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OBJECTIVE: To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS: The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS: The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers' meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION: The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.
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Mídias Sociais , Humanos , Brasil , Masculino , Feminino , Inquéritos e Questionários , Adulto , Mídias Sociais/estatística & dados numéricos , Saúde Ocupacional/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
ABSTRACT OBJECTIVE To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers' meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.
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Humanos , Masculino , Feminino , Epidemiologia , Inquéritos e Questionários , Metodologia como Assunto , Vulnerabilidade Social , Categorias de TrabalhadoresRESUMO
BACKGROUND: Low-income and middle-income countries have introduced different health insurance schemes over the past decades, but whether different schemes are associated with different neonatal outcomes is yet unknown. We examined the association between the health insurance coverage scheme and neonatal mortality in Colombia. METHODS: We used Colombian national vital registration data, including all live births (2â 506â 920) and neonatal deaths (17â 712) between 2008 and 2011. We used Poisson regression models to examine the association between health insurance coverage and the neonatal mortality rate (NMR), distinguishing between women insured via the contributory scheme (40% of births, financed through payroll and employer's contributions), government subsidised insurance (47%) and the uninsured (11%). RESULTS: NMR was lower among babies born to mothers in the contributory scheme (6.13/1000) than in the subsidised scheme (7.69/1000) or the uninsured (8.38/1000). Controlling for socioeconomic and demographic factors, NMRs remained higher for those in the subsidised scheme (OR 1.09, 95% CI 1.05 to 1.14) and the uninsured (OR 1.16, 95% CI 1.10 to 1.23) compared to those in the contributory scheme. These differences increased in models that additionally controlled for caesarean section (C-section) delivery. This increase was due to the higher fraction of C-section deliveries among women in the contributory scheme (49%, compared to 34% for the subsidised scheme and 28% for the uninsured). CONCLUSIONS: Health insurance through the contributory system is associated with lower neonatal mortality than insurance through the subsidised system or lack of insurance. Universal health insurance may not be sufficient to close the gap in newborn mortality between socioeconomic groups.
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Parto Obstétrico/estatística & dados numéricos , Mortalidade Infantil/tendências , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Sistema de Registros , Cesárea/estatística & dados numéricos , Colômbia , Feminino , Humanos , Lactente , Fatores de RiscoRESUMO
BACKGROUND: Several recent studies have described the presence of musculoskeletal complaints, presenting evidence that multisite musculoskeletal pain (MP) is more often present than single-site musculoskeletal pain. However, less is known about determinants of this multimorbidity, particularly, concerning the role of occupational factors and, mainly, what determines single or multisite pain. This study described the associations between pain in different body sites and investigated related factors to MP in workers from Brazil. METHODS: A total of 1070 workers (228 women and 842 men), from urban cleaning services and from shoe manufacturers, participated in this cross sectional study (response 97 %). Interviewer-administered questionnaire included sociodemographic factors, physical and psychosocial work demands, leisure-time activities and musculoskeletal pain which was presence of pain in previous seven days, considering eight body sites and MP, the sum score of all painful sites, varying 0-8. A factor analysis was performed that captured the nine variables of physical exposure into two latent factors. Associations of pain between different body sites were assessed. Cox regression analyses, presenting the prevalence ratio (PR), showed the related factors to MP. RESULTS: In the previous seven days, 30 % of workers had MP. For all body sites, comorbidity ranged from 72 % to 91 %. Having pain in one body site is associated with pain in other site and the associations between proximal sites were stronger than between more distal sites. High exposure to manual material handling and awkward postures (PR = 1.5, 95 % CI 1.1-2.0), job strain (PR = 1.2, 95 % CI 1.0-1.6), and low social support (PR = 1.3, 95 % CI 1.0-1.7) and being woman (PR = 1.7, 95 % CI 1.3-2.3) were associated with MP. Risk factors for single-site pain and for subsequent musculoskeletal comorbidity were very similar, suggesting an additive effect of risk factors. CONCLUSIONS: Most workers reported MP that was associated with several work-related factors. The findings support the idea that multisite pain is a continuum of single-site pain, maintained by exposure to several risk factors, rather than the result of a specific risk factor that initiates the multisite pain but not single-site pain. Workplace interventions are needed to decrease the number of pain sites, in order to improve the worker's health.
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Dor Musculoesquelética/epidemiologia , Doenças Profissionais/epidemiologia , Local de Trabalho , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Serviços de Saúde do Trabalhador , Medição da Dor , Prevalência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
PURPOSE: Despite the apparent importance of multisite musculoskeletal pain (MMP) for functioning, there is still a lack of studies that have investigated the influence of MMP on healthcare utilization (HU), sickness absence (SA) and restrictions of work (RW). This study described the HU, SA and RW due to musculoskeletal pain (MP) in different body sites and according to number of pain sites and investigated associations between number of pain sites with these three outcomes in workers from Bahia, Brazil. METHODS: This study was based on two cross-sectional surveys carried out in 2010 and 2012. The response in the pooled data was 97 % (n = 1070, 228 women and 842 men). Interviewer-administered questionnaire was used with questions on HU, SA and RW due to MP. The number of pain sites is the sum score of eight body sites with pain in previous 12 months. Covariates were age, gender, physical and psychosocial work demands, leisure-time physical activities and body mass index. Cox regression models, properly applied to a cross-sectional study, determined the associations between number of pain sites with the three outcomes. RESULTS: Prevalence of MP in the previous 12 months is 81.2 %, and MMP accounted for two-thirds of pain. We found consistently increasing occurrence of HU, SA and RW with increasing number of pain sites. For individuals with pain in four or more body sites, the utilization of health care was 1.7-fold the utilization by workers with single-site pain. Having pain in four or more sites increased the prevalence of SA 3.6-fold and of RW 4.0-fold compared with having single-site pain, after adjustment by covariates. CONCLUSIONS: The functional consequences of pain depend on how much body regions are affected, i.e., the more widespread pain, the higher the likelihood of medical consumption, sickness absence and restricted work. Given the high comorbidity, the number of pain sites, instead of specific body site of pain, seems to be a useful measure to anticipate interventions at workplaces for musculoskeletal disease prevention.
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Dor Musculoesquelética/epidemiologia , Doenças Profissionais/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Doenças Profissionais/etiologia , Prevalência , Inquéritos e QuestionáriosRESUMO
PURPOSE: The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers. METHOD: A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Cohens Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve. RESULT: There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders. CONCLUSION: Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.
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Professores Escolares , Autorrelato , Medida da Produção da Fala/métodos , Distúrbios da Voz/diagnóstico , Adulto , Idoso , Área Sob a Curva , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Adulto JovemRESUMO
Conditional cash-transfer (CCT) programmes have been shown to improve the nutritional and health status of children from poor families. However, CCT programmes may have unintended and not fully known consequences by increasing the risk of overweight and obesity. We examined the impact of Familias en Acción (FA), a large CCT programme in Colombia, on the double burden of malnutrition among pre-school and school-aged children. Height and weight were measured before programme enrolment and during follow-ups in 1290 children from thirty-one treatment municipalities, being compared with 1584 children from sixty-two matched control municipalities. We used a difference-in-differences approach to evaluate the effect of FA on children's stunting, BMI z-scores, thinness, overweight and obesity, controlling for individual and municipality-level confounders. At baseline, the prevalences of stunting and overweight were 30·3 and 15·4 %, respectively, in treatment municipalities and 27·9 and 17·4 % in control municipalities. FA was associated with reduced odds of thinness (OR 0·26; 95 % CI 0·09, 0·75) and higher BMI-for-age z-scores (BMI z-scores) (ß 0·14; 95 % CI 0·00, 0·27; P<0·05), although the latter was of small clinical significance. The prevalence of stunting, overweight and obesity decreased over time, but the effect of FA on these outcomes was not significant. The CCT programme in Colombia reduced the odds of thinness, but had no effect on stunting, a more prevalent outcome. The FA programme had no effect on overweight or obesity, although BMI z-scores were higher for children under treatment, raising the possibility of an increase of small clinical significance on BMI among pre-school and school-aged children.
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Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Sobrepeso/epidemiologia , Obesidade Infantil/epidemiologia , Assistência Pública , Magreza/epidemiologia , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Estado Nutricional , Prevalência , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
OBJECTIVE: Conditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment. DESIGN: Secondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas. SETTING: Colombia. SUBJECTS: Children (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities. RESULTS: Familias en Accion was associated with a significant increase in the probability of using preventive care services (OR=1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (ß=1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas. CONCLUSION: CCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.