Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

O cuidado psicológico ao médico em reprodução assistida: um enquadre diferenciado

Profissionais da área da saúde entram em contato com o sofrimento humano mesmo quando não trabalham diretamente no campo da Psicologia. Este estudo baseou-se no referencial da psicanálise com vistas a compreender os aspectos do sofrimento humano que emerge para os médicos no exercício da reprodução assistida, e a importância do estudo do imaginário coletivo sobre situações de difícil manejo em suas clínicas. Participaram vinte e dois médicos que atuam em hospitais e clínicas do estado de São Paulo em âmbitos público e privado, independentemente de sexo, idade e tempo de formação. Foi utilizado o procedimento desenhos-estórias com tema, compreendido como procedimento dialógico. A entrevista caracterizou-se como uma situação especial de comunicação e expressão das emoções geradas nos atendimentos relacionados à temática proposta. Constatou-se a necessidade de proposição de espaços facilitadores da expressão emocional, que promovem a continência do sofrimento humano e a ocorrência de experiências reflexivo-vivenciais transformadoras do real.

Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

Action en santé mentale au travail et syndicalisme québécois : l’expérience de représentants syndicaux

Dans certains milieux syndicaux québécois, des initiatives porteuses destinées à prévenir les problèmes de santé mentale au travail ont vu le jour. Des représentants syndicaux pionniers ont mis en place des structures d’entraide opérantes, obtenu des jurisprudences importantes et développé des approches innovantes pour corriger ou bonifier l’organisation du travail, et ce depuis plus de trois décennies. Alors que la montée de l’idéologie néolibérale et les principes d’organisation du travail qu’elle sous-tend engendrent une intensification du travail qui fragilise la psyché des travailleurs et que le rapport de force des syndicats s’effrite, il apparaît porteur d’interroger l’expérience de ces représentants syndicaux pour mieux comprendre comment se structure l’action syndicale en santé mentale au travail. Cette thèse fait l’étude de réalisations syndicales québécoises en matière de santé mentale au travail visant à prévenir et à corriger les problèmes de détresse psychologique, d’épuisement professionnel, de harcèlement, de dépression, de violence, de suicides reliés au travail, etc. Pour ce faire, un cadre théorique mixte a été utilisé. D’une part, une perspective large a été adoptée pour comprendre les enjeux entourant les rapports humains au travail et l’action. Pour ce faire, quatre auteurs influents de la philosophie des Lumières et de la philosophie contemporaine ont été sélectionnés, soit Thomas Hobbes, Adam Smith, Karl Marx et Hannah Arendt. Dégager ces différentes perspectives du monde, de l’action et du lien social avait pour objectif de mettre en place une grille d’analyse susceptible de relier l’expérience de représentants syndicaux à ces visions du monde. Il est apparu essentiel de mieux saisir les bases idéologiques sur lesquelles ces derniers ont construit leur action pour comprendre comment elles ont influencé leur démarche singulière et collective. D’autre part, la théorie de l’expérience sociale a été retenue (Dubet, 2009; 1994) pour analyser plus finement le travail des représentant syndicaux. Celle-ci distingue trois logiques d’action complémentaires et en tension avec lesquelles doivent composer les acteurs sociaux : une logique d’intégration, une logique stratégique et logique appuyée sur la subjectivation. La coexistence de ces trois logiques signifie que l’expérience que les individus font du monde n’est pas une simple reproduction de déterminismes qui les précèdent. Les acteurs sont aussi sujets de leur expérience et capables de prendre une distance du social pour comprendre les significations de leur agir; ils s’inscrivent dans le monde dans une dialectique critique. Cette théorie apporte un éclairage permettant de dégager à la fois ce qui freine et ce qui facilite l’action individuelle et collective en matière de santé mentale au travail et de décrire comment des représentants syndicaux se mobilisent pour répondre aux nombreuses attentes des membres. Cette recherche qualitative s’est appuyée sur une méthodologie de récit de vie (Rhéaume 2008; Bertaux 2006). Vingt représentants syndicaux ont témoigné de la souffrance au travail (Dejours, 2008) vécue par leurs membres et ont présenté des actions déployées pour leur venir en aide. Les réalités décrites par les participants montrent comment certains éléments de l’organisation du travail sont associés à des expériences de domination (Martuccelli, 2004): les méfaits du productivisme et de l’hyperflexibilité, les accidents de travail, les maladies professionnelles et les situations d’horreur au travail, les rapports sociaux au travail devenus délétères et les utilisations abusives de l’appareil judiciaire. L’étude démontre aussi à quel point des initiatives portées par des représentants syndicaux contribuent à une résolution de problèmes dans une perspective d’interdépendance, de développement du pouvoir d’agir, de justice sociale et de lutte pour la dignité. Quatre catégories d’initiatives ont été retenues : l’entretien du lien social dans l’entraide au quotidien, la défense juridique et légale des membres, les clauses de convention collective et les actions sur l’organisation du travail. Enfin, la recherche dégage trois profils de représentants syndicaux : la militance qui tente de former un nous, la professionnalisation qui tente de faire reconnaitre son utilité et sa compétence, et l’entraide qui cherche à développer une action engageant le Je. Leur rencontre laisse entrevoir le développement d’une praxis syndicale qui vise à promouvoir et protéger la dignité du travail et des travailleurs.

Queensland Aborigines, multiple realities and the social sources of suffering: Psychiatry and moral regions of being (Part 1)

This two part paper considers the experience of a range of magico-religious experiences (such as visions and voices) and spirit beliefs in a rural Aboriginal town. The papers challenge the tendency of institutionalised psychiatry to medicalise the experiences and critiques the way in which its individualistic practice is intensified in the face of an incomprehensible Aboriginal „other‟ to become part of the power imbalance that characterises the relationship between Indigenous and white domains. The work reveals the internal differentiation and politics of the Aboriginal domain, as the meanings of these experiences and actions are contested and negotiated by the residents and in so doing they decentre the concerns of the white domain and attempt to control their relationship with it. Thus the plausibility structure that sustains these multiple realities reflects both accommodation and resistance to the material and historical conditions imposed and enacted by mainstream society on the residents, and to current socio- political realities. I conclude that the residents‟ narratives chart the grounds of moral adjudication as the experiences were rarely conceptualised by local people as signs of individual pathology but as reflections of social reality. Psychiatric drug therapy and the behaviourist assumptions underlying its practice posit atomised individuals as the appropriate site of intervention as against the multiple realities revealed by the phenomenology of the experiences. The papers thus call into question Australian mainstream „commonsense‟ that circulates about Aboriginal and Torres Strait Islander people which justifies representations of them as sickly outcasts in Australian society.

Unpacking the micro-macro nexus: narratives of suffering and hope among refugees from Burma recently settled in Australia

Narratives of forced migration are open to a variety of interpretations. In mental health, refugee narratives of arduous journeys in the face of systemic macro socio-political forces are often transformed from this context into a medicalized micro context of inner individual worlds. Both the dominant pathogenic lens of trauma studies and the growing salutogenic lens embodied in resilience research, often reflect a western cultural idiom of focusing on the individualized nature of these phenomena. Using qualitative data collected from refugees from Burma now settling in Australia, the article emphasizes the need for a more reflexive and expansive account of both suffering and hope within refugee narratives. It recounts these narratives within a conceptual framework which acknowledges the importance of the connections between the micro individual experience and the macro, socio-political context. This is not only a question of political principle, but also a matter of listening to the voice of those who know most about the relationship between macro forces of human rights violations and their impact on individual, family and community trajectories.

The symbology of the sea in Lygia Bojunga Nunes's work: a reflection on utopian and dystopian framing

The ambivalent image of the sea is recurrent in Bojunga Nunes’s work. It receives a lot of symbolic meanings in her production, being sometimes a positive and sometimes a negative element. Thus, the sea is used in a utopic way, as a place for pleasure and leisure, and in a dystopic way, as scenery of a rite of passage, which includes the pain and suffering, part of the rite of passage that characterizes the bildungsromans. So, if in some texts the sea assumes a utopic character, being a place of snuggle, security, the ideal to reach, in others it is represented as dystopic, a place of distress, asphyxia and death. In this text we will study the hypothesis that, even in its dark symbolic meaning, in the author’s work the sea is an element of reflection and revelation. Thereby, it assumes metaphorically a sense of magnification of the reader’s expectative, being an element of emancipation. The objective of this text is to present a reflection on the sea’s symbolism on the mentioned texts and its importance for the reader’s formation.

Work organization and the health of bank employees

The Brazilian banking sector has undergone an intense restructuring process and taken a leading position in the incorporation of new technologies and organizational innovations. Computerization in the industry, in association with forms of work organization, has resulted in changes that reflect on the workers' health. Based on the theoretical and methodological frameworks of historical and dialectical materialism, this qualitative study investigates the work conditions of bank employees in order to identify the extent to which changes in work organization interfere with these workers' health. Data were collected through interviews held with 11 bank employees. In addition to physical sickening due to occupational diseases directly related to work intensification, the results also show an increased incidence of mental suffering and a feeling of loss of professional identity. Work-related frustration, instability and concerns related to psychological pressure resulting from the need to achieve goals predominated in the reports.

Work of gravediggers and health

Gravediggers have death as object of their work. Their activities are painful, physically and mental demanding, as well as unhealthy. Literature is scarce about this theme. The aim of this study is to evaluate gravediggers' work activities and health consequences. The methodological frame which guided this study was Dejours' psychic suffering and its association with the psychodynamic aspects of work. Data collection took place in April-May 2011 in one public and one private cemetery of Sao Paulo, Brazil. Four male workers, aged between 45 to 60 years old were interviewed. Their work activities were observed during a workday. Participants reported their life dreams, defense mechanisms and frustration. The discourse of gravediggers showed serious problems associated to physical and mental demands, public invisibility and/or social devaluation of work. The most important physical symptom was body pain. In spite this is a preliminary study, it was possible to raise a number of work stressors and health outcomes of gravediggers, an " invisible" worker of our society.

Levocetirizine is an effective treatment in patients suffering from chronic idiopathic urticaria: a randomized, double-blind, placebo-controlled, parallel, multicenter study

BACKGROUND: Chronic idiopathic urticaria (CIU) is defined by the almost daily presence of urticaria for at least 6 weeks without an identifiable cause. Symptoms include short-lived wheals, itching, and erythema. CIU impedes significantly a patient's quality of life (QoL). Levocetirizine is an antihistamine from the latest generation approved for CIU. AIM: To investigate the efficacy of levocetirizine, 5 mg, and placebo for the symptoms and signs of CIU, as well as for the QoL and productivity. METHODS: The primary criteria of evaluation were the pruritus severity scores over 1 week of treatment and over 4 weeks. The QoL was assessed via the Dermatology Life Quality Index (DLQI). RESULTS: Baseline pruritus severity scores were comparable in the two treatment groups (2.06+/-0.58). After 1 week, levocetirizine was superior to placebo and demonstrated a considerable efficacy (difference=0.78, P<0.001). This efficacy was maintained over the entire study period (4 weeks, P<0.001). The number and size of wheals were considerably reduced compared with placebo over 1 week and over the total treatment period (P work in the levocetirizine group (3.0 workdays lost per patient per month in the placebo group, 0.3 in the levocetirizine group). No unexpected adverse events occurred. CONCLUSIONS: Levocetirizine, 5 mg once daily, is an effective treatment for CIU, characterized not only by a rapid and sustained response, but also by an important improvement in QoL.

Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women

STUDY QUESTION: What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women? SUMMARY ANSWER: Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery. WHAT IS KNOWN ALREADY: The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before. However, previous studies focus on medical benchmarks without including the patient's perspective in a quantitative manner. STUDY DESIGN, SIZE, DURATION: A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women diagnosed with endometriosis and with at least one specific laparoscopic surgery in the past were enrolled in the study. The study investigated the effect of the minimally invasive surgery on health and on quality of work life of affected women. Questions used were obtained from the World Endometriosis Research Foundation (WERF) Global Study on Women's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 587 women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%) were included in the study. Our data show that 62% (n = 130) of the study population declared endometriosis as influencing the job during the period prior to surgery, compared with 28% after surgery (P < 0.001). The mean (maximal) absence from work due to endometriosis was reduced from 2.0 (4.9) to 0.5 (1.4) hours per week (P < 0.001). The mean (maximal) loss in working performance after the surgery averaged out at 5.7% (12.6%) compared with 17.5% (30.5%) before this treatment (P < 0.001). LIMITATIONS, REASONS FOR CAUTION: The mediocre response rate of the study weakens the representativeness of the investigated population. Considering the anonymous setting a non-responder investigation was not performed. A bias due to selection, information and negativity effects within a retrospective survey cannot be excluded, although study-sensitive questions were provided in multiple ways. The absence of a control group (sham group; e.g. patients undergoing specific diagnostic laparoscopy without treatment) is a further limitation of the study. WIDER IMPLICATIONS OF THE FINDINGS: Our study shows that indicated minimally invasive surgery has a clear positive effect on the wellbeing and working performance of women suffering from moderate to severe endometriosis. Furthermore, national net savings in indirect costs with the present number of surgeries is estimated to be €10.7 million per year. In an idealized setting (i.e. without any diagnosis delay) this figure could be more than doubled. STUDY FUNDING/COMPETING INTERESTS: The study was performed on behalf of the University Hospital of Bern (Inselspital) as one of the leading Swiss tertiary care centers. The authors do not declare any competing interests.

Clustering techniques for patients suffering acquired brain injury inneuro personal trainer

The study of the effectiveness of the cognitive rehabilitation processes and the identification of cognitive profiles, in order to define comparable populations, is a controversial area, but concurrently it is strongly needed in order to improve therapies. There is limited evidence about cognitive rehabilitation efficacy. Many of the trials conclude that in spite of an apparent clinical good response, differences do not show statistical significance. The common feature in all these trials is heterogeneity among populations. In this situation, observational studies on very well controlled cohort of studies, together with innovative methods in knowledge extraction, could provide methodological insights for the design of more accurate comparative trials. Some correlation studies between neuropsychological tests and patients capacities have been carried out -1---2- and also correlation between tests and morphological changes in the brain -3-. The procedures efficacy depends on three main factors: the affectation profile, the scheduled tasks and the execution results. The relationship between them makes up the cognitive rehabilitation as a discipline, but its structure is not properly defined. In this work we present a clustering method used in Neuro Personal Trainer (NPT) to group patients into cognitive profiles using data mining techniques. The system uses these clusters to personalize treatments, using the patients assigned cluster to select which tasks are more suitable for its concrete needs, by comparing the results obtained in the past by patients with the same profile.

Australian veterinarians who work with horses: attitudes to work and career

Objective To describe the attitudes to their work and career of those Australian veterinarians who work with horses. Method Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto Excel spreadsheets, and analysed using the SAS System for Windows. Results The main attractions of veterinary work with horses were the horses themselves and the equine industries, but working outdoors and with rewarding clients, and the satisfaction of successful outcomes were attractions for many. The list of disadvantages was longer, and included unreasonable and disagreeable clients as well as those who provided inadequate facilities, could not control their horses or did not care for them. The physical demands and risks of injury, the amount of time required, low rates of return and difficulties in collecting payment, were other major disadvantages. Some mentioned concerns about litigation, unethical behaviour, and recruiting and retaining veterinarians competent with horses. For many in mixed practice, the difficulties in affording modern equipment, and of developing and maintaining their own competence with horses, was a real concern. More than three-quarters of the respondents reported that their careers had lived up to expectations and that they would become veterinarians again; 70% of equine veterinarians would become an equine veterinarian again. Almost all (93%) of the respondents were either very glad, or 'generally glad though with some misgivings' that they had done the veterinary course. Older veterinarians reported suffering less stress, and being more content with their career, than younger colleagues. Conclusions The advantages of doing veterinary work with horses outweigh the disadvantages for most veterinarians, especially those well advanced in their careers.

A proposal for a corresponsible intervention on sexual harassment at work

Sexual harassment at work is a form of gender violence barely made visible but still present in labor organizations, where it keeps generating high levels of suffering, discrimination and inequality mainly affecting women. To address it properly it is necessary an organizational change towards equity arising from the knowledge of the subjective meanings that stakeholders (staff, union representatives, employers, public administration, etc.) attribute to that reality. In this article we present the main findings of a qualitative study on the social perception of sexual harassment. The work highlights the existence of many strategies aimed at legitimize and minimize the relevance of the problem, blaming the victim, justifying the lack of support from the environment and / or the involvement of the organization in the solutions. Among the conclusions we underline the need for new models of business management involving all stakeholders in the prevention and control of the in a responsible way.