Fortalecimento da Rede Nacional de Atenção Integral à Saúde do Trabalhador pela mobilização social: relato de experiência / Strengthening the National Network for Comprehensive Occupational Healthcare through social mobilization: an experience report

Resumo Introdução: a participação social é o pilar da implementação da Política Nacional de Saúde do Trabalhador e da Trabalhadora que estabelece as ações de atenção à Saúde do Trabalhador no Sistema Único de Saúde, a partir da Rede Nacional de Atenção Integral à Saúde do Trabalhador (Renast). Objetivo: descrever a parceria ensino-serviço para fortalecer a atenção à Saúde do Trabalhador em um município, em consonância com os princípios da Renast, a partir da formação e mobilização social em saúde. Métodos: trata-se de um relato do projeto de extensão desenvolvido por demanda da Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora municipal. Foram realizadas três oficinas de trabalho que utilizaram o diálogo em grupos de discussão como método para produção de conhecimento associado a estratégias de ensino-aprendizagem. Resultados: profissionais de saúde, estudantes, trabalhadores e representantes de entidades participaram das oficinas, que versavam sobre: organização da Renast; a epidemiologia e papel dos diversos atores para fortalecimento da Renast; a articulação intra e intersetorial da Renast, suas fragilidades e potencialidades; e a relevância de cada ator no sentido de mobilizá-los para mudança de suas realidades. Conclusão: as oficinas apresentaram-se como estratégia possível de formação e ponto de partida, visando à mobilização social para fortalecer a Renast.

Abstract Introduction: social participation is a cornerstone in implementing the National Policy for Occupational Heath, which establishes care actions for worker's health within the Unified Health System, based on the National Network for Comprehensive Occupational Healthcare (Renast). Objective: to describe the educational-service partnership aimed at strengthening occupational care in a municipality according to Renast principles by education and social mobilization in health. Methods: This experience report focuses on the outreach project developed to answer the demands of the municipal Intersectoral Commission on Occupational Health. Three workshops were conducted using discussion groups as a method for knowledge production associated with teaching and learning strategies. Results: health professionals, students, workers, and representatives of entities participated in the workshops, which addressed Renast organization; epidemiology and the role of various actors in strengthening Renast; Renast intra and intersectoral articulation, its weaknesses and potentialities; and the relevance of each actor in changing their realities. Conclusion: the workshops proved to be a feasible strategy for education and social mobilization aimed at strengthening Renast.

Vigilância em Saúde do Trabalhador na perspectiva de gestores e tomadores de decisão / Workers' Health Surveillance from managers' and decision-makers' perspectives

Resumo Objetivo: analisar as ações de implantação da Vigilância em Saúde do Trabalhador (Visat) na esfera municipal, pela perspectiva de gestores e tomadores de decisão. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado em duas etapas: (1) levantamento documental da legislação relacionada à Saúde do Trabalhador; (2) entrevistas semiestruturadas com 15 gestores e tomadores de decisão na área, que foram gravadas, transcritas e analisadas segundo análise temática. Resultados: a análise documental incluiu seis documentos, sendo três relacionados às ações de Visat e três relacionados às ações que guardam interface com a Saúde do Trabalhador. Sete categorias emergiram na análise temática: Aspectos legais da Saúde do Trabalhador; Implementação das ações de Visat; Fluxos de informação e comunicação da Visat; Papéis e competências relacionados à ST no Sistema Único de Saúde; Articulação entre os setores envolvidos na Visat; Atuação do Centro de Referência em Saúde do Trabalhador regional; Relevância do controle social e participação sindical para implementação da Visat municipal. Conclusão: o estudo evidenciou fragilidades na consolidação da Visat, com desarticulação dos setores envolvidos, ações fragmentadas, ausência de definições de papéis e fluxos de trabalhos e, ainda, desconhecimento dos aspectos relacionados à atenção à saúde dos trabalhadores pelos atores envolvidos em sua consolidação.

Abstract Objective: to analyze the implementation of Workers' Health Surveillance (WHS) at a regional level, from managers' and decision-makers' perspectives. Methods: descriptive-exploratory study with a qualitative approach performed in two steps (1) documental analysis related to Workers' Health legislation; (2) semi-structured interviews with 15 managers and decision-makers, that were recorded, transcribed, and analyzed by thematic analysis. Results: documental analysis found six documents, with three related to WHS and three related to actions interfacing Workers' Health. Seven categories were found in the speeches: Legal aspects of Workers' Health; Implementation of WHS actions; Communication and information flows of WHS; Roles and competencies related to Workers' Health in the Brazilian Unified Health System; Articulation among sectors involved in WHS; Role of the Regional Center of Reference in Workers' Health; and Relevance of social control and union participation for WHS implementation. Conclusion: this study shows flaws in the WHS consolidation, including non-articulation of involved sectors, fragmented actions, lack of defined roles and competencies, and lack of knowledge about Workers' Health care by the actors involved in its consolidation.

Educação em saúde mental no trabalho: protagonismo dos trabalhadores no contexto sindical / Mental health education at work: worker's protagonism within unions

Resumo Objetivo: relatar a experiência de uma atividade de extensão sobre saúde mental no trabalho, utilizando a estratégia de Educação em Saúde, desenvolvida por docentes de uma universidade pública federal, por demanda do Sindicato dos Metalúrgicos e trabalhadores de uma empresa do interior do Estado de São Paulo. Métodos: a atividade foi planejada conjuntamente por docentes e trabalhadores. Foram desenvolvidos cinco encontros com base em estratégias participativas de Educação em Saúde de forma a provocar a reflexão dos participantes a partir das experiências vivenciadas. Foram feitos ajustes ao longo do processo direcionados às demandas que surgiam nos encontros. Resultados: as discussões versaram sobre os tópicos: (a) temas emergentes em saúde mental; (b) depressão, ansiedade e uso de álcool/drogas; (c) Rede de Atenção Psicossocial municipal; (d) saúde mental no trabalho. Além disso, partindo das experiências prévias vivenciadas no cotidiano do trabalho, foram feitas reflexões sobre a importância da identificação precoce das situações de sofrimento, da rede de suporte entre trabalhadores e da organização do fluxo de cuidado na Rede de Atenção Psicossocial municipal. Conclusão: a parceria entre trabalhadores, sindicato e universidade se mostrou potente para ações de Educação em Saúde e fortalecimento do protagonismo do trabalhador no contexto do trabalho.

Abstract Objective: to report an extension activity on mental health at work, based on Health Education strategies, conducted by university professors-upon request by the Steelworkers Union-with participation of industrial workers, in São Paulo, Brazil. Methods: carried out by professors and workers, the planning resulted in five meetings based on Health Education participative strategies. Throughout the process, adjustments were made aimed at the demands that arose in the meetings. Results: the discussions included (a) emerging issues in mental health, (b) depression, anxiety and alcohol/drug use, (c) municipal Psychosocial Care Network, (d) mental health at work. Moreover, based on previous experiences in the daily work routine, the participant reflected on the importance of early identification of mental suffering, the need for a support network among workers, and the organization of the care flow within the municipal Psychosocial Care Network. Conclusion: the partnership between workers, the Union and university proved to be an important tool to develop Health Education actions and strengthen worker's protagonism.

Prescribed work, real work, and regulatory strategies for the work organization in an agricultural implement manufacturer.

BACKGROUND: The work organization not only comprises the formal structure but also social interactions, which are developed according to its own rules based on variabilities and professional competences. During real work, there are regulatory processes that result in the development of strategies to meet the requirements of the work organization and maintain health status. OBJECTIVE: To understand the regulatory processes involved in work activities and analyze the extent to which the developed strategies are sufficient to protect employees' integrity and guarantee performance. METHODS: This study was carried out in an agricultural implement manufacturing company, whose qualitative procedures were analyzed by combining activity observations, interviews, and self-confrontation. RESULTS: In view of the interaction of logic, operators comply with some rules to the detriment of others, based on the decision processes of their individual and collective experience. The availability of resources compatible with activity demands increases the possibility of action and competence development. The cost of regulations for less experienced operators is higher, taking into consideration the level of uncertainty resulting from contradictions and variabilities. CONCLUSION: It is necessary to discuss the contradictions manifested in operators' work routines through interactions between heterogeneous rationalities. From this, it is possible to construct a common reference about the activity and increase the possibilities of action during real work.

Design-in-use applied to Brazilian agriculture: The case of citrus and sugarcane harvesting.

BACKGROUND: Harvesting is one of the most critical phases in any crop once it determines the quality of raw material obtained and future production for the next seasons. Sugarcane crops are more uniform allowing the complete mechanization of harvesting. Citrus crops, on the other hand, present variability and require special handling to preserve quality so the harvesting process remains manual preponderantly. OBJECTIVE: The aim of this research was to explore how the distinct characteristics of sugarcane and citrus crops influence the design of respective instruments, promoting a discussion about design-in-use in Brazilian fields and its role to improve productivity and safety. METHODS: Multiple case studies were conducted at 9 sites: 3 sites of sugarcane crops and 6 sites of citrus crops. Task analysis, observations, interviews, questionnaires and video footage were undertaken at each site. RESULTS: The modifications made by the harvesting teams in all studied sites aimed the appropriateness of objects to local conditions and real needs, transforming them in instruments, improving reliability, safety, health and productivity. CONCLUSIONS: In agriculture, a sector where working conditions still need to be significantly improved especially in developing countries, design-in-use appears as a solution for the problems faced by workers in the field, as an essential mean to maintain health and productivity at work.

How do users design? The case of sugar cane harvester machines.

BACKGROUND: Design in use and inventiveness are key concepts in ergonomics. It is well-known that users design but is not explored in the literature how they manage to do that. OBJECTIVE: This paper aims to contribute to the discussion of how users actually design, by showing a research conducted in sugar cane harvesting in Brazil and in Australia. METHODS: Through the methodology of the Ergonomic Work Analysis (EWA), the design modifications made by the harvesting teams were identified as well as their elaboration process. RESULTS: Three categories of modifications in machines' design were identified: structural, functional and operational and they were more numerous in Brazilian situations. It is proposed that two theories underlying the theme are intertwined: the instrument-mediated activity approach and the design as bricolage. CONCLUSIONS: It is argued that users design through the articulation of: a) the operators' activity, b) the mechanical technicians' inventory to practice bricolage as a way of designing and c) the work organisation and the existence of social spaces of interaction between these two subjects.

Projeto ATO ? Ação, Trabalho e Oportunidade: inclusão de pessoas com deficiência no trabalho ? relato de experiência / Project ?ATO ? Ação, Trabalho e Oportunidade? (action, work and opportunity): insertion of disabled people in the labor market ? an experience report

Este artigo relata a experiência do Projeto ATO?Ação, Trabalho e Oportunidade: inclusão de pessoas com deficiência no trabalho em andamento no município de São Carlos desde 2008 a partir da operacionalização de um modelo de inclusão baseado na atividade. Trata-se de uma pesquisa interinstitucional desenvolvida academicamente por meio de uma atividade de extensão. As várias etapas desenvolvidas pela equipe interdisciplinar, os métodos empregados e os fundamentos teóricos que norteiam a consecução dos objetivos pretendidos são descritos. Os resultados quantitativos e qualitativos obtidos até o momento são analisados quanto aos elementos estratégicos facilitadores, bem como das relações de interesse que atuam como impedimentos para a participação das pessoas com deficiência no projeto e para a inclusão destas no trabalho. Verificou-se a necessidade de preparo da sociedade para a superação de barreiras atitudinais e arquitetônicas no ambiente de trabalho, além da difusão da cultura de inclusão e respeito às diferenças nas estruturas organizacionais, políticas e processos das empresas. Algumas propostas que poderiam contribuir para a eficiência de uma política pública de inclusão de pessoas com deficiência no trabalho concluem o presente estudo.(AU)

This article reports the experience of the Project ?ATO ?Ação, Trabalho e Oportunidade? (Action, Work and Opportunity): insertion of disabled people in the labor market in the municipality of São Carlos, state of Sao Paulo, which has been in progress since 2008 through the application of an insertion model based on the activity. It is an interinstitutional research academically developed through an extension activity. It describes the several stages developed by the interdisciplinary team, the methods applied, and the theoretical fundamentals that guide the achievement of the aimed targets. The quantitative and qualitative results found so far are analyzed with respect to the facilitating strategic elements as well as to the relations of interest that act as impediments to the participation of the mentally disabled in the project and for their insertion in the labor market. It was possible to observe that society needs to be prepared to overcome architectural and attitudinal barriers in the workplace, besides disseminating the concepts of inclusion culture and respect for differences in the organizational structures, policies and processes of companies. Some proposals that could contribute to the efficiency of a public policy of insertion of disabled people in the labor market close the present study.(AU)

Projeto ATO ? Ação, Trabalho e Oportunidade: inclusão de pessoas com deficiência no trabalho ? relato de experiência / Project "ATO - Ação, Trabalho e Oportunidade" (action, work and opportunity): insertion of disabled people in the labor market ? an experience report

Este artigo relata a experiência do Projeto ATO?Ação, Trabalho e Oportunidade: inclusão de pessoas com deficiência no trabalho em andamento no município de São Carlos desde 2008 a partir da operacionalização de um modelo de inclusão baseado na atividade. Trata-se de uma pesquisa interinstitucional desenvolvida academicamente por meio de uma atividade de extensão. As várias etapas desenvolvidas pela equipe interdisciplinar, os métodos empregados e os fundamentos teóricos que norteiam a consecução dos objetivos pretendidos são descritos. Os resultados quantitativos e qualitativos obtidos até o momento são analisados quanto aos elementos estratégicos facilitadores, bem como das relações de interesse que atuam como impedimentos para a participação das pessoas com deficiência no projeto e para a inclusão destas no trabalho. Verificou-se a necessidade de preparo da sociedade para a superação de barreiras atitudinais e arquitetônicas no ambiente de trabalho, além da difusão da cultura de inclusão e respeito às diferenças nas estruturas organizacionais, políticas e processos das empresas. Algumas propostas que poderiam contribuir para a eficiência de uma política pública de inclusão de pessoas com deficiência no trabalho concluem o presente estudo.

This article reports the experience of the Project ?ATO ?Ação, Trabalho e Oportunidade? (Action, Work and Opportunity): insertion of disabled people in the labor market in the municipality of São Carlos, state of Sao Paulo, which has been in progress since 2008 through the application of an insertion model based on the activity. It is an interinstitutional research academically developed through an extension activity. It describes the several stages developed by the interdisciplinary team, the methods applied, and the theoretical fundamentals that guide the achievement of the aimed targets. The quantitative and qualitative results found so far are analyzed with respect to the facilitating strategic elements as well as to the relations of interest that act as impediments to the participation of the mentally disabled in the project and for their insertion in the labor market. It was possible to observe that society needs to be prepared to overcome architectural and attitudinal barriers in the workplace, besides disseminating the concepts of inclusion culture and respect for differences in the organizational structures, policies and processes of companies. Some proposals that could contribute to the efficiency of a public policy of insertion of disabled people in the labor market close the present study.

Performance indicators of work activity.

The measurement of performance is a current topic in the management of people in companies, used as a parameter of effectiveness of processes and operations of production. The methods and models of the indicators of current use in the production have concentrated in the assessment of people's performance as determinative resource of the organizational success in the search for the competitiveness. Associated with the classic indicators of performance assessment of the production proceeding, other indicators are used in the assessment of risks and hazards, however with methods focused in the tasks, without connection with the real work activity. The present article explores literature on the models of performance measurement in use in companies and a field research to understand how companies interpret and use indicators that relate health and work, to direct future studies on the subject. Regarding the literature review, one can see that health indicators can be basically divided into two major groups: the legal and managerial indicators. When conducting case studies, it can be realized that companies do not have precisely the concept of health indicator, or were unable to define which of the indicators could be considered indicators of health, considering that absenteeism was the indicator mentioned by the four companies.

An ergonomics approach to citrus harvest mechanization.

Due to the increase of production costs in manual harvesting, strategies must be developed in order to overcome these effects, such as the attempts in implementing agricultural machines in harvest activities, whether being totally or partially mechanized. This study brings a qualitative and quantitative comparison on the impacts in work conditions and productivity in Brazilian orchards caused by the use of semi-mechanized harvesting systems, such as multiplatforms. The results come from the application of Ergonomic Work Analysis method, which focuses in the activity, quantifying and analyzing times and frequencies of the harvesting cycle, as well as the amount of movements. To achieve this, footage, interviews and a stopwatch were used in the observation 12 pickers' work cycles, six for each method of harvesting. The data interpretation pointed to improvement in working conditions with a reduction in the amount of movements performed by the picker, and increase of up to 60% in productivity with the use of semi-mechanized harvesting. Thus, the found results indicate the viability of this harvesting method. However, other variables must be observed in future studies in order to complete the guidelines for a healthy progress in the area of citrus harvesting in Brazil.

Ergonomics and design in the Brazilian agricultural sector: a proposal to build matrix of contradictions.

The paper presents a correlation between the parameters of classical TRIZ and variables of analysis of the EWA to construct a matrix of contradictions in ergonomics, with the objective of assisting the designing processes in the Brazilian agricultural sector. Given the representativeness of the sector in the economy, the boundary conditions in which the activities are developed and their impact on the health of workers, this proposal should contribute to the development of adaptable solutions and the promotion of Decent Work.

Human reliability in petrochemical industry: an action research.

This paper aims to identify conflicts and gaps between the operators' strategies and actions and the organizational managerial approach for human reliability. In order to achieve these goals, the research approach adopted encompasses literature review, mixing action research methodology and Ergonomic Workplace Analysis in field research. The result suggests that the studied company has a classical and mechanistic point of view focusing on error identification and building barriers through procedures, checklists and other prescription alternatives to improve performance in reliability area. However, it was evident the fundamental role of the worker as an agent of maintenance and construction of system reliability during the action research cycle.

Proposta de articulação entre abordagens metodológicas para melhoria do processo de reabilitação profissional / Proposing an articulation between methodologies to improve occupational rehabilitation process

Este artigo discute as limitações do atual modelo de reinserção do programa de reabilitação profissional do INSS para o retorno do trabalhador afastado por acidente ou doença ocupacional. Estas limitações são discutidas em relação à avaliação parcial da incapacidade do trabalhador e à não consideração estruturada da relação homem-trabalho por ocasião do retorno do trabalhador ao seu local de trabalho. Propõe-se um modelo que utiliza a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como referência para os profissionais selecionarem avaliações de caráter biopsicossocial para classificação das potencialidades do trabalhador reabilitado e a Análise Ergonômica do Trabalho (AET) como abordagem para a adaptação dos locais de trabalho. O modelo da CIF considera que a incapacidade não é um atributo da pessoa, mas sim um conjunto de condições que resulta da interação pessoa-meio. A AET pressupõe a compreensão do trabalho nas suas dimensões física, cognitiva e organizacional, cuja análise é centrada na atividade real. Resulta desta proposta uma maior aproximação entre as exigências do trabalho e as potencialidades do trabalhador numa visão social do problema da reinserção.

This article discusses the limitations of the current work reinsertion patternadopted by the National Social Security Institute (INSS) in its occupational rehabilitation program aimed at preparing workers to return to work after being on leave due to occupational illness or accident. These limitations are discussed regarding inadequate assessment of workers disability and established disregard for the man-work relationship at the time workers return to their workplaces. We propose a model, which uses the International Classification of Functionality, Disability and Health (ICF) as a reference to select biopsychosocial criterion to assess the rehabilitated workers potentials, and Ergonomic Work Analysis (EWA) as an approach to adapt workplaces for the rehabilitated workers return. ICF considers that disability is not an individual characteristic, but a set ofconditions resulting from the person-environment interaction. EWA presumes that work is understood in its physical, cognitive, and organizational dimensions, and analyzed focusing on real activity. The proposal of this article is to narrow the gap between job demands and workers potentials, viewing the reinsertion problem from a social standpoint.

A estratégia de redução e a carga de trabalho dos coletores de lixo domiciliar de uma grande cidade: estudo de caso baseado na Análise Ergonômica do Trabalho / The reduction strategy and the workload of a big city garbage collectors: a case study based on Ergonomic Work Analysis

Este trabalho descreve a utilização do método de redução como estratégia de trabalho desenvolvida pelos coletores de lixo (garis) de uma grande cidade e seus reflexos na organização e na carga de trabalho. O método de redução consiste de atividade preparatória à coleta de lixo por meio da formação de estoques intermediários antes do carregamento nos caminhões. O trabalho dos garis foi estudado utilizando-se a metodologia da Análise Ergonômica do Trabalho (AET),complementada por avaliações de esforço físico. Quanto à organização do trabalho, verificou-se que, ao utilizarem esta estratégia, os garis trabalham em ritmo mais cadenciado, conseguem executar melhor as tarefas de separação do lixo, como os sacos plásticos contendo vidros, podem interagir entre eles e estabelecer relações amistosas com os cidadãos sobre melhores práticas de acondicionamento do lixo. Em relação à segurança e à saúde, ao utilizarem este método, os garis ficam menos sujeitos a riscos de cortes, atropelamentos, quedas e desavenças com motoristas no trânsito, além de realizarem o trabalho com menos esforço físico. Concluiu-se que a utilização da redução não apenas diminui o esforço físico e a exposição a riscos de acidentes, mas também melhora a qualidade da coleta de lixo domiciliar.

This article discusses the reduction process as a working strategy implemented by the garbage collectors of a big city and its influence on workload and work organization. The so called reduction process consists in preparing garbage bags to be collected piling up intermediate stocks before they are loaded on trucks. Garbage collectors activitiy was studied through Ergonomic Work Analysis (EWA), supplemented by physiological and biomechanical workload measuring.As far as work organization is concerned, it was observed that when garbage collectors adopt this strategy they improve their work rhythm; they have more possibilities to separate garbage, such as plastic bags containing glass pieces from the rest; they manage to interact more with co-workers and communicate better with local residents on better ways of garbage packing. As regard to health and safety, when garbage collectors follow this process they are less liable to getting cut, to being run over, to falling down or to having quarrels with drivers, and theirtasks are performed with less biomechanical load. The authors concluded that the reduction strategy not only decreases biomechanical load and exposure to risks, but also improves residential garbage collection.

Analysis of industrial tasks as a tool for the inclusion of people with disabilities in the work market.

This article describes the application of a model for analyzing industrial tasks that was developed to identify jobs that could potentially be filled by people with disabilities (DP) and to serve as a guideline for a company hiring policy. In Brazil, Law No. 8213/91 makes it obligatory to hire DP based on quotas that are established according to the number of employees in a public and private company. Using a set of methods and techniques based on ergonomic work analysis and on occupational therapy, we sought to build a model to indicate the skills required to perform industrial tasks. The model was applied at 19 workstations at a Brazilian aircraft manufacturer in 2002. The task supervisor and the operator performing the task were interviewed, the work activity was filmed, a kinesiological analysis was done, the task was observed and a checklist was applied to help recognize and systematize the skills involved in performing the job task. The last step consisted of correlating the skills required to perform the task to the potential skills of the various types of disability. It was found that 100% of the jobs could be filled by workers with low-level paraplegia, 89% by workers with general paraplegia, 0% with low-level tetraplegia, 47% with auditory impairment, 42% with hemiplegia, 68% with upper limb amputees wearing adequate prostheses, and 89% handicapped wheelchair users. The company hired 14 DP based on the results of this model. The model proved adequate for analyzing industrial tasks with a view to the inclusion of DP, and it can be applied to other sectors of industrial production.

A triagem de lixo reciclável: análise ergonômica da atividade / Recycled materials' selection: an ergonomic work analysis

A análise do setor de triagem de uma cooperativa formada por catadores de material reciclável é objeto deste estudo. Utilizando a metodologia da Análise Ergonômica do Trabalho (AET), demonstra-se que, além dos riscos de acidentes e doenças, outras fontes de desconforto são geradas pela forma de organização adotada. O redirecionamento dos trabalhadores do antigo aterro sanitário para a cooperativa, na busca da inclusão social com geração de renda, intensificou sinais de sofrimento psíquico, sobrecarga física e mental e, especialmente, potencializou problemas financeiros que demandam modificações na organização do trabalho e parcerias institucionais.

The object of this paper is the analysis of a selection sector in a recycled material catcher cooperative. By using the Ergonomic Work Analysis, the paper shows that besides work-related risks and diseases other sources of discomfort are generated by the work organization mode. The guidance of workers from the Municipal Landfill Site to the cooperative organization in search of social inclusion and income generation activities seemed to intensify psycho-suffering, mental and physical overload and especially it determined financial problems. This situation asks for changes in the work organization mode and requests institutional partnership.