Cardiac Behavior and Heart Rate Variability in Elderly Hypertensive Individuals during Aerobic Exercise: A Non-Randomized Controlled Study

BACKGROUND

High blood pressure is an important public health problem due to its high prevalence, the difficulty to control it, and its high contribution to morbidity. A series of changes may be linked to the aging process, compromising cardiac conduction, and reducing cardiovascular baroreceptor function. Advancing age promotes a decline in heart rate variability and this decrease can increase the probability of cardiovascular disease. The aim of this study was to analyze the autonomic modulation of heart rate in hypertensive elderly individuals during and after a session of aerobic exercise, and to compare it with elderly individuals without cardiovascular or metabolic disease. Our study was a non-randomized controlled study with hypertensive elderly (HBP group) and elderly without cardiovascular and/or metabolic diseases (control group). Data on blood pressure and heart rate variability (HRV) were collected before, during, and after 30 min of aerobic physical exercise on a treadmill. There was a reduction in HF (ms2) and SD1 (ms) in the 5 min of recovery for the elderly in the control group. The elderly in the control group also had greater RMSSD and SD1 30 min post-exercise when compared to the initial mins of recovery. We concluded that there was no difference in autonomic modulation and global heart rate variability between elderly individuals without cardiovascular and metabolic diseases and hypertensive individuals after a bout of aerobic exercise. Elderly individuals without metabolic diseases showed a decrease in parasympathetic modulation and global variability between the time of rest and 5 min of recovery. However, up to 30 min of post-exercise recovery, they restored parasympathetic activity.

Project AquiLá: Community-engaged Planning to Explore the Relationship between Culture and Health

BACKGROUND

Elements of charrette planning were employed to develop and examine the relationship between transnationalism, culture and health.

OBJECTIVE

This paper describes the partnership, the first two stages of the planning charrette and lessons learned.

METHODS

During charrette planning phase 1 we collected data through social network interviews (n = 58), cultural conversations (n = 88), and photovoice (n = 9). In the second phase we performed five charrette planning meetings. Data were synthesized by the planning team.

LESSONS LEARNED

The issue centered focus facilitated trust among partners. The holistic, iterative process to planning and interpreting preliminary data provided a deeper understanding of the issues under investigation. Community partners at the table held us accountable to the communities we were studying and infused an undercurrent of social justice in our work.

CONCLUSIONS

There are advantages in employing a community engaged transdisciplinary team-based approach to the study of transnationalism, culture and health.

Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.

Reinventing Privatization: A Political Economic Analysis of the Social Health Organizations in Brazil

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations (Organizações Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen's right following its national constitution.

Comparison of factors associated with leukemia and lymphoma mortality in Brazil

In the last decades, few epidemiological studies have discussed the mortality rates due to leukemia and lymphoma in Brazil. This study analyzes the evolution over time of the number of deaths due to leukemia and lymphoma in Brazil, between 2010 and 2016, considering the population's characteristics and spatial distribution. This is a retrospective epidemiological study based on data obtained in the Brazilian Health Informatics Department (DATASUS), associated with the quantitative population. We created choropleth maps and predictive models of mortality rates, using the incidence rate ratio (IRR) to measure the size of the effect. Leukemia had a 1.76 higher mortality rate than lymphoma. Leukemia mortality trends increased by 1.2% per year between 2010 and 2016. Regions with the lowest social inequality had higher mortality rates for both diseases. There was a difference between peaks with higher chances of death due to leukemia (> 60 years) and lymphoma (> 70 years). Older age, male, white, and South and Southeast regions were associated with higher mortality by leukemia or lymphoma.

[Implementation of the More Doctors Program in Espírito Santo State, Brazil: logic model and proposed indicators]

The study aimed to assess the implementation of the More Doctors Program (PMM in Portuguese) based on a case study of the Espírito Santo State, Brazil. The first stage involved analyzing the documents that launched the PMM, allowing the creation of a logic model. In the second stage, data on the PMM in Espírito Santo State were analyzed (2013-2016) based on population brackets, creating indicators for the proportion of physicians before and after the Program with the following parameters: unacceptable (0 to 0.99 physicians/1,000 inhabitants); acceptable (1 to 1.99); and desirable (2.0 or more). Data were analyzed with the Wilcoxon and Kruskal-Wallis non-parametric tests. The model included the size, inputs, activities, outputs, results, and impact of the PMM, orienting analysis of the Program's implementation. Of all the physicians in the emergency supply to Espírito Santo State (432), the majority (63.8%) were cooperative exchange physicians (Cubans), while 31.2% were regional board-accredited Brazilians. The Brazilian and individual exchange physicians were allocated mainly in medium and large municipalities, while the Cubans were distributed more heterogeneously in municipalities of all population sizes and were thus more common in areas with greater social vulnerability and lower social capital. There was a significant increase in the number of physicians in Espírito Santo State, but the supply to the extremely poor population did not reach the desired level, presenting an unacceptable mean rate in municipalities with up to 10,000 inhabitants and an acceptable rate in municipalities in the other population brackets.

Políticas de prevenção ao abuso de drogas no Brasil e nos Estados Unidos

O objetivo deste estudo foi discutir as políticas públicas de prevenção ao abuso de drogas destinadas aos jovens no Brasil e nos Estados Unidos. A formulação dessa política no Brasil tem-se estabelecido a partir de programas que são questionados internacionalmente em termos epistemológicos, teóricos e metodológicos. Conclui-se que a construção de políticas sociais na América Latina permanece atravessada pela manutenção da dependência aos países centrais, uma vez que as tensões entre os modelos proibicionista e de redução de danos se mantêm entre o que preveem as políticas de prevenção ao abuso de drogas da Secretaria Nacional de Políticas sobre Drogas e do Ministério da Saúde e o que de fato é executado. Sugere-se buscar autonomia em relação aos modelos de ações preventivas impostos pelos países dominantes, por meio de um debate mais amplo entre pesquisadores, profissionais, usuários e movimentos sociais para o protagonismo de políticas mais adequadas ao Brasil.

Women's lives in times of Zika: mosquito-controlled lives?

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it to shed light on the social repercussions of Zika. Women were recruited through the snowball sampling technique and data was collected through semi-structured interviews. We describe the effects in mental health and the coping strategies that women use to deal with the Zika epidemic. Zika is taking a heavy toll on women's emotional well-being. They are coping with feelings of fear, helplessness, and uncertainty by taking drastic precautions to avoid infection that affect all areas of their lives. Coping strategies pose obstacles in professional life, lead to social isolation, including from family and partner, and threaten the emotional and physical well-being of women. Our findings suggest that the impacts of the Zika epidemic on women may be universal and global. Zika infection is a silent and heavy burden on women's shoulders.

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

Background

This study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested.

Methods

Drawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed.

Results

Our findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery.

Conclusion

Despite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.

Musculoskeletal disorders and perception of working conditions: A survey of Brazilian dentists in São Paulo

OBJECTIVES

To investigate the prevalence of work-related musculoskeletal disorders amongst dentists who work in public clinics in São Paulo, Brazil, to investigate their awareness of the presence of risk factors in the workplace, disability due to pain, and the influence of pain on this awareness and disability.

MATERIAL AND METHODS

A cross-sectional study was conducted among 204 dentists who work in public health clinics in the northwest of São Paulo, Brazil. The data was collected through interviews, using the Nordic Questionnaire and the Work-Related Activities that May Contribute to Job-Related Pain Questionnaire. In the case of workers who reported pain, the Pain Disability Questionnaire (PDQ) and the Numeric Pain Scale were also administered. Statistical analyses were performed using SPSS 21.0.

RESULTS

Most dentists (81.4%) had musculoskeletal disorders, especially in the neck, shoulders and lower back. We found that the presence of symptoms in the neck (15.7%), shoulders (12.7%) and lower back (15.7%) were the major causes of absenteeism over the past 12 months. Occupational risk factors perceived as the most problematic ones were: bending or twisting the back in an awkward way, continuing to work when injured or hurt and working in the same position for long periods. Comparison between the symptomatic and asymptomatic dentists showed a statistically significant difference (p < 0.05) in the perception of occupational risk factors. The analysis of the intensity of pain and disability with PDQ in the symptomatic dentists showed an average pain intensity of 3.8. Mean scores of the PDQ total (11.46) and its dimensions - functional condition (7.1) and psychosocial condition (4.4) - suggest a moderate disability in the dental surgeons. There was a strong t correlation (r = 0.697) between pain intensity and the total score of disability caused by pain.

CONCLUSIONS

Pain and work-related musculoskeletal disorders interfere significantly with the dentists' lives. In the case of dental surgeons there is a significant correlation between pain intensity and disability. Int J Occup Med Environ Health 2017;30(3):367-377.

Effects of social, economic, and labor policies on occupational health disparities

BACKGROUND

This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.

METHODS

We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.

RESULTS

Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker's compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.

CONCLUSIONS

There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

A experiência do Observatório de Saúde do Trabalhador (Observatoriost) no Brasil

Antecedentes históricos apontam a mobilização sindical e de pesquisadores para criar um Observatório de Saúde do Trabalhador (OST) que permitisse oferecer informações com credibilidade e subsidiar a defesa da saúde. Este trabalho teve o objetivo de rever e analisar os antecedentes internacionais e brasileiros da mobilização de sindicatos, centros de estudos sindicais e intersindicais e pesquisadores de instituições do setor que criaram um observatório presencial e virtual para comunicação e repositório de informações científicas. Foram utilizados métodos de intervenção e observação participantes e levantamento documental. O relato parte de iniciativas de superação das políticas neoliberais. Tais iniciativas impulsionaram a criação do Observatoriost em 2010 e o mantiveram ativo até 2013 compilando documentos, relatos de imprensa e agendas sindicais. O observatório foi conduzido em cogestão com seis centrais sindicais por meio do Comitê Editorial das centrais que respeitou a diversidade e a autonomia dos atores envolvidos. A coordenação rotativa do portal pelo comitê evidenciou a maturidade política e sua articulação. Os principais desafios postos para a continuação da iniciativa foram de integrar e formar pesquisadores e profissionais comprometidos organicamente com os trabalhadores na luta pela defesa da vida e saúde.

Escolas Técnicas do SUS (ETSUS) no Brasil: regulação da integração ensino serviço e sustentabilidade administrativa

O objetivo deste artigo foi discutir a sustentabilidade administrativa das Escolas Técnicas do SUS (ETSUS) a partir do princípio da integração ensino serviço, que traz uma nova dimensão do trabalho na saúde ainda não regulada pela administração pública brasileira. Trata-se de uma pesquisa qualitativa, por meio de um estudo de caso. A pesquisa foi realizada por meio de questionário semiestruturado junto aos gestores das ETSUS, abordando aspectos institucionais, administrativos e de gestão do trabalho. O universo amostral foi de 6 ETSUS pertencentes à Rede de Escolas Técnicas do SUS (RET-SUS). As ETSUS apresentaram gestão e planejamento centralizados e execução descentralizada de sua atividade fim, em sua maioria sem autonomia administrativa e altamente dependente de financiamento do governo federal. Segundo os gestores das escolas, a falta de regulação da atividade docente por servidor público fragiliza a gestão das ETSUS. Estas instituições apresentam problemas de gestão relacionados à integração ensino serviço, que precisa ser regulamentada para conferir sustentabilidade às escolas e evitar contradições com a legislação brasileira.

Photovoice in the workplace: A participatory method to give voice to workers to identify health and safety hazards and promote workplace change-a study of university custodians

BACKGROUND

Photovoice, a photographic participatory action research methodology was used in a workplace setting to assess hazards that were creating extremely high injury and incidents rates for university custodians and to promote the conditions to eliminate or reduce those hazards.

METHODS

University custodians participated in a Photovoice project to identify, categorize, and prioritize occupational hazards and to discuss and propose solutions to these problems. Results were presented to management and to all custodians for further discussion. The effort was led by a worker-based union-sponsored participatory evaluation team in partnership with a university researcher.

RESULTS

Visual depiction of hazardous tasks and exposures among custodians and management focused primarily on improper or unsafe equipment, awkward postures, lifting hazards, and electrical hazards. The process of taking pictures and presenting them created an ongoing discussion among workers and management regarding the need for change and for process improvements, and resulted in greater interest and activity regarding occupational health among the workers. In a follow-up evaluation 1-year later, a number of hazards identified through Photovoice had been corrected. Injury rates for custodians had decreased from 39% to 26%.

CONCLUSIONS

Photovoice can be an important tool, not just for identifying occupational hazards, but also empowering workers to be more active around health and safety and may facilitate important changes in the workplace.

Epidemiological surveillance of informal workers' health in two cities in southeastern Brazil: the experience of the TRAPP-TRAPPURA projects

Informal labor markets have grown in peripheral countries, accounting for more than 50% of jobs. There is anecdotal evidence of a direct relation between informal sector growth and an increase in the frequency and severity of work-related diseases and injuries. Two sister pilot projects were conducted in Uberaba and Campinas, Brazil to develop population-based epidemiological surveillance of workplace injuries in the informal sector. Results for Campinas and Uberaba found cumulative yearly incidences of 5.1% and 10.4%, with incidence rates of 2.2 and 6.5 injuries per 100,000 worked hours, respectively. The proportions of lost work time were 0.3% and 0.31%. Rates found were comparable to those found in the literature for both formal and informal jobs. These results suggest that bad working conditions in the formal labor market are replicated in the informal market as subcontracting and outsourcing contribute to the growth of informal jobs.

Melhor isso do que nada! Participação e responsabilização na gestão dos riscos do Pólo Petroquímico de Camaçari (BA)

O objetivo da pesquisa foi analisar o modelo adotado na construção dos conselhos comunitários consultivos. O recorte empírico trata do Conselho Comunitário de Camaçari (BA), primeiro no país e referência para a implantação de outros. Observação participante e dezessete entrevistas foram as principais fontes de dados. O conselho se constitui num sofisticado mecanismo de docilização e responsabilização pela disseminação de uma ideologia organizacional hegemônica e de modos de governança neoliberais.

The work environment justice fund: five years of funding work environment justice in Massachusetts

This article provides an assessment of the impact of five years of funding on work environment justice in Massachusetts. It first outlines the economic, historical, and political context in the 1990s in Massachusetts. Next, it describes the distribution of the Work Environment Justice Fund grants in detail by amounts presented, types of organizations and grants funded, and geographic representation of grantees. A discussion of the lessons learned from the work funded by the WEJF introduces a summary of major accomplishments of the grantees. The report concludes with recommendations for continuation and expansion of funding for grassroots work environment justice in Massachusetts.

An alternative to the neoliberal model in health: the case of Venezuela

The authors present a synthesis of the proposals put forth by the health sector of Venezuela during the framing of the new Venezuelan Constitution. They summarize the background to the National Constituent Assembly and the legal framework typical of the health sector at that time, identify the methodological aspects that substantiated the health topics included in the new Constitution, and analyze the articles that shape the current constitutional health framework in Venezuela, summarizing their most important features and comparing them with neoliberal health proposals.

A globalização dos movimentos sociais: resposta social à Globalização Corporativa Neoliberal

Este artigo apresenta, inicialmente, definições propostas para o termo Globalização Corporativa Neoliberal ou globalização neoliberal. Em seguida discute os principais problemas e impactos da globalização neoliberal identificados pelos movimentos sociais e intelectuais que propõem alternativas ao modelo neoliberal global, conhecido como movimento antiglobalização, "globalização por debaixo" ou das bases ("grassroots" globalization). Esses movimentos sociais se organizam, com freqüência, como redes de movimentos sociais articulados globalmente. A abordagem acerca do surgimento dessas redes é feita a partir de uma breve revisão das proposicões feitas por estudiosos das estruturas e dinâmicas de redes sociais. O artigo é concluído com sugestões de elementos para um programa alternativo ao neoliberalismo global.

The Observatory of the Américas as a network in environmental and worker health in the Americas

This article reviews the scope of several Observatories found by a search in the Internet through the Google search engine. After examining these observatories, it describes the aims and initial accomplishments of the Observatory of the Americas as a network of professionals and activists from different countries in the Americas. The article concludes with a discussion of the pattern identified among these observatories: they may be clearinghouses or networks, or both.

Dependent convergence: the importation of technological hazards by semiperipheral countries

This article complements the substantial body of literature produced over the last three decades on the export of hazards from developed countries to developing countries. After reviewing the central arguments proposed by this literature, the authors add to the debate by focusing on the role of national actors in the importation of these hazards, based on the experience of late 1970s' developments in the petrochemical industry in Brazil. The Brazilian case indicates that social struggles and/or interactions among actors in developing and developed nations determine to what extent hazardous technologies are imported without environmental controls and to what extent their hazardous effects are controlled by these nations. This study suggests that the future development of a more inclusive theory of export-import of hazardous technologies and products should take into account the dialectical relationship established between social actors internal to the exporting and importing countries.