Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study.

INTRODUCTION: Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. OBJECTIVES: This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. METHODOLOGY: A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SETTINGS: Intensive Care Units in Warmia and Mazury Region in Poland. MAIN OUTCOME MEASURES: Level of Nursing Care Rationing in Intensive Care Units. RESULTS: The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. CONCLUSIONS: It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. IMPLICATIONS FOR CLINICAL PRACTICE: Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Informal Employment Under the Skin: Informality and Health Inequalities Among Chilean Workers.

Informal employment has been identified as an important social determinant of health. This article addresses the processes through which informal employment affects workers' health in Chile. The study's methodological approach was based on qualitative interviews with 34 formal and informal workers. The findings show how workers perceive informal employment as negatively affecting their mental and physical health through different dimensions of their living and working conditions. Incorporating a gender perspective proves to be integral to the analysis of these processes. The article concludes by discussing how neoliberalism underlies such vulnerability processes and negatively impacts on the population's health.

Working hours and the regulations in Korea.

South Korea has the highest policy priority for working hour regulations because it has longer annual working hours than other Organization for Economic Development Co-operation and Development countries and has fewer holidays. According to the results of the Working Conditions Surveys between 2006 and 2020, in 2020, 6% of wage earners worked for > 52 hours weekly. The percentage of workers exceeding 52 hours weekly has decreased over time; however, disparities exist based on age, industry, occupation, company type, and company size, particularly in service-, arts-, and culture-related occupations and workplaces with fewer than 5 employees. South Korea's working hours system is greatly influenced by the 52-hour weekly maximum; sometimes, a maximum of 64-69 hours, including overtime, is theoretically possible. To ensure healthy working hours, it is important to actively protect workers who fall through the cracks, such as those in businesses with fewer than 5 employees.

Enhancing Self-Reported Assessment of Working Conditions in Policing: Revisiting the Psychometric Properties and Applications of the Police Stress Questionnaire.

OBJECTIVES: Policing is recognized as a highly stressful occupation, encompassing stressors not commonly encountered in other fields. In response, police-specific stress scales have been developed and used when studying police work. Despite changes in the composition of police personnel, most studies examining police working conditions focus on sworn police officers (SPO), excluding employees without police education (EWPE). To advance research and practice on stress in the police, align results, and increase the possibilities for comparisons across studies using police-specific measures (PSMs) we conducted a psychometric evaluation of the two scales in the Police Stress Questionnaire (PSQ). We examined whether adding "Not Applicable" to the response scales would reduce vulnerability and make the PSQ more robust. METHOD: Based on a survey with a randomised sample (N = 560) of SPO and EWPE in the Norwegian Police, we tested the original factor structures of the PSQ through Confirmatory Factor Analysis including tests of factor structures from previous studies. RESULTS: For all models, the indicators of fit indicated a poor fit with either our whole or stratified sample. The response choice 'Not Applicable' provided extended information for SPOs and EWPEs on the PSQ. CONCLUSIONS: To promote aligning results and enabling comparisons across studies using the PSQ, we suggest treating the PSQ scales as formative indexes, rather than reflective scales. Adding "Not Applicable" to the response scale offers an influential elaboration of the PSQ with beneficial and extended information. Generalised studies of stress in the police should include the entire population working there.

Work for the Prison Service: selected health consequences - investigating the role of personal resources, job demands, work stress, and burnout.

OBJECTIVES: The specific job demands of the Prison Service (PS) may affect the health of officers. The job demands-resources model (JD-R) model was used to design a survey of the consequences of working subject to particular job demands. The aim was to gain an insight into the relationship between job demands, personal resources, occupational stress and burnout and selected health consequence indicators (such as behaviors associated with the consumption of alcohol, stress symptoms). MATERIAL AND METHODS: A total of 1732 PS officers in Poland were surveyed. The following tools were used as part of the survey: the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Multidimensional Inventory for Assessing Coping Responses (COPE), the Alcohol Use Disorders Identification Test (AUDIT) and a form with a respondent's particulars. Path analysis using partial least squares structural equation modelling (PLS-SEM) was performed. RESULTS: The assumed hypotheses were partially confirmed by the results. Out of 4 job demands categories only work pace turned out not to be a significant predictor of burnout and stress. For alcohol related behaviors, stress level was the only significant predictor, both as a direct and indirect effect taking into account job demands. It transpired that support from superiors rather than support from colleagues or self-efficacy was a significant moderator in the emotional demands - stress relationship. Limitations of the study and perspectives for its continuation are also presented herein. CONCLUSIONS: Based on the obtained results it may be concluded that job demands and support from superiors do have an impact on stress in the PS group. This is also consistent with available reports in literature. At the same time stress is a significant predictor of alcohol related behaviors. Coping through the use of psychoactive substances was not a significant factor in statistical analyses and it has still not been subject to sufficient scientific analysis. Int J Occup Med Environ Health. 2023;36(6):744-60.

Perfil e essencialidade da Enfermagem no contexto da pandemia da COVID-19 / Profile and essentiality of Nursing in the context of the COVID-19 pandemic

Resumo A pesquisa tem por objetivo descrever o perfil sociodemográfico e de saúde dos profissionais de enfermagem no contexto da pandemia da COVID-19 e propõe uma análise reflexiva sobre a essencialidade da categoria frente às demandas intrínsecas dos pacientes e do sistema de saúde brasileiro, especialmente, no contexto da emergência de saúde pública deflagrada pelo avanço exponencial do vírus SARS-CoV-2. O estudo revela a relação entre as injustiças históricas e os diferentes tipos de desigualdade que afetam e causam a vulnerabilidade da profissão, com fulcro na apresentação de potenciais perspectivas decorrentes desse processo histórico e dos acontecimentos recentes.

Abstract The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.

Within-individual changes in physical work demands associated with self-reported health and musculoskeletal symptoms: a cohort study among Dutch workers.

PURPOSE: This study aimed to investigate changes in physical work demands in association with self-rated health and musculoskeletal symptoms. METHODS: Data from five waves over the period 2019-2021 of the Netherlands Working Conditions Survey COVID-19 were available for 7191 participants aged 19-64 years who worked (partly) on-site during at least two consecutive waves. Logistic generalized estimated equations (GEE) were used to estimate the odds ratios (OR) with 95% confidence interval (CI) for changes (increase or decrease compared to no change) in physical work demands between two waves and poor self-rated health and musculoskeletal symptoms in the following wave, adjusted for the health outcome at the first wave, age, educational level, working hours and hours worked from home. RESULTS: In females, a statistically significant association was found between an increase in physical work demands compared to no change and musculoskeletal symptoms (OR 1.39, 95% CI 1.17-1.65). A decrease in physical work demands in females was not statistically significantly associated with musculoskeletal symptoms (OR 0.93, 95% CI 0.80-1.08). Similar trends were found for poor self-rated health, although non-statistically significant. For males, comparable but attenuated associations were found. CONCLUSION: While our study showed that increasing physical work demands are associated with adverse health (self-reported and musculoskeletal), it did not appear to benefit worker's health to reduce work demands. Future research with multiple measurements in a shorter period and additionally using devices to measure physical work demands will be needed to confirm our study results.

Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort.

BACKGROUND: The distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions. METHODS: The study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18-64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI). RESULTS: In the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%. CONCLUSIONS: Individuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.

[The medical social measurements of conditions of professional activity of vegetable-growers of protected soil].

The working conditions in hothouse farming, medical social possibilities and limitations of prospects of professional longevity affect quality of life of employees and their family members, influencing development of state policy in health care, occupational safety and employment. The article identifies and describes, on the basis of sociological quantitative and qualitative methodology, medical and social problems of modern greenhouse farming. The quality of medical support in this professional field is assessed. The main factors of shortening of length of professional experience are established. The conclusions are made that professional resources of protected soil vegetable-growers are characterized by lacking of special education that to a certain degree is compensated by acquired long-term work experience. The main factors obstructing involvement of employees in this profession are physically hard labor and inconvenient operating conditions. The medical support of professional and labor practices in greenhouse farms is as rule only formal. Prevention and treatment of acquired diseases is implemented mainly in home conditions, in polyclinics of place of residence and in private medical organizations at the employees' own expense. The professional longevity does not cover retirement age by reason of debilitated health because of unhealthy working conditions and wide spectrum of acquired diseases.

Attracting adolescents to become doctors and nurses: differential importance of personal and environmental factors in 61 economies.

BACKGROUND: Doctors and nurses play a fundamental role in maintaining global health systems and achieving universal health care coverage. However, significant shortages persist, and little is known about the popularity of these careers among young people in various economies or the relative impact of personal inputs and contextual factors. METHODS: Using data from the large-scale Programme of International Student Assessment (PISA) 2018, we showed the recent distribution of adolescents' medical (doctor) and nursing career expectations in 61 economies. With multilevel logistic and hierarchical linear regression, we examined the relative importance of economic indicators, health work conditions, and personal background factors in affecting adolescents' health career expectations. RESULTS: Approximately 11% of adolescents expected to be doctors in each economy, while only 2% expected to be nurses. Adolescents were attracted to health professions mainly by system-level favourable conditions (accounting for 1/3 variance), including (a) government health expenditure beyond that expected gross domestic product (GDP); (b) a safe working environment for doctors in wealthy nations; and (c) high salaries for nurses in less-developed economies. In contrast, adolescents' background (gender, social status, and academic ability) was less influential, explaining only 10% of the differences. CONCLUSIONS: In the technological and digital era, high-ability students are equally competitive for emerging careers other than doctors and nurses. In developing countries, a high salary package and societal respect are enough to attract adolescents to nursing careers. In contrast, for developed countries, extra expenditures beyond regular GDP allocation and a safe work environment are crucial in attracting adolescents to become doctors. Salary may effectively attract international-trained doctors and nurses, but the work environment will likely emerge as an essential factor in retaining migrants in their positions. TRIAL REGISTRATION NUMBER: No human participants were involved in this study.

Linkage between working conditions and wellbeing: Insight from migrant and native farmhands on Ghana's cocoa farms.

Working conditions and wellbeing (quality of life) could be linked, and they in turn enhance social and economic development. Nevertheless, working conditions of farmhands have largely been ignored in policy and research. We explored working conditions of migrant and native farmhands on Ghana's cocoa farms, and implications on wellbeing, using primary data from 600 respondents. Multidimensional Poverty Index, Department for International Development sustainable livelihood approach, World Food Programme asset score, Zellner's seemingly unrelated regression and multinomial logistic regression were adopted. Living standards, resilience, health and asset ownership of farmhands were generally low. Natives had higher living standards than migrants. However, migrants had better food security, and were more resilient to shocks than natives. Working and living conditions like years as a farmhand, closeness to social amenities, years migrant had stayed in community, type of migrant, being joined by a household member, working hours and days, type of agreement, category of farmhand, bonuses, satisfaction with working conditions, and income influence living standards, resilience, health and asset ownership. Thus, there is a link between working conditions and wellbeing of cocoa farmhands. Farmhands should be given long-term contracts, bonuses/incentives and personal protective equipment (PPE) by cocoa farmers. Government and private agencies should provide social amenities/infrastructure in cocoa-growing communities. Farmhands should do their own farms and join associations.

The effect of different socio-economic and working conditions on body size and proportions: A case study on adults from Samsun, Turkey.

Conditions in the early stages of life shape body size and proportions. This study includes individuals who came from different socio-economic conditions and worked in physically demanding jobs in childhood. By determining the body sizes of these individuals and evaluating the proportional relationships between several groups, the goal was to understand the effect levels of socio-economic levels and working conditions on the body. For this purpose, an anthropometric study was conducted on 623 males and females between the ages of 20 and 45 living in Samsun, Turkey. The study sample consisted of four different groups. It was divided into two main groups of high and low socio-economic level, and the low socio-economic group was divided into two subgroups of heavy-worker and nonheavy-worker. The results demonstrated that socio-economic differences in the size and proportions of the individuals were statistically significant (p<0.05). The high socio-economic group had the highest values in all measures. External factors affected the lower limbs more than the upper limbs. The measurement most affected by these factors was leg length. Longer legs characterized the high socio-economic group, while longer arms characterized both low socio-economic groups. The relative differences observed can be said to derive from the distal limbs. This finding was valid for both sexes. The average values were close to each other in the low socio-economic group, for which the aim was to comprehend the effects of heavy working conditions. However, differences in proportional relationships were more significant. In this context, it was seen that heavy labour also affected growth, in addition to the well-known factors encountered during the growth period, such as nutrition, health, and illness. The observed changes were more significant in males than in females. Thus, it can be said that males were more affected by physiological and physical conditions.

Work as a social risk factor in pregnancy: A systematic review of screening practices related to working conditions and family leave among pregnant adults.

BACKGROUND: Paid family leave and working conditions are components of employment quality-a key social determinant of health across the life course, particularly during pregnancy. Increased research on prenatal social risk screening has not extended to employment quality. The objective of this systematic review was to identify prenatal screening practices and interventions in health care settings that address employment and working conditions as social risk factors among pregnant adults and to describe their properties and key findings. METHOD: We searched MEDLINE, PsychINFO, SocINDEX, EMBASE, and the SIREN Evidence and Resource Library for studies published through February 14, 2022. We selected multiple search terms related to four domains: (1) employment or working conditions; (2) screening; (3) health care settings; and (4) pregnancy or maternal health. RESULTS: Of the 2317 unique titles and abstracts that were potentially relevant, eight articles met all inclusion criteria and focused on pregnant populations. The content of identified screening practices varied substantially, highlighting the multiple ways employment is conceptualized as a potential risk factor. Few studies included multidimensional measures of employment to assess working conditions, which may be particularly relevant during pregnancy. CONCLUSIONS: Our review suggests that screening for employment as a social risk factor does not regularly occur in prenatal care. Although pragmatic properties of the screening tools we assessed are promising, tools seldom examine the multidimensional nature of work. Understanding the principal intent of screening for employment prenatally could provide greater opportunity to collect and interpret contextual factors that influence how both providers and patients respond to social risk.

Dificuldades no trabalho em saúde mental: percepção de trabalhadores do Núcleo de Apoio à Saúde da Família na Macrorregião Oeste de Minas Gerais / Difficulties in mental health work: the perception of Family Health Support Center workers in the Western Region of Minas Gerais state, Brazil

Resumo No atual cenário de manobras neoliberais no país, mudanças nas Políticas de Atenção em Saúde alteram formas de organização e financiamento dos serviços, desdobram-se em formas precarizadas de trabalho e ameaçam conquistas da Reforma Psiquiátrica e Atenção Psicossocial. Buscou-se identificar e analisar, na percepção de profissionais de 11 equipes de Núcleo de Apoio a Saúde da Família (NASF), dificuldades no processo de construção de uma política de Saúde Mental (SM) na Atenção Básica em Saúde (ABS). Realizou-se estudo qualitativo, a partir de entrevistas com 11 profissionais de SM dos NASF, e estas foram analisadas considerando-se o referencial da Análise de Conteúdo. As dificuldades identificadas foram: formas precárias de contratação; alta rotatividade; carga horária insuficiente; baixa remuneração; concentração da carga horária em atividades de assistência; falta de compartilhamento e integração de serviços e profissionais; desarticulação da Rede de Atenção Psicossocial (RAPS). O Apoio Matricial não estava incorporado e não havia políticas de Educação Permanente em Saúde (EPS) no conjunto dos municípios estudados. No entanto, os NASF contribuíam para melhorar o cuidado em SM. Conclui-se que as mudanças em curso impõem desafios para a sustentação de conquistas em SM e consolidação da política de SM na ABS dos municípios estudados.

Abstract The current scenario of neoliberal political maneuvers in Brazil brought several legislative changes regarding health care policies which alter many services' organizational forms and funding. These changes also come through as precarious work and threaten advances and accomplishments related to the Brazilian Psychiatric Reform and mental health care. This study aimed to identify and analyse difficulties regarding the construction of a mental health (MH) policy in Primary Health Care (PHC) according to professionals working at 11 teams of the Family Health Support Center (NASF). We developed a qualitative study through 11 semi-structured interviews conducted with 11 MH workers in PHC and explored the results using content analysis. The identified difficulties were precarious forms of employment; high professional turnover; insufficient working hours; low wages; working hours concentrated in care activities; lack of integration and communication among services and workers and disarticulation of the psychosocial attention network (RAPS). Matrix support was not present and there were no Permanent Health Education policies in the municipalities studied. Nevertheless, the NASF contributed to improve mental healthcare. The conclusion is that ongoing changes impose challenges to sustain mental health accomplishments and consolidation of mental healthcare policies at PHC at the studied municipalities.Resumo: No atual cenário de manobras neoliberais no país, mudanças nas Políticas de Atenção em Saúde alteram formas de organização e financiamento dos serviços, desdobram-se em formas precarizadas de trabalho e ameaçam conquistas da Reforma Psiquiátrica e Atenção Psicossocial. Buscou-se identificar e analisar, na percepção de profissionais de 11 equipes de Núcleo de Apoio a Saúde da Família (NASF), dificuldades no processo de construção de uma política de Saúde Mental (SM) na Atenção Básica em Saúde (ABS). Realizou-se estudo qualitativo, a partir de entrevistas com 11 profissionais de SM dos NASF, e estas foram analisadas considerando-se o referencial da Análise de Conteúdo. As dificuldades identificadas foram: formas precárias de contratação; alta rotatividade; carga horária insuficiente; baixa remuneração; concentração da carga horária em atividades de assistência; falta de compartilhamento e integração de serviços e profissionais; desarticulação da Rede de Atenção Psicossocial (RAPS). O Apoio Matricial não estava incorporado e não havia políticas de Educação Permanente em Saúde (EPS) no conjunto dos municípios estudados. No entanto, os NASF contribuíam para melhorar o cuidado em SM. Conclui-se que as mudanças em curso impõem desafios para a sustentação de conquistas em SM e consolidação da política de SM na ABS dos municípios estudados.

How hospital top managers reason about the central leadership task of balancing quality of patient care, economy and professionals' engagement: an interview study.

PURPOSE: This study aims to deepen the understanding of how top managers reason about handling the relationships between quality of patient care, economy and professionals' engagement. DESIGN/METHODOLOGY/APPROACH: Qualitative design. Individual in-depth interviews with all members of the executive management team at an emergency hospital in Norway were analysed using reflexive thematic method. FINDINGS: The top managers had the intention to balance between quality of patient care, economy and professionals' engagement. This became increasingly difficult in times of high internal or external pressures. Then top management acted as if economy was the most important focus. PRACTICAL IMPLICATIONS: For health-care top managers to lead the pursuit towards increased sustainability in health care, there is a need to balance between quality of patient care, economy and professionals' engagement. This study shows that this balancing act is not an anomaly top-managers can eradicate. Instead, they need to recognize, accept and deliberately act with that in mind, which can create virtuous development spirals where managers and health-professional communicate and collaborate, benefitting quality of patient care, economy and professionals' engagement. However, this study builds on a limited number of participants. More research is needed. ORIGINALITY/VALUE: Sustainable health care needs to balance quality of patient care and economy while at the same time ensure professionals' engagement. Even though this is a central leadership task for managers at all levels, there is limited knowledge about how top managers reason about this.

Work as an Understudied Driver of Racial Inequities in Breastfeeding.

Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.

Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries.

The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers' mental health.

Retrospective assessment of occupational disease trends in Russian Arctic apatite miners.

For many years in Russia, apatite ore mining has been associated with high levels of occupational morbidity. The aim of the study was to retrospectively assess occupational disease trends in Russian Arctic apatite miners. We analysed data from routine health screening of 2 649 underground apatite miners in 2007 and data of social-hygienic monitoring "Working conditions and occupational morbidity" in 2008-2020. In 2007, according to the results of routine health screening, 6 778 chronic diseases were diagnosed in 2 649 miners, the most prevalent being musculoskeletal (34.4%) and eye (16.0%) diseases. In the next 13 years, 572 occupational diseases were first diagnosed in 300 (11.3%) miners, most prevalent being musculoskeletal diseases (47.2%). The risk of developing occupational diseases in tunnellers exceeded that in all other miners, including timber-men (RR = 1.56; CI 1.06-2.30), vibration-loading machine operators (RR = 1.67; CI 0.99-2.80), drillers (RR = 1.51; CI 1.08-2.11) and blasters (RR = 2.12; CI 1.55-2.84). We conclude that ongoing modernisation of ore mining processes and medical preventive measures should include more effective health-improving interventions for underground apatite miners. Findings from the analysis of data can be used by health professionals and policy makers to address these problems.

Essential but also vulnerable? Work intensification, effort/reward imbalance, fatigue and psychological health of Spanish cargo drivers during the COVID-19 pandemic.

Objective: This study investigates the combined effect of the Effort/Reward Imbalance (ERI) model of stress and work intensification within the context of the COVID-19 pandemic on the psychological health (general and work-related fatigue, and psychological strain) of cargo drivers, one of the most demanded workforces during the first year of this pandemic. Methods: For this cross-sectional research, the data provided by n = 1,013 professional drivers from the different 17 autonomous communities (regions) of Spain were analyzed. Participants answered a questionnaire composed of the short version of the Effort Reward Imbalance (ERI) questionnaire, a Work Intensification Scale (WIS) designed for this study, the fatigue subscale of the Checklist Individual Strength (CIS), the Need for Recovery after Work Scale (NFR), and the General Health Questionnaire (GHQ). Results: Hierarchical regression analyses show that both (ERI and work intensification) models significantly predict driver's fatigue and psychological strain. The effect of work intensification exists above and beyond the effect of effort/reward imbalance, which has been previously related to the safety performance of cargo drivers. Conclusions: These findings suggest that the ERI and work intensification models can be complementarily used, especially in scenarios introducing substantial changes in the work environment, such as the COVID-19 crisis. Also, the results of this study support the need to intervene in the working conditions of professional drivers in order to improve their psychological health and well-being during both pandemic and post-pandemic times, as crisis-related management interventions are necessary to promote health and safety in professional drivers in potentially similar contexts in the future.

O processo de trabalho na Estratégia Saúde da Família voltado às pessoas com sobrepeso e obesidade em São Paulo / Work process in the Family Health Strategy oriented to people with overweight and obesity in São Paulo

RESUMO O objetivo do artigo é analisar as características dos processos de trabalho na Estratégia Saúde da Família direcionados às pessoas com sobrepeso e obesidade no município de São Paulo. Ancorado no referencial teórico da saúde coletiva sobre processo de trabalho, foi desenvolvido um estudo exploratório com abordagem qualitativa. Foram realizadas onze entrevistas com profissionais de uma unidade básica de saúde, na zona leste da cidade de São Paulo, entre os meses de julho e agosto de 2019. A partir da análise temática, o artigo apresenta os resultados e a discussão em três categorias analíticas: objeto de trabalho, instrumentos de trabalho e organização do trabalho. O cuidado às pessoas com sobrepeso e obesidade é mediado pelo baixo investimento em qualificação dos profissionais de saúde sobre o tema, pela falta de materiais técnicos de suporte ao trabalho e pelo modelo de gestão pautado pela produtividade e cobrança de resultados quantitativos. Conclui-se que os profissionais de saúde apresentam pouco domínio sobre seu processo de trabalho, cuja finalidade acaba sendo a mudança de comportamento e a perda de peso corporal, em vez de considerar as necessidades de saúde dos usuários e profissionais, produzindo, por vezes, insatisfação e desgaste com o trabalho.

ABSTRACT The goal of the article is to analyze the characteristics of the work processes in the Family Health Strategy directed to people with overweight and obesity in the city of São Paulo. Based on the theoretical framework of collective health about work processes, an exploratory study with a qualitative approach was developed. Eleven interviews were conducted with professionals from a basic health unit, in the east of the city of São Paulo, between July and August 2019. Starting with the thematic analysis, the article presents the results and discussion in three analytical categories: work object, work instruments and work organization. The care for people with overweight and obesity is mediated by the low investment in training health professionals on the subject, the lack of technical materials to support the work and the management model based on productivity and demand for quantitative results. It is concluded that health professionals have little control over their work process, whose purpose ends up being the change of behavior and the loss of body weight, instead of considering the health needs of users and professionals, sometimes producing dissatisfaction and weariness with work.