Associação entre infecção pelo vírus Chikungunya e sintomas depressivos entre trabalhadores e trabalhadoras da saúde / Association between Chikungunya infection and depressive symptoms among healthcare workers

Resumo Objetivo: analisar a associação entre infecção prévia por Chikungunya e sintomas depressivos em trabalhadores da saúde. Métodos: estudo transversal com amostra probabilística de trabalhadores atuantes na atenção primária e na média complexidade de um município do estado da Bahia, Brasil. Utilizou-se o teste rápido DPP-ZDC-IgM/IgG para identificar infecção recente (IgM) ou prévia (IgG) pelo vírus Chikungunya. O Patient Health Questionnaire-PHQ-9 foi usado para avaliar sintomas depressivos. Regressão de Poisson com variância robusta foi usada para estimar razões de prevalência e intervalos de confiança 95%. Resultados: participaram da pesquisa 392 trabalhadores, sendo 83,2% do sexo feminino. A frequência de infecção pelo vírus Chikungunya foi de 8,9%. A prevalência de sintomas depressivos foi de 22,7%. Na análise ajustada, a infecção por Chikungunya associou-se positivamente aos sintomas depressivos (RP=2,00; IC95%:1,29;3,07). As análises estratificadas apontaram associação de maior magnitude no sexo masculino (RP=7,57;1,15;50,06), em comparação ao feminino (RP=1,68;1,03;2,74). Conclusão: os achados corroboram a hipótese de associação positiva entre Chikungunya e sintomas depressivos. Mecanismos fisiopatológicos decorrentes de ação viral, bem como fatores emocionais, comportamentais e psicossociais associados à doença podem explicar os achados. Reitera-se a importância do cuidado em saúde mental para os trabalhadores da saúde.

Abstract Objective: to analyze the association between previous Chikungunya infection and depressive symptoms among healthcare workers. Methods: a cross-sectional study with a probabilistic sample of healthcare workers in primary and medium-complexity care settings in a municipality in the state of Bahia, Brazil. We used the rapid test DPP-ZDC-IgM/IgG to identify recent (IgM) or previous (IgG) Chikungunya virus infection, and the Patient Health Questionnaire-PHQ-9 to assess depressive symptoms. We applied regression with robust variance to estimate prevalence ratios and 95% confidence intervals. Results: 392 workers participated, 83.2% female. The frequency of Chikungunya virus infection was 8.9%. The prevalence of depressive symptoms was 22.7%. In the adjusted analysis, Chikungunya infection was positively associated with depressive symptoms (PR=2.00; 95%CI: 1.29; 3.07). Stratified analyses indicated a stronger association among males (PR=7.57; 95%CI: 1.15; 50.06) compared with females (PR=1.68; 95%CI: 1.03; 2.74). Discussion: the findings support the hypothesis of a positive association between Chikungunya and depressive symptoms. Physiopathological mechanisms resulting from viral action, as well as emotional, behavioral, and psychosocial factors associated with the disease, may explain the findings. We reiterate the importance of providing mental health care to healthcare workers.

Residência médica e multiprofissional: demandas e recursos de preceptores na atenção primária à saúde / Medical and multiprofessionalresidency: demands and resources of preceptors in primary health care

A Atenção Primária à Saúde (APS) é a estratégia preconizada pelo SUS para uma mudança do modelo de atenção à saúde, o que implica a necessidade de formar mais profissionais para essa área. Assim, há maior espaço para Programas de Residência que preconizam a formação em serviço, tendo um preceptor responsável pela supervisão direta das atividades práticas realizadas pelos residentes. Esta pesquisa traz as principais demandas e recursos do trabalho dos preceptores de um Programa Integrado de Residência Médicae Multiprofissional, na APS, sob a ótica do Modelo Job Demands and Resources(JDR). A pesquisa é recorte de dissertação de mestrado, com abordagem qualitativa e metodologia da Pesquisa Convergente Assistencial (PCA). Para a coleta de dados, foram realizadas, em formato virtual, entrevistas semiestruturadas e reuniões em formato de grupos convergentes. Participaram da pesquisa dez profissionais da APS vinculados ao Programa de Residência. Foram identificadas demandas relacionadas a excesso de atividades, falta de clareza nas funções, desvalorização, insegurança de direitos, conflitos políticos, intensidade da relação entre preceptor e residente, fragilidade da relação com a instituição, bem como a recursos, como o investimento em educação permanente e a organização política. As contribuições desses profissionais na interface entre ensino e serviço devem ser valorizadas na consolidação da formação em saúde.

PrimaryHealth Care (PHC) is the strategy advocated by the SUS (Unified Health System) to change the health care model, which implies the need to train more professionals in this area. There was greater space for residency programs that advocate in-service training with a preceptor responsible for direct supervision of practical activities carried out by the residents. This research identifies the main demands and resources of the preceptors' work at a PHC Integrated Medical and Multiprofessional Residency Programfrom the perspective of the Job Demands and Resources (JDR) Model. The research is part of a master's thesis, with a qualitative approach and methodology based on Convergent Care Research (CCR). For data collection, semi-structured interviews and convergent groups were carried out in a virtual format. Ten professionals from PHC, linked to the residency program, participated in the research. Demands were identified, such as: excess of activities, lack of clarity in functions, devaluation, insecurity of rights, political conflicts, relationship intensity between resident and preceptor, fragility in the relationship with the institution, and, as resources, the investment in permanent education and political organization. The contributions of these professionals, at the interface between teaching and service, should be valued in the consolidation of health education.

The Role of Workplace Bullying in Low Back Pain: A Study With Civil Servants From a Middle-Income Country.

This is a cross-sectional study that analysed the association between workplace bullying and LBP. The participants were 894 judicial civil servants from Porto Alegre, southern Brazil. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r) and Low Back Pain by the Nordic Questionnaire for Musculoskeletal Symptoms (NQMS). Logistic Regression was used to analyse data and test hypotheses. The prevalence of LBP in the last 7 days was 50.1%, while the overall prevalence of Chronic LBP was 19.3%. Some psychosocial factors at work were strongly associated with both outcomes. Workplace bullying was strongly associated with LBP, even after adjustment for several covariates. The odds of LBP in the last 7 days among bullied workers was 1.89 (95% CI: 1.31-2.71) times higher, compared to non-bullied. Workplace bullying was also associated with chronic LBP after adjustment for sociodemographic, behavioural and some occupational factors (OR = 1.60; 95% CI: 1.05-2.44). Psychosocial factors at work, and particularly workplace bullying, were strong risk factors for LBP, in contrast to most individual factors, and dose-response patterns were showed. Positive associations between bullying and LBP raise hypotheses on causation, and the role of psychosocial factors at work are discussed. Further longitudinal studies should address these hypotheses, investigating causal paths, mechanisms and possible mediation. PERSPECTIVES: As a psychosocial risk, workplace bullying may play a role in low back pain and can be focus of interventions to prevent LBP. Dose-response patterns on the association between workplace bullying and low back pain are discussed and hypotheses are raised. The paper addresses different ways of measuring and categorising bullying at work, in order to study the relationship between bullying and pain.

Association between workplace bullying and common mental disorders in civil servants from a middle-income country.

Workplace bullying (WB) is associated with Common mental disorders (CMD) in high-income countries, but there is a lack of evidence relating to this subject in low- and middle-income countries. Therefore, this study aimed to investigate the association between bullying and CMD in Brazil. A cross-sectional study with 907 judicial civil servants from Porto Alegre, southern Brazil, was carried out. WB was measured by the Negative Acts Questionnaire (NAQ-r) and CMD by the Self-Reporting Questionnaire (SRQ-20). Logistic regression was used to analyse data and test hypotheses. The overall prevalence of CMD was 32.8%, while the overall prevalence of bullying was 18.3%. WB was strongly associated with CMD, even after controlling for confounders. After adjustment for sociodemographic, personality and occupational confounders, weekly and daily exposures to negative acts increased 4.32 (95% CI: 2.00-9.33) and 6.80 (95% CI: 3.42-13.51) times the risk of CMD, respectively. Considering the operational definition, bullied workers had a 3.45 (95% CI: 2.26-5.25) higher risk of CMD. The results are consistent with studies from high-income countries. Different ways of categorising exposure to WB and testing association with CMD are suggested. Interventions to prevent bullying, focusing on work processes and psychosocial factors at work, could reduce the risk of mental health problems.

Suicidality among South Brazilian tobacco growers.

OBJECTIVE: To assess prevalence of suicidal ideation and suicide attempt among South Brazilian tobacco growers and to analyze the associated factors related to the suicidal ideation. METHODS: A cross-sectional study was conducted in 2011 with a random sample of 2469 tobacco growers in São Lourenço do Sul/RS. Suicidal ideation was characterized by the question "Has the thought of ending your life been on your mind?". Suicide attempt was assessed by the question "Have you ever tried to kill yourself?". Investigation of factors associated with suicidal ideation was done by means of Poisson regression. RESULTS: Prevalence of suicidal ideation and suicide attempt was 2.5 % and 1.2 % respectively. In the adjusted analysis, suicidal ideation was associated with being female, older age, moderate participation in religious activities and difficulty in paying debts. Those who worked in activities that required inadequate postures (hunched over or other forced positions), as well as farmers who performed 6-9 pesticide-related tasks demonstrated greater risk of suicidal ideation. Regarding health conditions, medical diagnosis of asthma, chronic low back pain, number of lifetime green tobacco sickness episodes and lifetime pesticide poisoning were positively associated with suicidal ideation. CONCLUSION: Suicidal thoughts and attempts are relevant mental health problems among tobacco growers. Reducing pesticide use, as well as exposure to nicotine and improving socio-economic conditions, can reduce suicidal ideation and improve the mental health of exposed workers.

Contexto de Trabalho e Transtornos Mentais Comuns em Trabalhadores do Judiciário Federal no Rio Grande do Sul, Brasil / Occupational Context and Common Mental Disorders in Workers from the Federal Judiciary in Rio Grande do Sul, Brazil / Contexto de Trabajo y Trastornos Mentales Comunes en Trabajadores del Poder Judicial Federal en Rio Grande del Sur, Brasil

Os servidores do Judiciário têm sido expostos a modelos de gestão que colocam sua saúde mental em vulnerabilidade. Analisou-se a associação entre contexto de trabalho no Judiciário Federal do Rio Grande do Sul e Transtornos Mentais Comuns (TMC). Participaram 2.063 servidores, que responderam: questionário sociodemográfico e laboral, Escala de Avaliação do Contexto de Trabalho (EACT) e Self-Reporting Questionnaire. Realizaram-se análises bivariadas e regressão de Poisson. A prevalência de TMC foi de 27,2%. Constatou-se forte associação positiva entre contexto de trabalho e TMC. Servidores expostos à Organização do Trabalho (OT) e Relações Socioprofissionais (RS) graves apresentaram prevalências de TMC 3,95 vezes maior, comparados aos com OT e RS satisfatórias. Ao analisar a relação independente entre dimensões do contexto de trabalho e TMC, as associações permaneceram fortes, com prevalências até 2,5 vezes maiores, indicando que o contexto laboral do Judiciário, quando em situações críticas e/ou graves, é potencializador de sofrimento psíquico.

Civil servants from the Judiciary have been exposed to management models that bring risks to their mental health. Associations between the occupational context of workers from the Federal Judiciary of Rio Grande do Sul and Common Mental Disorders (CMD) were analyzed. Participants included 2,063 workers who responded to: sociodemographic and labor questionnaire, Work Context Assessment Scale, and Self-Reporting Questionnaire. We ran bivariate analyses and multivariate Poisson Regression. General prevalence of CMD was 27.2%. There was strong, positive association between work context and CMD. Workers exposed to severe work organization (WO) and severe socio-professional relations (SR) presented 3.95-fold higher prevalence of CMD, compared to those with satisfactory WO and SR. Regarding the independent relationship between work context dimensions and CMD, associations remained strong, with prevalence up to 2.5 times higher, suggesting that the Judiciary's work context, in critical or severe situations, can generate psychological suffering.

Los servidores del Poder Judicial vienen siendo expuestos a modelos de gestión que ponen su salud mental en riesgo. Se analizó la asociación entre contexto de trabajo en el Judiciario Federal de Rio Grande del Sur y Trastornos Mentales Comunes (TMC). Participaron 2.063 servidores que respondieron: cuestionario sociodemográfico y laboral, Escala de Evaluación del Contexto de Trabajo y Self-Reporting Questionnaire. Se realizaron análisis bivariados y regresión (Poisson). La prevalencia general de TMC fue 27,2%. Se constató fuerte asociación positiva entre contexto de trabajo y TMC. Trabajadores expuestos a Organización del Trabajo (OT) y Relaciones Socioprofesionales graves (RS) presentaron prevalencias de TMC 3,95 veces mayor, comparativamente a los con OT y RS satisfactorios. Analizando la relación independiente entre dimensiones del contexto de trabajo y TMC, las asociaciones permanecieron fuertes (prevalencias hasta 2,5 veces mayores), indicando que el contexto laboral del Poder Judicial, cuando en situaciones críticas/graves, es potencializador de sufrimiento psíquico.

Occupational dermatoses reported in Brazil from 2007 to 2014.

BACKGROUND: Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil. OBJECTIVES: To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns. METHODS: We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses. RESULTS: All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability. STUDY LIMITATIONS: The amount of missing information for various items in the system draws attention. CONCLUSIONS: Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

Occupational dermatoses reported in Brazil from 2007 to 2014

Abstract: Background: Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil. Objectives: To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns. Methods: We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses. Results: All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability. Study limitations: The amount of missing information for various items in the system draws attention. Conclusions: Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

Estresse ocupacional em trabalhadores de uma fundação de atendimento socioeducativo: prevalência e fatores associados / Occupational stress in workers from a socio-educational assistance foundation: prevalence and associated factors

Contexto: São raros os estudos sobre trabalho e saúde nas Fundações de Atendimento Socioeducativo (FASE). A literatura científica existente sobre o assunto indica que as atividades desenvolvidas nessas instituições podem ser fonte de estresse e adoecimento psíquico. Objetivos: Tendo em vista o importante papel do estresse em diversos desfechos de saúde, este estudo objetivou descrever a prevalência de estresse ocupacional e seus fatores associados em trabalhadores da Fundação de Atendimento Socioeducativo do Rio Grande do Sul (FASE-RS). Métodos: Estudo transversal com amostra de 211 trabalhadores. Utilizou-se a Job Stress Scale para a mensuração do estresse ocupacional por meio do modelo demanda-controle. Estatística descritiva, testes t de Student e χ2, regressão de Poisson e teste de Wald foram utilizados para a apresentação dos resultados, a análise das diferenças entre grupos e o controle de confundidores. Resultados: Os trabalhadores dos Centros de Atendimento Socioeducativo (CASE), que laboram diretamente com jovens em cumprimento de medida socioeducativa, apresentam 41,2% de prevalência de trabalho de alta exigência, enquanto nos profissionais da Sede Administrativa (SEDE) esse percentual é de 9,3%. Alta demanda psicológica esteve presente em 68,7% dos servidores dos CASE e em 34,9% dos trabalhadores da SEDE. Baixo controle sobre o trabalho e baixo apoio social estiveram presentes em 38 e 24,8% dos profissionais da SEDE e em 57,8 e 85,3% dos trabalhadores dos CASE, respectivamente. Violência, regime de trabalho, ter contato com jovens que cumprem medida socioeducativa e horas extras foram os fatores mais fortemente associados ao estresse. Conclusões: Existe alta exposição ao estresse ocupacional nessa população, o que demanda intervenções nos processos de trabalho para diminuir o risco de adoecimento.

Background: Studies addressing work and health in socio-educational support foundations are rare. According to the available literature, the activities performed at such institutions might be a source of stress and mental illness. Objectives: Considering the relevant role of stress in several health outcomes, the present study sought to establish the prevalence of occupational stress and related factors among workers at Socio-educational Assistance Foundation of Rio Grande do Sul, Brazil (Fundação de Atendimento Socioeducativo do Rio Grande do Sul, FASE-RS). Methods: Cross-sectional study conducted with a sample comprising 211 employees, who responded the Job Stress Scale to assess occupational stress, based on the demand-control model. We used descriptive statistics, Student's t test, the χ2 test, Poisson multiple regression and the Wald test to describe the sample data, compare between groups, analyze differences in prevalence and control confounders. Results: The prevalence of high job strain was 41.2% among the employees allocated to Socioeducational Assistance Centers (Centros de Atendimento Socioeducativo, CASE), who provide direct care to youths on probation, and 9.3% among the employees allocated to the Administration Section (Sede Administrativa, SEDE). The prevalence of high psychological demand was 68.7% and 34.9% among CASE and SEDE workers, respectively. The prevalence of low work control and low social support was 38% and 24.8% for SEDE employees and 57.8% and 85.3% among CASE workers, respectively. Violence, shift work, contact with youths on probation and overtime were the factors more strongly associated with stress. Conclusion: The analyzed population exhibits high exposure to occupational stress, which demands interventions in the work process to reduce the risk of illness among these workers.