Maria Helena Palucci Marziale

A produção científica sobre os acidentes de trabalho com material perfurocortante entre trabalhadores de enfermagem

A investigacao ora apresentada teve por objetivos identificar as abordagens metodologicas das pesquisas publicadas em periodicos indexados nas bases de dados Lilacs e Medline, nos ultimos 16 anos, referentes, ao estudo dos acidentes de trabalho com material perfurocortante e a identificacao dos fatores predisponentes a ocorrencia de tais acidentes entre trabalhadores da enfermagem. Foram analisados 55 artigos, sendo 39 internacionais, e 16 nacionais. As abordagens metodologicas mais utilizadas foram descritiva de campo, pesquisa-acao e bibliografica. Dentre os fatores predisponentes a ocorrencia dos acidentes em varios paises, destaca-se a pratica inadequada de re-encape de agulhas e o inadequado descarte do material.

Riscos de contaminação ocasionados por acidentes de trabalho com material pérfuro-cortante entre trabalhadores de enfermagem

Esta pesquisa teve por objetivo identificar dentre os trabalhadores de enfermagem, de quatro hospitais da regiao de Ribeirao Preto-SP, aqueles que foram acometidos por acidente de trabalho com material perfuro-cortante e encaminhados para avaliacao a um servico especializado no tratamento de doencas infecciosas, os que foram contaminados e as condutas adotadas diante do acidente. Trata-se de pesquisa de campo de carater descritivo. A amostra foi constituida por 30 sujeitos e os dados foram coletados atraves de consulta ao prontuario medico dos trabalhadores. Os resultados revelaram que nenhum dos trabalhadores foi contaminado pelos virus HBV, HCV, ou HIV, no entanto, foi observado que apenas 23,33% dos trabalhadores compareceram a todos os retornos agendados para verificacao de possivel soroconversao. Em relacao as condutas tomadas diante do acidente, foi indicado o uso de quimioprofilaxia em 76,67% dos casos, exames sorologicos em 100% dos casos e imunizacao contra hepatite em 9,99% dos casos. Devido a grande ocorrencia de acidentes percutâneos, segundo estimativas oficiais de outros paises, concluimos que maior atencao deva ser direcionada para a prevencao desses acidentes, bem como ao rigor do seguimento pos-exposicao ocupacional.

Absenteísmo de trabalhadores de enfermagem em um hospital universitário

Objetivando identificar os indice de absenteismo-doenca entre os trabalhadores de enfermagem do hospital universitario, foi realizado um levantamento das faltas por licenca-saude registradas durante doze meses e calculado o indice de frequencia e a porcentagem de tempo perdido. Os dados foram coletados atraves de consulta documental aos registros do departamento pessoal da instituicao estudada e transcritos em um protocolo. Diante dos resultados obtidos, constatou-se que o maior indice de frequencia ocorreu na Pediatria (If=0,35) e a porcentagem de tempo perdido de trabalho ocorreu no Pronto Atendimento (Tp=4,19). Concluiu-se que os indices de absenteismo-doenca entre os trabalhadores apresentam-se elevados, indicando a necessidade de criacao de um banco de dados para otimizar o registro das faltas, facilitar seu controle e possibilitar futuras pesquisas.The purpose of this study was to identify the rates of absenteeism of nursing workers from a University Hospital due to diseases. Therefore, the author verified the number of absences due to health problems registered during 12 months, calculating the frequency rate as well as the percentage of wasted time. Data were collected and transcribed after consultation to reports organized by the human resources department of the institution studied. Results showed that the higher rate of absence occurred in the Pediatric Unit (If = 0.35) and the higher percentage of wasted time occurred in the Emergency Unit (Tp = 4.19). The author concluded that the rate of absenteeism due to disease was high among the workers, indicating the need of creating a database in order to optimize the registration of absences and their control as well as of stimulating the development of future research.

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.

Doenças do sistema osteomuscular em trabalhadores de enfermagem

Esta pesquisa, de carater descritivo e retrospectivo, realizada na Fundacao Hospitalar do Estado de Minas Gerais-Brasil, teve por objetivo analisar os problemas de saude relacionados ao sistema osteomuscular encontrados nos trabalhadores de enfermagem de 23 instituicoes de saude, atendidos pela Divisao de Assistencia a Saude do Trabalhador, em 2002. Os dados foram coletados nos mapas de atendimentos e nos prontuarios medicos norteados por um roteiro elaborado pelos autores. Os diagnosticos foram agrupados segundo o Codigo Internacional de Doencas CID-10 e comparados a Lista de doencas relacionadas ao trabalho do Ministerio da Saude. Na analise dos dados, utilizou-se o programa estatistico SPSS. Entre os 6070 atendimentos realizados, 11,83% deles (718) apresentaram diagnosticos de problemas relacionados ao sistema osteomuscular, envolvendo diversas estruturas corporais como a coluna vertebral, membros superiores e inferiores. As doencas legalmente consideradas como doencas do trabalho relacionadas ao sistema musculo-esqueletico foram identificadas em 255 (35%) atendimentos, destacando-se as dorsalgias (20%) e as sinovites e tenossinovites (13,7%), agrupadas como LER-DORT. Conclui-se que maior atencao deva ser direcionada as posturas adotadas pelos trabalhadores na execucao das atividades laborais e as condicoes dos mobiliarios, bem como se faz necessario disponibilizar instrumentos e equipamentos ergonomicamente planejados, visando a reducao da incidencia dos problemas osteomusculares.

Estresse ocupacional entre profissionais de enfermagem do bloco cirúrgico

This descriptive, correlation, and cross-sectional study aimed to evaluate the presence of occupational stress among nursing professionals working in surgical settings and to investigate relations between occupational stress and the work characteristics. The Demand-Control Model proposed by Karasek was used to evaluate occupational stress. The sample was composed of 211 nursing professionals from 11 hospitals located in the city of Londrina-PR, Brazil. A questionnaire regarding socio-demographic and professional data and the Job Stress Scale were applied. Data was collected from April to November, 2007. Among the participants, most were auxiliary nurses (62.6%), women (86.7%), and married (54.0%). The average age was 40 years. The average for Demand, Control, and Social Support dimensions was 14.8 (S.D.=2.4), 16.5 (S.D.=2.3) and 18.7 (S.D.=2.8), respectively. Considering the results related to the Job Stress Scale, the Demand dimension showed a statistically significant association with the professional category (p=0.01), and Control showed a statistically significant association with the type of hospital, professional category, and weekly working hours (p<0.05).This descriptive, correlation, and cross-sectional study aimed to evaluate the presence of occupational stress among nursing professionals working in surgical settings and to investigate relations between occupational stress and the work characteristics. The Demand-Control Model proposed by Karasek was used to evaluate occupational stress. The sample was composed of 211 nursing professionals from 11 hospitals located in the city of Londrina-PR, Brazil. A questionnaire regarding socio-demographic and professional data and the Job Stress Scale were applied. Data was collected from April to November, 2007. Among the participants, most were auxiliary nurses (62.6%), women (86.7%), and married (54.0%). The average age was 40 years. The average for Demand, Control, and Social Support dimensions was 14.8 (S.D.=2.4), 16.5 (S.D.=2.3) and 18.7 (S.D.=2.8), respectively. Considering the results related to the Job Stress Scale, the Demand dimension showed a statistically significant association with the professional category (p=0.01), and Control showed a statistically significant association with the type of hospital, professional category, and weekly working hours (p<0.05). DESCRIPTORS: Stress. Nursing. Surgicenters. ESTRES OCUPACIONAL ENTRE PROFESIONALES DE ENFERMERiA QUE LABORAN EN UNIDADES QUIRURGICAS RESUMEN: Se trata de un estudio de correlacion, descriptivo y transversal, cuyo objetivo fue evaluar la incidencia de estres laboral de trabajadores de enfermeria que laboran en unidades quirurgicas y las posibles asociaciones entre la medida de estres laboral y las caracteristicas del trabajo. El modelo Demanda-Control de Karasek fue utilizado para evaluar el estres laboral. La muestra fue constituida por 211 profesionales de enfermeria de 11 hospitales de la ciudad de Londrina-PR, Brasil. Los participantes respondieron a un cuestionario de datos generales, ocupacionales y la Job Stress Scale. La recoleccion de los datos fue hecha en el periodo de abril a noviembre de 2007. Los resultados demostraron que la mayoria eran auxiliares de enfermeria (62,6%), del sexo femenino (86,7%), casados (54,0%), con media de edad de 40 anos y con exposicion intermediaria al estres ocupacional (56,1%). Las medias relacionadas a las dimensiones Demanda, Control y Apoyo Social fueron de 14,8 (D.P.=2,4), 16,5 (D.P.=2,3) y 18,7 (D.P.=2,8), respectivamente. Las asociaciones cuyo resultado fue estadisticamente significante ocurrieron entre la Demanda y la categoria profesional (p=0,01), el Control y tipos de hospitales, categoria profesional y carga horaria semanal (p<0,05). DESCRIPTORES: Estres. Enfermeria. Centros quirurgicos.

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.

Occupational violence problems in an emergency hospital in Londrina, Paraná, Brazil

Workplace violence is currently a worrying factor at many hospitals. The objectives of this study were to characterize the occupational violence problems detected by health workers in an emergency hospital. The study was exploratory and transversal, with a quantitative data approach. It took place at the emergency ward of a general hospital in Londrina, Paraná. The study population included 33 people from the nursing team and 14 medical doctors. Data were collected through interviews with health workers and staff managers, as well as assessment of violence records from the last seven years. 100% of nurses, 88.9% of technicians, 88.2% of nurse assistants, and 85.7 % of doctors said that they had been victims of workplace violence, although not documented. The types of violence suffered included verbal assault (95.2%) and moral and sexual battery (33.3%). Preventive measures to reduce occupational violence should be applied.

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.