Intention to leave profession, psychosocial environment and self-rated health among registered nurses from large hospitals in Brazil: a cross-sectional study.

BACKGROUND: Nurses' intention to leave their profession is a worldwide concern. Studies have shown that it can take the form of a chain reaction: many nurses first leave the unit, then the hospital, and finally the profession. Organisation and other labour factors, personal and conjunctural, have been associated with the intention to quit nursing. This study aimed to examine the factors associated with the intention to leave the profession among registered nurses (RNs) at large public hospitals in Brazil. METHODS: This was a cross-sectional study, conducted from 2010 to 2011: all RNs at Rio de Janeiro's 18 largest public hospitals (>150 beds) were invited to participate. The study sample comprised 3,229 RNs (82.7% of those eligible), who answered a self-completed, multidimensional paper questionnaire. The outcome was defined as thoughts of leaving the profession sometimes a month or more. We based the analyses on hierarchical logistic regression models, considering three blocks of determinants: socio-demographic data (block I), occupational factors (block II), and health conditions (block III). RESULTS: Of the study population, 22.1% indicated the intention to leave the profession. In the final model after adjustment, the variables associated with the intention to leave were as follows: male sex (odds ratio [OR] = 1.65), not holding a leadership position (OR = 1.28), highly demanding work (OR = 2.49), passive work (OR = 2.10), effort-reward imbalance (OR = 2.00), poor self-rated health (OR = 1.92), over-commitment to the job (OR = 1.87), and poor supervisor support (OR = 1.33). The likelihood of expressing the intention to leave increased with age (OR = 0.98 for the oldest). CONCLUSIONS: Self-rated health and factors connected with the work environment, particularly those that generate psychosocial strain, were most strongly associated with the intention to leave the profession. From the profiles of nurses who wished to leave the profession, we found that for many people who go into nursing-especially men and younger entrants-their prospects of remaining in the profession are poor. The potential role of psychosocial job characteristics and self-rated health indicates the need for long-term action involving all stakeholders, i.e. managers, employers, and workers.

Factors associated with overweight: are the conclusions influenced by choice of the regression method?

BACKGROUND: Different analytical techniques have been used to study the determinants of overweight. However, certain commonly used techniques may be limited by the continuous nature and skewed distribution of body mass index (BMI) data. In this article, different regression models are compared to identify the best approach for analysing predictors of BMI. METHODS: Data collected on 2270 nurses at 18 public hospitals in Rio de Janeiro, RJ (2010-2011) were analysed (80.6 % of the respondents). The explanatory variables considered were age, marital status, race/colour, mother's schooling, domestic overload, years worked at night, consumption of fried food, physical inactivity, self-rated health and BMI at age 20 years. In addition to gamma regression, regarded as the reference method for selecting the set of explanatory variables described here, other modelling strategies - including linear, quantile (for the 0.25, 0.50 and 0.75 quantiles), binary and multinomial logistic regression - were compared in terms of final results and measures of fit. RESULTS: The variables age, marital status, race/colour, domestic overload, self-rated health, physical inactivity and BMI at age 20 years were significantly associated with BMI, independently of the method used. In the same way, consumption of fried food was significant in all the models, but a dose-response pattern was identified only in the gamma and normal models and the quantile model for the 0.75 quantile. Years worked at night was also associated with BMI in these three models only. The variable mother's schooling returned significant results only for the category 12 or more years of schooling, except for overweight in the multinomial model and for the 0.50 quantile in the quantile model, in which the two categories were not significant. The results of the quantile regression showed that, generally, the effects of the variables investigated were greater in the upper quantiles of the BMI distribution. Of the models using BMI in its continuous form, the gamma model showed best fit, followed by the quantile models (0.25 and 0.5 quantiles). CONCLUSIONS: The different strategies used produced similar results for the factors associated with BMI, but differed in the magnitude of the associations and goodness of fit. We recommend using the different approaches in combination, because they furnish complementary information on the problem studied.

Work-family conflict, lack of time for personal care and leisure, and job strain in migraine: Results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Work-family conflict and time scarcity may affect health. We investigated the association between these issues and migraine, taking into account job strain. METHODS: Baseline data from ELSA-Brasil (6,183 women; 5,664 men) included four indicators of work-family conflict: time- and strain-based interference of work with family (TB-WFC, SB-WFC), interference of family with work (FWC) and lack of time for personal care and leisure (LOT). Migraine was classified according to International Headache Society criteria. RESULTS: Among women, definite migraine was associated with SB-WFC (odds ratio [OR] = 1.28; 95% confidence interval [CI] 1.06-1.55), FWC (OR = 1.32; 1.00-1.75), and LOT (OR = 1.30; 1.08-1.58). Probable migraine was associated with SB-WFC (OR = 1.17; 1.00-1.36). High psychological job demands and low social support interacted with LOT in association with definite migraine. Among men, probable migraine was associated with LOT (OR = 1.34; 1.09-1.64), and there were interactions between job strain and WFC for probable migraine. CONCLUSIONS: Balancing the demands of professional and domestic spheres could be highly relevant in the management of migraines. Am. J. Ind. Med. 59:987-1000, 2016. © 2016 Wiley Periodicals, Inc.

Years worked at night and body mass index among registered nurses from eighteen public hospitals in Rio de Janeiro, Brazil.

BACKGROUND: Employees working night shifts are at a greater risk of being overweight or obese. Few studies on obesity and weight gain analyze the years of exposure to night work. The aim of this study was to determine the relationship between the years of exposure to night work and body mass index (BMI) among registered nurses. METHODS: A cross-sectional analysis was performed in 18 largest public hospitals in Rio de Janeiro, Brazil. A total of 2,372 registered nurses (2,100 women) completed a comprehensive questionnaire concerning sociodemographic, professional, lifestyle, and health behavioral data. Current and past exposures to night shifts as well as BMI values were measured as continuous variables. A gamma regression model was used with an identity link function to establish the association. RESULTS: The association between years of exposure to night work and BMI was statistically significant for both women and men after adjusting for all covariates [ß = 0.036; CI95% = 0.009-0.063) and ß = 0.071 (CI95% = 0.012-0.129), respectively]. The effect of night work was greater among men than women. For example, for those women who have worked at night for 20 years the estimated average BMI was 25.6 kg/m2 [range, 25.0-26.2]. In relation to men, after 20 years of exposure to night work the estimated average BMI was 26.9 kg/m2 [range, 25.6-28.1]. CONCLUSIONS: These findings suggest that night shift exposure is related to BMI increases. Obesity prevention strategies should incorporate improvements in work environments, such as the provision of proper meals to night workers, in addition to educational programs on the health effects of night work.

Mental health and poor recovery in female nursing workers: a contribution to the study of gender inequities.

OBJECTIVE: To address the association between work and mental health from a gender perspective by investigating the combination of domestic work and adverse aspects of professional work (night shifts and psychosocial stress) with regard to minor psychiatric disorders (MPD) and poor recovery from work. METHODS: A cross-sectional study was carried out at three public hospitals in Rio de Janeiro, Brazil, in 2006 (n = 1 122). Data collection was based on a census of all female nurses, technicians, and auxiliary nurses. A multidimensional instrument containing information about health, professional work, and the domestic work was used. The domestic work hours (longer or shorter than 10 hours per week) were combined with the work schedule (day or night shifts) and with psychosocial stress (absence or presence of effort-reward imbalance [ERI]). These combinations were tested with regard to the association with MPD and poor recovery from work. The adjusted odds ratios (OR) and their confidence intervals were calculated using multiple regression models. RESULTS: The combination of long domestic work hours with night work was significantly associated with MPD (OR = 1.94) and poor recovery (OR = 2.67). Long domestic work hours combined with the presence of ERI resulted in significantly higher odds ratios (OR = 4.37 and OR = 5.53, respectively). In all analyses, greater odds ratios were observed in groups with long domestic work hours, compared to short work hours. CONCLUSIONS: These findings suggest that carrying out domestic activities over a certain number of hours can increase the detrimental consequences of professional work in regard to MPD and poor recovery. The interaction between professional and domestic work and its potential implications to mental suffering must be considered in discussions on health equity.

[Gender relations and interdependence: reflections on changes in the hospital configuration]. / Relações de gênero e interdependências: reflexões a partir de mudanças na configuração hospitalar.

The article analyzes changes that have occurred in hospitals over the years, with a focus on the dynamics of gender relations as experienced by healthcare workers. We use the notions of configuration and interdependence, taken from Norbert Elias' theory of the civilizing process, along with discussions of gender relations at work; drawing from Michel Foucault, we also reference the disciplinary practices employed down through hospital history. This linkage of discussions on gender issues and on interdependent relations opens up to a reflection on conflicts of interests, power struggles, and the balance of tensions, which in turn makes it possible to problematize gender inequalities with the ultimate aim of achieving an interdisciplinary effort that will promote health care of an integral nature.

[Perceived risk from COVID-19 and depression, anxiety, and stress among workers in healthcare units]. / Percepção de risco de adoecimento por COVID-19 e depressão, ansiedade e estresse entre trabalhadores de unidades de saúde.

The objective was to analyze associations between perceived risk from COVID-19 and symptoms of depression, anxiety, and stress among workers in healthcare units. This was a cross-sectional study of workers from different professions who appeared voluntarily at one of the first COVID-19 Testing Centers in the municipality of Rio de Janeiro, Brazil. The workers were invited to answer an online questionnaire from May to August 2020. The COVID-19 Risk Perception Scale and the Depression, Anxiety, and Stress Scale (DASS-21) were used. Odds ratios (OR) and 95% confidence intervals were estimated. Of the total sample (N = 2,996), 81.5% were women, and mean age was 40.7 years. About half presented mild, moderate, or severe depression, anxiety, or stress, and the rates for workers with severe symptoms were 18.5%, 29.6%, and 21.5%, respectively. The associations between perceived risk and symptoms of depression, anxiety, and stress increased with the increase in each symptom's severity. Workers with higher perceived risk from COVID-19 showed higher OR for severe symptoms of depression (OR = 4.67), anxiety (OR = 4.35), and stress (OR = 4.97). The findings point to the demand for measures to protect workers' health and that should not be limited to personal protective equipment. It is essential for health system administrators to promote collective spaces for discussion and actions to favor workers' recovery in the context of a prolonged pandemic.

O objetivo foi analisar as associações entre a percepção de risco de adoecimento por COVID-19 e os sintomas de depressão, ansiedade e estresse em profissionais atuantes em unidades de saúde. Estudo transversal com trabalhadores de diversas categorias profissionais que buscaram voluntariamente um dos primeiros Centros de Referência em Testagem de COVID-19 no Município do Rio de Janeiro, Brasil. Os trabalhadores foram convidados a responder a um questionário online entre maio e agosto de 2020. Foram utilizadas a escala Percepção de Risco de Adoecimento por COVID-19 e a Escala de Depressão, Ansiedade e Estresse (DASS-21). Foram estimados razão de chance (OR) e intervalo de 95% de confiança. Do total (N = 2.996), 81,5% eram mulheres com idade média de 40,7 anos. Cerca da metade apresentava grau leve, moderado ou severo de depressão, ansiedade ou estresse, sendo a frequência de trabalhadores com sintomas severos, respectivamente, 18,5%, 29,6% e 21,5%. Observou-se que as associações entre a percepção de risco e os sintomas de depressão, ansiedade e estresse foram mais fortes à medida que aumentava a classificação de gravidade de cada sintoma. Os trabalhadores com alta percepção de risco de adoecimento por COVID-19 apresentaram OR mais elevadas para sintomas severos de depressão (OR = 4,67), ansiedade (OR = 4,35) e estresse (OR = 4,97). Os achados apontam a demanda por medidas de proteção à saúde dos trabalhadores, que não devem se restringir aos equipamentos de proteção individual. É essencial que os gestores promovam espaços coletivos de discussão e ações que favoreçam a recuperação dos trabalhadores em contexto pandêmico de longa duração.

El objetivo fue analizar las asociaciones entre la percepción de riesgo de enfermedad por COVID-19 y los síntomas de depresión, ansiedad y estrés en profesionales activos en unidades de salud. Estudio transversal con trabajadores de diversas categorías profesionales que buscaron voluntariamente uno de los primeros Centros de Referencia en Tests de COVID-19 en el municipio de Río de Janeiro, Brasil. Los trabajadores fueron invitados a responder a un cuestionario online entre mayo y agosto de 2020. Se utilizaron la escala Percepción de Riesgo de Enfermedad por COVID-19 y la Escala de Depresión, Ansiedad y Estrés (DASS-21). Se estimaron razón de oportunidad (OR) e intervalo de 95% de confianza. Del total (N = 2.996), un 81,5% eran mujeres con una edad media de 40,7 años. Cerca de la mitad presentaba grado leve, moderado o severo de depresión, ansiedad o estrés, siendo la frecuencia de trabajadores con síntomas severos, respectivamente, 18,5%, 29,6% y 21,5%. Se observó que las asociaciones entre la percepción de riesgo y los síntomas de depresión, ansiedad y estrés fueron más fuertes a medida que aumentaba la clasificación de la gravedad de cada síntoma. Los trabajadores con alta percepción de riesgo de enfermedad por COVID-19 presentaron OR más elevadas para síntomas severos de depresión (OR = 4,67), ansiedad (OR = 4,35) y estrés (OR = 4,97). Los resultados apuntan la demanda de medidas de protección a la salud de los trabajadores, que no se deben restringir a equipamientos de protección individual. Es esencial que los gestores promuevan espacios colectivos de discusión y acciones que favorezcan la recuperación de los trabajadores en un contexto pandémico de larga duración.

The Deepwater Horizon oil rig accident, 12 years later: analysis focusing on the collective dimension of work and the organizational factors. / O acidente da plataforma de petróleo Deepwater Horizon após 12 anos: análise com foco na dimensão coletiva do trabalho e nos fatores organizacionais.

The Deepwater Horizon oil rig accident, in 2010, is considered the biggest disaster of the 21st century in the oil and gas industry. A total of 11 workers died, 17 were injured, total loss of the unit, and the largest environmental disaster in the Gulf of Mexico (United States). The existing literature encompasses its environmental, chemical, biological, and economic effects, focusing on immediate causes, that is, situations close to the event in time and space, especially human errors and technical failures. This approach is taken at the expense of identifying possible underlying causes, which refer to managerial and organizational factors. This essay aims to answer the question: wich factors may have contributed to the disaster that affected the platform, considering the relevance of the collective dimension of work? Our theoretical-methodological contribution is based on the activity ergonomics and the work psychodynamics, also valuing the synergistic conduction of the relationship between the knowledge of the sciences and the experience of the workers, as proposed by the ergological perspective. We identified decision failures from those who are at the tip of the process, operating systems of high complexity, that should not be interpreted as an endpoint, but as a starting point in the analysis of major accidents. Understanding such decisions demands the comprehension of the representations constructed by the workers, including in their collective and shared dimension. The communication (or communication gaps) between workers and organizational factors in the context of the accident are essential aspects to be considered in the analysis of events involving complex systems.

O acidente com a plataforma Deepwater Horizon, em 2010, é considerado o maior desastre do século no setor de óleo e gás. Esse evento teve como consequências 11 trabalhadores mortos, 17 feridos, perda total da unidade e maior desastre ambiental no Golfo do México (Estados Unidos). A literatura existente abarca seus impactos ambientais, químicos, biológicos e econômicos, concentrando-se nas causas imediatas, ou seja, situações próximas no tempo e no espaço do evento, em especial erros humanos e falhas técnicas. Tal abordagem se dá em detrimento da identificação de possíveis causas subjacentes, que remetem a fatores gerenciais e organizacionais. O objetivo deste ensaio é responder à pergunta: que fatores teriam contribuído para a ocorrência do desastre que acometeu a plataforma, considerando-se a relevância da dimensão coletiva do trabalho? Nosso aporte teórico-metodológico se baseia na ergonomia da atividade e na psicodinâmica do trabalho, valorizando também a condução sinérgica da relação entre os saberes das ciências e da experiência dos trabalhadores, como propõe a perspectiva ergológica. Foram identificadas falhas de decisão tomadas por quem se situa à ponta do processo, na operação de sistemas de alta complexidade, mas que não devem ser vistas como ponto de chegada, e sim de partida na análise de grandes acidentes. O entendimento de tais decisões demanda a compreensão das representações construídas pelos trabalhadores, inclusive em sua dimensão coletiva e compartilhada. A comunicação (ou lacunas de comunicação) entre os trabalhadores e fatores organizacionais no contexto do acidente são aspectos essenciais a serem considerados na análise de eventos que envolvem sistemas complexos.

El accidente de Deepwater Horizon en 2010 es considerado el mayor desastre del siglo en el sector del petróleo y gas. Este evento resultó en 11 trabajadores muertos, 17 heridos, pérdida total de la unidad y un gran desastre ambiental en el Golfo de México (EE.UU.). La literatura existente abarca sus impactos ambientales, químicos, biológicos y económicos, enfocándose en las causas inmediatas, es decir, situaciones próximas en el tiempo y espacio del evento, especialmente errores humanos y fallas técnicas. Tal enfoque no identifica las posibles causas subyacentes, que se refieren a factores gerenciales y organizacionales. El objetivo de este ensayo es responder a la pregunta: ¿qué factores habrían contribuido a la ocurrencia del desastre que afectó a la plataforma, considerando la relevancia de la dimensión colectiva del trabajo? Nuestro aporte teórico-metodológico se fundamenta en la ergonomía de la actividad y en la psicodinámica del trabajo, valorando además la conducción sinérgica de la relación entre el saber de las ciencias y la experiencia de los trabajadores, tal como lo propone la perspectiva ergológica. Se identificaron fallos de decisión, tomados por quienes están al final del proceso, en la operación de sistemas de alta complejidad, pero que no deben ser vistos como un punto de llegada, sino un punto de partida en el análisis de accidentes mayores. Comprender tales decisiones requiere comprender las representaciones construidas por los trabajadores, incluso en su dimensión colectiva y compartida. La comunicación (o brechas de comunicación) entre los trabajadores y los factores organizacionales en el contexto del accidente son aspectos esenciales a ser considerados en el análisis de eventos que involucran sistemas complejos.

Gender, work-family conflict, and weight gain: four-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

This study sought to analyze the effect of work-to-family conflict (demands from work that affect one's family/personal life), family-to-work conflict (demands from family/personal life that affect work), and lack of time for self-care and leisure due to professional and domestic demands on the incidence of weight gain and increase in waist circumference by gender in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Our study included 9,159 ELSA-Brasil participants (4,413 men and 4,746 women) who attended baseline (2008-2010) and the first follow-up visit (2012-2014). Weight gain and increase in waist circumference were defined as an annual increase ≥ 75th percentile, i.e., ≥ 1.21kg/year and ≥ 1.75cm/year, respectively for women; and ≥ 0.96kg/year and ≥ 1.41cm/year respectively for men. Associations were estimated by Poisson regression applying robust variance with the R software. Analyses were stratified by gender and adjusted for socioeconomic variables. Adjusted models showed a higher risk of weight gain among women who reported family-to-work conflict frequently and sometimes (relative risk - RR = 1.37 and RR = 1.15, respectively) and among those who reported frequent lack of time for self-care and leisure (RR = 1.13). Among men, time-based work-to-family conflict (RR = 1.17) and strain-based work-to-family conflict (RR = 1.24) were associated with weight gain. No associations were observed between work-family conflict domains and increase in waist circumference. These findings suggest that occupational and social health promotion programs are essential to help workers balance work and family life to reduce weight gain.

Is work-family conflict a pathway between job strain components and binge eating? A cross-sectional analysis from the ELSA-Brasil study.

BACKGROUND: Job strain has been reported as a trigger for binge eating, yet the underlying mechanisms have been unclear. The aim of this study was to evaluate whether work-family conflict is a pathway in the association between job strain and binge eating, considering the possible effect-modifying influence of body mass index (BMI). METHODS: This cross-sectional analysis included 12,084 active civil servants from the multicenter Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job strain was assessed using the Demand-Control-Support Questionnaire. Work-family conflict was considered as a latent variable comprising three items. Binge eating was defined as eating a large amount of food in less than 2 h at least twice a week in the last six months with a sense of lack of control over what and how much was eaten. Structural equation modelling was used to test the role of work-family conflict in the association between job strain and binge eating, stratifying for BMI. RESULTS: For individuals of normal weight, positive associations were found between skill discretion and binge eating (standardized coefficient [SC] = 0.209, 95%CI = 0.022-0.396), and between psychological job demands and work-family conflict (SC = 0.571, 95%CI = 0.520-0.622), but no statistically significant indirect effect was found. In overweight individuals, psychological job demands, skill discretion, and work-family conflict were positively associated with binge eating (SC = 0.099, 95%CI = 0.005-0.193; SC = 0.175, 95%CI = 0.062-0.288; and SC = 0.141, 95%CI = 0.077-0.206, respectively). Also, work-family conflict was observed to be a pathway on the associations of psychological job demands and decision authority with binge eating (SC = 0.084, 95%CI = 0.045-0.122; and SC = - 0.008, 95%CI = - 0.015- - 0.001, respectively). CONCLUSIONS: Work-family conflict partly explains effects of high levels of psychological job demands and low levels of decision authority on binge eating among overweight individuals. Moreover, skill discretion is positively associated with binge eating, regardless of BMI category.

Recent studies have found work-family conflict (i.e., incompatible work and family demands) to link between work issues and physical and mental health. Accordingly, this study investigated whether the relationship between job strain and binge eating is explained by work-family conflict, by body mass index (BMI), in a large sample of Brazilian civil servants. Overall, this study demonstrated that, among overweight individuals, excessive job demands and low decision authority (over what to do at work and how) contribute to binge eating by increasing work-family conflict. Also, excessive skill discretion at work, including opportunities to acquire and use specific job skills, is related to binge eating, regardless of BMI, which deserves further investigation. In conclusion, the results indicate that work-family conflict is a potential mechanism through which job strain can affect eating behavior among overweight individuals.

Relationship between sleeping on the night shift and recovery from work among nursing workers - the influence of domestic work.

AIM: This paper is a report of a study on the association between sleep patterns during work nights and recovery from work among nursing workers, considering domestic work hours. BACKGROUND: Several hospitals allow nursing workers to sleep during the night shift, but this is rarely evaluated from the workers' health perspective. The need for recovery from work concept can be useful for testing the impact of night work on sleep. Recovery is not a problem if workers have enough time to recover between periods of work. Therefore, domestic work would be likely to interfere in the recovery process. METHODS: This cross-sectional study was carried out at three hospitals in 2005-2006, through a comprehensive questionnaire. All nursing teams engaged in assistance to patients were invited to participate. Analyses included female night workers with no incidence of insomnia. Participants (n = 396) were classified into those who did not sleep during night shifts, those who slept for up to 2 hours and those who slept for 2-3 hours. RESULTS: Binomial logistic regression analysis showed that sleeping on the job for 2-3 hours during night shifts is related to a better recovery from work provided the workers do not undergo long domestic work hours. CONCLUSIONS: Being allowed to sleep at work during night shifts seemed to contribute to, but was not enough to guarantee, a good recovery from work in the studied population. Recommendations to deal with sleep-deprivation among night workers should consider the complexity of gender roles on the recovery process.

Doses of exposure to night shift work and nutritional status among nursing workers.

Introduction: Exposure to night work (NW) has been identified as a possible risk factor for body weight gain. Recent studies highlight the need to assess the intensity and frequency of exposure to night work (i.e., years of exposure and number of nights worked). Objectives: To investigate the relationships between the dose of exposure to night work (years working nights and number of nights worked) and nutritional status (excess weight, waist circumference), abdominal obesity, and body mass index in nursing professionals. Methods: Data were analyzed on night workers (n = 529) from a public hospital in Rio de Janeiro, Brazil. Descriptive analyses were conducted and crude and adjusted regression models were constructed to test the associations between exposures and outcomes. Analyses were performed using R, version 2.15. Results: Working at night for 10 years or more was associated with excess weight (odds ratio [OR] = 1.76; 95% confidence interval [95%CI] 1.14-2.72), with abdominal obesity (OR = 1.76; 95%CI 1.14-2.74), with increased body mass index (ß = 2.28; 95%CI 1.31-3.26), and with increased waist circumference (ß = 4.63; 95%CI 2.38-6.88), when compared with exposure to NW for less than 10 years, after adjusting for covariates. The current dose of night work only exhibited a borderline association between > 5 nights/fortnight and abdominal obesity (OR = 1.55; 95%CI 1.01-2.01). Conclusions: Detailing night work exposure can contribute data to support strategies for organizing working hours that consider the possibility of limiting the time exposed to night work.

Introdução: A exposição ao trabalho noturno (TN) vem sendo apontada como possível fator de risco para o aumento do peso corporal. Estudos recentes destacam a necessidade de avaliação da intensidade e da frequência da exposição ao TN (ou seja, anos de exposição e número de noites trabalhadas). Objetivos: Investigar a relação entre a dose de exposição ao TN (anos e número de noites trabalhadas) e o estado nutricional (excesso de peso, circunferência abdominal, obesidade abdominal e índice de massa corporal) em profissionais de enfermagem. Métodos: Foram analisados os dados referentes aos trabalhadores noturnos (n = 529) de um hospital público do Rio de Janeiro. Realizaram-se análises descritivas e modelos de regressão brutos e ajustados para testar as associações entre as exposições e os desfechos. As análises foram realizadas no programa R, versão 2.15. Resultados: Trabalhar à noite por 10 anos ou mais associou-se ao excesso de peso (odds ratio [OR] = 1,76; intervalo de confiança de 95% [IC95%] 1,14-2,72), à obesidade abdominal (OR = 1,76; IC95% 1,14-2,74), ao índice de massa corporal aumentado (ß = 2,28; IC95% 1,31-3,26) e à cintura abdominal aumentada (ß = 4,63; IC95% 2,38-6,88), comparado ao TN realizado há menos de 10 anos, após ajuste pelas covariáveis. No que se refere à dose atual de TN, foi observada apenas uma associação limítrofe entre mais de 5 noites/quinzena e a obesidade abdominal (OR = 1,55; IC95% 1,01-2,01). Conclusões: O detalhamento da exposição ao TN pode contribuir para subsidiar as estratégias de organização dos horários de trabalho que considerem a possibilidade de limitação do tempo de exposição ao TN.

Impact of Work-Family Conflict on Sleep Complaints: Results From the Longitudinal Study of Adult Health (ELSA-Brasil).

Background: Balancing work and family demands is often a challenge. Family and job responsibilities may affect many aspects of health, and sleep is an important issue. Work-family conflict (WFC) refers to situations where it is difficult to reconcile family and professional demands. WFC can act in two directions: work-to-family conflicts occur when job demands interfere in family life; family-to-work conflicts arise when family demands interfere with job performance. This study evaluated whether dimensions of WFC-time- and strain-related, work-to-family conflict; family-to-work conflict; and lack of time for self-care and leisure due to work and family demands-were cross-sectionally and longitudinally associated with sleep complaints, by gender. Methods: The sample comprised 9,704 active workers (5,057 women and 4,647 men) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Standardized questionnaires were used to collect data. WFC was measured at baseline (2008-2010), and sleep complaints were measured at baseline and approximately 4 years after the first visit (2012-2014). To test the association between the four WFC dimensions and sleep complaints, crude and multiple logistic regressions were conducted to estimate odds ratios and 95% confidence intervals. The adjusted model included age, education, marital status, hours worked and work schedule. Results: Mean age at baseline was 48.2 years. Most participants were educated to University degree level (54.5%), married (68.2%) and worked ≤ 40 h/week (66.1%). At baseline, 48.3% of women and 41.1% of men reported sleep complaints. Frequent WFC was reported by women and men, respectively, as follows: time-related work-to-family conflict (32.6 and 26.1%), strain-related work-to-family conflict (25.3 and 16.0%), family-to-work conflict (6.6 and 7.6%) and lack of time for self-care (35.2 and 24.7%). For both women and men, time- and strain-related work-to-family conflicts and conflicts for lack of time for self-care were cross-sectionally and longitudinally associated with sleep complaints. The findings also suggest a weaker and non-significant association between family-to-work conflict and sleep complaints. Conclusions: The statistically significant associations observed here underline the importance of reducing WFC. In the modern world, both WFC and sleep problems are increasingly recognized as frequent problems that often lead to ill health, thus posing a public health challenge.

Does Work after Retirement Matter? Sleep Features among Workers in the Brazilian Longitudinal Study of Adult Health.

A growing number of people keep working after retirement, a phenomenon known as bridge employment. Sleep features, which are related to morbidity and mortality outcomes, are expected to be influenced by bridge employment or permanent retirement. The objective of this study was to analyze sleep duration and quality of bridge employees and permanent retirees compared to nonretired, i.e., active workers, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (second wave of ELSA-Brasil, 2012-2014) comprised permanently retired (n = 2348), career bridge workers (n = 694), bridge workers in a different place (n = 760), and active workers (n = 6271). The associations of all studied retirement schemes and self-reported sleep quality and duration were estimated through logistic and linear regression analysis. Workers from all studied retirement schemes showed better sleep patterns than active workers. In comparison to active workers, bridge workers who had changed workplace also showed a reduced chance of difficulty falling asleep and too-early awakenings, which were not found among career bridge workers. Bridge employment and permanent retirement were associated with a reduced chance of reporting sleep deficit. Bridge work at a different place rather than staying at the same workplace seems to be favorable for sleep. Further study is needed to explain mechanisms.

On-shift naps are associated with systolic and diastolic blood pressure level among night working nursing professionals.

Few studies have analyzed on-shift naps with regard to shift workers' health. The aim of this study was to examine the association between exposure to night work (intensity and length of exposure to night work) and blood pressure (BP), considering the impact of on-shift naps. A cross-sectional study was carried out at a hospital based on a questionnaire and measurement of BP. The outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), and casual hypertension (HTN), i.e., SBP > 140 mmHg, or DBP > 90 mmHg, or reporting a prescription of antihypertensive medication. The sample comprised 449 fixed 12 h night workers who were (unofficially) allowed to nap during the night shift for up to 3 h. Approximately 42% of the sample reported napping. Among non-nappers (but not among nappers), those exposed to more work nights (≥5/fortnight) showed a DBP that was 3.66 mmHg higher than that of the reference group. The likelihood of casual HTN was more than three-fold greater among non-nappers working more nights/fortnight than among those working fewer nights/fortnight. A similar tendency was observed in a subsample of workers who did not take antihypertensive medication. The results were less consistent regarding length of exposure to night work (in years). A possible explanation is that workers who usually take on-shift naps could experience suppression of the BP increase derived from the many nights worked, while the non-nappers did not experience this suppression. The results may be explained by the relationship between napping, melatonin secretion, and attenuation of circadian misalignment. Napping likely contributes to creating a "physiologically nocturnal environment" that tends to favor the circadian system and, therefore, health. Possible negative effects related to sleep inertia deserve attention. The findings encourage new studies on this topic to improve the management of night work at hospitals in regard to workers' health.

Call me for a conversation and I will enjoy it: analysis of a clinical-institutional experience with the nursing staff of a psychiatric hospital. / Me chama para conversar que eu gosto: análise de experiência clínico-institucional com a enfermagem de um hospital psiquiátrico.

The teams that work in psychiatric wards are direct heirs of a practice marked by the institutionalizing discourse but need to dialogue with the clinic and care advocated by the Psychiatric Reform. This article aims to analyze how mental health work occurs and what are the relationships between the way of working and the health of nursing workers of a university psychiatric hospital. The theoretical reference used was based on the concepts of activity and self body by Schwartz and the dimension of health established by Canguilhem, understanding that health work is also a work of creation, of production of knowledge and use of their capacities and tacit knowledge. BasedonConversations about Work and Health carried out with the nursing teams of the Institute of Psychiatry of Universidade Federal do Rio de Janeiro (IPUB/UFRJ), we address specific topicsrelated to nursing in mental health. We conclude that there is a very heterogeneous panel of speeches, which express the diversity of ways of thinking and acting in nursing work, so that each worker brings to the scene what they believe to be the best for the patient and it is in the name of that care ethicsthat the most dramatic issues revolvewithin a psychiatric ward.

As equipes que atuam em enfermarias psiquiátricas são herdeiras diretas de uma prática marcada pelo discurso institucionalizante, mas precisam dialogar com a clínica e o cuidado preconizados pela Reforma Psiquiátrica. O presente artigo tem por objetivo analisar como se dá o trabalho em saúde mental e quais as relações entre o modo de trabalhar e a saúde de trabalhadores de enfermagem de um hospital psiquiátrico universitário. O referencial teórico utilizado teve como base os conceitos de atividade e corpo-si trazidos por Schwartz e a dimensão da saúde estabelecida por Canguilhem, entendendo que o trabalho em saúde é também um trabalho de criação, de produção de saber e de uso de suas capacidades e saberes tácitos. A partir de "Conversas sobre o Trabalho e a Saúde" realizadas com as equipes das enfermarias do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), abordamos temáticas específicas da enfermagem em saúde mental. Concluímos que existe um painel bastante heterogêneo de falas, que expressam a diversidade de formas de pensar e agir no trabalho da enfermagem, de modo que cada trabalhador traz à cena aquilo que acredita ser o melhor para o paciente e é em nome dessa ética no cuidar que orbitam as questões mais dramáticas dentro de uma enfermaria psiquiátrica.

Association between Presenteeism, Psychosocial Aspects of Work and Common Mental Disorders among Nursing Personnel.

Presenteeism is the term used to describe going in to work even with a health problem. The phenomenon has been identified as one prior factor in sickness absence and, accordingly, the better it is understood, the better will be the prevention strategies. This study aimed to examine the mediating role of presenteeism (the ability to concentrate on work and to complete work despite a health problem) in the association between psychosocial factors at work and common mental disorders (CMD). This cross-sectional study included 1218 nursing personnel at a public hospital in Brazil. Structural equation modelling was performed. The sample comprised mostly women (85.4%), and the mean age was 44.1 (SD = 11.3; range: 24-70) years. Prevalence of presenteeism was 32.8%. Among presenteeist workers (n = 400), a relationship was observed between presenteeism and higher CMD scores. Furthermore, being able to concentrate on work even with a health problem mediated the relationship between social support and CMD and between psychological demands and CMD. Working when sick impairs both the work and the worker's health. Interventions designed to improve working conditions and interpersonal relations can be effective strategies against presenteeism.

Dietary patterns in a nursing team measured by principal component analysis.

OBJECTIVE: To characterize the dietary pattern of nursing professionals at a public hospital in Rio de Janeiro, RJ, Brazil. METHOD: A sectional study with nursing professionals (nurses, technicians and nursing assistants). Two 24-hour food recall records were applied, totaling 459 foods, being reduced to 24 food groups. Food patterns were identified using the Principal Component Analysis technique, followed by orthogonal varimax rotation. A Scree Plot graph indicated three factors to be extracted and loads > +0.30 were adopted to define dietary patterns. RESULTS: A total of 309 professionals participated. The sample consisted of 85.8% of female individuals. The patterns were named "traditional" which included rice (0.747), beans (0.702) and meat (0.713); "healthy": vegetables (0.444), greens (0.450), fruits (0.459), bananas and oranges (0.379), and "snacks": sugar (0.661), bread (0.471), cakes and cookies (0.334), non-alcoholic drinks (0.727). CONCLUSION: The results highlight the "traditional" food pattern of Brazilian food consumption based on the combination of rice, beans and meat. Future studies may investigate the effect of dietary patterns on health outcomes among nursing workers.

Lifetime night work exposure and the risk of type 2 diabetes: results from the longitudinal study of adult health (ELSA-Brasil).

The aim of this research project was to test the effects of lifetime night work exposure on type 2 diabetes (T2DM) risk. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of chronic conditions, such as diabetes and cardiovascular disease. The participants (N = 15105) were recruited (2008-2010) at five public universities and one research institute in six cities in Brazil. Participants from the first wave (2008-2010) were followed up for a mean of 3.8 years. Current analyses comprise 4671 women and 3965 men. Hazard ratios (HR) were estimated using Cox regression models. Crude T2DM incidence rates were 2.26 and 1.44 per 100 person-years, respectively, for women and men who reported ≥ 10 years' working nights. In women, ≥ 10 years of night work was associated with a higher risk of T2DM (HR 1.46 [95% CI: 1.03; 2.08]), after adjusting for age, education, work hours, and BMI. The additional adjustment for physical activity attenuated the association (HR 1.36 [95% CI: 0.94; 1.96]). In men, the results were not statistically significant (HR = 0.65 [95% CI: 0.40; 1.07]). The findings indicate the effects of lifetime night work on T2DM incidence seem to be greater among women than men.

Sex differences in the association between self-reported sleep duration, insomnia symptoms and cardiometabolic risk factors: cross-sectional findings from Brazilian longitudinal study of adult health.

BACKGROUND: The U-shaped associations between sleep durations and cardiometabolic risk factors (glycated hemoglobin levels, obesity, hypertriglyceridemia, hypertension and cholesterol levels) are still inconclusive. Moreover, as sleep is comprised of quantitative and qualitative aspects, exploring both insomnia symptoms and sleep duration are relevant when evaluating the potential effects of sleep problems on health. The aim was to evaluate sex-specific associations between sleep problems and cardiometabolic risk factors. METHODS: This cross-sectional study used data from wave two of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), including 7491 women and 6232 men. Questionnaires were administered to provide information about socioeconomic conditions, lifestyle, and sleep characteristics. A 12-h fasting blood sample was drawn to measure serum cholesterol, triglycerides, and glycated hemoglobin. Blood pressure, weight and height were also measured using standard equipment. Generalized additive models were used to evaluate the curve shape of the relationship between self-reported sleep duration and the outcomes. Logistic regression was performed to investigate the magnitude of the associations of self-reported sleep duration, insomnia symptoms, and short sleep plus insomnia symptoms with cardiometabolic risk factors. RESULTS: For women, self-reported sleep duration and insomnia symptoms (either separately or linked to short sleep duration) were associated with obesity, hypertension and glycated hemoglobin after adjusting for the confounders. The magnitudes of the associations between self-reported short sleep duration plus insomnia symptoms and the outcomes were slightly increased, considering sleep duration or insomnia symptoms separately. For men, both long sleep duration and insomnia symptoms were associated with hypertriglyceridemia after adjusted for the confounders. CONCLUSION: These findings suggest possible sex-specific patterns, since obesity, hypertension and high glycated hemoglobin were associated with self-reported sleep duration and insomnia symptoms in women, but not in men, and reinforce the importance of considering quantitative and qualitative aspects of sleep for the prevention and management of the outcomes.