Occupational stressors and work accidents among health workers.

OBJECTIVE: To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS: Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS: A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio's risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS: Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio's prevention in health.

[Job dissatisfaction, psychosocial aspects, personal satisfaction, and mental health of male and female health workers]. / Insatisfação com o trabalho, aspectos psicossociais, satisfação pessoal e saúde mental de trabalhadores e trabalhadoras da saúde.

The objective was to evaluate the relationship between job dissatisfaction and the occurrence of common mental disorders (CMD), considering the psychosocial aspects of work and personal satisfaction. Cross-sectional study, with a sample of 3,084 health workers from five municipalities in Bahia. Structural equation modeling analysis, stratified by gender, was used. Dissatisfaction with work was the main exposure variable. The CMD, the outcome variable, was assessed by the Self-Reporting Questionnaire (SRQ-20). Personal satisfaction (SAP), assessed by World Health Organization Quality of Life (WHOQOL) questions, and stressful (AE) and protective (AP) psychosocial aspects, measured by the Job Content Questionnaire (JCQ) and the Effort-Reward Imbalance scale (ERI), were treated as latent variables. Dissatisfaction with work was associated with higher CMD prevalence, among men (0.160; CI95%: 0.024; 0.295) and women (0.198; CI95%: 0.135; 0.260). AEs were associated with greater dissatisfaction and higher CMD prevalence, while APs were associated with lower dissatisfaction and lower CMD prevalence, among men and women. Dissatisfaction with work mediated the effect of psychosocial aspects and personal satisfaction on the occurrence of CMD. The final model showed good adjustment. High job dissatisfaction, stressful psychosocial aspects, lack of protective aspects, and personal dissatisfaction were associated directly or indirectly with CMD. The results reinforce the need for actions to protect mental health at work by redesigning the harmful aspects identified and strengthening the aspects associated with the lower occurrence of CMD.

O objetivo foi avaliar a relação da insatisfação no trabalho e ocorrência de transtornos mentais comuns (TMC), considerando os aspectos psicossociais do trabalho e a satisfação pessoal (SAP). Estudo transversal, em amostra de 3.084 trabalhadores/as de saúde de cinco municípios baianos. Empregou-se análise de modelagem de equações estruturais, estratificada por gênero. A insatisfação com o trabalho foi a variável de exposição principal. Os TMC, variável desfecho, foram avaliados pelo Self-Reporting Questionaire (SRQ-20). Satisfação pessoal, avaliada por questões do World Health Organization Quality of Life (WHOQOL), e os aspectos psicossociais estressores (AE) e protetores (AP), mensurados pelo Job Content Questionnaire (JCQ) e pela escala Effort-Reward Imbalance (ERI), foram tratadas como variáveis latentes. A insatisfação com o trabalho associou-se positivamente aos TMC, entre homens (0,160; IC95%: 0,024; 0,295) e mulheres (0,198; IC95%: 0,135; 0,260). Os AE associaram-se positivamente à insatisfação com o trabalho e aos TMC, enquanto os AP associaram-se negativamente a esses dois eventos, entre homens e mulheres. A insatisfação com o trabalho mediou o efeito dos aspectos psicossociais e da SAP na ocorrência de TMC. O modelo final apresentou bom ajuste nos grupos analisados. Elevada insatisfação, presença de aspectos psicossociais estressores, carência de aspectos protetores e insatisfação pessoal associaram-se aos TMC direta ou indiretamente. Os resultados reforçam a necessidade de ações voltadas à proteção da saúde mental no trabalho em saúde com o redesenho dos aspectos nocivos identificados e fortalecimento dos aspectos associados à menor ocorrência de TMC.

El objetivo fue evaluar la relación de la insatisfacción en el trabajo y la ocurrencia de trastornos mentales comunes (TMC), considerando aspectos psicosociales del trabajo, así como la satisfacción personal. Se trata de un estudio transversal, en una muestra de 3084 trabajadores/as de salud de cinco municipios bahianos. Se utilizó un análisis de modelado de ecuaciones estructurales, estratificado por género. La insatisfacción con el trabajo fue la variable de exposición principal. Los TMC, variable de desenlace, se evaluaron mediante el Self-Reporting Questionaire (SRQ-20). Satisfacción personal (SAP), evaluada por cuestiones del World Health Organization Quality of Life (WHOQOL), y los aspectos psicosociales estresores (AE) y protectores (AP), medidos por el Job Content Questionnaire (JCQ) y por la escala Effort-Reward Imbalance (ERI), fueron tratadas como variables latentes. La insatisfacción con el trabajo se asoció positivamente a los TMC, entre hombres (0,160; IC95%: 0,024; 0,295) y mujeres (0,198; IC95%: 0,135; 0,260). Los AE se asociaron positivamente a la insatisfacción con el trabajo y a los TMC, mientras que los AP se asociaron negativamente a esos dos eventos, entre hombres y mujeres. La insatisfacción con el trabajo medió el efecto de los aspectos psicosociales y de la satisfacción personal en la ocurrencia de TMC. El modelo final presentó un buen ajuste en los grupos analizados. Elevada insatisfacción, presencia de aspectos psicosociales estresores, carencia de aspectos protectores e insatisfacción personal se asociaron a los TMC directa o indirectamente. Los resultados refuerzan la necesidad de acciones dirigidas a la protección de la salud mental en el trabajo en salud, con el rediseño de los aspectos nocivos identificados, así como el fortalecimiento de los aspectos asociados a una menor ocurrencia de TMC.

Occupational stressors and work accidents among health workers / Estressores ocupacionais e acidentes de trabalho entre trabalhadores da saúde

ABSTRACT OBJECTIVE To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio's risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio's prevention in health.

RESUMO OBJETIVO Testar associação entre estressores ocupacionais e acidentes de trabalho por exposição a material biológico (ATbio) em trabalhadores da saúde, considerando a análise isolada e combinada das dimensões de dois modelos, o modelo demanda-controle (MDC) e o modelo de desequilíbrio esforço-recompensa (ERI). MÉTODOS Estudo de corte transversal em amostra representativa de trabalhadores de nível superior, técnico, médio, incluindo agentes de saúde de unidades da atenção básica e média complexidade em cinco cidades da Bahia. Selecionou-se amostragem aleatória, estratificada por área geográfica, nível de complexidade do serviço e ocupação. A variável desfecho foi ATbio; a exposição principal foram os estressores ocupacionais, avaliados pelo MDC e ERI. As incidências e os riscos relativos foram estimados em função do caráter agudo, de curta duração, do desfecho de interesse. Testaram-se associações entre ATbio e as dimensões do MDC e ERI isolados e combinados. RESULTADOS Participaram do estudo 3.084 trabalhadores. A incidência global de ATbio foi de 3,4% e mostrou-se associada a alta demanda psicológica, alto esforço e alto comprometimento com o trabalho, com ajuste por sexo, idade, escolaridade e turno de trabalho. Trabalho de alta exigência e situação de desequilíbrio entre esforços e recompensas estavam associados aos ATbio. Com a combinação dos modelos, observou-se incremento da medida de associação com o desfecho. As associações significantes e de maior magnitude foram observadas nos modelos combinados completos. O risco de ATbio foi 5,23 vezes maior entre os expostos em ambos os modelos completos em comparação com a ausência de exposição nos dois modelos. CONCLUSÕES Estressores ocupacionais mostraram-se associados aos ATbio. Observaram-se vantagens no uso dos modelos combinados. A abordagem de diferentes dimensões psicossociais ampliou a capacidade de identificação de grupos expostos, oferecendo base sólida para intervenções de prevenção dos ATbio em saúde.

Insatisfação com o trabalho, aspectos psicossociais, satisfação pessoal e saúde mental de trabalhadores e trabalhadoras da saúde / Job dissatisfaction, psychosocial aspects, personal satisfaction, and mental health of male and female health workers / Insatisfacción con el trabajo, aspectos psicosociales, satisfacción personal y salud mental de trabajadores y trabajadoras de salud

Resumo: O objetivo foi avaliar a relação da insatisfação no trabalho e ocorrência de transtornos mentais comuns (TMC), considerando os aspectos psicossociais do trabalho e a satisfação pessoal (SAP). Estudo transversal, em amostra de 3.084 trabalhadores/as de saúde de cinco municípios baianos. Empregou-se análise de modelagem de equações estruturais, estratificada por gênero. A insatisfação com o trabalho foi a variável de exposição principal. Os TMC, variável desfecho, foram avaliados pelo Self-Reporting Questionaire (SRQ-20). Satisfação pessoal, avaliada por questões do World Health Organization Quality of Life (WHOQOL), e os aspectos psicossociais estressores (AE) e protetores (AP), mensurados pelo Job Content Questionnaire (JCQ) e pela escala Effort-Reward Imbalance (ERI), foram tratadas como variáveis latentes. A insatisfação com o trabalho associou-se positivamente aos TMC, entre homens (0,160; IC95%: 0,024; 0,295) e mulheres (0,198; IC95%: 0,135; 0,260). Os AE associaram-se positivamente à insatisfação com o trabalho e aos TMC, enquanto os AP associaram-se negativamente a esses dois eventos, entre homens e mulheres. A insatisfação com o trabalho mediou o efeito dos aspectos psicossociais e da SAP na ocorrência de TMC. O modelo final apresentou bom ajuste nos grupos analisados. Elevada insatisfação, presença de aspectos psicossociais estressores, carência de aspectos protetores e insatisfação pessoal associaram-se aos TMC direta ou indiretamente. Os resultados reforçam a necessidade de ações voltadas à proteção da saúde mental no trabalho em saúde com o redesenho dos aspectos nocivos identificados e fortalecimento dos aspectos associados à menor ocorrência de TMC.

Abstract: The objective was to evaluate the relationship between job dissatisfaction and the occurrence of common mental disorders (CMD), considering the psychosocial aspects of work and personal satisfaction. Cross-sectional study, with a sample of 3,084 health workers from five municipalities in Bahia. Structural equation modeling analysis, stratified by gender, was used. Dissatisfaction with work was the main exposure variable. The CMD, the outcome variable, was assessed by the Self-Reporting Questionnaire (SRQ-20). Personal satisfaction (SAP), assessed by World Health Organization Quality of Life (WHOQOL) questions, and stressful (AE) and protective (AP) psychosocial aspects, measured by the Job Content Questionnaire (JCQ) and the Effort-Reward Imbalance scale (ERI), were treated as latent variables. Dissatisfaction with work was associated with higher CMD prevalence, among men (0.160; CI95%: 0.024; 0.295) and women (0.198; CI95%: 0.135; 0.260). AEs were associated with greater dissatisfaction and higher CMD prevalence, while APs were associated with lower dissatisfaction and lower CMD prevalence, among men and women. Dissatisfaction with work mediated the effect of psychosocial aspects and personal satisfaction on the occurrence of CMD. The final model showed good adjustment. High job dissatisfaction, stressful psychosocial aspects, lack of protective aspects, and personal dissatisfaction were associated directly or indirectly with CMD. The results reinforce the need for actions to protect mental health at work by redesigning the harmful aspects identified and strengthening the aspects associated with the lower occurrence of CMD.

Resumen: El objetivo fue evaluar la relación de la insatisfacción en el trabajo y la ocurrencia de trastornos mentales comunes (TMC), considerando aspectos psicosociales del trabajo, así como la satisfacción personal. Se trata de un estudio transversal, en una muestra de 3084 trabajadores/as de salud de cinco municipios bahianos. Se utilizó un análisis de modelado de ecuaciones estructurales, estratificado por género. La insatisfacción con el trabajo fue la variable de exposición principal. Los TMC, variable de desenlace, se evaluaron mediante el Self-Reporting Questionaire (SRQ-20). Satisfacción personal (SAP), evaluada por cuestiones del World Health Organization Quality of Life (WHOQOL), y los aspectos psicosociales estresores (AE) y protectores (AP), medidos por el Job Content Questionnaire (JCQ) y por la escala Effort-Reward Imbalance (ERI), fueron tratadas como variables latentes. La insatisfacción con el trabajo se asoció positivamente a los TMC, entre hombres (0,160; IC95%: 0,024; 0,295) y mujeres (0,198; IC95%: 0,135; 0,260). Los AE se asociaron positivamente a la insatisfacción con el trabajo y a los TMC, mientras que los AP se asociaron negativamente a esos dos eventos, entre hombres y mujeres. La insatisfacción con el trabajo medió el efecto de los aspectos psicosociales y de la satisfacción personal en la ocurrencia de TMC. El modelo final presentó un buen ajuste en los grupos analizados. Elevada insatisfacción, presencia de aspectos psicosociales estresores, carencia de aspectos protectores e insatisfacción personal se asociaron a los TMC directa o indirectamente. Los resultados refuerzan la necesidad de acciones dirigidas a la protección de la salud mental en el trabajo en salud, con el rediseño de los aspectos nocivos identificados, así como el fortalecimiento de los aspectos asociados a una menor ocurrencia de TMC.

Occupational stress and job dissatisfaction with health work.

OBJECTIVE: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. METHODS: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). RESULTS: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). CONCLUSIONS: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health.

Occupational stress and job dissatisfaction with health work

Abstract Objective: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. Methods: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). Results: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). Conclusions: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health. (AU)

Vacinação contra hepatite B e Anti-HBS entre trabalhadores da saúde / Hepatitis B and Anti-HBS vaccination among health workers

ResumoObjetivoAvaliar a prevalência de vacinação para hepatite B e os fatores associados entre trabalhadores da atenção primária e da média complexidade do setor saúde.MetodologiaEstudo transversal com 506 trabalhadores do setor saúde de um município do Recôncavo Baiano. Utilizou-se questionário para investigar situação vacinal para hepatite B. Análises uni e bivariada foram utilizadas para avaliação dos fatores associados à vacinação.ResultadosHouve predomínio do sexo feminino (78,3%) e do vínculo de trabalho permanente (63,8%); além disso, 78,1% dos trabalhadores fizeram uma avaliação positiva da saúde. A maioria referiu ter recebido três doses da vacina contra hepatite B (59,9%). Enfermeiras, técnicas e médicos estiveram mais imunizados (91,8%). Os fatores associados à vacinação foram: sexo, idade, escolaridade, uso de equipamento de proteção individual e contato com material biológico.DiscussãoA prevalência da vacinação completa contra hepatite B foi de 59,9%, indicando uma cobertura baixa. É preciso estimular os profissionais que não desenvolveram um nível de anticorpos adequado após o esquema vacinal primário a refazer uma quarta dose.ConsideraçõesIndivíduos que não estão imunes à doença devem ser informados que são suscetíveis ao VHB até que tenham comprovação imunológica. Questões sobre biossegurança nos currículos acadêmicos colaboraram para incorporação de atitudes mais positivas frente à adesão à vacinação.

AbstractObjectiveTo evaluate Hepatitis B vaccination coverage and its associated factors among health workers.MethodologyIt is a cross-sectional study conducted with 506 primary care and medium complexity health workers in a municipality of the ‘Recôncavo’ region of Bahia state, Brazil. A questionnaire was applied to assess the vaccination status for Hepatitis B and the sociodemographic and occupational characteristics of health workers. Univariate and bivariate analyses were used to evaluate the factors associated with vaccination.ResultsThe population studied was predominately female (78.3%) composed of individuals with steady employment (63.8%) and who rated themselves in good or very good health (78.1%). The majority reported having received three doses of the vaccine against Hepatitis B (59.9%). Nurses, technicians, and physicians were the most immunized (91.8%). The following factors were associated with self-reported Hepatitis B vaccination: sex, age, educational level, use of individual protection equipment (IPE), and contact with biological material.DiscussionA low coverage of complete Hepatitis B vaccination was observed (59.9%). Health professionals who did not develop an adequate level of antibodies after vaccination should be encouraged to complete a fourth dose (booster).ConsiderationsThose without immunity should be informed of their susceptibility to VHB until they present evidence of immune response. Biosecurity should be incorporated into academic curriculums to create positive attitudes regarding adhesion to vaccination.