Manuel Parra

Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (N_participants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.

Introduction Teaching environments can influence performance and health of teachers. In Latin America little research was done to explore teaching conditions and health. The objective was to assess demands and barriers for teaching and work-related strain in school-teachers in Chuquisaca, Bolivia. Methods Cross-sectional study was conducted in sixty randomly selected schools (August to November 2015). All teachers (1062) were invited to participate (response 56%). Teaching demands and barriers were explored through a set of questions previously used by UNESCO-OREALC (4-points Likert scales). Demands included sociocultural differences, indiscipline, learning problems, desertion, and repetition. Barriers explored about lack of student families and colleagues support, poor social and economic conditions, lack of pedagogical support and leadership of the director. A validated version of the irritation index (7-points Likert scale) was used to explore work-related strain (emotional and cognitive irritation). Scores for demands, barriers and irritation were added and dichotomized in lower (1 st and 2nd) and upper (3rd) tertiles. Crude and adjusted odds ratios with 95% confidence intervals for work-related strain were estimated through logistic regression models. Missing data was imputed using chained equations imputation method. Sensitive analysis was performed using imputed and non-imputed data. Results Most of teachers were female (72%), in public schools (81%), exclusively in primary level (48%). About one-third of teachers (37%) have bachelor or postgraduate training (37%). Teaching in primary level (adjusted OR 2.21; 95% CI: 1.4 to 3.6) and high academic barriers (1.73; 1.1–2.8), were statistically significant risk factors for work-related strain. University graduated teachers had lower risk (0.6; 0.4–0.9). Discussion Structural barriers seem to play an important role in work-related strain in teachers, while they are able to cope with pedagogical demands. Comprehensive actions need to be taken considering families and social resources in order to take care of teachers’ physical and mental health for a better performance.

Introduction Workers’ depression is an increasing concern for occupational health. Latin American researches have evaluated workplace psychosocial. Less is known about associations with working-hours schedules. This research was aimed to determine the prevalence of depressive symptoms associated with unconventional job schedules in industrial and artisanal fishermen in Ecuador. Materials and methods 111 industrial (response 100%) and 122 artisanal fishermen (response 80%) were invited to answer a questionnaire, applied by a trained interviewer, in Manabí, Ecuador. Depressive symptoms in previous two weeks were evaluated with a validated version of Patients Health Questionnaire-9 items (PHQ9) each item scoring 0–3, total scale score from 0 to 27; cut-off=5. Job schedules were evaluated through a tailored set of questions including shifts, night work, hours per week, time of stay in the sea and rest period while in the sea. Other variables considered were socio-demographics (marital status, number of children, educational level). Adjusted logistic regression models were calculated to estimate Odds Ratios. Results Both groups were similar in educational level and number of children. Industrial fishermen were older and lived more in couples, compared to artisanal ones. Industrial also had less employment security, they worked longer shifts and they had less rest periods in the sea. Artisanal had less formal job contracts. Depression was more prevalent in industrial fishermen (36.0% vs 19.7%, pDiscussion Depressive symptoms may increase in workers who have unconventional work schedules and without rest periods during the shift. Fishermen are exposed to such working conditions, mainly in the industrial sub-sector.

Introduction Work in oil industry often has workers living transiently in camps for 1–2 weeks periods. This is a challenge for workers’ personal-family life. The objective was to evaluate relationship of psychosocial factors and work-family interactions with psychological distress in Ecuadorian petroleum workers living transiently in camps, comparing to those who stay in cities. Methods 350 workers invited to answer a self-administered questionnaire (response 88%; October 2015 to January 2016). Psychological distress assessed through General Health Questionnare – 12 items (GHQ-12; dichotomized GHQ-score, GHQ_case=cut off 4/5). Psychosocial factors: Effort-Reward Imbalance (ERI) Questionnaire, short version (ERI and Overcommitment (OC) sub-scales, cut-off upper tertile). Work and family-personal life interaction evaluated with Work-Home Interaction – Nijmegen questionnaire (SWING; 4 dimensions, scores rescaled to 0–3, cut-off upper tertile). Other variables were socio-demographics and commuting time from house or camp to workplace. Result Higher prevalences of GHQ_cases were found in workers who perceived higher ERI (38.1% vs 18.2%, pcases (pcase showed significant associations with ERI [2.34; (1.13–4.84)] and residing in cities while working [3.36; (1.38–8.16)]. Positive influences from domestic-personal life to work were associated with lower risk of psychological distress [0.25 (0.10–0.61)]. Discussion Perception of imbalance between effort and reward is associated with lower mental health. If skills and learnings acquired in domestic life are allowed to be displayed in work, workers seem to experience better mental health. Workers living transiently in camps exhibited better mental health in this group.

Musculoskeletal disorders (MSD) are important health problems in working populations. The study aimed to determine the prevalence of MSD among school teachers from urban and rural areas in Chuquisaca, Bolivia. A cross-sectional study was conducted in 60 randomly selected schools. In total, 1062 teachers were invited to participate (response 58%). The Spanish version of the Standardized Nordic questionnaire was used assessing the 12-months and 7-days prevalence of MSD as well as the 12-months prevalence of work limiting pain. Prevalence were calculated for the different parts of the body; as summary measures, MSD in any part of the body and in ≥3 parts of the body were assessed. Crude and adjusted odds ratios with 95% confidence intervals were calculated using logistic regression models adjusting for age, sex, teaching level and school type. Prevalence of MSD in any part of the body was 86% during the last 12 months, 63% during the last 7 days and 15% for work limiting pain. MSD was most common in the neck (12-months prevalence 47%) and least common in the wrist/hands (26%). In the adjusted model, teachers working in rural areas presented significantly higher odds than teachers from urban schools for work-limiting pain during the last 12-months considering any part of the body (aOR 2.2; 95% CI 1.1–4.1), and for ≥3 parts of the body (aOR 3.7; 95% CI 1.3–10.6). The prevalence of MSD is high in School teachers, even more in teachers working in rural areas. It is needed to identify risk factors for MSD in teachers in order to propose appropriate strategies to control and reduce it.

Objetivo: Comparar las dimensiones de riesgo psicosocial en profesores de áreas urbanas y rurales de Chuquisaca, Bolivia. Método: Se realizó un estudio transversal en 60 escuelas seleccionadas al azar (27 urbanos, 33 rurales) de Chuquisaca, invitando a participar a 1.062 profesores (Respuesta 58%). Se utilizó la versión breve del cuestionario SUSESO-ISTAS21 para medir riesgos psicosociales, calculando odds ratios y su Intervalo de Confianza de 95% a través de modelos de regresión logística ajustados por edad, sexo, grado académico más alto e ingresos. Resultados: Los profesores de áreas rurales presentaron porcentajes más alto de riesgo psicosocial en comparación con los del área urbana, principalmente en las dimensiones: exigencias psicológicas (ORa 1,6; IC 95% 1,1-2,5), apoyo social y calidad del liderazgo (2,9; 1,9-4,8) y doble presencia (2,2; 1,5-3,4). Conclusiones: Se encontraron diferencias en riesgos psicosociales, de manera desfavorable en profesores de áreas rurales, lo que podría repercutir en la salud física y mental.