Poliana de Freitas La Rocca

Factors related to sickness absenteeism among nursing personnel

OBJECTIVE To analyze short-term leaves among the healthcare staff of a university hospital. METHODS Study population included 965 nursing professionals active on 1 January 2000. Leaves up to 30 days in one year were analyzed. Sickness leaves (one-year aggregate), service demand, and diagnoses were described. Relative risk was estimated through multivariate analysis, using negative binomial distribution. RESULTS About 65% of workers generated 1,988 appointments, of which 68.6% lead to absence from work. The greatest demand occurred among nursing technicians, women, and statutory workers (OR=1.61; 1.47; 1.53 respectively). Over half the studied population (57.6%) had at least one absence. This corresponds to 87.8% of workers who had physician appointments. These workers generated a total 1,364 leaves of absence--1.41 per worker--and 5,279 workdays were missed. Multivariate analysis was carried out considering each gender separately. An effect was found only for work regime (RR=1.45 e RR=2.43) for both men and women. CONCLUSIONS A relationship exists between absenteeism and work regime. It is necessary to include other variables, such as time working for the company, shift, and number of children.

Respiratory effects from industrial talc exposure among former mining workers

OBJETIVO: Evaluar efectos respiratorios tardios de la inhalacion ocupacional de talco contaminado por asbesto. METODOS: Analisis de serie de casos de 29 extrabajadores de mineria de talco contaminado con asbestos provenientes de Carandai, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clinico-ocupacional, radiografia de torax y espirometria. Fue creado un escore de exposicion que multiplicado por la duracion, origino un indice de exposicion acumulativa al talco. Para testar la asociacion del indice de exposicion acumulativa con la presencia de alteraciones radiologicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresion logistica exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 anos. En las radiografias de torax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirometricas ocurrieron en tres. La regresion logistica indico odds ratio de 1,059 (IC 95%:1,012;1,125) para el indice acumulado, es decir, cada unidad en el indice resulta en un aumento de 5,9% en el chance de presentar alteracion radiologica compatible o con sospecha de neumoconiosis. Con relacion a la mediana del tiempo estimado de latencia entre el inicio de la exposicion y el diagnostico de las placas pleurales, ocurrio diferencia significativa (p=0,013) entre los casos (27,0 anos) y no casos (14,3 anos). CONCLUSIONES: Los resultados muestran la necesidad de control clinico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardios de la exposicion a este mineral.

Indice de exposição à sílica na atividade de mineração de ouro

OBJECTIVE To develop a cumulative silica exposure index, including time period, duration and intensity of exposure, and to test this index as for occurrence and severity of silicosis. METHODS A cross-sectional study was carried out comprising 140 former gold miners from two localities in Southeastern Brazil between November 1997 and December 1999. Complete data on occupational and medical histories, chest x-rays and spirometry were analyzed. Borderline cases on the x-rays were also submitted to high-resolution chest computed tomography. The exposure index was the sum of scores obtained by logarithmic transformation of respirable silica concentration related to job tasks, mines and work time. Parametric tests were used for comparing averages between the groups of interest. RESULTS The silica exposure index was able to discriminate the main outcome (silicosis) as well as other outcomes (tuberculosis and lung emphysema) in the whole group at p-values of 0.008, 0.016 and <0.001 respectively. In regard to the four main categories of silicosis, the Tukey test showed differences in the averages of the exposure index in the categories 0 and 3 and 1 and 3. However, in the borderline cases subgroup, the exposure index was not satisfactory for cases submitted to x-rays and tomography and it could not differentiate other outcomes. CONCLUSIONS The silica exposure index represents an advance in exposure evaluation of former miners. However, other information, such as clinical and lung functional data are needed for better understanding disease progress in silica exposed cases, especially among borderline cases.OBJETIVO: Propor um indice que sintetize a exposicao cumulativa a silica, incluindo intensidade, duracao e epoca da exposicao e testa-lo em relacao a presenca e gravidade de silicose. METODOS: Estudo transversal realizado com 140 ex-mineiros de ouro, residentes em duas localidades do Estado de Minas Gerais, examinados entre 11/1997 e 12/1999. Foram analisadas informacoes sobre historia clinica e ocupacional, radiografia de torax e espirometria. Casos borderline de silicose pela radiografia foram submetidos a tomografia computadorizada de alta resolucao. O indice representa a soma dos escores extraidos da transformacao logaritmica das taxas de concentracao de silica respiravel nas diversas funcoes, minas e periodos trabalhados. Foram aplicados testes parametricos para comparacao das medias entre os grupos de interesse. RESULTADOS: O indice proposto apresentou-se discriminativo em relacao ao desfecho principal (silicose) e aos desfechos secundarios (enfisema e tuberculose) pulmonar no grupo total, incluindo os diversos estagios da doenca, com valores p: 0,008, 0,016 e <0,001 respectivamente. Em relacao as quatro categorias principais da silicose, o teste de Tukey evidenciou diferencas nas medias do indice entre as categorias 0 e 3 e 1 e 3. Porem, no subgrupo constituido pelos casos borderline, a discriminacao entre os desfechos nao foi satisfatoria, tanto com diagnosticos obtidos pela radiografia quanto pela tomografia. CONCLUSOES: O indice proposto representa um avanco na sintese da exposicao ocupacional dos participantes, podendo ser usado para outras profissoes. Entretanto, torna-se importante a incorporacao de fatores clinicos e funcionais para entender a evolucao da doenca em expostos a silica, especialmente nos casos duvidosos.

Silicose em trabalhadores de quartzito da região de São Thomé das Letras - Minas Gerais: dados iniciais indicam um grave problema de saúde pública

Introduction: Quatzite quarrying has been a long ongoing activity in the region of Sao Thome das Letras, Minas Gerais, Brazil, and 2000 workers are involved in its extraction and processing. However, only recently silicosis has been consistently reported. Objective: To describe the occupational and radiologic profiles of a group of workers in Sao Thome stone production. Methods: Occupational and X-rays data were analized in a workers’ health center, and a series of 46 cases were selected from a group of 185 extraction and processing workers. Results: All 185 subjects were male, with average age of 41.3 years and median exposure time of 6.1 years, and 46 of them (24.9%) presented radiological images compatible with silicosis. Silicosis was more frequent in stone processing, where the most severe cases were found, including 3 workers with large opacities and 8 with accelerated forms of the disease. The latter were, generally, of younger age and with shorter exposure time, suggesting exposure to higher silica concentrations. Conclusion: Despite the limitations of the study, the high occurence of silicosis in the group suggests that adopted measures to prevent silica dust inhalation has been inefficient and have worsen in recent times as a consequence of the intense mechanization taken place in the last years. Adequate surveillance and prevention measures should, therefore, become priority in this industrial sector.

Cohort Profile: The Hospital das Clínicas Cohort Study, Belo Horizonte, Minas Gerais, Brazil

This article presents the Hospital das Clı́nicas da UFMG Cohort (HC UFMG cohort), a study carried out in Belo Horizonte, Brazil. After a review of the specialized literature, we believe that it represents the only stable cohort of workers in Latin America. Hospitals are appropriate settings where worker cohorts can be followed, their numerous occupational hazards and complex types of job, and hence a great variability of activities, admit the possibility of selecting various groups exposed to different environment risks. Like the Whitehall Study which enrolled civil servants in a well-designed longitudinal study, workers in public hospitals tend to have stable contracts, so that long-term follow-up is possible and effects due to hazard exposures may be observed and evaluated according to related risk factors. Also, like the ‘closed population’ of the Framingham Heart Study, the hospital population has a homogeneous structure and definite risk factors, the set of possible confounding factors being smaller than if the cohort were to involve a general ‘open’ population. When the Serviço de Atenção à Saúde do Trabalhador (SAST), a worker’s health care service, was created in 1999, within the Universidade Federal de Minas Gerais, the necessity of knowing the university hospital worker’s health status indicators was immediately perceived. In order to obtain the maximum of the necessary information, a computerized medical form was created and has been completed at each consultation since then. The Hospital das Clı́nicas Hospital das Clı́nicas of the Universidade Federal de Minas Gerais (HC UFMG) is a public institution, whose principal activity is provision of health care, but it is also engaged in medical education and research. The hospital is regarded as a reference in the municipal and state health system in the care of patients whose diseases are of medium or high complexity. The installed capacity is about 470 beds. Every month the hospital handles over 3500 emergency cases, 1600 admissions, 32000 ambulatory consultations and 98000 complementary tests. Patients are from the Sistema Único de Saúde (SUS) the Public and Unified Health System of Brazil. Initially, the SAST staff proposal was to analyse not only prevalence rates of any morbidity problem, but also incidence density rates, in order to evaluate different risk factors associated to hospital activities. With this aim, a longitudinal study of short duration work absences by disease and their main risk factors, by age and sex, was planned. After 1 year of gathering data and preliminary analyses, the data was considered of adequate quality and sufficiently stable to start a cohort study. The date 1 January 2000 was fixed as the start of study. Prior to constitution of SAST, a cooperative project between UFMG and the Universitat Autónoma de Barcelona (UAB) was signed as a consequence of a previous collaboration study on Strain Repetitive Injury and factors associated to job organization conditions involving Belo Horizonte workers, as well as a short-term study about nursing absenteeism at this same hospital in Belo Horizonte.

Efectos respiratorios de la exposición al talco industrial en extrabajadores de minería

OBJETIVO: Evaluar efectos respiratorios tardios de la inhalacion ocupacional de talco contaminado por asbesto. METODOS: Analisis de serie de casos de 29 extrabajadores de mineria de talco contaminado con asbestos provenientes de Carandai, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clinico-ocupacional, radiografia de torax y espirometria. Fue creado un escore de exposicion que multiplicado por la duracion, origino un indice de exposicion acumulativa al talco. Para testar la asociacion del indice de exposicion acumulativa con la presencia de alteraciones radiologicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresion logistica exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 anos. En las radiografias de torax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirometricas ocurrieron en tres. La regresion logistica indico odds ratio de 1,059 (IC 95%:1,012;1,125) para el indice acumulado, es decir, cada unidad en el indice resulta en un aumento de 5,9% en el chance de presentar alteracion radiologica compatible o con sospecha de neumoconiosis. Con relacion a la mediana del tiempo estimado de latencia entre el inicio de la exposicion y el diagnostico de las placas pleurales, ocurrio diferencia significativa (p=0,013) entre los casos (27,0 anos) y no casos (14,3 anos). CONCLUSIONES: Los resultados muestran la necesidad de control clinico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardios de la exposicion a este mineral.

Efeitos respiratórios da exposição ao talco industrial em ex-trabalhadores de mineração

OBJETIVO: Evaluar efectos respiratorios tardios de la inhalacion ocupacional de talco contaminado por asbesto. METODOS: Analisis de serie de casos de 29 extrabajadores de mineria de talco contaminado con asbestos provenientes de Carandai, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clinico-ocupacional, radiografia de torax y espirometria. Fue creado un escore de exposicion que multiplicado por la duracion, origino un indice de exposicion acumulativa al talco. Para testar la asociacion del indice de exposicion acumulativa con la presencia de alteraciones radiologicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresion logistica exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 anos. En las radiografias de torax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirometricas ocurrieron en tres. La regresion logistica indico odds ratio de 1,059 (IC 95%:1,012;1,125) para el indice acumulado, es decir, cada unidad en el indice resulta en un aumento de 5,9% en el chance de presentar alteracion radiologica compatible o con sospecha de neumoconiosis. Con relacion a la mediana del tiempo estimado de latencia entre el inicio de la exposicion y el diagnostico de las placas pleurales, ocurrio diferencia significativa (p=0,013) entre los casos (27,0 anos) y no casos (14,3 anos). CONCLUSIONES: Los resultados muestran la necesidad de control clinico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardios de la exposicion a este mineral.