Abordagem multifatorial do absenteísmo por doença em trabalhadores de enfermagem

OBJETIVO: Analisar fatores associados ao absenteísmo por doença autorreferido em trabalhadores de enfermagem. MÉTODOS: Estudo transversal com 1.509 trabalhadores de três hospitais públicos no município do Rio de Janeiro, RJ, em 2006. O absenteísmo foi classificado em três níveis: nenhum dia, poucos dias (um a nove dias) e muitos dias (>; 10 dias), a partir da resposta a uma pergunta do questionário de avaliação do índice de capacidade para o trabalho. As análises de regressão logística levaram em conta um modelo conceitual com base em determinantes distais (condições socioeconômicas), de níveis intermediários I (características ocupacionais) e II (características do estilo de vida), e proximais (doenças e condições de saúde). RESULTADOS: As frequências de absenteísmo por doença foram de 20,3% e 16,6% para poucos e muitos dias, respectivamente. Aqueles que referiram mais de um emprego, doenças osteomusculares e avaliaram sua saúde como ruim ou regular apresentaram chances mais elevadas de absenteísmo. Comparados aos enfermeiros, os auxiliares tiveram menor chance de referir poucos dias e os técnicos, maiores chances de apresentar muitos dias de ausência. Chances mais elevadas de referir muitos dias de ausência foram observadas entre os servidores públicos em relação aos contratados (OR = 3,12; IC95% 1,86;5,22) e entre os casados (OR = 1,73; IC95% 1,14;2,63) e separados, divorciados e viúvos (OR = 2,06; IC95% 1,27;3,35), comparados aos solteiros. CONCLUSÕES: Diferentes variáveis foram associadas às duas modalidades de absenteísmo, o que sugere sua determinação múltipla e complexa, relacionada a fatores de diversos níveis que não podem ser explicados apenas por problemas de saúde.OBJETIVO: Analizar factores asociados al ausentismo por enfermedad auto referida en trabajadores de enfermería. MÉTODOS: Estudio transversal con 1.509 trabajadores de tres hospitales públicos en Rio de Janeiro, Sureste de Brasil, en 2006. El ausentismo fue clasificado en tres niveles: ningún día, pocos días (uno a nueve días) y muchos días (>;10 días), a partir de la respuesta a una pregunta de cuestionario de evaluación del índice de capacidad para el trabajo. Los análisis de regresión logística tomaron en cuenta un modelo conceptual con base en determinantes distales (condiciones socioeconómicas), de nivel intermedio I (características ocupacionales) y II (características de estilo de vida) y, proximales (enfermedades y condiciones de salud). RESULTADOS: Las frecuencias de ausentismo por enfermedad fueron de 20,3% y 16,6% para pocos y muchos días, respectivamente. Aquellos que mencionaron más de un empleo, enfermedades osteomusculares y evaluaron su salud como mala o regular presentaron chances más elevados de ausentismo. En comparación con los enfermeros, los auxiliares tuvieron menor chance de relatar pocos días y los técnicos, mayores chances de presentar muchos días de ausencia. Chances mas elevados de mencionar muchos días de ausencia fueron observados entre los servidores públicos con relación a los contratados (OR=3,12; IC95% 1,86;5,22) y entre los casados (OR= 1,73; IC95% 1,14;2,63) y separados, divorciados y viudos (OR= 2,06; IC95% 1,27;3,35), en comparación con los solteros. CONCLUSIONES: Diferentes variables fueron asociadas con las dos modalidades de ausentismo, lo que sugiere su determinación múltiple y compleja, relacionada con factores de diversos niveles que no pueden ser explicados sólo por problemas de salud.OBJECTIVE: To analyze factors associated with self-reported sickness absenteeism among nursing workers. METHODS: Cross-sectional study with 1,509 workers from three public hospitals in the city of Rio de Janeiro (Southeastern Brazil) in 2006. Absenteeism was classified in three levels: no day, a few days (1-9 days) and many days (>; 10 days), based on the answer to a question of the work ability index questionnaire. The logistic regression analysis considered a conceptual model based on distal (socioeconomic status), intermediate I (occupational characteristics), intermediate II (lifestyle characteristics), and proximal (diseases and health conditions) determinants. RESULTS: The frequencies of sickness absenteeism were 20.3% and 16.6% for a few days and many days, respectively. Those who reported more than one job, musculoskeletal diseases and rated their health as poor or regular had higher odds of absenteeism. Compared to nurses, nursing assistants were less likely to mention a few days, and technicians were more likely to have many days of absence. Higher odds of mentioning many days of absence were observed among public servants, compared to contract workers (OR = 3.12; 95%CI 1.86;5.22), and among married (OR = 1.73; 95%CI 1.14;2.63) and separated, divorced and widowed individuals (OR = 2.06, 95%CI 1.27;3.35), compared to singles. CONCLUSIONS: Different variables were associated with the two forms of absenteeism, which suggests its multiple and complex determination related to factors from different levels that cannot be exclusively explained by health problems

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Combined measurement of differential and total cross sections in the H → γγ and the H → ZZ* → 4ℓ decay channels at s=13 TeV with the ATLAS detector

A combined measurement of differential and inclusive total cross sections of Higgs boson production is performed using 36.1 fb−1 of 13 TeV proton–proton collision data produced by the LHC and recorded by the ATLAS detector in 2015 and 2016. Cross sections are obtained from measured H→γγ and H→ZZ*(→4ℓ event yields, which are combined taking into account detector efficiencies, resolution, acceptances and branching fractions. The total Higgs boson production cross section is measured to be 57.0−5.9 +6.0 (stat.) −3.3 +4.0 (syst.) pb, in agreement with the Standard Model prediction. Differential cross-section measurements are presented for the Higgs boson transverse momentum distribution, Higgs boson rapidity, number of jets produced together with the Higgs boson, and the transverse momentum of the leading jet. The results from the two decay channels are found to be compatible, and their combination agrees with the Standard Model predictions