Lúcia Rotenberg

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.

Self-Reported Health and Sleep Complaints Among Nursing Personnel Working Under 12 h Night and Day Shifts

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables—health conditions, sleep complaints, and insufficient time for nonprofessional activities—was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12 h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR = 0.71; CI = 0.55–0.92 and PR = 0.71; CI = 0.52–0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57–0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR = 0.76; CI = 0.59–0.98) and ex-night workers (PR = 0.68; CI = 0.50–0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07–6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR = 1.96; CI = 1.38–2.78) and rest/leisure (PR = 1.54; CI = 1.20–1.99). These results can be related to the “social value of time,” as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.

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.

Beyond simple approaches to studying the association between work characteristics and absenteeism: Combining the DCS and ERI models

Abstract The Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models assess different psychosocial factors. This study investigates whether a combination of these models increases their ability to predict sickness absence, as compared to results based on each model separately. A cross-sectional study with nursing personnel (N = 1307) in Brazil was performed. Regression analyses were conducted in three stages: analysis of each scale of the models and sickness absences; assessment of the independent association of each model with sickness absences; assessment of the associations of three combinations of models/scales with sickness absences: DC and social support (SS), ERI and overcommitment, and DC and ERI. As regards comparisons between the stress models, ERI was shown to be independently associated with short (up to 9 days) and long (10 days or more) spells of absenteeism. The same result held true for low social support. The combinations DC-ERI and DC-SS were better predictors for short spells than each model/scale separately, whereas for long spells, the combination DC-SS was the best predictor. ERI seems to be a good instrument for predicting absenteeism if used alone, whereas DC performed better when combined with ERI or SS. An improved risk estimation of sickness absences by combining information from the two models was observed.

Sleep on the job partially compensates for sleep loss in night-shift nurses

Nursing personnel in Brazil are usually submitted to fixed 12 h shifts with no consecutive working days or nights. Moonlighting is common in this group, with a consequent increase in the number of working hours. The possibility of sleeping on the job during the night shift in the studied hospitals had already been described. The present study aims to analyze whether the time devoted to daily activities (sleep, rest, leisure, housework, commuting, personal needs, care of children or other people, non‐paid work, and study) is related to the number of worked hours and to nap‐taking during the night shift. The field study took place at two public hospitals in Rio de Janeiro, Brazil. Workers filled out a structured form on time devoted to the above‐mentioned activities for at least four consecutive days. The time devoted to sleep was analyzed according to its occurrence at home or on the job. Workers were classified according to the number of jobs (one job/two jobs) and the time dedicated to work according to the median of the whole series (below the median/above the median). All workers who had at least one working night were analyzed as to nap‐taking on the job. They were classified according to the sleep occurrence during the night shift—the sleep group and the non‐sleep group, both of which were compared to daytime workers. Statistical treatment of data included non‐parametrical procedures. The study group comprised 144 workers (mean age: 35.7±10.5 years old; 91% women; 78% nurse assistants, the remainder registered nurses). They recorded their daily activities for 4–11 days; 829 cumulative days were analyzed for the whole group. A total of 165 working nights were analyzed; sleep or rest occurred during 112 (68%) of them, with mean sleep/rest duration of 141±86 min. Time devoted to sleep and leisure varied according to the number of working hours, being significantly reduced in those submitted to longer work hours (p<0.001 and p=0.002, respectively). Results close to significance point to a reduction in the time dedicated to housework among workers with long work hours (p=0.053). The time spent on sleep/rest per working night did not differ according to the number of worked hours (p=0.490). A tendency was observed for those who have two jobs to devote more time to sleep/rest on the job (p=0.058). The time of personal needs was significantly lower among those who did not sleep on the job as compared to day workers (p=0.036). The total sleep time was significantly lower among those who did not sleep on the job, as compared to day workers and to those who slept on the job (p=0.004 and p=0.05, respectively). As to home sleep length, workers who slept and those who did not sleep on the job were similar and slept significantly less than exclusively daytime workers (p<0.001 and p=0.002, respectively). Sleeping on the job during the night shift seems to partially compensate for the shorter sleep at home among night workers and may play a beneficial effect in coping with two jobs.

Jornadas de trabalho na enfermagem: entre necessidades individuais e condições de trabalho

OBJETIVO: Analisar fatores associados a jornada de trabalho profissional e a jornada de trabalho total (profissional + domestica) em profissionais de enfermagem. METODOS: Estudo transversal realizado em hospital universitario no municipio de Sao Paulo, SP, entre 2004 e 2005. Participaram 696 trabalhadores (enfermeiros, tecnicos e auxiliares de enfermagem), predominantemente mulheres (87,8%), que trabalhavam em turnos diurnos e/ou noturnos. Foi aplicado questionario autopreenchivel sobre dados sociodemograficos, condicoes de trabalho e de vida; e versoes traduzidas e adaptadas para o portugues das escalas de demanda-controle-apoio social no trabalho, de desequilibrio esforco-recompensa, do Questionario Generico de Avaliacao de Qualidade de Vida e do Indice de Capacidade para o Trabalho. Foram utilizados modelos de regressao logistica para a analise dos dados. RESULTADOS: Ser o unico responsavel pela renda familiar, o trabalho noturno e o desequilibrio esforco-recompensa foram as unicas variaveis associadas tanto a jornada profissional (OR = 3,38; OR = 10,43; OR = 2,07, respectivamente) quanto a jornada total (OR = 1,57; OR = 3,37; OR = 2,75, respectivamente). Nenhuma das variaveis ligadas as jornadas de trabalho se associou significativamente ao baixo Indice de Capacidade para o Trabalho. O tempo insuficiente para o repouso se mostrou estatisticamente associado as jornadas profissional (OR = 2,47) e total (OR = 1,48). O tempo insuficiente para o lazer se mostrou significativamente associado a jornada profissional (OR = 1,58) e valor limitrofe para a jornada total (OR = 1,43). CONCLUSOES: A responsabilidade financeira, o trabalho noturno e o desequilibrio esforco-recompensa sao variaveis que merecem ser contempladas em estudos sobre as jornadas de trabalho em equipes de enfermagem. Sugere-se que estudos sobre o tema abordem a renda individual do trabalhador, detalhando melhor a relacao entre os esforcos e recompensas, e principalmente discussoes que considerem as relacoes de genero.

Uso combinado de modelos de estresse no trabalho e a saúde auto-referida na enfermagem

OBJECTIVE To identify combinations of two models of psychosocial stress at work among nursing teams and their associations with self-rated health. METHODS This was a cross-sectional study among workers at three public hospitals in the municipality of Rio de Janeiro, Southeastern Brazil (N = 1307). In 2006, a multidimensional questionnaire including two scales for measuring stress at work (demand-control and effort-reward imbalance models) was administered. Partial and complete (including social support at work) demand-control models were considered, along with partial and complete (including excessive commitment to work) effort-reward models. Multiple logistic regression models were used to estimate adjusted odds ratios and their respective 95% confidence intervals. RESULTS The dimensions of both models were independently associated with self-rated health, with odds ratios between 1.70 and 3.37. The partial demand-control model was less associated with health (OR = 1.79; 95%CI 1.26;2.53) than was the partial effort-reward imbalance model (OR = 2.27; 95%CI 1.57;3.30). Incorporation of social support and excessive commitment to work increased the strength of the demand-control and effort-reward imbalance models, respectively. Increased strength of association was observed when the two partial models were combined. CONCLUSIONS The results indicate that the effort-reward imbalance model performed better for this specific group and for the outcome evaluated, and that there was an advantage in using complete models or combinations of partial models.OBJETIVO: Identificar combinaciones de dos modelos de estres psicossocial del trabajo en equipos de enfermeria y su asociacion con la salud auto referida. METODOS: Estudio transversal con trabajadoras de tres hospitales publicos del Municipio de Rio de Janeiro, Sureste de Brasil, (N=1307). Se aplico cuestionario multidimensional que incluyo dos escalas de estres en el trabajo (modelo demanda-control y desequilibrio esfuerzo-recompensa) en 2006. Se consideraron el modelo demando y control parcial y completo (incluye apoyo social en el trabajo), asi como el esfuerzo y recompensa parcial y completo (incluye exceso de compromiso con el trabajo). Se utilizaron modelos estadisticos multiples para estimar razones de probabilidades ajustadas y sus respectivos intervalos con 95% de confianza. RESULTADOS: Las dimensiones de ambos modelos estuvieron independientemente asociadas con la salud autoreferida, con odds ratios entre 1,70 y 3,37. El modelo parcial demanda-control se mostro menos asociado a la salud (OR=1,79; IC 95% 1,26;2,53) al compararlo con el desequilibrio esfuerzo-recompensa (OR=2,27; IC 95% 1,57;3,30). La incorporacion del apoyo social y del exceso de compromiso con el trabajo aumento la fuerza de asociacion de los modelos demanda-control y desequilibrio esfuerzo-recompensa, respectivamente. Se observo aumento en la fuerza de asociacion al combinarse los dos modelos parciales. CONCLUSIONES: Los resultados indican mejor desempeno del modelo desequilibrio esfuerzo-recompensa para este grupo especifico y para el resultado evaluado y ventaja en el uso de modelos completos o del uso combinado en modelos parciales.

Latitude and Social Habits as Determinants of the Distribution of Morning and Evening Types in Brazil

Previous application of a Portuguese version of the Horne and Ostberg (H&O) questionnaires in Brazil showed a displacement of the distribution of Morningness/Eveningness (M/E) types towards morningness, demanding a reclassification of the scores limits for each of the 5 possible M/E types. Among city, age and sex, city was the only factor determining significant group differences. In the present paper, the same version of the H&Os questionnaire was applied to a distinct population of 260 adults, balanced according to age, sex and city. Data were collected from October to December, to control the effect of the photoperiod. City remains the only factor determining significant group differences (p <0.001). Moreover, there does not appear a coherent latitude trend that could explain differences among cities as a function of photoperiod. Local social habits could probably explain our results, suggesting further investigations of peculiar temporal patterns.

Abordagem multifatorial do absenteísmo por doença em trabalhadores de enfermagem

OBJECTIVE To analyze factors associated with self-reported sickness absenteeism among nursing workers. METHODS Cross-sectional study with 1,509 workers from three public hospitals in the city of Rio de Janeiro (Southeastern Brazil) in 2006. Absenteeism was classified in three levels: no day, a few days (1-9 days) and many days (> 10 days), based on the answer to a question of the work ability index questionnaire. The logistic regression analysis considered a conceptual model based on distal (socioeconomic status), intermediate I (occupational characteristics), intermediate II (lifestyle characteristics), and proximal (diseases and health conditions) determinants. RESULTS The frequencies of sickness absenteeism were 20.3% and 16.6% for a few days and many days, respectively. Those who reported more than one job, musculoskeletal diseases and rated their health as poor or regular had higher odds of absenteeism. Compared to nurses, nursing assistants were less likely to mention a few days, and technicians were more likely to have many days of absence. Higher odds of mentioning many days of absence were observed among public servants, compared to contract workers (OR = 3.12; 95%CI 1.86;5.22), and among married (OR = 1.73; 95%CI 1.14;2.63) and separated, divorced and widowed individuals (OR = 2.06, 95%CI 1.27;3.35), compared to singles. CONCLUSIONS Different variables were associated with the two forms of absenteeism, which suggests its multiple and complex determination related to factors from different levels that cannot be exclusively explained by health problems.OBJETIVO: Analisar fatores associados ao absenteismo por doenca autorreferido em trabalhadores de enfermagem. METODOS: Estudo transversal com 1.509 trabalhadores de tres hospitais publicos no municipio do Rio de Janeiro, RJ, em 2006. O absenteismo foi classificado em tres niveis: nenhum dia, poucos dias (um a nove dias) e muitos dias (> 10 dias), a partir da resposta a uma pergunta do questionario de avaliacao do indice de capacidade para o trabalho. As analises de regressao logistica levaram em conta um modelo conceitual com base em determinantes distais (condicoes socioeconomicas), de niveis intermediarios I (caracteristicas ocupacionais) e II (caracteristicas do estilo de vida), e proximais (doencas e condicoes de saude). RESULTADOS: As frequencias de absenteismo por doenca foram de 20,3% e 16,6% para poucos e muitos dias, respectivamente. Aqueles que referiram mais de um emprego, doencas osteomusculares e avaliaram sua saude como ruim ou regular apresentaram chances mais elevadas de absenteismo. Comparados aos enfermeiros, os auxiliares tiveram menor chance de referir poucos dias e os tecnicos, maiores chances de apresentar muitos dias de ausencia. Chances mais elevadas de referir muitos dias de ausencia foram observadas entre os servidores publicos em relacao aos contratados (OR = 3,12; IC95% 1,86;5,22) e entre os casados (OR = 1,73; IC95% 1,14;2,63) e separados, divorciados e viuvos (OR = 2,06; IC95% 1,27;3,35), comparados aos solteiros. CONCLUSOES: Diferentes variaveis foram associadas as duas modalidades de absenteismo, o que sugere sua determinacao multipla e complexa, relacionada a fatores de diversos niveis que nao podem ser explicados apenas por problemas de saude.

Enfermeiros dos grandes hospitais públicos no Rio de Janeiro: características sociodemográficas e relacionadas ao trabalho

O objetivo do estudo foi analisar caracteristicas sociodemograficas e de trabalho de enfermeiros que atuam em hospitais publicos. Realizou-se estudo epidemiologico, seccionais, envolvendo 3.229 enfermeiros dos dezoito maiores hospitais publicos no municipio do Rio de Janeiro. Observou-se predominância feminina (87,3%) e idade media de 39,9±10 anos. Cerca de 7% referiram ter titulo de mestrado e/ou doutorado, 58,5% formaram-se em instituicoes publicas e 24,5% trabalhavam no setor saude antes de serem enfermeiros. Metade pensou em abandonar a Enfermagem e quase um quarto se considera insatisfeito com a profissao. Cerca de 10% esteve procurando emprego fora e 30% na propria Enfermagem. Entre os homens foi mais frequente o trabalho noturno, mais de um emprego e carga semanal de trabalho mais elevada. O estudo apontou aspectos desafiadores para os enfermeiros/as. Em funcao de sua abrangencia, os resultados podem subsidiar estrategias de melhoria das condicoes de trabalho nos hospitais publicos.