Rodolfo Andrade de Gouveia Vilela

Saúde do Trabalhador no SUS: desafios para uma política pública

O texto debate a situacao da atencao integral em Saude do Trabalhador no Brasil. Os avancos e as contradicoes das politicas publicas no campo sao analisados a partir do contexto de crescimento economico brasileiro, que ocorre em detrimento das politicas sociais, da insuficiente acao do Estado no âmbito da prevencao e, por fim, dos desafios colocados aos servicos pela recem-publicada Politica Nacional de Saude do Trabalhador e da Trabalhadora. Pretende-se assim fomentar a discussao, o entendimento, a implementacao e o avanco das acoes em Saude do Trabalhador, que deveriam estar no centro das politicas publicas.

O sistema de vigilância de acidentes do trabalho de Piracicaba, São Paulo, Brasil

The authors report on the development of a work accident monitoring system in Piracicaba, Sao Paulo State, Brazil, with the following characteristics: information feeding the system is obtained in real time directly from accident treatment centers; the system has universal monitoring, covering all work-related accidents in Piracicaba, regardless of the nature of the workers employment conditions, place of work, or place of residence; health surveillance and promotion of health initiatives are triggered by identification of sentinel events; spatial distribution analysis of work-related accidents is a basic tool in designing accident awareness strategies and accident prevention policies. The system was implemented in November 2003 and by October 2004 had identified 5,320 work-related accidents, or a 3.8% annual proportional incidence of work-related accidents in the municipal area. We illustrate spatial analysis of registered work-related accidents and present a detailed investigation of one example of a serious accident.

Da vigilância para prevenção de acidentes de trabalho: contribuição da ergonomia da atividade

Work-related accidents are complex phenomena determined by the work organization process, the dimensions of which are usually invisible to surveillance agents. The scope of this paper was a case study based on documentary evidence to analyze and compare the success of an intervention conducted at a meat processing and packaging factory, by focusing on checking health and safety norms in 1997, and incorporating ergonomic concepts in 2008. In 1997, surveillance actions focused primarily on visible risk factors. Despite fulfilling sanitation requirements, the company still had an annual accident rate of 26% in 2008, which motivated the search for a new approach. In 2008, it was seen that accidents were caused by a vicious cycle involving intense work, technical inadequacy, absenteeism and high turnover (84%) that led the company to recruit inexperienced workers. This scenario was aggravated by authoritarian management practices. The ergonomics of the activity contributed to the understanding of organizational causes -thus superseding the normative aspects of traditional surveillance - which revealed the importance of ensuring that surveillance actions for prevention are more effective.

Experiência do Programa de Saúde do Trabalhador de Piracicaba: desafios da vigilância em acidentes do trabalho

Resumo Apresenta-se neste estudo a descrição da experiência de saúde do trabalhador no Município de Piracicaba-SP e as propostas de vigilância com ênfase nos acidentes do trabalho graves. O texto representa o esforço coletivo da equipe em sua atuação. Ele mostra a importância de ações interinstitucionais, a parceria entre o Programa de Saúde do Trabalhador SUS, com membros do Ministério do Trabalho e Emprego (MTE), a integração do serviço com as universidades e com representantes da sociedade civil, na proteção e promoção da saúde. Os dados das Comunicações de Acidentes do Trabalho (CAT) processados em 1997 serviram de base para o planejamento das atividades e mostram que o município possui uma proporção de incidência anual de 5,43 acidentes e doenças do trabalho para 100 trabalhadores expostos (regidos pela Consolidação das Leis do Trabalho CLT), bem acima da média nacional de 1,62 por 100, ano base de 1996. A rede local de prontos-socorros atende a cerca de 60% dos Acidentes e Doenças Profissionais, o que mostra a importância das ações preventivas do setor público, neste contexto. Propõe-se um sistema de vigilância aos acidentes graves e fatais, nos moldes de eventos sentinela, que inclui um sistema de comunicação, a busca ativa de casos e o registro das ocorrências na rede de pronto atendimento e ações ou negociações coletivas setoriais para prevenção dos riscos mais relevantes. Palavras-Chave Saúde Ocupacional; Doenças Ocupacionais; Programa de Saúde Ocupacional; Promoção da Saúde; Prevenção de Acidentes. Summary This study describes a worker’s health experience in Piracicaba city and proposes surveillance actions with an emphasis on severe work-related accidents. This text represents our collective work as a team. It reveals the importance of interinstitutional actions in prevention and health promotion, such as: the partnership among the Worker’s Health Program of the Unified Health System SUS, with members of the Ministry of Labour, and the integration of health services with the universities and representatives of the community. Data of the Work Related Accident Register (CAT) of 1997, served as the basis for planning the activities and showed an annual incidence of 5,43 work-related accidents and occupational diseases per 100 exposed workers, much more than the National average (1,62 per 100) registered in 1996. The local emergency services assist about 60% of work-related accidents and professional diseases, showing the importance of these health problems and the potential impact of local preventive actions and workers’ health promotion. A sentinel surveillance system for severe occupational accidents is proposed, which would include an information system, active search and reporting of the cases at the local emergency services. Another aspect proposed is the actions or collective negotiations for risk prevention.

Precarização do trabalho e risco de acidentes na construção civil: um estudo com base na Análise Coletiva do Trabalho (ACT)

Este artigo descreve a atividade e a percepcao dos trabalhadores da construcao civil sobre os riscos e a carga de trabalho. O estudo, com base na Analise Coletiva de Trabalho (ACT), e parte de pesquisa em politicas publicas para aprimoramento do Sistema de Vigilância em Acidentes de Trabalho (SIVAT) de Piracicaba-SP. Priorizou-se a construcao civil pela magnitude epidemiologica de ocorrencia de acidentes de trabalho e a baixa eficacia das acoes tradicionais de vigilância pelas caracteristicas de informalidade, terceirizacao e rotatividade do setor. Os trabalhadores revelaram elevada percepcao dos riscos de acidentes e que as medidas de seguranca dificultam ou impedem a realizacao do trabalho. Os achados questionam a eficacia dos treinamentos para adesao as medidas de seguranca e evidenciam a necessidade de uma pedagogia transformadora nas acoes de promocao da saude e prevencao dos acidentes de trabalho.

Trabalhadores da saúde sob risco: o uso de pulverizadores no controle de vetores

Aims: Present results of ergonomic job analyze with emphasis at noise and heat evaluation and control during application of pesticides with. Methods: Based on Guerin et all (2001) such as meeting with team-workers, video-records and job analyze. Quantitative evaluation of emitted noise from equipment. Experiments for noise level reduction through changes in the exhaust equipment and placement of sound barriers. Measurement of environment heat from solar radiation, through the Wet Bulb Globe Temperature Index. Study of weight loss before and after the spraying activities, comparing a group of exposed and not-exposed to solar radiation. Medical examination of the exposed workers. Results: The equivalent noise level is 97,5 dB (A), with high levels (over 100 dB in the low frequency). WBGT index was 29,37oC. Weight loss in exposed workers was 2,31% in average weight loss being 1,71% in the control-group. Conclusions: New studies of work organization and engineering are needed to decrease damage caused by this equipment design and to reduce the health negative effects during the job activity.

Modelo de Análise e Prevenção de Acidentes - MAPA: ferramenta para a vigilância em Saúde do trabalhador

The analysis of work-related accidents is important for accident surveillance and prevention. Current methods of analysis seek to overcome reductionist views that see these occurrences as simple events explained by operator error. The objective of this paper is to analyze the Model of Analysis and Prevention of Accidents (MAPA) and its use in monitoring interventions, duly highlighting aspects experienced in the use of the tool. The descriptive analytical method was used, introducing the steps of the model. To illustrate contributions and or difficulties, cases where the tool was used in the context of service were selected. MAPA integrates theoretical approaches that have already been tried in studies of accidents by providing useful conceptual support from the data collection stage until conclusion and intervention stages. Besides revealing weaknesses of the traditional approach, it helps identify organizational determinants, such as management failings, system design and safety management involved in the accident. The main challenges lie in the grasp of concepts by users, in exploring organizational aspects upstream in the chain of decisions or at higher levels of the hierarchy, as well as the intervention to change the determinants of these events.

Migrant labor and wear-out in manual sugarcane harvesting in São Paulo, Brazil

The scope of this paper is to describe the work of manual sugarcane harvesters, assessing the nutritional behavior and body composition between the beginning and the end of the harvest. A descriptive longitudinal study was made of harvesters in Piracicaba, São Paulo, Brazil, who answered a socio-demographic questionnaire and authorized measurement of Body Mass Index, Body Fat Percentage and Arm Muscle Circumference at three stages. Creatine kinase on the skeletal isoform, C-reactive protein and plasma urea were measured at the end of the harvest. Thirty male migrant harvesters with ages ranging from 18 to 44 from the Northeast (Ceará) were assessed over a nine-month period. The workers suffered significant body fat and weight loss in the first half of the harvest. Eighteen workers had abnormal levels of creatine kinase and four - out of 24 who had donated blood - had altered urea levels. Sugarcane harvesting work causes weight and body fat loss and gains in the lean body mass index, which suffers wear-out when working on consecutive harvests. It can also cause changes in biochemical markers of chronic systemic inflammation. Further studies will make it possible to comprehend the relationships between stress, wear-out, labor longevity and health in sugarcane harvesting.

Sobre a "aceitabilidade social" dos acidentes do trabalho e o inacei tável conceito de ato inseguro

havia editado, em 2007, no volume 32 numero 115, dossie sobre o tema “Acidentes do trabalho e sua prevencao”. A intencao dos editores do dossie (ALMEIDA; JACKSON FILHO, 2007) foi destacar a insuficiencia dos metodos “tradicionais de analise de acidentes”, fundados nas ideias de “ato inseguro” ou “erro humano” e publicar pesquisas e estudos baseados em abordagens sistemicas e/ou organizacionais.No entanto, a despeito dos avancos da ciencia em compreender tais fenomenos, os metodos tradicionais permanecem hegemonicos no seio de nossa sociedade, nas empresas e instituicoes, nas normas e regras profissionais. Judicializa-se o problema e nao se opera a pre-vencao, sendo as decisoes judiciais influenciadas por estes modelos e, consequentemente, produzindo injustica e impactadando negati-vamente na vida dos trabalhadores e de seus familiares. Dai a impor-tância do manifesto publico acima referido. Assim, considerando que, do ponto de vista cientifico e, em par-ticular, do estado da arte das pesquisas no campo da analise de ca-tastrofes e acidentes do trabalho, a persistencia do uso da nocao de ato inseguro e inaceitavel (LLORY; MONTMAYEL, 2010), decidimos discutir neste editorial o porque da sua “aceitabilidade social”. Para faze-lo, apoiar-nos-emos na analise antropologica proposta por Mary Douglas (1985) em

Acidente do trabalho investigado pelo CEREST Piracicaba: confrontando a abordagem tradicional da segurança do trabalho

Exploring different concepts of work-related accidents and intending to discuss their implications on prevention, this article presents a case-study on work related accident (WRA) investigation conducted by the System of Surveillance of Accidents at Work (SIVAT) at the Center of Reference on Worker’s Health (CE REST) in Piracicaba, using cases notified by all emergency rooms and hospitals of the Municipal district. The methodology of investigation of WRA used by CEREST includes interviews, analysis of documents, pictures, observation, and investigation of the situation at worksite. On the other hand, companies present simplistic explanations of WRA occurrences, using the traditional approach based on individual unsafe action, facilitated by reports issued by the State Criminalistics Institute (IC). Consequently victims are blamed for the events, and aspects of work organization or equipment conception are ignored. Such factors, if properly analyzed, could point out solutions for improvements in safety and reliability of the systems. Authors concluded that cultural changes in the safety field are necessary, with continuous investments in training and diffusion of new concepts on accidents among social actors, professionals, and the Judiciary.