Return to work after sick leave due to musculoskeletal disorder or injury: a longitudinal study conducted in Brazil

BACKGROUND

Musculoskeletal disorders and injuries (MSDI) are conditions that affect the locomotor system characterized by pain and impairment of functionality. They are the leading cause of years lived with disability. The aim of this study was to analyze the factors that influence the return to work (RTW) among workers on sick leave due to MSDI.   METHODS: A longitudinal study was conducted in the city of São Paulo, Brazil, between 2020-2022. The participants were 216 workers who required social security compensation due to MSDI. They filled out online questionnaires about their sociodemographic characteristics, health risk behaviors, work characteristics and health conditions. They were followed for 365 days after their first day of sick leave. A Cox regression was performed to identify the factors that influenced their first RTW.

RESULTS

Most participants were male (53.0%), mean age was 39.5 years (SD 10.6), 70.4% returned to work within the one-year follow-up period. The mean duration of sick leave was 192.6 days. Factors associated with a lower RTW were age 40 years and older (HR 0.54; 95%CI 0.39-0.76) and the interaction between perceptions of the need for improvement in the physical and psychological domains of quality of life (HR 0.67; 95%CI 0.48-0.94).

CONCLUSIONS

Occupational healthcare professionals should pay greater attention to patients who are aging and those with perceived worse physical and psychological conditions, in order to facilitate the reintegration process and promote sustained RTW after sick leave due to musculoskeletal disorder or injury.

Factors associated with visual function among computer-based administrative workers: a Brazilian cross-sectional study

Introduction

Several studies have shown that eye and vision problems are among the most significant issues reported by individuals who use computers at work.

Objectives

To investigate individual and occupational environmental factors associated with visual function among workers who perform computer-based administrative tasks.

Methods

This is a cross-sectional study conducted in 2014-2015 with 303 workers of a public hospital in the city of São Paulo, Brazil. The participants answered a structured questionnaire, including the 25-Item National Eye Institute Visual Function Questionnaire. Statistical analyses used descriptive analysis, tests of association and multiple linear regression analysis.

Results

Most participants were female (61.1%); the mean age was 46.0 (standard deviation [SD]) ± 12.5, and approximately 91.7% of them reported wearing corrective lenses. Regarding visual function, the mean score at the 25-Item National Eye Institute Visual Function Questionnaire was 78.0, SD ±7.1. A regression analysis showed that visual function declined with age (ß -0.218; 95%CI -0.276--0.16l) and effort at work (ß -0.656; 95%CI -0.928--0.383).

Conclusions

The mean quality of visual health in the studied group was good. The younger the age and the lower the effort at work, the better the visual function. Our results point to the relevance of establishing periodical and preventive health actions, including eye health assessments.

COVID-19 Pandemic: Analysis of Health Effects on Emergency Service Nursing Workers via a Qualitative Approach

During the COVID-19 pandemic, longstanding issues involving nursing work, which has always involved significant risks of illness and infection, were intensified. It is necessary to acknowledge the risks and nurses' perceptions about the risks qualitatively during the period of the health crisis. The aim of this study was to examine the health repercussions perceived by nursing workers in emergency services during the outbreak of the COVID-19 pandemic in Brazil. This was a qualitative, descriptive, cross-sectional study. The settings of the study were emergency services with a national scope; the participants were nursing workers. Data were collected via face-to-face virtual calling interviews and analyzed via a content analysis technique, which was supported by IRAMUTEQ software. The formation of textual classes pointed in three thematic directions, from which three categories emerged: nursing workers' exposure, due to a lack of protective equipment, to the risk of being contaminated with, falling ill from, and transmitting the COVID-19 virus; changes in work environments, processes, and relations in response to the pandemic; and physical, mental, and psychosocial alterations perceived by emergency service nursing workers. The exposure to the virus, risk of contamination, and changes in the work environment and relations all resulted in health repercussions, which were perceived as physical, mental, and psychosocial alterations that were described as dietary disturbances, physical fatigue, burnout, increased smoking, anxiety, sleep alterations, fear, exhaustion, stress, social isolation, loneliness, distancing from relatives, and social stigma.

Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil

Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12-6.91) or southern region (HR: 2.68; 95% CI 1.04-6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07-6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05-6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation.

Validity Evidence of Brazilian Portuguese Version of the Professional Fulfillment Index

PURPOSE

The questionnaire "Professional Fulfillment Index" (PFI) was validated to assess emotional exhaustion, interpersonal disengagement, and professional achievement among physicians. This study presents the process of cross-cultural adaptation of the PFI to the Brazilian context.

DESIGN

Analytical cross-sectional study carried out between July and October 2020. Settings: For conceptual equivalence, a panel of experts was constituted who conducted analyzes on the translation and back-translation processes from English to Brazilian Portuguese.

SUBJECTS

For the operational equivalence, 432 physicians in the field of Occupational Medicine were invited.

MEASURES

They answered the PFI in an online platform. Analysis: Both exploratory and confirmatory factor analysis were performed to seek evidence of the hypothesized structure of PFI item responses. Reliability was assessed using three indicators.

RESULTS

The Brazilian version can be considered similar to the original. Most of participants were female (57.6%) and mean age 49.6 years-SD 14.0. The mean time since graduation was 18.5 years-SD 9.67. Most of them had a full-time job (88.0%) and were trained through post-graduation courses 83.8%. The most frequent job task was to perform worker´s clinical evaluations (84.9%). Exploratory and confirmatory analyzes showed the adequacy of the items in measuring the instrument's construct, with stability for use in other populations and samples.

CONCLUSION

The PFI was developed to evaluate positive and negative aspects of physicians' role and performance. The process described in this article was the first cross-cultural adaptation of the questionnaire. The PFI can help in mapping potential risk situations for negative impacts on physicians' occupational well-being and performance at work, in order to propose interventions that reduce exhaustion and expand professional fulfillment.

Distress and pleasure indicators in health care workers on the COVID-19 front line

Abstract Objective to evaluate distress and pleasure indicators in health care workers on the front line of care for suspected or confirmed COVID-19 cases. Method an exploratory, analytical and cross-sectional study with a quantitative approach. The studied sample consisted of 437 health professionals invited by electronic means, who answered the questionnaire on sociodemographic information, occupational aspects and clinical conditions. Distress and pleasure at work were considered as outcomes, which were analyzed with multinomial logistic regression regarding the associated independent variables. Results Most of the participants were female (71.0%), nurses (55.6%), with a weekly working shift of 40 hours or more (75.8%); 61.6% of the participants suffered from mental distress. The psychosocial characteristics of high-strain work and low social support were reported by 23.8% and 52.9% of the participants, respectively. In the multiple analysis, distress and lack of pleasure at work were associated with high job strain, low support from co-workers and mental distress. The profession is also associated with distress at work. Conclusion distress and lack of pleasure at work are associated with occupational characteristics and mental strain among health care workers in the COVID-19 scenario.

Sick leave due to dorsopathies among bus drivers from a company in São Paulo, Brazil

Introduction

Dorsopathies are common among bus drivers and may result in absenteeism due to work disability. Dorsopathies have a multifactorial etiology, including those related to occupational risk factors.

Objectives

To analyze the factors associated with sick leave due to dorsopathies among bus drivers from a public transport company.

Methods

This was a cross-sectional, analytical study with information from a database of 2,229 professional bus drivers from a company in the city of São Paulo, Brazil. The study period was from 2016 to 2017. Independent variables were sex, age group, length of service, and work shift; the outcome was the history of sick leave due to dorsopathies in the study period. Logistic regression analysis was performed to investigate the factors associated with the outcome.

Results

Mean sample age was 47.33 years, and mean length of service was 8.65 years. Most participants were men (98.06%) and worked during the day (85.9%). There was a 17% prevalence of sick leave in the study period, with an average of 1.86 days per medical certificate. Age group was the only variable with a statistically significant distribution, with a reduced probability of sick leave due to dorsopathies in those aged ≥ 40 years.

Conclusions

Younger workers were more likely to be on sick leave due to dorsopathies than older workers. Actions aimed at permanent health promotion and disease prevention are important to improve the quality of life and well-being of these workers.

Working conditions are associated with the occurrence of sleepiness of nursing professionals: a case-control study

Objectives

To identify the factors associated with the occurrence of sleepiness among nursing professionals.

Material and Methods

A case-control study nested in a cross-sectional one, conducted with 364 controls and 121 cases. Data on demographic and occupational characteristics were collected, as well as about lifestyle, physical and psychosocial work environment and somnolence. A multiple logistic regression analysis was performed.

Results

The independent factors associated with the presence of sleepiness were as follows: imbalance between efforts and rewards (ORa=3.81; p<0.001), high overcommitment (ORa=3.20; p<0.001), workload equal to or greater than 45 hours a week (ORa=2.30; p=0.001), situations that can generate pain/injury with moderate or high exposure (ORa=1.85; p=0.037), and night work (ORa=1.71; p=0.038). The model was adjusted by gender and age group.

Conclusion

Individual and historical-occupational characteristics and, mainly, those related to the physical and psychosocial work environment, were associated with the occurrence of sleepiness. Public and institutional preventive policies must include improvements in the conditions of the physical and psychosocial work environment, as well as strengthening of the individual resources.

Atualização 2020 da Lista de Doenças Relacionadas ao Trabalho no Brasil

Resumo Objetivo: apresentar o processo de atualização de 2020 da Lista de Doenças Relacionadas ao Trabalho (LDRT) do Brasil. Métodos: entre 2019 e 2020, foi conduzido plano de trabalho em cinco etapas para produzir versão atualizada da LDRT. Resultados: na Etapa 1, a LDRT de 1999 foi comparada a outras listas internacionais e estrangeiras e foram consultados profissionais que fazem uso da lista brasileira. Na Etapa 2, organizou-se uma oficina de trabalho para discutir sobre a primeira versão da atualização. A Etapa 3 envolveu a análise das discussões da oficina de trabalho, a elaboração da segunda versão da atualização e a disponibilização para consulta pública. Na Etapa 4, após a análise das contribuições da consulta pública, elaborou-se a terceira versão, que foi encaminhada para análise governamental. A Etapa 5 consistiu na publicação da legislação com a atualização de 2020 da LDRT. Conclusão: a atualização da LDRT propiciou o aumento do número de códigos diagnósticos de 182 para 347. O capítulo com maior crescimento foi o relativo aos Transtornos Mentais e Comportamentais. Após intervalo de 21 anos, o processo amplamente participativo utilizado proporcionou a atualização, cumprindo a legislação sanitária nacional e contribuindo para o aprimoramento da integralidade na atenção à saúde dos trabalhadores.

Indicadores de sufrimiento y placer en trabajadores de la salud en la primera línea del COVID-19

Resumen Objetivo evaluar indicadores de sufrimiento y placer en trabajadores de la salud en la primera línea de atención de casos sospechosos o confirmados de COVID-19. Método estudio exploratorio, analítico, transversal con enfoque cuantitativo. La muestra estudiada estuvo conformada por 437 profesionales de la salud invitados por medios electrónicos, que respondieron el cuestionario sobre información sociodemográfica, aspectos ocupacionales y condiciones clínicas. Se consideraron como resultados el sufrimiento y el placer en el trabajo, que fueron analizados con regresión logística multinomial en cuanto a las variables independientes asociadas. Resultados la mayoría de los participantes era de sexo femenino (71,0%), enfermera (55,6%), tenía una jornada laboral semanal de 40 horas o más (75,8%); el 61,6% de los participantes presentaban sufrimiento mental. En cuanto a las características psicosociales del trabajo, los participantes lo consideraron de alta exigencia y bajo apoyo social, 23,8% y 52,9% respectivamente. En el análisis múltiple, la angustia y la falta de placer en el trabajo se asociaron con una alta exigencia laboral, poco apoyo de los compañeros de trabajo y sufrimiento mental. La profesión también está asociada al sufrimiento en el trabajo. Conclusión el sufrimiento y la falta de placer en el trabajo se asocian con características ocupacionales y el agotamiento mental en los trabajadores de la salud en el escenario del COVID-19.

Indicadores de sofrimento e prazer em trabalhadores de saúde na linha de frente da COVID-19

Resumo Objetivo avaliar indicadores de sofrimento e prazer em trabalhadores de saúde na linha de frente do cuidado aos casos suspeitos ou confirmados de COVID-19. Método estudo exploratório, analítico, transversal, com abordagem quantitativa. A amostra estudada foi constituída por 437 profissionais da saúde convidados por meio eletrônico, que responderam ao questionário sobre informações sociodemográfica, aspectos ocupacionais e condições clínicas. Foram considerados como desfechos o sofrimento e o prazer no trabalho, os quais foram analisados com regressão logística multinomial quanto às variáveis independentes associadas. Resultados a maioria dos participantes era do sexo feminino (71,0%), enfermeira (55,6%), com jornada de trabalho semanal de 40 horas ou mais (75,8%); 61,6% dos participantes estavam em sofrimento mental. As características psicossociais do trabalho de alta exigência e de baixo apoio social foram informadas, respectivamente, por 23,8% e 52,9% dos participantes. Na análise múltipla, o sofrimento e a falta de prazer no trabalho estiveram associados com a alta exigência no trabalho, baixo apoio dos colegas de trabalho e sofrimento mental. A profissão também está associada ao sofrimento no trabalho. Conclusão o sofrimento e a falta de prazer no trabalho estão associados às características ocupacionais e ao desgaste mental entre trabalhadores da saúde no cenário da COVID-19.

Factors associated with the death of healthcare workers due to COVID-19 in the state of Amapá, Brazil

Introduction:

Frontline healthcare workers providing care for COVID-19 are more likely to get infected and die compared with other professionals. Deaths or sick leaves due to COVID-19 can affect the smooth operation of health services in areas with shortage of workers.

Objectives:

To analyze factors associated with the death of healthcare workers due to COVID-19 in the state of Amapá, Brazil.

Methods:

Analytical cross-sectional study using COVID-19 data from Amapá between March 2020 and January 2021. The association of independent variables (sex, race/color, age group, region of residence, comorbidity) with death was analyzed by logistic regression.

Results:

Data from 1,258 workers were analyzed. The majority were women (67.7%; 852/1,258), multiracial (66.9%; 759/1,135), aged between 18 and 64 (98.3%; 1,226/1,247), with no comorbidity (86.6%; 1,090/1,258), from the Macapá metropolitan area (56.7%; 713/1,258). The mortality rate was 1.59%. Factors associated with death were: age group = 65 years (odds ratio = 10.43; 95% confidence interval [CI] = 2.78-39.11), comorbidity (odds ratio = 4.52; 95%CI = 1.74-11.74), and residence in the Macapá metropolitan area (odds ratio = 4.37; 95%CI = 1.25-15.29).

Conclusions:

The recognition of factors that may have caused the death of healthcare workers in Amapá can support the recommendation of protective measures for the most susceptible, such as switching to activities with lower exposure to the virus or teleworking.

Occupational psychosocial stressors and mental distress among healthcare workers during COVID-19 pandemic

OBJECTIVE

To analyze the factors associated with mental distress among health workers who cared for patients with a suspected or confirmed diagnosis of coronavirus disease 2019 (COVID-19).

METHODS

A cross-sectional analytical study of national scope, carried out between in the second quarter of 2020. A total of 437 health professionals, who filled out an electronic form about sociodemographic data, occupational aspects, psychosocial characteristics of work and mental distress. Multiple logistic regression was performed to analyze the covariables associated with mental distress.

RESULTS

There was a predominance of workers on the nursing team (65.0%), female (71.0%), from Southeastern region of the country (68.6%) and with no morbidities (36.2%). The prevalence of mental distress was 61.6%. Job strain was reported by 24% of participants, and the perception of low support from coworkers was described by 52.9%. The final multiple regression model showed that mental distress was associated with females (odds ratio - OR: 1.93; 95%CI: 1.22-3.07), age up to 40 years (OR: 1.64; 95%CI: 1.07-2.52), weekly working hours equal or over 60 hours (OR: 1.87; 95%CI: 1.15-3.11), job strain (OR: 2.45; 95%CI: 1.41-4.40) and low support from co-workers (OR: 3.47; 95%CI: 2.26-5.38).

CONCLUSION

Six out of ten participants presented mental distress, which was associated to both individual characteristics and factors related to the work carried out during the pandemic. There is an urgent need to map services that have such characteristics, to outline actions to promote mental health and prevent emotional distress at different levels of health care.

Prevalence of COVID-19 testing among health workers providing care for suspected and confirmed cases

Objectives

To describe the prevalence of testing among health workers providing care for suspected and confirmed cases of COVID-19.

Methods

This quantitative, cross-sectional study was conducted from April to June 2020, using a convenience sample. An online questionnaire was used for collecting sociodemographic, occupational, and clinical data, which were analyzed descriptively.

Results

In total, 437 health workers participated in the study, with a predominance of nursing workers (58.68%), women (70.3%), age between 30 and 49 years (54.2%), individuals living in the Southeast region of Brazil (60.54%), working in the public care system (69.11%), and focused on primary care (30.89%). Among the participants, 36% reported comorbidities, 21.1% had symptoms suggestive of COVID-19, and only 27% had undergone some type of COVID-19 testing.

Conclusions

Despite the existence of risk comorbidities and symptoms suggestive of contamination, the frequency of testing was below one third among respondents. The lack of action compromises health surveillance and protection strategies for workers providing care for the population and may favor the contamination of new patients and the community.

Aging and the Future of Decent Work

The United Nations identified decent work and economic growth as a sustainable development goal for 2030. Decent work is a term that sums up aspirations for people in their working lives. One of the factors that influences the achievement of decent work is aging. This article examines how aspects of aging and organizational factors affect work ability across the lifespan and throughout one's work career. Additionally, the critical issue of worker physical mobility was also addressed as a practical limitation to functional aging. Through our investigation, we identified gaps in the literature where research and interventions should be promoted. These include early disability studies; population dashboards of workers' health metrics; intervention and cost effectiveness in health promotion and prevention of early functional aging at work; policies for tailoring demands to individual needs and abilities; and inequities of social protection for aging workers.

Return to Work After a Disabling Mental Disorder: Predictors From a Brazilian 1-Year Longitudinal Study

OBJECTIVE

This study aims to analyze factors that influence return to work (RTW) among workers on sickness absence due to mental disorders.

METHODS

A longitudinal study conducted between 2014 and 2017 in São Paulo, Brazil. The 385 participants answered a questionnaire including sociodemographics, habits/lifestyle, job characteristics, and clinical information. Survival analysis was performed to identify factors influencing the RTW.

RESULTS

Most of participants were females (74.5%), worked in jobs dealing with public (44.2%) and were depressed (52.4%). RTW occurred for 68.3% participants over 1-year follow-up. Mean duration of absence was 163.83 days. The risk profile for remaining absent was heavy smokers, be abstainer, obese, deal with the public, perceived great effort at work, and low self-efficacy.

CONCLUSIONS

These findings can contribute in discussion about disability prevention and interventions to assure mental health care for workers.

Mental distress in workers at two metallurgical companies in the state of São Paulo, Brazil

This study aimed to map the prevalence of mental distress among employees at two metallurgical companies and to analyze differences according to the sex of workers and the employing company. An analytical cross-sectional study was conducted using the 20-item Self-Reporting Questionnaire to map the prevalence of mental distress. A total of 439 workers participated in the study. The overall prevalence was 10.0%, being 4 times higher in women (32.3%) than in men (8.3%) (p < 0.001). There was no significant difference between the prevalence rates of mental distress according to employing company (p = 0.271) or sector (p = 0.239). The most frequent complaint was ‘nervousness, tension, and worry’ (48.7%). These results indicate the need for management of workers’ mental health, especially among women.

Hand warts among butchers in a supermarket in São Paulo

Background

Butchers are exposed to biological hazards as a function of their continuous handling of meat containing blood, fat and fluids. Biological hazards include contamination with viruses, such as the papillomavirus (HPV), especially HPV type 7, which is associated with the so-called "butcher's wart."

Objective

To investigate wart-like lesions among meat handlers.

Method

Cross-sectional descriptive study conducted at a supermarket in São Paulo in 2017. Twenty-four employees allocated to the meat handling section were interviewed and subjected to skin visual examination; lesions were photographed.

Results

Most participants were male (87.5%) and half of them (50.0%) were within age range 31 to 40 years old. Only one employee had started working in this section less than 2 years earlier. Wart-like lesions or scars with black dots on their center were found on the hands of 11 butchers (45.8%).

Conclusion

Almost half of the participants had history of hand warts. Most of the participants with lesions were male, aged up to 40, right-handed and had worked as meat handlers for 2 years at least. We might infer we found cases of wart-like occupational dermatosis among butchers at a supermarket in São Paulo.

Trends in the Cumulative Incidence of Vocational Rehabilitation Indicators in Brazil, 2007-2016

Vocational rehabilitation (VR) aims at improving work ability to facilitate workers’ return to work. VR is provided in Brazil by the public social security system. The aim of the present study was to analyze trends in VR indicators for Brazil from 2007 to 2016. Based on open-access, secondary aggregate data, we calculated the cumulative incidence of VR indicators. We fitted Prais-Winsten generalized linear regression models to estimate trends and calculated annual percent variation with the corresponding 95% confidence interval (95% CI). The mean cumulative incidence of referrals to VR services was 37.16/1000 temporary disability benefits granted and exhibited a decreasing trend of −6.92% (95% CI: −8.38; −5.43). The mean cumulative incidence of admissions to VR services was 57.34/100 referrals and exhibited an increasing trend of 3.31% (95% CI: 1.13; 5.53). The mean cumulative incidence of rehabilitation was 57.43/100 admissions and remained stable along the analyzed period, −2.84 (95% CI: −5.87; 0.29). Our findings evidence a reduction in the number of workers referred for VR, an increase of admissions, and stability in the cumulative incidence of rehabilitated workers.

Validity and test-retest reliability of the Brazilian version of the Return-to-work self-efficacy questionnaire

OBJECTIVE

To investigate the validity and test-retest reliability of the Brazilian version of the Dutch questionnaire “Verwachtingen over werken”.

METHODS

We analyzed data from a longitudinal study conducted in the city of São Paulo, Brazil, from 2014 to 2016. Participants were 411 workers on sick leave for more than 15 days due to mental disorders. A subsample of 126 participants responded the questionnaire a second time, seven to 21 days later. Factorial and concurrent validities and the test-retest reliability were analyzed.

RESULTS

Most participants were female (71.5%), the average age was 36.7 years; 83.1% had attended 12 or more years of formal schooling; the average length of sick leave was 84 days. The average self-efficacy score tended to be below the scale midpoint. The construct had a two-dimensional structure and the concurrent validity confirmed the original construct. For all items, the test-retest reliability adjusted for prevalence ranged from good (0.70) to almost perfect (0.83).

CONCLUSIONS

While the two-dimensional structure diverges from the original, other parameters were adequate. Application of the Return-to-work self-efficacy questionnaire to Brazilian workers might contribute to the planning of return-to-work process. Additional studies are needed to complement the analysis of the use of this instrument in Brazil.

Sickness absence due to mental disorders and psychosocial stressors at work

INTRODUCTION

Mental disorders are the third leading cause of social security benefit due to sickness in Brazil. Occupational exposure to psychosocial stressors can affect the workers' mental health. The social security medical experts are responsible for characterizing if those sicknesses are work-related.

OBJECTIVE

To evaluate the factors associated with sick leave due to mental disorders, in particular, the perception of workers on psychosocial factors at work.

METHODS

This is an analytical study carried out in São Paulo, Brazil, with 131 applicants for sickness benefit due to mental disorders. Questionnaires were applied to assess the sociodemographic data, habits/lifestyle information, and perceived psychosocial factors at work.

RESULTS

The most common diagnosis was depressive disorders (40.4%). The medical experts considered 23.7% of all applications as work-related. Most of the participants were female (68.7%), up to 40 years of age (73.3%), married/common-law marriage (51.1%), with educational level greater than or equal to 11 years (80.2%), nonsmokers (80.9%), not alcohol consumers (84%), and practice of physical activities (77.9%). Regarding psychosocial factors, most of the participants informed a high job strain (56.5%), low social support (52.7%), effort-reward imbalance (55.7%), and high overcommitment (87.0%). There was no statistical association between the work-related mental disorders sickness benefits and independent variables.

CONCLUSION

The concession of social security sickness benefits is not associated with sociodemographic data, habits/lifestyle, or psychosocial factors at work. Occupational exposure to unfavorable psychosocial factors was reported by most workers on sick leave due to mental disorders. However, several cases were not recognized by the social security medical experts as work-related, which may have influenced the results of the associations.

Warm-water immersion foot among car wash workers

Background

Warm-water immersion foot (WWIF) is associated with prolonged contact with water at high temperature. Car wash workers are frequently exposed to humidity, however, there are not studies targeting diseases affecting this category of employees.

Objective

To investigate the frequency of WWIF among car wash workers.

Methods

The study was carried out in 2013 at a car wash service in Jundiaí, São Paulo, Brazil. A group of 30 workers was subjected to clinical interview and dermatological examination. Statistical tests were performed to assess the association between WWIF and independent variables.

Results

All the participants were male, their average age was 23 years old, and the most (60%) had worked at the investigated company for more than one year. Sixty percent of the participants exhibited lesions compatible with WWIF. Age and length of work at the company were associated with the assessed outcome. The participants were frequently and permanently exposed to humidity along the working day without wearing impermeable clothes.

Conclusion

Most participants exhibited WWIF; the ones over 30 years old and having worked less than 1 year at the investigated company exhibited higher odds of WWIF due to occupational exposure to humidity.

Preventing occupational stress in healthcare workers

BACKGROUND

Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems.

OBJECTIVES

To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers.

METHODS

SEARCH METHODS

We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database.

SELECTION CRITERIA

Randomised controlled clinical trials (RCT) of interventions aimed at preventing psychological stress in healthcare workers. For work-directed interventions interrupted time series and prospective cohort were also eligible.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed trial quality. Meta-analysis and qualitative synthesis were performed where appropriate.

MAIN RESULTS

We identified 14 RCTs, three cluster-randomised trials and two crossover trials, including a total of 1,564 participants in intervention groups and 1,248 controls. Two trials were of high quality. Interventions were grouped into 1) person-directed: cognitive-behavioural, relaxation, music-making, therapeutic massage and multicomponent; and 2) work-directed: attitude change and communication, support from colleagues and participatory problem solving and decision-making, and changes in work organisation. There is limited evidence that person-directed interventions can reduce stress (standardised mean difference or SMD -0.85; 95% CI -1.21, -0.49); burnout: Emotional Exhaustion (weighted mean difference or WMD -5.82; 95% CI -11.02, -0.63) and lack of Personal Accomplishment (WMD -3.61; 95% CI -4.65, -2.58); and anxiety: state anxiety (WMD -9.42; 95% CI -16.92, -1.93) and trait anxiety (WMD -6.91; 95% CI -12.80, -1.01). One trial showed that stress remained low a month after intervention (WMD -6.10; 95% CI -8.44, -3.76). Another trial showed a reduction in Emotional Exhaustion (Mean Difference or MD -2.69; 95% CI -4.20, -1.17) and in lack of Personal Accomplishment (MD -2.41; 95% CI -3.83, -0.99) maintained up to two years when the intervention was boosted with refresher sessions. Two studies showed a reduction that was maintained up to a month in state anxiety (WMD -8.31; 95% CI -11.49, -5.13) and trait anxiety (WMD -4.09; 95% CI -7.60, -0.58). There is limited evidence that work-directed interventions can reduce stress symptoms (Mean Difference or MD -0.34; 95% CI -0.62, -0.06); Depersonalization (MD -1.14; 95% CI -2.18, -0.10), and general symptoms (MD -2.90; 95% CI -5.16, -0.64). One study showed that the difference in stress symptom level was nonsignificant at six months (MD -0.19; 95% CI -0.49, 0.11).

AUTHORS' CONCLUSIONS

Limited evidence is available for the effectiveness of interventions to reduce stress levels in healthcare workers. Larger and better quality trials are needed.