Leila Maria Mansano Sarquis

Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?

&NA; Large international variation in the prevalence of disabling forearm and low back pain was only partially explained by established personal and socioeconomic risk factors. &NA; To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross‐sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1‐month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up‐to 8‐fold difference in prevalence remained. Systems of compensation for work‐related illness and financial support for health‐related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20–59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Patterns of multisite pain and associations with risk factors

Summary In a large cross‐sectional survey, pain affecting 6–10 anatomical sites showed substantially different associations with risk factors from pain limited to 1–3 sites. ABSTRACT To explore definitions for multisite pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross‐sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20–59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6–10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants vs 41.9 expected). In comparison with pain involving only 1–3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.

The CUPID (Cultural and Psychosocial Influences on Disability) Study: Methods of Data Collection and Characteristics of Study Sample

Background The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample. Methods/Principal Findings A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as “repetitive strain injury” (RSI). Conclusions/Significance The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.

Acidentes de trabalho com instrumentos perfurocortantes entre os trabalhadores de enfermagem

O presente estudo analisou os acidentes de trabalho ocorridos com trabalhadores de enfermagem, de um hospital publico, provocados por instrumentos perfurocortantes. A instituicao campo de estudo foi um hospital publico do interior de Sao Paulo. A populacao foi composta por 787 trabalhadores de enfermagem. Na coleta de dados foram usados dois instrumentos: o primeiro foi o questionario que se destinou ao levantamento dos dados referentes aos acidentes de trabalho ocorridos no ano de 1996; o segundo foi a entrevista realizada com estes trabalhadores que sofreram acidentes com instrumentos perfurocortantes. Os resultados encontrados mostram a significativa frequencia desse tipo de acidente entre os auxiliares de enfermagem. A interacao do trabalhadores de enfermagem com instrumentos perfurocortantes, indica a grande exposicao aos riscos biologicos e as graves doencas.The present study analyzed the accidents happened at work with the nursing staff of a public hospital, provoked by sharp instruments. All the nursing staff composed the study population. In the collection of data two instruments were used: a questionnaire designed to collect data referring to all working accidents that happened in the year of 1996; the second was an interview accomplished with these workers that suffered accidents with sharp instruments. The results showed that the nursing staff health is under risk with sharp instruments is involved in the accidents. For these accidents, the greater risk coefficients were for nursing auxiliary. High subnotification was verified for those accidents. The relative results of the interaction of the nursing staff working with sharp instruments indicate the great exposure to the biological risks and the serious diseases.: The present study analyzed the accidents happened at work with the nursing staff of a public hospital, provoked by sharp instruments. All the nursing staff composed the study population. In the collection of data two instruments were used: a questionnaire designed to collect data referring to all working accidents that happened in the year of 1996; the second was an interview accomplished with these workers that suffered accidents with sharp instruments. The results showed that the nursing staff health is under risk with sharp instruments is involved in the accidents. For these accidents, the greater risk coefficients were for nursing auxiliary. High subnotification was verified for those accidents. The relative results of the interaction of the nursing staff working with sharp instruments indicate the great exposure to the biological risks and the serious diseases.

Os sentimentos vivenciados após exposição ocupacional entre trabalhadores de saúde: fulcro para repensar o trabalho em instituições de saúde

Este estudo objetivou captar os sentimentos psicossociais e percepcoes dos trabalhadores apos acidente com fluido biologico identificando as dificuldades para realizar o acompanhamento. Pesquisa de abordagem qualitativa cuja amostra foi intencional, compreendeu 15 trabalhadores de saude. O medo foi o primeiro sentimento expresso. O medo que o trabalhador sofre no desempenho de suas atribuicoes, potencia o desenvolvimento de situacoes estressantes geradas no ambiente de trabalho e desencadeiam sofrimento psiquico. Os sentimentos de raiva e revolta aparecem nos discursos diante da indignacao do trabalhador. Outro sentimento manifestado pelos sujeitos e a culpa pelo desencadeamento do acidente. Essa constatacao permite recomendar propostas de reestruturacao organizacional, bem como no comportamento dos trabalhadores envolvidos na dinâmica do trabalho.

O uso dos equipamentos de proteção individual entre os trabalhadores de enfermagem acidentados com instrumentos perfurocortantes

O presente estudo analisou os acidentes de trabalho ocorridos com trabalhadores de enfermagem em um hospital publico do interior de Sao Paulo. A amostra foi composta por todos os trabalhadores de enfermagem. Os resultados obtidos mostram a significativa frequencia de acidentes com instrumentos perfurocortantes. Nesse tipo de acidente, os mais altos foram encontrados na categoria auxiliar de enfermagem, o que mostra tambem que o trabalhador de enfermagem muitas vezes nao utiliza o equipamento de protecao individual, mesmo que seja fornecido no local de trabalho. A manipulacao de instrumentos perfurocortantes por profissionais dessa area mostra a grande exposicao aos riscos biologicos e graves doencas. Esses resultados, evidenciam a necessidade de prevenir tais acidentes.

Multicausalidade nos acidentes de trabalho da Enfermagem com material biológico

A fin de analizar las multiples causas de accidentes de trabajo con exposicion biologica entre el personal de enfermeria se llevo a cabo una investigacion descriptiva y exploratoria en un hospital de tamano medio en el Estado de Parana, en el periodo comprendido entre enero de 2008 y enero de 2009. La poblacion fue de 26 personales de enfermeria de la clinica medica. La recoleccion de datos se realizo mediante entrevistas semi-estructuradas con cinco de los ocho heridos en el periodo y sus contenidos fueron analizados por Diagrama de Causas y Efectos. Las categorias de causas materiales, organizacionales, institucionales y de comportamiento de los trabajadores mostraron la disposicion inadecuada de los objetos punzocortantes, sobrecarga de trabajo, no uso de normas de bioseguridad y la mala supervision y formacion de los trabajadores, como factores para la ocurrencia de estos accidentes. La adopcion de la herramienta de Diagrama de Causas y Efectos ha permitido un analisis de los accidentes en sus multiples causas, que muestra la interaccion entre ellas.In order to analyze the multiple causes of occupational accidents with biological exposure among nursing staff was carried out a descriptive and exploratory research in a medium-sized hospital in the State of Paraná, in the period between January 2008 and January 2009. The population was 26 nursing staff of the medical clinic. Data collection was performed by semi-structured interviews with five of the eight injured in the period and its contents were analyzed by Causes and Effects Diagram. The categories of causes material, organizational, institutional and workers behavior, showed the inappropriate disposal of sharps, work overload, no use of bio-security standards and poor supervision and training of workers, as factors for the occurrence of these accidents. The adoption of the tool of Causes and Effects Diagram provided an analysis of accidents in its multiple causes, showing the interaction between them.

Cargas e desgastes de trabalho vivenciados entre trabalhadores de saúde em um hospital de ensino

Estudo exploratorio, de carater descritivo e de abordagem quantitativa, alicercado nas categorias “processo de trabalho”, “cargas de trabalho” e “desgaste” em um hospital de ensino em Curitiba, regiao sul do Brasil. Neste artigo, sao caracterizadas as cargas e os desgastes vivenciados em um hospital universitario, captados pelo estudo previo intitulado “Sistema de monitoramento da saude do trabalhador de enfermagem” (SIMOSTE). Os resultados demonstram que o genero feminino foi o mais acometido (85,9%); os profissionais mais afetados foram os auxiliares de enfermagem (53,1%). O maior numero de afastamentos ocorreu por doencas do sistema osteoarticular (25,2%) e, dentre as cargas apresentadas, as mais expressivas foram as mecânicas e fisiologicas, com 33,06%, cada. Estes resultados poderao subsidiar estrategias de intervencao nas politicas direcionadas a saude do trabalhador, para assegurar uma melhor qualidade de vida a este profissional e, por consequencia, promover melhorias na qualidade da assistencia prestada ao usuario.

Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability and prognosis among 12,195 workers from 18 countries

Abstract To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.