Frida Marina Fischer

WORK ABILITY OF HEALTH CARE SHIFT WORKERS: WHAT MATTERS?

This paper aims at identifying variables associated with inadequate work ability among nursing personnel at a public hospital, considering factors related to socio‐demographic, lifestyles, working conditions, and health outcomes. A cross‐sectional study was conducted in a university hospital in São Paulo, Brazil, as part of a larger research study on tolerance to 12 h night work. Nursing staff included registered nurses, nurse technicians, and nurse aides; in total, there were 996 healthcare workers (878 female; 118 male) at the time of the study. Some 696 workers (69.9%) of the population agreed to participate. Data collection (October 2004–July 2005) was based on a comprehensive questionnaire about living and working conditions (including incivility at work, work demands, work control, and support), mental and physical health symptoms (fatigue and sleep problems), and work ability. This report presents analyses of the adapted Brazilian version of the Work Ability Index (WAI) and associated variables. The study population worked one of the following shift schedules at this hospital: 12 h nights followed by 36 h off or 9 h or 6 h day (morning or afternoon) shifts. The mean age of the respondents was 34.9 (S.D.±10.4) years of age; 31.5% of the participants held two jobs. Statistical analyses using a hierarchical multiple logistic regression model were performed to evaluate the factors associated with inadequate (moderate and low scores) of the WAI. The significantly associated factors were socio‐demographic (income responsibility, sole breadwinner, raising kids, age group), working conditions (thermal discomfort, organization of the workplace, and verbal abuse), and health outcomes (high body mass index, obesity, sleep problems, and fatigue). In spite of limitations of the study design, results indicate that the nursing profession is associated with stressful working conditions, contributing to inadequate WAI. This is in addition to bad living conditions and precarious work. Intervention measures, either at the workplace or at individual levels, are necessary to prevent a decrease in work ability, even in this quite young working population.

Job control, job demands, social support at work and health among adolescent workers

OBJETIVO: Avaliar as dimensoes fisicas e psicologicas do trabalho de adolescentes (demanda de trabalho, controle no trabalho e apoio social e ambiental), relacionando-os a relatos de: dores no corpo, acidentes de trabalho, duracao de sono e duracao diaria da jornada de trabalho. METODOS: Participaram do estudo 354 estudantes do periodo noturno de escola publica no Municipio de Sao Paulo, entre abril e maio de 2001. Esses, responderam a questionario sobre condicoes de vida, trabalho (escalas Karasek de controle no trabalho) e estado de saude. Foram feitas analises de regressao logistica multipla a fim de determinar a relacao entre variaveis. RESULTADOS: As exigencias psicologicas mostraram-se associadas aos relatos de dores no corpo (OR=3,3), maiores riscos de ocorrencia de acidentes de trabalho (OR=3,0) e reducao da duracao do sono durante os dias de semana (segunda a quinta-feira) (p<0,01). Baixa autoridade de decisao (p=0,03) e maior seguranca no emprego (p=0,02) estao relacionadas a maior duracao da jornada diaria de trabalho. CONCLUSOES: Concluiu-se que nao somente os estressores fisicos, mas tambem os psicologicos devem ser levados em consideracao quando avaliadas as condicoes de trabalho de adolescentes, ja que esses podem ser associados as mas condicoes de trabalho e efeitos negativos na saude.OBJECTIVE To evaluate physical and psychological dimensions of adolescent labor (such as job demands, job control, and social support in the work environment), and their relation to reported body pain, work injuries, sleep duration and daily working hours. METHODS A total of 354 adolescents attending evening classes at a public school in Sao Paulo, Brazil, answered questionnaires regarding their living and working conditions (Karaseks Job Content Questionnaire, 1998), and their health status. Data collection took place in April and May 2001. Multiple logistic regression analysis was used to determine relations among variables. RESULTS Psychological job demands were related to body pain (OR=3.3), higher risk of work injuries (OR=3.0) and reduced sleep duration in weekdays (Monday to Thursday) (p<0.01). Lower decision authority in the workplace (p=0.03) and higher job security (p=0.02) were related to longer daily working hours. CONCLUSIONS It was concluded that besides physical stressors, psychological factors are to be taken into account when studying adolescent working conditions, as they may be associated with negative job conditions and health effects.

Sleep and sleepiness among working and non-working high school evening students.

The aim of this study was to evaluate patterns of sleepiness, comparing working and non‐working students. The study was conducted on high school students attending evening classes (19:00–22:30 h) at a public school in São Paulo, Brazil. The study group consisted of working (n=51) and non‐working (n=41) students, aged 14–21 yrs. The students answered a questionnaire about working and living conditions and reported health symptoms and diseases. For seven consecutive days, actigraphy measurements were recorded, and the students also filled in a sleep diary. Sleepiness ratings were given six times per day, including upon waking and at bedtime, using the Karolinska Sleepiness Scale. Statistical analyses included three‐way ANOVA and t‐test. The mean sleep duration during weekdays was shorter among workers (7.2 h) than non‐workers (8.8 h) (t=4.34; p<.01). The mean duration of night awakenings was longer among workers on Tuesdays and Wednesdays (28.2 min) and shorter on Mondays (24.2 min) (t=2.57; p=.03). Among workers, mean napping duration was longer on Mondays and Tuesdays (89.9 min) (t=2.27; p=.03) but shorter on Fridays and Sundays (31.4 min) (t=3.13; p=.03). Sleep efficiency was lower on Fridays among non‐workers. Working students were moderately sleepier than non‐workers during the week and also during class on specific days: Mondays (13:00–15:00 h), Wednesdays (19:00–22:00 h), and Fridays (22:00–00:59 h). The study found that daytime sleepiness of workers is moderately higher in the evening. This might be due to a work effect, reducing the available time for sleep and shortening the sleep duration. Sleepiness and shorter sleep duration can have a negative impact on the quality of life and school development of high school students.

Explaining Sleep Duration in Adolescents: The Impact of Socio‐Demographic and Lifestyle Factors and Working Status

Previous studies found students who both work and attend school undergo a partial sleep deprivation that accumulates across the week. The aim of the present study was to obtain information using a questionnaire on a number of variables (e.g., socio‐demographics, lifestyle, work timing, and sleep‐wake habits) considered to impact on sleep duration of working (n=51) and non‐working (n=41) high‐school students aged 14–21 yrs old attending evening classes (19:00–22:30 h) at a public school in the city of São Paulo, Brazil. Data were collected for working days and days off. Multiple linear regression analyses were performed to assess the factors associated with sleep duration on weekdays and weekends. Work, sex, age, smoking, consumption of alcohol and caffeine, and physical activity were considered control variables. Significant predictors of sleep duration were: work (p < 0.01), daily work duration (8–10 h/day; p < 0.01), sex (p=0.04), age 18–21 yrs (0.01), smoking (p=0.02) and drinking habits (p=0.03), irregular physical exercise (p < 0.01), ease of falling asleep (p=0.04), and the sleep‐wake cycle variables of napping (p < 0.01), nocturnal awakenings (p < 0.01), and mid‐sleep regularity (p < 0.01). The results confirm the hypotheses that young students who work and attend school showed a reduction in night‐time sleep duration. Sleep deprivation across the week, particularly in students working 8–10 h/day, is manifested through a sleep rebound (i.e., extended sleep duration) on Saturdays. However, the different roles played by socio‐demographic and lifestyle variables have proven to be factors that intervene with nocturnal sleep duration. The variables related to the sleep‐wake cycle—naps and night awakenings—proved to be associated with a slight reduction in night‐time sleep, while regularity in sleep and wake‐up schedules was shown to be associated with more extended sleep duration, with a distinct expression along the week and the weekend. Having to attend school and work, coupled with other socio‐demographic and lifestyle factors, creates an unfavorable scenario for satisfactory sleep duration.

Efeitos do trabalho sobre a saúde de adolescentes

O estudo analisa consequencias do trabalho para as condicoes de vida, saude e desenvolvimento psicossocial de adolescentes. Participaram do estudo 354 estudantes de 14 a 18 anos, do ensino medio, periodo noturno. A analise das representacoes foi realizada a partir da coleta de evocacoes livres. Os dados sobre sono foram obtidos por meio de questionarios, sobre auto-percepcoes acerca das condicoes de vida e trabalho, sintomas de saude e doencas. A analise de dados foi realizada com o software EVOC 2000 e SPSS. Constataram-se diferencas significativas na duracao media de sono entre os adolescentes: os trabalhadores relataram menores medias de duracao de sono. Entre os trabalhadores, referiram dormir menos os que sentem sono no trabalho e nas aulas, tem maiores exigencias psicologicas no trabalho, ganham acima de 1 salario minimo mensal, jornadas acima de 6 horas diarias ou acima de 20 horas semanais, trabalham em local barulhento e com presenca de gases e vapores. As representacoes do trabalho entre os jovens apontam contradicao entre o seu reconhecimento como valor moral positivo para o desenvolvimento psicossocial e a construcao da identidade, e as consequencias negativas decorrentes da exposicao a cargas fisicas e psicologicas precocemente.

A gender approach to work ability and its relationship to professional and domestic work hours among nursing personnel

The association between working hours and work ability was examined in a cross-sectional study of male (N=156) and female (N=1092) nurses in three public hospitals. Working hours were considered in terms of their professional and domestic hours per week and their combined impact; total work load. Logistic regression analysis showed a significant association between total work load and inadequate work ability index (WAI) for females only. Females reported a higher proportion of inadequate WAI, fewer professional work hours but longer domestic work hours. There were no significant differences in total work load by gender. The combination of professional and domestic work hours in females seemed to best explain their lower work ability. The findings suggest that investigations into female well-being need to consider their total work load. Our male sample may have lacked sufficient power to detect a relationship between working hours and work ability.

What aspects of shiftwork influence off-shift well-being of healthcare workers?

Characteristics of shiftwork schedules have implications for off-shift well-being. We examined the extent to which several shift characteristics (e.g., shift length, working sundays) are associated with three aspects of off-shift well-being: work-to-family conflict, physical well-being, and mental well-being. We also investigated whether these relationships differed in four nations. The Survey of Work and Time was completed by 906 healthcare professionals located in Australia, Brazil, Croatia, and the USA. Hierarchical multiple regression analyses supported the hypothesis that shiftwork characteristics account for significant unique variance in all three measures of well-being beyond that accounted for by work and family demands and personal characteristics. The patterns of regression weights indicated that particular shiftwork characteristics have differential relevance to indices of work-to-family conflict, physical well-being, and mental well-being. Our findings suggest that healthcare organizations should carefully consider the implications of shiftwork characteristics for off-shift well-being. Furthermore, although our findings did not indicate national differences in the nature of relationships between shift characteristics and well-being, shiftwork characteristics and demographics for healthcare professionals differ in systematic ways among nations; as such, effective solutions may be context-specific.

Twelve-Hour Night Shifts of Healthcare Workers: A Risk to the Patients?

We assessed the impact of 12h fixed night shift (19:00–07:00h) work, followed by 36h of off-time, on the sleep–wake cycle, sleep duration, self-perceived sleep quality, and work-time alertness on a group composed of 5 registered and 15 practical nurses. Wrist actigraphy (Ambulatory Monitoring, Inc.), with data analysis by the Cole-Kripke algorithm, was applied to determine sleep/wake episodes and their duration. The sleep episodes were divided into six categories: sleep during the night shift (x¯=208.6; SD±90.6mins), sleep after the night shift (x¯=138.7; SD±79.6min), sleep during the first night after the night work (x¯=318.5; SD±134.6min), sleep before the night work (x¯=104.3; SD±44.1min), diurnal sleep during the rest day (x¯=70.5; SD±43.0min), and nocturnal sleep during the rest day (x¯=310.4; SD±188.9mins). A significant difference (p<.0001; T-test for dependent samples) was detected between the perceived quality of sleep of the three diurnal sleep categories compared to the three nocturnal sleep categories. Even thought the nurses slept (napped) during the night shift, their self-perceived alertness systematically decreased during it. Statistically significant differences were documented by one-way ANOVA (F=40.534 p<.0001) among the alertness measurements done during the night shift. In particular, there was significant difference in the level of perceived alertness (p<.0001) between the 7th and 10thh of the 12h night shift. These findings of decreased alertness during the terminal hours of the night shift are of concern, since they suggest risk of comprised patient care.

Capacidade para o trabalho: revisão de literatura

The aim of this article is to present a literature review on work ability and functional ageing. An extensive search of publications from 1966 to 2006 was conducted using the databases MEDLINE, LILACS and SciELO. Several aspects of work ability are presented in this manuscript: the historical context when the theme emerged, the theoretical framework, the determinant factors and an explanatory model, the current methodology to evaluate and monitor the work ability, the importance of its promotion. Highlights of the current situation about the research, practice and future perspectives regarding the theme are also discussed. In the context of the workforce aging, the work ability became an important indicator because their consequences to the workers health, well-being and employability, with impacts to the individuals, organizations and society. In spite of their relevance, there is a lack of attention to the issues about work ability and functional ageing.O objetivo deste trabalho e apresentar uma revisao de literatura sobre a capacidade para o trabalho de trabalho e envelhecimento funcional. Foi realizada uma extensa busca de publicacoes do periodo de 1966 a 2006, usando as bases de dados MEDLINE, Lilacs e SciELO. Sao apresentados varios aspectos relativos a capacidade para o trabalho: o contexto historico no qual o tema emergiu, o referencial teorico, os fatores determinantes, um modelo explicativo, a metodologia atual para avaliar e monitorar a capacidade para o trabalho e a importância de sua promocao. Tambem e destacada a situacao atual da pesquisa, pratica e perspectivas futuras relativas ao tema. No contexto do envelhecimento da forca de trabalho, a capacidade para o trabalho tornou-se um indicador importante em funcao de suas consequencias para a saude, bem-estar e empregabilidade dos trabalhadores, com impactos para os individuos, organizacoes e sociedade. As questoes sobre o tema, apesar de relevantes, ainda carecem de maior atencao.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities. METHODS A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries. RESULTS Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines. CONCLUSIONS The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.