Ada Ávila Assunção

O professor, as condições de trabalho e os efeitos sobre sua saúde

O estudo das relacoes entre o processo de trabalho docente, as reais condicoes sob as quais ele se desenvolve e o possivel adoecimento fisico e mental dos professores constituem um desafio e uma necessidade para se entender o processo saude-doenca do trabalhador docente e se buscar as possiveis associacoes com o afastamento do trabalho por motivo de saude. Este artigo apresenta o perfil dos afastamentos do trabalho por motivos de saude de uma populacao de profissionais da educacao. Buscando elementos na literatura disponivel, aventa a hipotese de que as condicoes de trabalho nas escolas podem gerar sobreesforco dos docentes na realizacao de suas tarefas. Foram analisados os dados apresentados no Relatorio preparado pela Gerencia de Saude do Servidor e Pericia Medica (GSPM) da Prefeitura Municipal de Belo Horizonte, Minas Gerais, relativos aos afastamentos do trabalho de funcionarios da Secretaria Municipal de Educacao, de abril de 2001 a maio de 2003. Os afastamentos foram indicados pelos atestados medicos fornecidos pela propria instituicao. Os dados obtidos, embora nao permitissem discriminar o numero de professores envolvidos, possibilitaram o conhecimento do numero de afastamentos entre os professores, sendo que os transtornos psiquicos ficaram em primeiro lugar entre os diagnosticos que provocaram os afastamentos.

Condições de trabalho, qualidade de vida e disfonia entre docentes

Voice disorders are common among teachers, with adverse consequences for their work and quality of life. This study focuses on factors associated with voice-related quality of life among female teachers in the municipal school system in Belo Horizonte, Southeast Brazil. A cross-sectional study with 2,133 female teachers was conducted, using the Voice-Related Quality of Life (VRQL) questionnaire, which has two domains: socio-emotional and physical. Teachers were grouped into quartiles based on the distribution of the final score in each domain. Those in the lowest quartile were then compared with all the others for a number of factors, using multiple logistic regression analysis. Less creativity at work and poor relationship with pupils were associated with worse voice-related quality of life in both domains. Mental disorders (GHQ12 > 4) were associated with worse voice-related quality of life in the socio-emotional domain, and intra-class noise with worse voice-related quality of life in the physical domain. Improvements in working conditions are key factors for achieving better voice-related quality of life among teachers.

Uma contribuição ao debate sobre as relações saúde e trabalho

O objetivo e apresentar os pressupostos teorico-metodologicos das investigacoes sobre problemas de saude atuais marcados pelas mutacoes nos processos de trabalho em curso. Para isso, o artigo apresenta os resultados de algumas pesquisas recentes realizadas no campo de estudo das relacoes saude e trabalho que observam os efeitos das mutacoes do trabalho, a partir das queixas que os trabalhadores vem apresentando no que diz respeito a sua saude e disposicao para o enfrentamento cotidiano. Os resultados dos estudos descritos permitem visualizar um quadro de adoecimento dos trabalhadores em que as queixas sao inespecificas e suscitam o interesse pela abordagem da etnografia e pela metodologia da analise ergonomica do trabalho. As abordagens tradicionais sao criticadas e o autor vislumbra a possibilidade de articular as disciplinas, a fim de resolver impasses colocados pelas abordagens classicas.

Interactions between physical and psychosocial demands of work associated to low back pain

OBJECTIVE To examine the interaction between physical and psychosocial demands of work associated to low back pain. METHODS Cross-sectional study carried out in a stratified proportional random sample of 577 plastic industry workers in the metropolitan area of the city of Salvador, Northeast Brazil in 2002. An anonymous standard questionnaire was administered in the workplace by trained interviewers. Physical demands at work were self-rated on a 6-point numeric scale, with anchors at each end of the scale. Factor analysis was carried out on 11 physical demand variables to identify underlying factors. Psychosocial work demands were measured by demand, control and social support questions. Multivariate analysis was performed using the likelihood ratio test. RESULTS The factor analysis identified two physical work demand factors: material handling (factor 1) and repetitiveness (factor 2). The multiple logistic regression analysis showed that factor 1 was positively associated with low back pain (OR=2.35, 95% CI 1.50;3.66). No interaction was found between physical and psychosocial work demands but both were independently associated to low back pain. CONCLUSIONS The study found independent effects of physical and psychosocial work demands on low back pain prevalence and emphasizes the importance of physical demands especially of material handling involving trunk bending forward and trunk rotation regardless of age, gender, and body fitness.OBJETIVO: Analisar a interacao entre demandas fisicas e psicossociais no trabalho sobre a ocorrencia de lombalgia em trabalhadores. METODOS: Estudo transversal com amostra aleatoria, estratificada, proporcional de 577 trabalhadores da industria de plasticos da regiao metropolitana de Salvador (BA), realizado em 2002. Questionario padronizado, anonimo, foi administrado no local de trabalho por entrevistadores treinados. As demandas fisicas foram medidas pelo auto-registro de trabalhadores com uma escala numerica de seis pontos, com âncoras nas extremidades. A analise de fator foi realizada com 11 variaveis de demandas fisicas, a fim de identificar os fatores subjacentes. As demandas psicossociais no trabalho foram medidas por meio de questoes sobre demanda psicologica, controle e suporte social. Realizou-se analise de regressao logistica, utilizando o teste da razao de verossimilhanca. RESULTADOS: A analise de fator identificou dois fatores de demandas fisicas no trabalho: fator 1, caracterizando manuseio de carga; fator 2, caracterizando repetitividade. Resultados da regressao logistica multipla mostraram que o fator 1 estava associado com lombalgia (OR=2,35, IC 95% 1,50; 3,66). Nao houve associacao estatistica entre demandas fisicas e psicossociais no trabalho, mas ambas atuaram de forma independente no desfecho. CONCLUSOES: Os achados mostraram que para ocorrencia de lombalgias houve efeitos independentes e importantes para demandas psicossociais e fisicas no trabalho, com destaque para: manuseio de carga, inclinacao e rotacao de tronco na ocorrencia de lombalgia, mesmo considerando a idade, sexo e condicionamento fisico.

Voice Disorder: case definition and prevalence in teachers

Several studies have shown a high prevalence of voice disorders among teachers. However, it is difficult to establish comparisons among the results found given the great variability among criteria and symptoms used to define the presence of vocal alteration, in addition to the variations in the composition of the populations studied (age, gender, origin, working schedule, profession, among others). This study aims to discuss the need for a standard definition of functional voice disorder and possible implications of the lack of such a standard definition on estimating the prevalence of functional voice disorders among teachers. A systematic bibliographic review on voice disorders in teachers was carried out as of 1990 in the Medline, Scielo, Ovid, Pubmed and Lilacs databases. Of the 3,186 citations, 15 fulfilled the inclusion criteria to discuss prevalence of vocal disorder in teachers. Nine articles defined vocal disorder based solely on the presence of vocal symptoms, which varied in relation to type, number, frequency, and reference period. Hoarseness and vocal tiredness were mentioned in all studies that evaluated vocal symptoms. Only three studies reported prevalence based on professional examination. Prevalence rates varied according to reference period and frequency of symptoms. The results ratified the importance of standardizing the case definition of voice disorder in order to better study and understand its occurrence and to compare prevalence obtained from different populations and along time in the same population. Standardized definitions should include laryngeal alterations observed in later phases of voice disorder as well as signs and symptoms present in phases previous to organic alterations, when they are potentially reversible.

O trabalho dos pediatras em um serviço público de urgências: fatores intervenientes no atendimento

This qualitative empirical study discusses the material and organizational conditions of work by pediatricians in a public emergency service, with the aim of identifying factors that affect care. The work was studied using group interviews and direct observation in the emergency unit. The results were compared with statistical and historical data from documental research. Forty-four pediatricians from seven teams were interviewed, and seven of the pediatricians were observed while on duty. The precarious referral and counter-referral system was a determinant factor leading to the heavy demand on the emergency unit. Agglomeration of patients and families at the entrance to the emergency service led to time pressure and interfered directly in the pediatric care. The study identified informal strategies devised and implemented by these physicians in attempts to guarantee the quality of care in keeping with pediatric principles.

Prevalence of musculoskeletal disorders among plastics industry workers

The prevalence of musculoskeletal disorders among workers in the plastics industry in Salvador, Bahia State, Brazil was estimated. Cases were defined by reported symptoms of pain in the previous 12 months, lasting more than a week or having monthly minimum frequency, which had given rise to restrictions at work or to seeking medical attention, or where respondents had a severity score greater than or equal to 3 (on a numerical scale of 0 to 5). A stratified proportional random sample of 577 workers was studied. The prevalence of musculoskeletal disorders, considering of all body segments, was 50.1%. The prevalence of musculoskeletal disorders was higher among women than among men at distal upper extremities (34.6% and 11.6% respectively) and also in the region of the neck, shoulder or upper part of the back (27.4% and 17.6% respectively). There was no difference between genders for the prevalence of lower back pain (21.2% and 21.4% respectively); 65% of cases in this region had reports of pain in the previous seven days. Due to the importance and prevalence of musculoskeletal disorders, it is necessary that their measurement in epidemiological studies be done properly.

Musculoskeletal disorders among workers in plastic manufacturing plants

BACKGROUND Epidemiological studies have indicated an association between musculoskeletal disorders (MSDs) and physical work demands. Psychosocial work demands have also been identified as possible risk factors, but findings have been inconsistent. OBJECTIVES To evaluate factors associated with upper back, neck and upper limb MSD among workers from 14 plastic manufacturing companies located in the city of Salvador, Brazil. METHODS A cross-sectional study design was used to survey a stratified proportional random sample of 577 workers. Data were collected by questionnaire interviews. Factor analysis was carried out on 11 physical demands variables. Psychosocial work demands were measured by demand, control and social support questions. The role of socio-demographic factors, lifestyle and household tasks was also examined. Multiple logistic regression was used to identify factors related to upper back, neck and upper limb MSDs. RESULTS Results from multiple logistic regression showed that distal upper limb MSDs were related to manual handling, work repetitiveness, psychosocial demands, job dissatisfaction, and gender. Neck, shoulder or upper back MSDs were related to manual handling, work repetitiveness, psychosocial demands, job dissatisfaction, and physical unfitness. CONCLUSIONS Reducing the prevalence of musculoskeletal disorders requires: improving the work environment, reducing biomechanical risk factors, and replanning work organization. Programs must also be aware of gender specificities related to MSDs.

Occupational and individual risk factors for dysphonia in teachers

BACKGROUND In recent decades several groups of researchers have been interested in describing and understanding vocal morbidity in teachers in order to explain the large number of teachers diagnosed with dysphonia and account for the absenteeism attributed to vocal disability. AIMS To determine the proportion of teachers who reported a diagnosis of dysphonia and measure associations between individual and contextual factors and the event of interest. METHODS Teachers were recruited from the city of Belo Horizonte and invited to complete a web-based institutional intranet questionnaire. RESULTS In total, 649 teachers responded; 32% (CI 28.5-35.5) reported that they had received a physician diagnosis of dysphonia. This prevalence was significantly higher among female teachers (prevalence ratio (PR) 2.33; CI 1.41-3.85), and groups who reported limited technical resources and equipment (PR 1.56; CI 1.14-2.15), a diagnosis of gastritis (PR 1.59; CI 1.28-1.98), not being summoned for an annual physician examination (PR 0.47; CI 0.32-0.68), or absenteeism (PR 1.39; CI 1.06-1.81). CONCLUSIONS The high prevalence of dysphonia in teachers was not associated with any individual variables, except for sex and comorbidity (diagnosis of gastritis). Limited technical resources and equipment were associated with dysphonia and suggests policy change is important in preventing dysphonia.

Associação entre distúrbios do ombro e trabalho: breve revisão da literatura

Este artigo apresenta os resultados de uma breve revisao da literatura focalizada nos disturbios do ombro. As publicacoes foram pesquisadas nos sites do Medline, Ovid, Lilacs e periodicos Capes, no periodo de janeiro de 1993 a julho de 2004, com as seguintes palavras-chave: shoulder pain, rotator cuff, job, dor no ombro, manguito rotador, trabalho. Foram selecionados os artigos de acordo com os seguintes criterios: estudo epidemiologico publicado em ingles, portugues ou espanhol, com informacoes sobre a carga fisica ou sobre os fatores psicossociais do trabalho, explicitacao do metodo de avaliacao da exposicao, presenca de dor no ombro ou tendinopatia do manguito rotador. Vinte artigos preencheram todos os criterios de inclusao. Encontrou-se associacao positiva entre os disturbios do ombro e o trabalho praticado pelos sujeitos dos estudos revisados. Restaram como limite da revisao: a heterogeneidade dos artigos quanto a avaliacao da exposicao, ao tipo de diagnostico, a metodologia utilizada na conducao da pesquisa, e aos meios para avaliacao da dor. Os autores discutem a necessidade de aprofundamento dos metodos de investigacao de problemas musculoesqueleticos relacionados ao trabalho.