Vanda Elisa Andres Felli

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.

Absenteísmo - doença na equipe de enfermagem: relação com a taxa de ocupação

This is a qualitative descriptive, transversal study aiming to analyze the amount and causes of sick leave of nursing professionals and its relationship with the occupation tax of the hospitalization units in a teaching hospital. The methodology was divided into two phases: demographic characterization of professionals and identification and analysis of absences regarding the amount and type of sick leaves, medical diagnosis and its relationship with the occupation tax of the Hospital. The nursing professionals presented the greatest amount of sick leaves. Diseases of the osteomuscular system and of the connective tissue represented 4,957 days (41.5%) of absences and mental and behavioral disorders 3,393 days (28.4%). The monthly percentage of sick licenses was inversely proportional to the occupation tax, suggesting that professionals were absent due to diseases after being submitted to greater work load.This is a qualitative descriptive, transversal study aiming to analyze the amount and causes of sick leave of nursing professionals and its relationship with the occupation tax of the hospitalization units in a teaching hospital. The methodology was divided into two phases: demographic characterization of professionals and identification and analysis of absences regarding the amount and type of sick leaves, medical diagnosis and its relationship with the occupation tax of the Hospital. The nursing professionals presented the greatest amount of sick leaves. Diseases of the osteomuscular system and of the connective tissue represented 4,957 days (41.5%) of absences and mental and behavioral disorders 3,393 days (28.4%). The monthly percentage of sick licenses was inversely proportional to the occupation tax, suggesting that professionals were absent due to diseases after being submitted to greater work load.Estudio de naturaleza descriptiva, transversal, elaborada con el objetivo de analisar la cantidad y las causas del afastamiento por enfermedad de los profesionales de enfermeria y su relacion com la tasa de ocupacion de las unidades de internacion de un hospital de ensenanza. La metodologia fue desarrollada en dos etapas: caracterizacion demografica de los profisionales y la identificacion y analisis de las ausencias en relacion a la cantidad y tipos de afastamiento por enfermedad, a los diagnosticos medicos y en relacion con la tasa de ocupacion en el hospital. Los tecnicos de enfermeria fueron los que presentaron la mayor cantidad de licencias por enfermedad. Las enfermedades del sistema osteomuscular y del tejido conjuntivo representaron 4,957 dias (41.5%) de ausencias y los trastornos mentales y comportamentales 3.393 dias (28.4%). El percentual mensal de licencias por enfermedad fue inversamente proporcional a la tasa de ocupacion, sugeriendo que los profesionales se ausentaron por enfermedad despues de haberen sido sometidos a ritmos mayores de trabajo

Qualidade de vida no trabalho docente em enfermagem

The research deals with the quality of life at work - QLW of nursing teachers. The main goal is to point the meanings and the extenuating and enabling QLW processes, generating the health-sickness profile. The theoretical background was constituted by social determination and by content analysis of the interviews. QLW mainly means working conditions, professional identification and interpersonal relationship. In the health-sickness profile, the extenuating factors exceed the enabling factorsO estudo aborda a qualidade de vida no trabalho-QVT-docente de enfermagem, tendo como objetivo conhecer o significado e os processos desgastantes e potencializadores da QVT, geradores de seu perfil saude-doenca. O referencial teorico foi aquele da determinacao social e a analise de conteudo das entrevistas. QVT tem como significado marcante as condicoes de trabalho, identificacao profissional e relacionamento interpessoal. No perfil saude-doenca os fatores desgastantes sobrepoem-se aos fatores potencializadores.

Psychic workloads and strain processes in nursing workers of brazilian university hospitals

O objetivo deste estudo foi identificar o processo de trabalho, as cargas psiquicas e os desgastes gerados em trabalhadores de enfermagem, Esta pesquisa foi desenvolvida em cinco hospitais universitarios brasileiros. A amostra foi composta por 62 trabalhadores de enfermagem e a coleta foi realizada por meio da tecnica de grupo focal, seguida da aplicacao da enquete coletiva. Os dados foram descritos numericamente e sistematizados, segundo analise tematica. A populacao de estudo representou 35,37% da forca de trabalho hospitalar, no cenario nacional. Os resultados mostram que os trabalhadores referiram exposicao a diversos tipos de cargas psiquicas, relacionando-as a outras cargas de trabalho, destacando-se os desgastes decorrentes desse tipo de carga, como estresse, fadiga, gastrite e cefaleia. Conclui-se que os trabalhadores de enfermagem estao expostos a diversas cargas de trabalho no ambiente hospitalar, especialmente as cargas psiquicas. Essa exposicao desencadeia processos de desgaste que comprometem a saude e qualidade de vida, sinalizando a necessidade de intervencoes nessa realidade.OBJECTIVE To identify the work process, the psychic workloads and the strains generated in nursing workers. METHOD The study was developed in five Brazilian university hospitals. The sample was composed by 62 nursing workers and the data collection was done by focal group technique, followed by the application of a collective inquire. The data were quantitatively described and systematized according to a thematic analysis. RESULTS The study population represented 35,37% of the hospital workforce in national setting. The workers mentioned are exposure to several kinds of psychic workload and link them to with others workloads, highlighting the strain processes resulting from this kind of workload, such stress, fatigue, complaints of gastritis and headaches. CONCLUSIONS Nursing workers are exposed to several workloads in the hospital environment, especially psychic workloads. This exposure starts strain processes that compromise the health and quality of life, signaling the necessity of interventions in this reality.

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.

Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.

O trabalho de enfermagem psiquiátrica e os problemas de saúde dos trabalhadores

This study, based on social determination and the systematization by Laurell and Noriega, aims to understand the health-disease process experienced by nursing workers at a psychiatric hospital, with a view to identifying the burdens nursing workers at a psychiatric hospital are exposed to; understanding the exhaustive processes they experience and analyzing the coping strategies indicated as processes that increase quality of life at work. Data were collected through a focal group with 6 participants. Results showed that the object of work, i.e. the psychiatric patient, is seen as socially excluded. With regard to the work load, workers are exposed to all kinds of burdens, but the work load is intensified by the mental burden. Exhaustion is present in physical as well as mental terms. Workers present great mental exhaustion, due to the work conditions experienced or not, specifically because of living with the object of work.This study, based on social determination and the systematization by Laurell and Noriega, aims to understand the health-disease process experienced by nursing workers at a psychiatric hospital, with a view to identifying the burdens nursing workers at a psychiatric hospital are exposed to; understanding the exhaustive processes they experience and analyzing the coping strategies indicated as processes that increase quality of life at work. Data were collected through a focal group with 6 participants. Results showed that the object of work, i.e. the psychiatric patient, is seen as socially excluded. With regard to the work load, workers are exposed to all kinds of burdens, but the work load is intensified by the mental burden. Exhaustion is present in physical as well as mental terms. Workers present great mental exhaustion, due to the work conditions experienced or not, specifically because of living with the object of work.

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.