli Santos de; VICENTINI, Adriana Pardini; APOLIANO, Carlos Fernando; FERNANDES, Juliana Ruiz; DIAS, Alana dos Santos; GIMENES, Viviane Favero Mazo; BENARD, Gil; VASCONCELOS, Dewton MoraesIn this study we produced antigenic extracts from prototypical strains of C. neoformans (VNI-VNIV) and C. gattii (VGI-VGIV) and tested IFN-gamma secretion by Elispot. Antigens from the eight Cryptococcus molecular types (VNI -VNIV and VGI - VGIV) were obtained after capsule reduction. IFN-gamma secretion by Elispot method were stimulated with C. neoformans and C. gattii antigens. Peripheral blood mononuclear cells of fourteen healthy control subjects, being: five ecotourists, two mycologists, three poultry keepers, and four individuals without reports of exposure to the fungus. We observed a significant increase in IFN-gamma secretion in the group of ecotourists, mycologists and bird keepers in relation to the group of individuals without reports of occupational exposures to these agents. Our results suggest the significant increase in IFN-gamma secretion may be related to the continuous exposure of these groups of individuals to the fungus, as well as to the specific antigen memory immune response developed during exposure to Cryptococcus.
- Systemic autoimmune diseases and work outcomes in Brazil: a scoping review(2022) CORDEIRO, Rafael Alves; FISCHER, Frida Marina; SHINJO, Samuel KatsuyukiOBJECTIVE: To review articles that assessed work-related outcomes such as workability, work productivity, presenteeism, absenteeism, sick leave, return to work, and employment status of Brazilian patients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren's syndrome, and systemic autoimmune myopathies. METHODS: This study was conducted in Medline databases (PubMed), SciELO, and Lilacs through a combination of descriptors of interest. Studies published until December 2020 were considered in the search strategy. RESULTS: Eight out of 90 articles met the eligibility criteria and were included in this review. The studies are highly heterogeneous. Most of them are cross-sectional, and all of them address rheumatoid arthritis or systemic lupus erythematosus. A common denominator among these studies is the high proportion of patients outside the labor market. CONCLUSIONS: In general, the studies show unfavorable labor outcomes and impaired participation in the Brazilian workforce among the samples of patients assessed. There is a need to better understand several topics about Brazilian patients with systemic autoimmune diseases and their work context, as well as to conduct studies focusing on rarer diseases and on the themes of return and reintegration to work.