212 resultados para Absenteeism
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OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.
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OBJECTIVE To analyze the correlation between sociodemographic factors and working conditions of bus workers in a metropolitan area and violence against them.METHODS This cross-sectional study used a nonprobabilistic sample estimated according to the number of workers employed in bus companies located in three cities in the Belo Horizonte metropolitan region in 2012 (N = 17,470). Face-to-face interviews were conducted using a digital questionnaire. The factors associated with violence were analyzed in two stages using Poisson regression, according to each level. The magnitude of the association was evaluated using prevalence ratios with robust variance and a statistical significance of 5%, and 95% confidence intervals were obtained.RESULTS The study sample comprised 782 drivers and 691 fare collectors; 45.0% participants reported at least one act of violence in the workplace in the last 12 months, with passengers being predominantly responsible. The age of the bus workers was inversely associated with violence. Chronic diseases, sickness absenteeism, and working conditions were also associated with violence.CONCLUSIONS The findings on the correlation between violence and working conditions are essential for implementing prevention strategies by transportation service managers.
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Resumo Poltica(s) de sade no trabalho: um inqurito sociolgico s empresas portuguesas A literatura portuguesa sobre polticas, programas e actividades de Segurana, Higiene e Sade no Trabalho (abreviadamente, SH&ST) ainda escassa. Com este projecto de investigao pretende-se (i) colmatar essa lacuna, (ii) melhorar o conhecimento dos sistemas de gesto da sade e segurana no trabalho e (iii) contribuir para a proteco e a promoo da sade dos trabalhadores. Foi construda uma tipologia com cinco grupos principais de polticas, programas e actividades: A (Higiene & Segurana no Trabalho / Melhoria do ambiente fsico de trabalho); B (Avaliao de sade / Vigilncia mdica / Prestao de cuidados de sade); C (Preveno de comportamentos de risco/ Promoo de estilos de vida saudveis); D (Intervenes a nvel organizacional / Melhoria do ambiente psicossocial de trabalho); E (Actividades e programas sociais e de bem-estar). Havia uma lista de mais de 60 actividades possveis, correspondendo a um ndice de realizao de 100%. Foi concebido e desenhado, para ser auto-administrado, um questionrio sobre Poltica de Sade no Local de Trabalho. Foram efectuados dois mailings, e um follow-up telefnico. O trabalho de campo decorreu entre a primavera de 1997 e o vero de 1998. A amostra (n=259) considerada representativa das duas mil maiores empresas do pas. Uma em cada quatro uma multinacional. A taxa de sindicalizao rondava os 30% da populao trabalhadora, mas apenas 16% dos respondentes assinalou a existncia de representantes dos trabalhadores eleitos para a SH&ST. A hiptese de investigao principal era a de que as empresas com um sistema integrado de gesto da SH&ST seriam tambm as empresas com um (i) maior nmero de polticas, programas e actividades de sade; (ii) maior ndice de sade; (iii) maior ndice de realizao; e (iv) maior percentagem dos encargos com a SH&ST no total da massa salarial. As actividades de tipo A e B, tradicionalmente associadas SH&ST, representavam, s por si, mais de 57% do total. Os resultados, correspondentes s respostas da Seco C do questionrio, apontam, para (i) a hipervalorizao dos exames de medicina do trabalho; e por outro para (ii) o subaproveitamento de um vasto conjunto de actividades (nomeadamente as de tipo D e E), que so correntemente levadas a cabo pelas empresas e que nunca ou raramente so pensadas em termos de proteco e promoo da sade dos trabalhadores. As actividades e os programas de tipo C (Preveno de comportamentos de risco/Promoo de estilos de vida saudveis), ainda eram as menos frequentes entre ns, a seguir aos Programas sociais e de bem-estar (E). a existncia de sistemas de gesto integrados de SH&ST, e no o tamanho da empresa ou outra caracterstica sociodemogrfica ou tcnico-organizacional, que permite predizer a frequncia de polticas de sade mais activas e mais inovadores. Os trs principais motivos ou razes que levam as empresas portuguesas a investir na proteco e promoo da sade dos seus trabalhadores eram, por ordem de frequncia, (i) o absentismo em geral; (ii) a produtividade, qualidade e/ou competitividade, e (iii) a filosofia de gesto ou cultura organizacional. Quanto aos trs principais benefcios que so reportados, surge em primeiro lugar (i) a melhoria da sade dos trabalhadores, seguida da (ii) melhoria do ambiente do ambiente de trabalho e, por fim, (iii) a melhoria da produtividade, qualidade e/ou competitividade.Quanto aos trs principais obstculos que se pem, em geral, ao desenvolvimento das iniciativas de sade, eles seriam os seguintes, na percepo dos respondentes: (i) a falta de empenho dos trabalhadores; (ii) a falta de tempo; e (iii) os problemas de articulao/ comunicao a nvel interno. Por fim, (i) o empenho das estruturas hierrquicas; (ii) a cultura organizacional propcia; e (iii) o sentido de responsabilidade social surgem, destacadamente, como os trs principais factores facilitadores do desenvolvimento da poltica de sade no trabalho. Tantos estes factores como os obstculos so de natureza endgena, susceptveis portanto de controlo por parte dos gestores. Na sua generalidade, os resultados deste trabalho pem em evidncia a fraqueza tericometodolgica de grande parte das iniciativas de sade, realizadas na dcada de 1990. Muitas delas seriam medidas avulsas, que se inserem na gesto corrente das nossas empresas, e que dificilmente podero ser tomadas como expresso de uma poltica de sade no local de trabalho, (i) definida e assumida pela gesto de topo, (ii) socialmente concertada, (iii) coerente, (iv) baseada na avaliao de necessidades e expectativas de sade dos trabalhadores, (v) divulgada, conhecida e partilhada por todos, (vi) contingencial, flexvel e integrada, e, por fim, (vii) orientada por custos e resultados. Segundo a Declarao do Luxemburgo (1997), a promoo da sade engloba o esforo conjunto dos empregadores, dos trabalhadores, do Estado e da sociedade civil para melhorar a segurana, a sade e o bem-estar no trabalho, objectivo isso que pode ser conseguido atravs da (i) melhoria da organizao e das demais condies de trabalho, da (ii) participao efectiva e concreta dos trabalhadores bem como do seu (iii) desenvolvimento pessoal. Abstract Health at work policies: a sociological inquiry into Portuguese corporations Portuguese literature on workplace health policies, programs and activities is still scarce. With this research project the author intends (i) to improve knowledge on the Occupational Health and Safety (shortly thereafter, OSH) management systems and (ii) contribute to the development of health promotion initiatives at a corporate level. Five categories of workplace health initiatives have been identified: (i) Occupational Hygiene and Safety / Improvement of Physical Working Environment (type A programs); (ii) Health Screening, Medical Surveillance and Other Occupational Health Care Provision (type B programs); (iii) Preventing Risk Behaviours / Promoting Healthy Life Styles (type C programs); (iv) Organisational Change / Improvement of Psycho-Social Working Environment (type D programs); and (v) Industrial and Social Welfare (type E programs). A mail questionnaire was sent to the Chief Executive Officer of the 1500 largest Portuguese companies, operating in the primary and secondary sectors ( 100 employees) or tertiary sector ( 75 employees). Response rate has reached about 20% (259 respondents, representing about 300 companies). Carried out between Spring 1997 and Summer 1998, the fieldwork has encompassed two direct mailings and one phone follow-up. Sample is considered to be representative of the two thousand largest companies. One in four is a multinational. Union membership rate is about 30%, but only 16% has reported the existence of a workers health and safety representative. The most frequent workplace health initiatives were those under the traditional scope of the OSH field (type A and B programs) (57% of total) (e.g., Periodical Medical Examinations; Individual Protective Equipment; Assessment of Working Ability). In SMEs (< 250) it was less likely to find out some time-consuming and expensive activities (e.g., Training on OSH knowledge and skills, Improvement of environmental parameters as ventilation, lighting, heating).There were significant differences in SMEs, when compared with the larger ones ( 250) concerning type B programs such as Periodical medical examinations, GP consultation, Nursing care, Other medical and non-medical specialities (e.g., psychiatrist, psychologist, ergonomist, physiotherapist, occupational social worker). With regard to type C programs, there were a greater percentage of programs centred on Substance abuse (tobacco, alcohol, and drug) than on Other health risk behaviours. SMEs representatives reported very few prevention- oriented programs in the field of Drug abuse, Nutrition, Physical activity, Off- job accidents, Blood pressure or Weight control. Frequency of type D programs included Training on Human Resources Management, Training on Organisational Behaviour, Total Quality Management, Job Design/Ergonomics, and Workplace rehabilitation. In general, implementation of this type of programs (Organisational Change / Improvement of Psychosocial Working Environment) is not largely driven by health considerations. Concerning Industrial and Social Welfare (Type E programs), the larger employers are in a better position than SMEs to offer to their employees a large spectrum of health resources and facilities (e.g., Restaurant, Canteen, Resting room, Transport, Infra-structures for physical activity, Surgery, Complementary social protection, Support to recreational and cultural activities, Magazine or newsletter, Intranet). Other workplace health promotion programs like Training on Stress Management, Employee Assistance Programs, or Self-help groups are uncommon in the Portuguese worksites. The existence of integrated OSH management systems, not the company size, is the main variable explaining the implementation of more active and innovative workplace health policies in Portugal. The three main prompting factors reported by employers for health protection and promotion initiatives are: (i) Employee absenteeism; (ii) Productivity, quality and/or competitiveness; and (iii) Corporate culture/management philosophy. On the other hand, (i) Improved staffs health, (ii) Improved working environment and (iii) Improved productivity, quality and/or competitiveness were the three main benefits reported by companies representatives, as a result of successful implementation of workplace health initiatives. (i) Lack of staff commitment; (ii) Lack of time; and (iii) Problems of co-operation and communication within company or establishment (iii) are perceived to be the main barriers companies must cope with. Asked about the main facilitating factors, these companies have pointed out the following ones: (i) Top management commitment; (ii) Corporate culture; and (iii) Sense of social responsibility. This sociological research report shows the methodological weaknesses of workplace health initiatives, carried out by Portuguese companies during the last 90s. In many cases, these programs and actions were not part of a corporate health strategy and policy, (i) based on the assessment of workers health needs and expectancies, (ii) advocated by the employer or the chief executive officer, (ii) planned and implemented with the staff consultation and participation or (iv) evaluated according to a cost-benefit analysis. In short, corporate health policy and action were still rather based on more traditional OSH approaches and should be reoriented towards Workplace Health Promotion (WHP) approach. According to the Luxembourg Declaration of Workplace Health Promotion in the European Union (1997), WHP is a combination of: (i) improving the work organisation and environment; (ii) promoting active participation; (iii) encouraging personal development.Rsume Politique(s) de sant au travail: une enqute sociologique aux entreprises portugaises Au Portugal on ne sait presque rien des politiques de sant au travail, adopts par les entreprises. Avec ce projet de recherche, on veut (i) amliorer la connaissance sur les systmes de gestion de la sant et de la scurit au travail et, au mme temps, (ii) contribuer au dveloppement de la promotion de la sant des travailleurs. Une typologie a t use pour identifier les politiques, programmes et actions de sant au travail: A. Amlioration des conditions de travail / Scurit au travail; B. Mdecine du travail /Sant au travail; C. Prvention des comportements de risque / Promotion de styles de vie sains; D. Interventions organisationnelles / Amlioration des facteurs psychosociaux au travail; E. Gestion de personnel et bien-tre social. Un questionnaire postal a t envoy au reprsentant maximum des grandes entreprises portugaises, industrielles ( 100 employs) ou des services ( 75 employs). Le taux de rponse a t environ 20% (259 rpondants, concernant trois centaines dentreprises et dtablissements). La recherche de champ, conduite du printemps 1997 lt 1998, a compris deux enqutes postales et un follow-up tlphonique. Lchantillon est reprsentatif de la population des deux miles plus grandes entreprises. Un quart sont des multinationales. Le taux de syndicalisation est denviron 30%. Toutefois, il y a seulement 16% de lieux de travail avec des reprsentants du personnel pour la sant et scurit au travail. Les initiatives de sant au travail les plus communes sont celles concernant le domaine plus traditionnel (types A et B) (57% du total): par exemple, les examens de mdecine du travail, lquipement de protection individuelle, les tests daptitude au travail. En ce qui concerne les programmes de type C, les plus frquents sont le contrle et la prvention des addictions (tabac, alcool, drogue). Les interventions dans le domaine de du systme technique et organisationnelle du travail peuvent comprendre les courses de formation en gestion de ressources humaines ou en psychosociologie des organisations, lergonomie, le travail post ou la gestion de la qualit totale. En gnral, la protection et la promotion de la sant des travailleurs ne sont pas prises en considration dans limplmentation des initiatives de type D. Il y a des diffrences quand on compare les grandes entreprises et les moyennes en matire de politique de gestion du personnel e du bien-tre (programmes de type E, y compris lallocation de ressources humaines ou logistiques comme, par exemple, restaurant, journal dentreprise, transports, installations et quipements sportifs). Dautres activits de promotion de la sant au travail comme la formation en gestion du stress, les programmes d assistance aux employs, ou les groupes de soutien et dauto-aide sont encore trs peu frquents dans les entreprises portugaises. Cest le systme intgr de gestion de la sant et de la scurit au travail, et non pas la taille de lentreprise, qui aide prdire lexistence de politiques actives et innovatrices dans ce domaine. Les trois facteurs principaux qui encouragent les actions de sant (prompting factors, en anglais) sont (i) labsentisme (y compris la maladie), (ii) les problmes lis la productivit, qualit et/ou la comptitivit, et aussi (iii) la culture de lentreprise/philosophie de gestion. Du cot des bnfices, on a obtenu surtout lamlioration (i) de la sant du personnel, (ii) des conditions de travail, et (iii) de la productivit, qualit et/ou comptitivit.Les facteurs qui facilitent les actions de sant au travail sont (i) lengagement de la direction, (ii) la culture de lentreprise, et (iii) le sens de responsabilit sociale. Par contre, les obstacles surmonter, selon les organisations qui ont rpondu au questionnaire, seraient surtout (i) le manque dengagement des travailleurs et de leur reprsentants, (ii) le temps insuffisant, et (iii) les problmes de articulation/communication au niveau interne de lentreprise/tablissement. Ce travail de recherche sociologique montre la faiblesse mthodologique des services et activits de sant et scurit au travail, mis en place par les entreprises portugaises dans les annes de 1990, la suite des accords de concertation sociale de 1991. Dans beaucoup de cas, (i) ces politiques de sant ne font pas partie encore dun systme intgr de gestion, (ii) il na pas dvaluation des besoins et des expectatives des travailleurs, (iii) cest trs bas ou inexistant le niveau de participation du personnel, (iv) on ne fait pas danalyse cot-bnfice. On peut conclure que les politiques de sant au travail sont plus proches de la mdecine du travail et de la scurit au travail que de la promotion de la sant des travailleurs. Selon la Dclaration du Luxembourg sur la Promotion de la Sant au Lieu de Travail dans la Communaut Europenne (1997), celle-ci comprend toutes les mesures des employeurs, des employs et de la socit pour amliorer l'tat de sant et le bien tre des travailleurs e ceci peut tre obtenu par la concentration des efforts dans les domaines suivants: (i) amlioration de l'organisation du travail et des conditions de travail ; (ii) promotion d'une participation active des collaborateurs ; (iii) renforcement des comptences personnelles .
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The objective of this study was to investigate an association between pre-harvest sugarcane burning and respiratory diseases in children under five years of age. The following data were collected in five schools in the city of Araraquara, SP, Southeastern Brazil, between March and June 2009: daily records of absences and the reasons stated for these absences, total concentration of suspended particulate matter (g/m3), and air humidity. The relationship between the percentage of school absences due to respiratory problems and the concentration of particulate matter in March and from April to June presented a distinct behavior: absences increased alongside the increase in particulate matter concentration. The use of school absences as indicators of this relationship is an innovative approach.
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ABSTRACT OBJECTIVE To analyze the scientific literature about the effects of exposure to psychosocial risk factors in work contexts. METHODS A systematic review was performed using the terms “psychosocial factors” AND “COPSOQ” in the databases PubMed, Medline, and Scopus. The period analyzed was from January 1, 2004 to June 30, 2012. We have included articles that used the Copenhagen Psychosocial Questionnaire (COPSOQ) as a measuring instrument of the psychosocial factors and the presentation of quantitative or qualitative results. German articles, psychometric studies or studies that did not analyze individual or work factors were excluded. RESULTS We included 22 articles in the analysis. Individual factors, such as gender, age, and socioeconomic status, were analyzed along with work-related factors such as labor demands, work organization and content, social relationships and leadership, work-individual interface, workplace values, justice and respect, personality, health and well-being, and offensive behaviors. We analyzed the sample type and the applied experimental designs. Some population groups, such as young people and migrants, are more vulnerable. The deteriorated working psychosocial environment is associated with physical health indicators and weak mental health. This environment is also a risk factor for the development of moderate to severe clinical conditions, predicting absenteeism or intention of leaving the job. CONCLUSIONS The literature shows the contribution of exposure to psychosocial risk factors in work environments and their impact on mental health and well-being of workers. It allows the design of practical interventions in the work context to be based on scientific evidences. Investigations in specific populations, such as industry, and studies with more robust designs are lacking.
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Dissertao apresentada Associao de Politcnicos do Norte para obteno do Grau de Mestre em Gesto das Organizaes, Ramo de Gesto de Empresas Orientao: Prof. Doutor Jorge Ferreira Dias de Figueiredo Co-Orientao: Mestre Lus Francisco de Oliveira Marques Metello
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Dissertao de Mestrado em Gesto Integrada da Qualidade, Ambiente e Segurana
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RESUMO: O absentismo actividade profissional devido condio de Dor Lombar apresenta-se como um problema de sade pblica com elevados custos econmicos nas sociedades ocidentais. estimado que cerca de 20% a 47% dos utentes com Dor Lombar no retornam sua actividade profissional no perodo de 3 meses, sendo responsveis por 75% a 90% de todos os custos e baixas mdicas associadas condio. Objectivo: O objectivo deste estudo foi analisar a capacidade de retorno actividade profissional em utentes com Dor Crnica Lombar (DCL), que procuraram a Fisioterapia em situao de agudizao dos seus sintomas, e averiguar a sua relao com os nveis de Incapacidade auto-reportados. Secundariamente pretendemos avaliar a influncia das Crenas de medo-evitamento, nos nveis de Incapacidade auto-reportados. Metodologia: Foi efectuado um estudo correlacional prospectivo no qual se observou uma amostra de 56 utentes com DCL que tivessem apresentado novos episdios de agudizao dos seus sintomas. Aps 3 meses de follow-up (n=42) foi avaliado o regresso ao trabalho em boas condies e a sua relao com os nveis de Incapacidade iniciais, bem como o contributo das Crenas de medo-evitamento para essa Incapacidade funcional. Resultados: Foi verificada uma correlao negativa entre os nveis de Incapacidade funcional e o Sucesso no regresso ao trabalho em boas condies ( = -0.369; p =0.016), sendo que os scores mais elevados da Incapacidade correspondem Falha nesse regresso. Verificmos tambm uma correlao positiva entre a existncia das Crenas de medo-evitamento relativas ao Trabalho e a Incapacidade (r =0.511; p =0,001), apresentando estas Crenas um valor preditivo (= 0.533; p =0.001) na Incapacidade auto-reportada. Concluses: A capacidade de retorno actividade profissional nos utentes com DCL, aps um novo episdio de agudizao dos seus sintomas, est relacionada com nveis de Incapacidade funcional. Os factores psicossociais, nomeadamente as Crenas de medo-evitamento relativas ao Trabalho apresentam um valor preditivo para essa Incapacidade auto-reportada.------------------------------ABSTRACT:Work-absenteeism due to the condition of Low Back Pain (LBP) presents itself as a public health problem with high economic costs in Western societies. It is estimated that 20% to 47% of patients with LBP not returned to their work-activity in period of 3 months, accounting for 75% to 90% of all medical costs and sickness compensation associated. Objective: The aim of the present study was to assess the ability to return to work on patients with chronic LBP, who searched for physical therapy in a situation of worsening of their symptoms, and examine their relationship with levels of self-reported disability. Secondly we intend to evaluate the influence of fear-avoidance beliefs to the levels of self-reported disability. Methods: We conducted a prospective cross-sectional study in which we observed 56 patients chronic LBP with new episodes of exacerbation of their symptoms. After a 3 months follow-up (n = 42) we evaluated the return to work in good health and its relationship with initial levels of disability and the contribution of fear-avoidance beliefs for that disability. Results: There was a negative correlation between levels of disability and return to work in good health success ( = -0.369, p = 0.016), with the highest scores correspond to the failure in the work-return. We also found a positive correlation between the existence of fear-avoidance beliefs for work and disability (r = 0.511; p = 0.001), with a predictive value of these fear-avoidance beliefs ( = 0.533; p = 0.001) in self-reported disability. Conclusions: The ability to return to work in chronic LBP patients, after a new episode of exacerbation of symptoms is related to the levels of functional disability. Psychosocial factors, including fear-avoidance beliefs for work showed a predictive value for the self-reported disability.
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Introduction: bronchial asthma is a chronic disease that affects a high percentage of adolescents, with a significant restriction of daily activities, and is a cause of school absenteeism. The relationships between adolescents and asthma disease in school were assessed, with a view to improving knowledge about the asthmatic adolescent. Methods: a survey was conducted in the Lisbon metropolitan area, covering urban (Lisbon) and rural (Lourinha ) zones and including 1879 students and 81 teachers from the 7th to 9th high school years. The study groups were asthmatic students, their peers, and teachers. A self-administered questionnaire was applied to collect information. The results were compared with a reference group of 91 asthmatic students attending our Department of Immunoallergy-Hospital Dona Estefnia. Cotinine urinary measurements were made in a sample of asthmatics and a control group. Results: the prevalence of current asthma among students was 10%. Estimates of asthma annual burden among 7th to 9th year students from Lisbon and Lourinha high schools included 4,307 days missed from school, 4,148 medical consultations and a minimum of 351 hospital emergency care and 80 hospital admissions. Exposure to passive smoking was not significantly different between asthmatic students and theirs peers. Cotinine urinary measurements did not discriminate between exposed and non-exposed individuals. Cigarette smoking was almost as common among adolescent asthmatics (5.4%) as it was in non-asthmatic subjects (6.7%). However, 55% of asthmatics mentioned active and passive smoking as an asthma exacerbating factor. Asthmatic students, theirs peers and teachers showed a deficient knowledge about asthma (mean group scores: 17.6; 14.2 and 17.7 of a possible 30), particularly in the areas related to asthma recognition and its management. Asthmatics attending our Allergy Department had the highest scores. All groups showed tolerance in the sense of a positive and understanding attitude toward a person with asthma. However, traditional beliefs about asthma disease (dependence, inferiority...) were confirmed. A positive correlation between knowledge levels and tolerance attitudes was found. Conclusion: in view of the dimension of the asthma problem in adolescence and its social and economic impact, it is justifiable to assess the need for the implementation of asthma education programs in schools in order to improve asthma management by the adolescents and their schools.
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RESUMO - A morbilidade associada s leses msculo-esquelticas da coluna lombar estimada em 0,8 milhes de DALYS em todo o mundo, constituindo-se a maior causa de absentismo ao trabalho, o que induz uma enorme perda econmica. Os profissionais de sade so um grupo vulnervel a ocorrncia de leses-msculo-esquelticas ligadas ao trabalho (LMELT), nomeadamente aqueles que mobilizam os doentes no seu dia-a-dia. Perante a frequente perspetiva da imutabilidade da situao de trabalho, a presso organizacional na prestao de cuidados e o reduzido nmero de recursos humanos, subsiste a implementao de programas centrados na formao dos profissionais de sade sobre tcnicas e mobilizao de doentes, com o intuito de prevenir as LMELT inerentes a esta atividade. O objetivo do estudo analisar as principais intervenes descritas na bibliografia no que respeita ao impacto da formao dos profissionais de sade sobre mobilizao de doentes, nomeadamente enfermeiros, de modo a contribuir para a preveno de LMELT ao nvel da coluna vertebral. Realizou-se uma reviso sistemtica segundo a metodologia do Prisma Statement nas bases de dados PubMed, Web of Science, B-On, JSTOR, Science, Nature, Scielo e IndeX, no perodo de 1998-2011, em Portugus, Ingls e Francs. Foram identificados 79 artigos. Aps triagem e avaliao da qualidade dos estudos foram selecionados 11. Verificou-se que no existe evidncia cientfica que suporte o investimento em programas centrados na formao/informao dos profissionais de sade acerca das tcnicas de mobilizao de doentes com o intuito de prevenir as leses msculo-esquelticas da coluna lombar. Constatou-se que os programas de interveno multifatorial, apoiados na componente sistmica e integrada, permitem compreender as relaes entre o trabalhador, o trabalho e os efeitos sobre a sade, de forma a implementar medidas eficazes para a preveno de LMELT.
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One of the largest health problems faced worldwide, when evaluated by direct (clinical) as well indirect cost (absenteeism), is the degeneration of the intervertebral disc (IVD) that leads to back pain and, potentially disability and individuals quality of life decreasing. The intervertebral disc is a mechanical and biological complex structure, formed by a tough outer layer of fibrocartilage called Annulus Fibrosus (AF),which surrounds a soft, elastic and gelatinous core called Nucleus Pulposus (NP). These two structures are completed by two upper and lower encasing layer called Vertebral Endplates (VEP). The degeneration of the IVD is marked by the dehydration of the Nucleus Pulposus, reducing the hydrostatic pressure inside the nucleus, resulting in a loss of capability to support compressive forces, during the active period, and to regain height during the resting period. This situation will compromise the role of shock absorber by the NP and transfers these forces to the AF. This transfer will result in cracks on the AF, deteriorating the IVD, allowing the ingrowth of vessels and nerves. This project was based on the developing a protocol to test suitable NP replacements, in hope to future assessment of discrete mechanical values and characteristics for an NP replacement. For this, Nucleus pulposus samples from goat, encapsulated Hydromed gel denominated Raviolis and Chitosan gels, produced via wet route using an ammonium environment, were confined compressed. Chitosan was rheologically tested and swelling capability of all the three type of materials was assessed. Results showed that the Nucleus Pulposus and Raviolis have similar mechanical behavior, being able to swell and build up hydrostatic pressure after a compression stage, while the Chitosan gel did not showed that ability. Therefore, Raviolis are a more suitable candidate to replace the NP than Chitosan gels. It was also observed that confined compression is the key test to perform on any possible candidate to replace the NP.
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RESUMO - Hoje, facilmente se poder constatar que as doenas orais possuem uma expressiva influncia perante a sade geral, no apenas pela presena da condio por si s, mas tambm a nvel pessoal, social e econmico. O seu reflexo traduz-se em parte, no absentismo escolar e laboral, diminuio considervel de produtividade e eficincia, falta de ateno e objetividade. Pelo que ento considerado, um grave problema de sade pblica, afetando de forma mais expressiva, grupos socioeconomicamente desfavorecidos. O acompanhamento e anlise do desenvolvimento de iniciativas internacionais, no que ao seguimento das recomendaes da Organizao Mundial de Sade diz respeito, poder ser um timo beneficio e impulso para a identificao e aplicao de novos planos de ao. O presente projeto, pretendeu contribuir para a identificao de duas propostas de interveno em sade oral ajustadas ao alcance das recomendaes da OMS que simultaneamente possam sejam proveitosas para a resoluo dos problemas de sade oral nacionais. Foi realizado um estudo observacional, descritivo e retrospetivo onde foram recolhidos dados acerca de 8 Sistemas de Sade Oral europeus, previamente selecionados segundo critrios especficos, e iniciativas de sade oral por eles desenvolvidas. Por fim, foram eleitas duas iniciativas de interesse, possveis de aplicao futura. Os resultados do estudo apontam para a existncia de diferentes iniciativas, enquadradas com as recomendaes da OMS. De entre as mesmas, destaca-se uma implementada em 2009, na Sucia, que estando essencialmente assente num acessvel subsidio anual fixo pago por cada indivduo adulto, procura fundamentalmente preservar os esforos de preveno aplicados nas ltimas dcadas.
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RESUMO - A morbilidade associada s leses msculoesquelticas ligadas ao trabalho (LMELT) origina uma elevada perda de produtividade (absentismo e presentismo) em organizaes de sade, o que induz um substantivo impacto (custo) econmico. Nesse contexto, os profissionais de sade, como grupo vulnervel ocorrncia de LMELT, nomeadamente aqueles que mobilizam os doentes diariamente, apresentam elevadas taxas de acidentes de trabalho com absentismo. Considerando a importncia do capital humano em sade e tendo em conta o contexto actual de conteno da despesa no sector da sade portugus, o despiste de situaes de perda de produtividade e seu impacto econmico em instituies de sade, assume um papel fundamental na gesto dessas organizaes. O presente estudo teve como objetivo avaliar o impacto (custo) das LMELT por acidente de trabalho em enfermeiros e assistentes operacionais do CMRA durante o perodo de 2009 a 2013. Partindo da identificao dos acidentes de trabalho (AT) ocorridos nestes grupos profissionais entre 2009 e 2013, da leso musculoesqueltica resultante e do absentismo registado os participantes no estudo responderam aos itens da escala WQL-8 e SPS-6, para se determinar tambm os nveis de presentismo. Este estudo adotou a metodologia do capital humano para estimar os custos indiretos ou perda de produtividade das LMELT. Constatou-se que so as transferncias a maior causa das LMELT, com uma sintomatologia mais prevalente na regio lombar. Existe perda de produtividade nesta instituio entre 2009 e 2013 com um custo total estimado em 222.015,98, absentismo e presentismo, sendo a Distrao Evitada a dimenso que apresenta maiores valores.
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RESUMO: Nos pases desenvolvidos a lombalgia a condio msculo-esqueltica mais prevalente. Quando evolui para um quadro crnico responsvel por um encargo econmico bastante considervel, no s em relao aos indivduos, mas tambm para a sociedade. A lombalgia crnica por isso uma das principais causas de perda de produtividade e de perda de independncia econmica, nomeadamente atravs do absentesmo (ausncia do trabalho), do presentesmo (perda de produtividade no trabalho, devido capacidade diminuda provocada pela lombalgia) e da incapacidade para trabalhar (invalidez permanente, total ou parcial). At data, em Portugal, a prevalncia e carga social da lombalgia crnica eram desconhecidas. At agora no existiam estudos populacionais de grande dimenso sobre este tema. O objetivo principal desta tese foi determinar a prevalncia de lombalgia crnica, e tambm avaliar a carga social que esta tem na populao adulta Portuguesa. O trabalho de investigao foi desenvolvido no mbito do Estudo Epidemiolgico de Doenas Reumticas em Portugal (EpiReumaPt). Este foi o primeiro estudo de larga escala e de base populacional, que determinou a prevalncia de doenas reumticas e msculo- esquelticas na populao adulta portuguesa. Foi realizado numa amostra aleatria e representativa, de 10.661 indivduos do Continente, da Regio Autnoma dos Aores e da Regio Autnoma da Madeira, entre Setembro de 2011 e Dezembro de 2013. Esta tese foi dividida em duas seces. A primeira seco incluiu o detalhe das questes relativas ao desenvolvimento e gesto do EpiReumaPt, constituindo-se como um guia prtico sobre como realizar um estudo de base populacional de larga escala, em Portugal. A metodologia detalhada do EpiReumaPt foi tambm descrita nesta seco e incluiu os objectivos, o desenho do estudo, as caractersticas de recrutamento e a preparao de dados para anlise. Nesta seco foram ainda descritos os principais resultados do EpiReumaPt. Estes evidenciaram que a lombalgia foi a condio msculo-esqueltica com maior prevalncia na populao adulta portuguesa.A segunda seco desta tese estimou a prevalncia da lombalgia crnica ativa na populao adulta Portuguesa, e avaliou a carga social esta condio. A lombalgia ativa foi definida com base na dor auto-relatada no dia da entrevista e que persistia h pelo menos 90 dias (independentemente da causa). A lombalgia foi definida como dor na rea definida entre a margem inferior das dcimas segundas costelas at s pregas glteas inferiores, com ou sem dor nos membros inferiores. A carga social foi medida tendo em conta os seguintes parmetros: qualidade de vida, funo, consumo de recursos de sade, consumo de analgsicos e outros frmacos usados no alvio da dor, sintomas de ansiedade e sintomas de depresso. Os resultados mostraram que o consumo de recursos em sade e a carga social da lombalgia crnica na populao adulta Portugus significativa. Tambm a incapacidade causada pela lombalgia crnica,nos indivduos com idade ativa, responsvel por elevadas taxas de absentesmo e m qualidade de vida, aos quais acresce o consequente nus socioeconmico. Esta tese tambm concluiu que o consumo de analgsicos e outros medicamentos para alvio da dor, na populao adulta portuguesa com lombalgia crnica ativa, relativamente baixa. A maioria destes indivduos no tomava nenhum medicamento analgsico, independentemente da intensidade da dor. Mesmo os indivduos que reportaram dor intensa, apenas 4.0% estavam no primeiro degrau da escada analgsica da Organizao Mundial de Sade; 2.3% usavam opiides fracos e 0.03% usavam opiides fortes para controlar a dor (segundo e terceiro degrau da escada analgsica da Organizao Mundial da Sade). O trabalho de investigao tambm confirmou que a prevalncia de sintomas de ansiedade e depresso entre os indivduos adultos portugueses com lombalgia crnica ativa elevada. Nestes indivduos, registou-se um consumo mais elevado de analgsicos e outros medicamentos para alvio da dor, quando comparados com os indivduos com lombalgia crnica activa sem esses sintomas psicolgicos. Os grupos teraputicos mais utilizados foram os ansiolticos, sedativos e hipnticos, os antidepressivos e os anti-inflamatrios no esterides. A intensidade mdia da dor reportada foi tambm maior entre os indivduos com lombalgia ativa e sintomas de ansiedade e/ou depresso. Tambm nestes, foi reportada pior funo e pior estado de sade. Em relao ao consumo de recursos de sade foram encontradas diferenas significativas entre as duas populaes: os indivduos com lombalgia ativa e sintomas psicolgicos concomitantes registaram maior nmero de consultas de psiquiatria de outras especialidades mdicas, assim como precisaram de mais apoio domicilirio nos 12 meses prvios entrevista do EpiReumaPt. Foram tambm identificados os fatores associados a sintomas isolados de ansiedade, a sintomas isolados de depresso e a sintomas de ansiedade e depresso. Resumindo,esta tese permitiu concluir que a lombalgia crnica um problema de sade comum na populao adulta portuguesa, contribuindo para um elevado grau de incapacidade e que consequentemente afeta o desempenho laboral e o bem-estar dos indivduos. A lombalgia crnica tambm responsvel por um consumo considervel de recursos de sade. Acresce ainda que os sintomas de ansiedade e depresso so comuns, entre os indivduos com lombalgia crnica, contribuindo com uma carga social adicional.---------------------------------- ABSTRACT:Low Back Pain(LBP) is the most prevalent of musculoskeletal condition in developed countries.When it becomes chronic, LBP causesan enormous economic burden on individuals and society - it is one of the leading causes of loss of productivity and economic independence through absenteeism (time off work), presenteeism (lost productivity because of diminished capacity while at work) and work disability (permanent, partial or complete disablement for work purposes). In Portugal the prevalence and burden of LBP and chronic LBP (CLBP) were poorly defined. Until now no large population-based studies have focused on this. The main aim of this thesis was to determine the prevalence of LBP and CLBP, and also to assess the burden of CLBP in the adult rtuguese population. The research work was developed under the scope of EpiReumaPt (the Portuguese Epidemiologic Study of Rheumatic Diseases). EpiReumaPt was the first national large population-based and prevalence study of rheumatic and musculoskeletal diseases (RMD). It was performed among a randomized and representative sample of 10,661 adult Portuguese subjects recruited in Mainland, Azores and Madeira Islands, from September 2011 to December 2013. The first section of this thesis included detailed issues regarding the development and management of EpiReumaPt, and provided a practical guide on how to set-up a large population-based study in Portugal. The detailed methodology of EpiReumaPt, including its objectives,study design,recruitment features,and data preparation for analyses were also described. The main results from EpiReumaPt study were provided in this section and showed that LBP was the musculoskeletal condition with highest prevalence among Portuguese population. The second section of this thesis estimated the prevalence of active CLBP among adult Portuguese population, and assessed the social burden of this condition. Active CLBP was defined based on self-reported pain on the day of the interview, and for most of the time for at least 90 days (independently from cause). LBP was defined as pain in the back area from the lower margin of the twelfth ribs to he lower gluteal folds, with or without pain referred to the lower limbs. Social burden was measured taking into account the following outcomes: quality of life, function, healthcare resources consumption, analgesic and other pain relief drugs intake, anxiety and depression symptoms. Results showed that the healthcare consumption and social burden of CLBP among adult Portuguese population were enormous, and the disability caused by CLBP among subjects in a working age provides high rates of absenteeism (work loss) and poor quality of life, with a consequent socioeconomic burden. This thesis also concluded that analgesic and other pain relief drugs untake among adult Portuguese population with active CLBP was very low. Most of the subjects with active CLBP did not take any analgesic drug regardless pain severity. Even when subjects self-reported severe pain, only 24.0% were in the 1st step of the analgesic ladder,2.3% used weak analgesic opioids and 0.03% used strong opioids (2nd and 3rd step of WHO analgesic ladder, respectively) to control pain . The research work also confirmed that the prevalence of anxiety and depression symptoms among adult Portuguese subjects with active CLBP was high. Regarding pharmacological therapy, the intake of analgesic and other pain relief drugs was higher among subjects with anxiety and/or depression symptoms, when compared with subjects without these psychological symptoms. Anxiolytics, sedatives and hypnotics, antidepressants and NSAIDs intake had higher usage rates among these subjects. The pain severity mean was also higher among this subjects and function and health status was worse. Regarding healthcare resources consumption,significant differences between the two populations were found. Subjects with ctive CLBP and concomitant psychological symptoms had a higher number of psychiatrist and other physician visits. They also needed more home care in the previous 12 months. Factors associated with isolated symptoms of anxiety, depression,and concomitant anxiety and depression symptoms were also identified. Summarizing, we concluded that CLBP is a common health problem among adult Portuguese population contributing to disability and affecting labor performance, and the well being of subjects. it is also responsible for considerable healthcare resource consumption. Anxiety and depression symptoms are common among subjects with CLBP and provided an additional burden among them.
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Dissertao de mestrado integrado em Engenharia e Gesto Industrial
