Resumo em Espanhol:

Objetivos. La atención primaria proporciona la oportunidad de identificar y tratar a personas cuyo consumo de alcohol se encuentra por encima de los niveles permisibles. Con el fin de preparar a los médicos de atención primaria de todo el mundo para prevenir y tratar los problemas relacionados con el alcohol, el Instituto Nacional sobre el Abuso de Alcohol y el Alcoholismo (National Institute on Alcohol Abuse and Alcoholism: NIAAA) de los Estados Unidos de América (EE. UU.) ha creado y probado un Programa Internacional de Educación Médica sobre el Alcohol, destinado a aumentar las aptitudes clínicas, educativas e investigadoras del profesorado de las facultades de medicina que trabaja con los estudiantes universitarios, los residentes y los médicos de atención primaria. Venezuela fue uno de los países seleccionados para la puesta en marcha de esta iniciativa. Métodos. Durante 5 días del mes de septiembre de 1999 se realizó en la Universidad del Zulia, Maracaibo, Venezuela, un curso de formación del profesorado que consistió en 19 talleres. Los métodos de enseñanza fueron clases, representaciones demostrativas, presentaciones de casos, talleres de desarrollo de aptitudes y la creación de un plan educativo por cada uno de los participantes. Resultados. En el proyecto participaron 33 profesores de nueve de las 10 escuelas de medicina en Venezuela: 18 mujeres y 15 hombres con un promedio de 44 años, 9 de ellos con formación en medicina de familia, 7 en psiquiatría, 6 en pediatría, 4 en obstetricia, 3 en medicina interna, y 4 en especialidades no especificadas. El 76% de los participantes completaron una entrevista 6 meses más tarde. Este grupo refirió que su competencia en 14 áreas clínicas había aumentado de forma significativa y que había emprendido con buenos resultados nuevas actividades curriculares en sus respectivas facultades de medicina y programas de residencia. Conclusiones. Este modelo demostró ser eficaz para incrementar la formación de los médicos en la prevención y el tratamiento de los problemas relacionados con el alcohol en Venezuela. La evaluación del programa proporcionó resultados similares a los obtenidos en otros países en los que también se ha puesto en marcha.

Resumo em Inglês:

Objective. Primary care offers an opportunity to identify and treat persons who drink alcohol above permissible levels. In order to prepare primary care practitioners around the world to prevent and treat alcohol-related problems, the National Institute on Alcohol Abuse and Alcoholism of the United States of America has developed and tested a model international program for educating physicians about such problems. The model was designed to increase the clinical, teaching, and research skills of medical school faculty who work with medical students, residents, and primary care physicians. Venezuela was one of the countries selected for the initiative. Methods. During September 1999 a five-day faculty-development course consisting of 19 workshops was conducted at the University of Zulia, which is located in the city of Maracaibo, Zulia, Venezuela. Teaching strategies included class presentations, role plays, case presentations, skills-building workshops, and having each participant develop a teaching plan that he or she would use. Results. Thirty-three faculty members from 9 of Venezuela's 10 medical schools participated in the project. The 18 female and 15 male participants had an average age of 44 years. The areas of specialization of the 33 participants were: family medicine (9 participants), psychiatry (7), pediatrics (6), obstetrics (4), internal medicine (3), and unspecified (4). Of the 33 participants, 25 of them (76%) completed a six-month follow-up interview. This group said they had significantly increased their competence in 14 clinical areas and that they had successfully implemented new teaching activities within their respective medical schools and residency programs. Conclusions. This model proved to be an effective strategy for increasing training for physicians in the prevention and treatment of alcohol-related problems in Venezuela. The evaluation confirms similar findings in other countries where the program has been implemented.

Resumo em Espanhol:

Objetivos. Aunque se han hecho grandes esfuerzos por encontrar tratamientos eficaces para las lumbalgias, la eficacia de las diferentes modalidades terapéuticas puede depender de su cumplimiento por parte del paciente. El objetivo de este estudio prospectivo consistió en investigar si las características demográficas del paciente, los factores clínicos, los obstáculos externos al cumplimiento del tratamiento y la percepción subjetiva de la discapacidad y la calidad de vida, la depresión y el control sobre la salud permiten predecir el cumplimiento de un programa fisioterapéutico para pacientes con lumbalgia. Métodos. El estudio, de cohorte, prospectivo y exploratorio, se realizó en la ciudad de Nueva York en 1999. Todos los participantes contestaron un cuestionario durante el examen clínico inicial, realizado por un fisioterapeuta, y fueron seguidos durante el tratamiento. Se investigó el cumplimiento de los tres regímenes terapéuticos prescritos a cada uno de los pacientes, que consistieron en asistir a sesiones programadas de fisioterapia, realizar un programa de ejercicios en su casa y visionar cintas de vídeo educativas sobre la espalda. Dependiendo de cada caso, el programa terapéutico planeado podía durar entre 2 y 6 semanas. Para caracterizar a los pacientes se empleó un conjunto de instrumentos que medían la limitación funcional subjetiva, la calidad de vida, la depresión y las creencias sobre su salud. Para detectar diferencias estadísticamente significativas entre los pacientes no cumplidores o con bajo cumplimiento y aquellos con alto cumplimiento se utilizaron las pruebas de la t de Student y de la x². Las razones de probabilidades (odds ratios) ajustadas que expresaban la asociación entre determinadas variables y el cumplimiento se estimaron mediante regresión logística. Resultados. En términos generales, 51% de los pacientes incumplieron total o parcialmente el programa terapéutico. Hubo diferencias entre los tres regímenes en lo que se refiere a su cumplimiento; el mayor correspondió a los vídeos educativos y el menor al programa de ejercicios a realizar en casa. El bajo cumplimiento global se asoció de forma positiva a la previsión de obstáculos para seguir el tratamiento propuesto, a la comorbilidad y a la mayor duración del tratamiento. Conclusiones. Los resultados de este estudio indican que el cumplimiento de los tratamientos de la lumbalgia es un problema serio y complejo. Aunque solo se trató de un estudio exploratorio, los autores creen que sus resultados pueden servir a los profesionales de la salud para identificar a los pacientes con probabilidades de no cumplir el tratamiento, y a los investigadores para planear estudios específicos sobre la eficacia de los programas de tratamiento de la lumbalgia.

Resumo em Inglês:

Objective. Great efforts have been made to find effective treatments for back pain. Nevertheless, the effectiveness of a particular treatment can depend on patient compliance. The objective of this study was to prospectively investigate whether patients' demographic factors, clinical factors, external barriers in following the treatment, and perceptions of disability, quality of life, depression, and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain. Methods. This was an exploratory prospective cohort study that was carried out in New York City during 1999. All study participants answered a questionnaire at the initial clinical evaluation by a physical therapist and were followed during the treatment. The study assessed compliance with the three treatment regimens that were prescribed for every patient: attending scheduled physical therapy sessions, following a program of home exercises, and watching back-education videotapes. Depending on the individual patient, the planned treatment program could last from 2 to 6 weeks. The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations, perceived quality of life, depression, and their beliefs about their health. Student's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients. Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance. Results. We found that 51% of the patients were either noncompliant or low-compliant overall with the low back pain treatment program. There were differences in compliance behavior among the three treatment regimens, with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises. Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment, with comorbidity, and with longer duration of treatment in this program. Conclusions. The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem. Nevertheless, while this study was only an exploratory one, we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by researchers to plan specific studies on the effectiveness of treatment programs for patients with low back pain.

Resumo em Português:

Objetivo. Comparar os padrões de sono de enfermeiros dos turnos diurno e noturno em um hospital de Campinas (SP), Brasil. Métodos. Participaram 59 enfermeiros entre 23 e 59 anos. Para os enfermeiros do dia, analisou-se o sono noturno, e, para os da noite, os sonos diurno e noturno. Os informantes preencheram um diário do sono durante 1 semana, ao acordar. Foram analisados hora de ir deitar, de dormir, e de acordar; latência do sono; horas de sono noturno e diurno; cochilos; qualidade do sono; modo de acordar; e comparação do sono registrado no diário com o sono habitual. Também foram coletadas informações pessoais e profissionais. Resultados. O grupo diurno ia dormir às 23h36min e o grupo noturno, às 23h52min (P <=0,004, Wilcoxon). Os enfermeiros diurnos acordavam mais cedo (7h3min) do que os noturnos quando dormiam à noite (8h30min). A latência média do sono foi de 23min26s para os enfermeiros diurnos contra 22min50s para os noturnos; a duração do sono noturno foi de 7h11min e 9h6min, respectivamente. O cochilo esteve presente apenas no grupo diurno (média de 2h3min). O sono diurno dos enfermeiros da noite foi caracterizado pelo fracionamento (dois períodos, tempo de sono de 4h7min e 2h38min). O sono noturno do grupo noturno foi de melhor qualidade. O tempo médio de trabalho em hospital foi de 14,31 anos no grupo diurno contra 7,07 no grupo noturno (P <=0,05, Wilcoxon). Os sujeitos possuíam hábitos saudáveis, principalmente quanto ao consumo de álcool. Verificou-se uso de anti-hipertensivos, diuréticos e analgésicos. Conclusões. Os achados foram semelhantes aos descritos anteriormente. Seria recomendável que os enfermeiros do turno da noite pudessem tirar cochilos para compensar o déficit de sono durante a atividade noturna.

Resumo em Inglês:

Objective. To compare sleep patterns in nurses working day and night shifts in a hospital in Campinas (SP), Brazil. Methods. Fifty-nine nurses between 23 and 59 years of age participated in the study. For day shift workers, the pattern of nocturnal sleep was examined; for night shift workers, nocturnal and diurnal sleep patterns were examined. During 1 week, participants filled out a sleep diary right after waking up. The following items were assessed: time going to bed, falling asleep, and waking up; sleep latency; duration in hours of nocturnal and diurnal sleep; naps; quality of sleep; mode of waking up; and comparison between the sleep recorded in the diary with the usual sleep. Personal and professional information was also collected. Results. Day shift workers went to bed at 23h36min, and night workers at 23h52min (P > 0.05). The nurses working a day schedule woke up earlier (7h3min) than those working a night schedule when they slept at night (8h30min) (P <= 0.004, Wilcoxon). Mean sleep latency was 23min26s for day shift nurses versus 22min50s for night shift nurses; the duration of nocturnal sleep was 7h11min and 9h6min, respectively. Only day workers took naps (mean 2h3min). The average diurnal sleep of night shift nurses was fractionated (two periods, mean time asleep 4h7min and 2h38min). The quality of the nocturnal sleep of night shift workers was better than that of day shift workers. The mean period working in a hospital was 14.31 years for day workers versus 7.07 for night shift workers (P <= 0.05, Wilcoxon). The study participants had healthy habits, especially concerning alcohol consumption. We verified the use of antihypertensives, diuretics, and analgesics. Conclusions. The present findings are similar to those previously described in the literature. Night shift nurses should be able to take naps to compensate for the sleep deficit accrued when they work at night.

Resumo em Espanhol:

Objetivos. Evaluar la eficacia de un proyecto de intervención en la comunidad destinado a reducir la mortalidad materna e infantil en un distrito urbano pobre de la ciudad de Natal, en el nordeste de Brasil. Métodos. La intervención, denominada proyecto ProNatal, introdujo en una población geográficamente definida un programa de atención sanitaria comunitaria integrada. Las intervenciones incluyeron el establecimiento de clínicas de atención prenatal en los centros de salud del distrito, la apertura en la policlínica de servicios de maternidad para los partos de bajo riesgo, la creación de una clínica de planificación familiar y otra de lactancia materna, el apoyo de pediatras a las clínicas para niños sanos de menos de 5 años, la creación de servicios ambulatorios y de urgencias pediátricas, y la incorporación de agentes de salud reclutados en la comunidad. Al inicio del proyecto (julio de 1995) y 30 meses después (diciembre de 1997), se realizaron encuestas representativas de la población en las que se usó un cuestionario de salud general adaptado a las condiciones locales. Los datos de mortalidad procedieron de los registros locales y de las autopsias de lactantes y niños fallecidos en el período neonatal. Resultados. En 1995, de 1 195 embarazadas, fallecieron 4 (mortalidad materna de 335/100 000); tres de estas muertes se debieron a problemas hipertensivos y una a perforación uterina tras un aborto ilegal. En 1998 no hubo muertes maternas durante el embarazo ni el parto. En 1993 no hubo partos en la policlínica, pero en 1998 tuvieron lugar allí 946 partos, sin que se produjeran complicaciones graves. El modo del parto, la incidencia de prematuridad y la incidencia de bajo peso al nacer no cambiaron de forma significativa a lo largo del período de estudio. En la encuesta posterior a la intervención, 75% de las mujeres dijeron haber recibido en el año anterior información sobre la anticoncepción, proporcionada por un médico; antes de la intervención, este porcentaje había sido de 50%. En un estudio de mortalidad realizado en 1993-1995, la tasa de mortalidad infantil estimada fue de 60/1 000 nacidos vivos. En 1998, según los datos locales recogidos por vigilancia activa, la cifra disminuyó a 37/1 000 nacidos vivos. Las causas de mortalidad infantil predominantes en ambos períodos fueron las infecciones respiratorias y las enfermedades diarreicas. El porcentaje de niños con lactancia materna fue superior a 95% en ambas muestras, pero la proporción de niños con lactancia materna durante más de 6 meses fue mayor después de la intervención (41%, frente a 32%; P = 0,0005). No hubo diferencias apreciables en el uso de las consultas para menores de 5 años, pero las tasas de vacunación aumentaron tras la intervención. Asimismo, se registró un aumento de los conocimientos de las madres sobre las medidas higiénicas básicas, las causas de las enfermedades más frecuentes y el tratamiento de las infecciones respiratorias agudas y la diarrea en los niños; esto fue particularmente notable en las familias visitadas por agentes de salud comunitarios. Conclusiones. Es posible reducir las desigualdades en la atención sanitaria de las poblaciones urbanas pobres mediante intervenciones en la comunidad, entre ellas el uso de agentes de salud comunitarios.

Resumo em Inglês:

Objective. To evaluate the effectiveness of a community-based intervention project aimed at reducing maternal and infant mortality in a poor urban district in the city of Natal, in the Northeast of Brazil. Methods. The intervention, called the ProNatal project, introduced a program of integrated community health care to a geographically defined population. The interventions included the establishment of antenatal clinics at the district's health centers, the opening of the maternity facilities at the polyclinic for low-risk deliveries, the introduction of a family planning clinic and a breast-feeding clinic, support from pediatricians for under-5 (well-baby) clinics, children's outpatient services and children's emergency care, and the introduction of health agents recruited from the local community. Representative surveys of the population were taken at the project's inception (July 1995) and then 30 months later (December 1997), using a general health questionnaire adapted to the local conditions. Mortality data were collected from local registration systems as well as from an autopsy survey of perinatal and infant deaths. Results. During 1995 there were 4 maternal deaths from 1 195 pregnancies (maternal mortality of 335/100 000); three of the deaths were related to hypertension and one to uterine perforation after an illegal abortion. During 1998 (post-intervention), there were no maternal deaths in pregnancy or childbirth. In 1993 no deliveries took place at the polyclinic, but in 1998 there were 946 deliveries at the clinic without any serious complications. The method of delivery, the incidence of prematurity, and the incidence of low birthweight did not change significantly over the study period. In the post-intervention survey, 75% of women reported receiving contraceptive advice from a doctor in the preceding year, compared to 50% in the first sample. A mortality survey carried out in 1993-1995 estimated the infant mortality rate to be 60/1 000 live births. By 1998, using data collected locally by active surveillance, the infant mortality rate was 37/1 000 live births. The causes of infant death in both those periods were dominated by respiratory infections and diarrheal disease. Over 95% of both samples initiated breast-feeding, but a higher proportion of the post-intervention sample reported breast-feeding for longer than 6 months (41% vs. 32%, P = 0.0005). No differences were apparent in the use of under-5 clinics, but immunization rates improved. Post-intervention, significant improvements were documented in the mothers' understanding of basic hygiene, their knowledge of causes of common diseases, and their management of acute respiratory infections and diarrhea in children. This was particularly true for the households visited by a community health agent. Conclusions. Inequalities in health care in poor urban populations can be reduced by integrated community-based interventions, including the use of health agents recruited from the local community.

Resumo em Espanhol:

Objetivos. La varicela es una infección común de la infancia en países que no han incorporado la vacunación correspondiente en sus calendarios vacunales. Generalmente es benigna en niños inmunocompetentes y no necesita tratamiento. Los objetivos de este estudio consistieron en investigar la frecuencia y características de las complicaciones de la varicela que requieran tratamiento hospitalario en niños inmunocompetentes y el curso clínico de los hijos de madres con varicela perinatal. Además, se calculó el gasto hospitalario asociado a la varicela en los niños estudiados. Métodos. Estudio retrospectivo de los expedientes clínicos de niños con varicela ingresados en el Hospital del Niño de Panamá, de enero de 1991 a diciembre de 2000. Se analizaron el tipo de complicaciones, el curso clínico y los costos hospitalarios de los pacientes afectados por varicela. Resultados. De 5 203 niños atendidos en consultas externas, 568 (11%) fueron hospitalizados. En el estudio se incluyeron 513 niños: 381 (74%) con varicela adquirida en la comunidad, 92 (18%) hijos de madres con varicela y 40 (8%) con varicela nosocomial. Las complicaciones más frecuentes fueron las infecciones cutáneas y subcutáneas (45%), las infecciones respiratorias (25%) y las alteraciones neurológicas (7%). Las complicaciones respiratorias y cutáneas ocurrieron a menor edad y en fases más tempranas de la varicela que las alteraciones neurológicas. Trece niños (2,5%) fallecieron, con una letalidad del 8% para la varicela con complicaciones respiratorias y neurológicas y nula para las complicaciones cutáneas. Sesenta de los 92 (65%) hijos de madres con varicela no desarrollaron la enfermedad y ninguno falleció. En cambio, 2 de los 32 neonatos (6%) con varicela perinatal fallecieron. La duración media de la hospitalización fue de 8,9 (1 a 27) días. Se utilizó farmacoterapia parenteral en una gran proporción de los niños, especialmente antibióticos (54%), aciclovir (17%) e inmunoglobulinas intravenosas (14%). El costo medio por paciente hospitalizado fue de 1 209 dólares estadounidenses. Conclusiones. Los resultados obtenidos indican que la varicela es una infección que puede asociarse a un número importante de complicaciones costosas y a una letalidad no despreciable en niños inmunocompetentes. La vacunación rutinaria contra la varicela podría reducir el impacto de esta enfermedad sobre la salud infantil en nuestro país.

Resumo em Inglês:

Objectives. Chickenpox is a common infection of childhood in countries that have not included the corresponding vaccination in their immunization schedules. Chickenpox is usually benign in immunocompetent children, and treatment is not needed. The objectives of this study were to investigate the frequency and characteristics of chickenpox complications that require hospital treatment in immunocompetent children and the clinical progression in children of mothers with perinatal chickenpox. In addition, the hospital costs associated with chickenpox in the studied children were calculated. Methods. This was a retrospective study using the clinical records of children with chickenpox hospitalized at the Children's Hospital of Panama, from January 1991 through December 2000. We analyzed the types of complications, the clinical progression, and the hospital costs of the chickenpox patients. Results. Of 5 203 children seen in outpatient consultations, 568 of them (11%) were hospitalized. We included 513 children in our study: 381 (74%) with chickenpox acquired in the community, 92 (18%) the children of mothers with chickenpox, and 40 (8%) with nosocomial chickenpox. The most frequent complications were cutaneous and subcutaneous infections (45%), respiratory infections (25%), and neurological changes (7%). The respiratory and cutaneous complications occurred sooner and among younger patients than did the neurological changes. Overall, 13 of the children (2.5%) died. The case fatality rate was 8% for chickenpox with respiratory and neurological complications and 0% for chickenpox with cutaneous complications. Of the 92 children with a mother with chickenpox, 60 of them (65%) did not develop the disease, and none of the 92 died. In contrast, 2 of the 32 neonates (6%) with perinatal chickenpox died. The mean length of hospitalization was 8.9 days (standard deviation, ± 17.4 days). Parenteral pharmacotherapy was used with the great majority of the children, particularly antibiotics (54%), acyclovir (17%), and intravenous immunoglobulin (14%). The mean per-patient cost of hospitalization was US$ 1 209. Conclusions. Our results show that chickenpox is associated with a sizable number of expensive complications and a not-insignificant case fatality rate in immunocompetent children. Routine vaccination against chickenpox could reduce the impact of this disease on the health of children in Panama.

Resumo em Português:

A deficiência de vitamina A é considerada um dos problemas de saúde pública de fácil prevenção mais importantes em diversos países, inclusive o Brasil. Assim, o objetivo do presente trabalho foi revisar a literatura sobre carência de vitamina A publicada entre 1970 e 2000, disponível nas bases de dados MEDLINE e LILACS, e avaliar a hipovitaminose A na América Latina e no Brasil. A pesquisa revelou que até os anos 1980, a atenção dada pela saúde pública à vitamina A se concentrou na importância dessa vitamina para a visão. Na segunda metade dessa década, estudos epidemiológicos sugeriram que, em nível populacional, a deficiência sub-clínica de vitamina A também poderia ser deletéria para certas etapas do metabolismo, com grande influência sobre os índices de morbidade e mortalidade infantil. Em todas as regiões brasileiras para as quais existem dados, foi constatada a carência marginal de vitamina A, com alta prevalência em diferentes faixas etárias, o que não se justifica com a tecnologia e os recursos atualmente disponíveis. É preciso que se assuma o compromisso de reduzir a deficiência de vitamina A para garantir o desenvolvimento adequado das próximas gerações.

Resumo em Inglês:

Vitamin A deficiency is considered one of the most important of the easily preventable public health problems in a number of countries, including Brazil. The objective of this study was to review the scientific literature in the MEDLINE and LILACS databases that was published between 1970 and 2000 concerning vitamin A deficiency, and to assess the occurrence of hypovitaminosis A in Latin America, especially Brazil. Our research showed that until around 1980 the public health concerns focused mainly on the importance of vitamin A in ensuring good vision. In the second half of the 1980s, epidemiological studies suggested that, on a population level, subclinical vitamin A deficiency could also have a negative effect on metabolic functions, with a great impact on childhood morbidity and mortality. Marginal vitamin A deficiency has been reported in all the regions of Brazil for which there are data available, with high prevalences in various age groups. This situation is inexcusable, given the health care technology and resources that are now available. There must be a commitment to reducing vitamin A deficiency in order to ensure the adequate development of future generations.

Resumo em Inglês:

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.

Resumo em Espanhol:

Cada año mueren en todo el mundo unos dos millones de personas por enfermedades y accidentes laborales, pero la repercusión total es mucho mayor aun. Según el informe de la Organización Internacional del Trabajo (OIT) titulado Informe introductorio: trabajo decente, trabajo seguro, de mayo de 2002, dependiendo del tipo de trabajo, por cada accidente mortal se producen 500 a 2 000 lesiones. Según la OIT, la principal causa de muerte relacionada con el trabajo es el cáncer, responsable de 32% de las muertes, seguido de las enfermedades circulatorias (23%), los accidentes (19%) y las enfermedades transmisibles (17%). Las lesiones y las enfermedades laborales suponen un considerable costo económico. Cerca de 4% del producto interno bruto (PIB) mundial se pierde en gastos de tratamiento e ingresos no percibidos. El informe de la OIT dice que se podría prevenir cerca de 80% de los accidentes y muertes laborales si todos los países que pertenecen a la organización aplicaran los métodos de prevención de accidentes ya existentes. En los países industrializados, las prioridades deben ser los factores psicosociales ligados a las malas relaciones y gestiones en el lugar de trabajo, las consecuencias mentales y físicas de las tareas repetitivas muy técnicas y la información sobre la manipulación de las nuevas tecnologías y sustancias, entre ellas los productos químicos. En los países que todavía están en fase de industrialización se les debería dar prioridad al mejoramiento de las prácticas sanitarias y de seguridad en las actividades primarias, como la agricultura, la pesca y la explotación maderera; la prevención de los accidentes industriales y la prevención de los accidentes y enfermedades en talleres informales e industrias domésticas.