Occupational health and safety: a study on worker illness

doi:10.21203/rs.3.rs-1522877/v1

Background: This study aimed to evaluate and describe the indicators of occupational health, with a focus on the medical expertise and periodic medical examination.

Methods: This is exploratory-descriptive, cross-sectional, documentary, quantitative, and retrospective research, in the historical series: 2011 to 2015.

Results: The number of lost days of work per worker and the frequency of licenses increased despite the decrease in the Absenteeism Duration Index and stabilization of the Frequency of Medical Workers. As for the adhesion of the workers to the Periodic Medical Examinations, it was decreasing, with a higher percentage in the year 2012 (35.3%). During the analyzed period, 5,186 workers performed the Periodic Medical Examination, and the majority (60.6%) presented non-ideal weight, 41.1% were sedentary, 33.2% had dyslipidemia, 29.0% were alcoholic, 3.2% were smokers, 5.9% had diabetics, and 16.4% reported high noise in the workplace, 27.8% inadequate lighting and 35.9% inadequate work furniture.

Conclusions: The results highlight the need to maintain and strengthen the Worker Health and Safety Policy with emphasis on surveillance, aiming at the promotion and protection of the health of the workers, based on the elaboration of the epidemiological profile of health and, consequently, the implementation of positive impact strategies.

occupational health

occupational health services

surveillance

workers health

Historically, in Brazil, Occupational Health and Safety (HOS) is strongly associated with the political-social and economic evolution of the country and is presented as the achievement of rights resulting from claims and struggles of the workers. Work is one of the determinants that most impact man’s conditions, quality of life, and health.

Working is essential for human beings since it is the way in which respect, integration, sociability, recognition, and bonds of friendship are obtained. On the other hand, the living conditions of Brazilian workers are aggravated by the alternation of stages of growth and accelerated industrialization with moments of recession, resulting in the government’s adoption of adjustment measures and financial cuts in social policies, such as education, health, safety, transportation, housing, and work, among others [1, 2].

Nowadays, the epidemiological profile of workers' morbidity and mortality in Brazil is characterized by the coexistence of diseases that have an intrinsic relationship with working conditions: diseases related to work and typical work accidents, which have their frequency, appearance, and severity modified by the activity. Added to this reality are diseases common to the population as a whole, which have no etiological relationship with work [3].

Health Promotion and Surveillance refer to the pillar of the Occupational Safety and Health Care Policy (PASS, in Portuguese) that encompasses quality of life and vigilance actions in the environmental and work processes. Standing out among these are the institution of guidelines and programs in the area of mental health and occupational diseases of higher prevalence; the mandatory provision of Periodic Medical Examinations (PME) for all employees; the training in health and safety at work; the creation of an Internal Committee on Health and Safety at Work and a survey of environmental risks, with a stimulus to the active participation of employees in processes involving their health [4, 5].

From this perspective, this study aimed to evaluate and describe occupational health indicators focusing on the Official Health Expertise and PME of federal public servants.

This is a cross-sectional, retrospective study with a quantitative approach, where secondary data were obtained regarding PME and official health expertise, specifically the SIAPE HEALTH module of federal public servants of a public institution of higher education in Brazil.

The period chosen for the study was from 2011 to 2015. The preference for this time interval was justified by the fact that the year 2011 marks the beginning of the PME through the computerized system SIAPE HEALTH, and the end of the study period in 2015 characterizes five complete years and the historical nature of epidemiological studies.

The official health expertise and the PME were used as a dependent variable. For each indicator, independent variables were selected: a) Official Health Expertise: gender, age, position, number of active statutory employees away, number of days of leave and number of days away; and b) PME: Gender, age, position, ethnicity, smoking, physical activity, BMI, hypertension, diabetes mellitus, dyslipidemia, spinal pain, inadequate furniture, inadequate lighting, likes what you do, good relationship with the boss, good relationship with colleagues and fast pace. In addition, the following indicators were observed: Absence Severity Index (IGA), Medical Frequency Leave (FML), Frequency of Workers on Sick Leave (FWML) and Absenteeism Duration Index (IDA).

The data were analyzed using the Statistical Package for Social Science (SPSS), version 22.0, serial number 10101141047. For this, we used the relative and absolute frequency distribution, the measures of central tendency and dispersion and the student t test for the quantitative variables. In addition, chi-square test and odds ratio were used, with a 95% confidence interval and significance level of 5% (p < 0.05) for all tests.

To calculate the degree of absenteeism, four indicators were used: IGA, FML, IDA and FWML, as recommended by the Permanent Commission and International Association on Occupational Health [6] and the authors Hensing et al. [7].

Concerning the ethical aspects, the project was submitted to the Research Ethics Committee where it was appraised and subsequently approved under opinion no. 1.707.691, from the principles of ethical and legal aspects that govern scientific research on human beings, as recommended by Resolution no. 466/12 [8], and the principles expressed in the Declaration of Helsinki.

The results showed that there were 4,293 (35%) departures from administrative records and 7,946 (65%) absences from work granted by expert examination.

Data regarding the sociodemographic characteristics of the studied population revealed that 67.9% (8,312) of the departures occurred in female workers and, for males, 32.1% (3,927). Regarding the age group, 34.6% (4,234) of the licenses were approved for workers between 51 and 60 years old, 24.0% (2,934) from 41 to 50 years, 19.2% (2,355) from 31 to 40 years, 11.8% (1,449) from 18 to 30 years, and 10.4% (1,267) over 60 years. In relation to the post variable, the number of workers occupying the position of administrative technician in education levels C and D predominated, with a prevalence of 62.2% (4,941), while 23.8% (1,889) workers were in higher-level positions.

Figure 1 shows the absence of workers at work due to health care in the period from 2011 to 2015. It is noteworthy that there is an increase between 2011 and 2013, when there is a peak of 7.1 days not worked. The following years show an oscillation, but with a tendency for growth.

In this sense, it is also relevant to present the individual absence duration, according to the cause of illness, in order to facilitate the adoption of specific measures focused on the pathologies with the greatest impact on lost days of work. Figure 2 shows the IDA according to each International Classification of Diseases (CID), 10 chapter, and it can be seen that the highest indexes refer to neoplasms (45.64), mental disorders (32.40), congenital malformations (27.00), and diseases of the circulatory system (23.96), respectively. These findings reveal that absences of longer duration were caused by pathologies of a chronic non-transmissible nature, except for causes of absences in chapter XVII of CID-10.

Figure 3 presents the results of this study regarding the adherence of the workers to the Periodic Medical Exam, considering the historical series from 2011 to 2015, when an average of 4,362 workers were called. It can be observed that the call-up ratio increased by 42.0% from 2011 (0.49) to 2012 (0.91). From the year 2013 (0.84), there were oscillations characterized by drop and growth in the calls.

As for non-adherence, in 2012, there was a decrease, and in 2013 (0.78), 2014 (0.8), and 2015 (0.86), there was an increase in the results, characterizing a relevant increase of 15. 0% between the years of 2011 (0.71) and 2015 (0.86).

With regard to PME membership, it is clear that growth occurred only in 2012 (0.35). Then, the index decreased throughout the series, namely: 2013 (0.22), 2014 (0.2) and 2015 (0.14), which explains the non-adherence data being an unfavorable reality in relation to the PME recommendation. This may be related to factors such as excessive work activities of workers, periodic examinations performed through private health insurance, and also to the lack of recognition of the importance of PME by workers.

The coverage ratio of the PME increased significantly in the year 2012 (0.4), showing a growth of 26.0% in relation to 2011. Thereafter, the ratio decreased, with an average of 0.26 between the years of 2013 (0.33), 2014 (0.26) and 2015 (0.2), as shown in Fig. 3.

In the list of risk factors, health indicators of different epidemiological natures were analyzed. Among them, those related to cardiovascular diseases and occupational risk factors, such as the existence of inadequate work furniture and accelerated work rhythm, are presented in Tables 1 and 2.

In the list of chronic pathologies covering categories II and III of the Schilling classification, the most common causes of morbidity among workers are: Systemic Arterial Hypertension (SAH), chronic respiratory diseases, diseases of the locomotor system and mental disorders. These are pathologies of multiple etiology in which work is considered a risk factor associated with the increased probability of occurrence of these diseases [9]. Thus, the present study highlights cardiovascular diseases, especially SAH.

Table 1 shows the distribution of the aforementioned risk factors associated with SAH. It is pointed out that 60.6% (3,143) of the workers that performed the EMP presented non-ideal weight; 58.7% (3,044) practiced some type of physical activity; 70.8% (3,670) denied alcohol use; 96.5% (5.005) did not smoke; 93.9% (4,870) did not have diabetes mellitus (DM); and 66.6% (3,453) did not have dyslipidemia. The association between hypertension and all correlated variables was significant at p < 0.001.

Table 1

Risk factors associated with hypertension, 2011–2015. Natal/RN, 2017.
	Total (n = 5186)	Frequency (%)	Raw OR (IC95%)	p
BMI
Non-ideal weight	3143	60.6	0.015 (0.011–0.019)	< 0.001
Ideal Weight	2042	39.4	0.015 (0.011–0.019)	< 0.001
Sedentarism
Sedentary	2134	41.1	0;001 (0.001–0.002)	< 0.001
Non-sedentary	3044	58.7	0;001 (0.001–0.002)	< 0.001
Etilism
Yes	1504	29.0	0.646 (0.631–0.662)	< 0.001
No	3670	70.8	0.646 (0.631–0.662)	< 0.001
Smoking
Yes	167	3.5	0.740 (0.728–0.752)	< 0.001
No	5005	96.5	0.740 (0.728–0.752)	< 0.001
Diabetes
Yes	305	5.9	1.085 (1.075–1.095)	< 0.001
No	4870	93.9	1.085 (1.075–1.095)	< 0.001
Dyslipidemia
Yes	1722	33.2	1.801 (1.751–1.853)	< 0.001
No	3453	66.6	1.801 (1.751–1.853)	< 0.001
OR: odds ratio; p: p value

Table 2

Risk factors associated with fast pace of work, 2011–2015, Natal/RN, Brazil, 2017.
	Total (n = 5186)	Frequency (%)	Raw OR (IC95%)	p
Good relationship with colleagues
Yes	4994	96.3	0.764 (0.571–1.022)	0.080
No	190	3.7	0.764 (0.571–1.022)	0.080
Good relationship with bosses
Yes	4957	95.6	0.724 (0.555–0.945)	0.021
No	227	4.4	0.724 (0.555–0.945)	0.021
Inadequate furniture
Yes	1862	35.9	1.558 (1.387–1.750)	< 0.001
No	3115	60.1	1.558 (1.387–1.750)	< 0.001
Loud Noise
Yes	852	16.4	1.994 (1.719–2.313)	< 0.001
No	4332	83.5	1.994 (1.719–2.313)
Inadequate lighting
Yes	1442	27.8	1.659 (1.466–1.877)	< 0.001
No	3536	68.2	1.659 (1.466–1.877)
Likes what do
Yes	5055	97.5	1.040 (0.725–1.490)	0.856
No	129	2.5	1.040 (0.725–1.490)	0.856
OR: odds ratio; p: p value

In Table 2, it is possible to observe that 35.9% of the interviewed workers do not have adequate for their activities. In addition, 16.4% report loud noise in the workplace and 27.8% do not have adequate lighting. Social factors were also obtained, noting that 3.7% of the workers surveyed say they do not have a good relationship with their co-workers, while 4.4% do not have a good relationship with their boss and 2.5% show dissatisfaction with what they are doing.

It should be noted that absenteeism is a term used to denote the employee's absence from work [10]. The International Organization of Work (OIT) defines it as the period of absence of work that is accepted as attributable to an incapacity of the individual, except for that derived from normal pregnancy or prison [11].

According to the report of the National Audit Office [12], in the city of Guernsey, United Kingdom, approximately 3.8% of working time was lost due to illness, and civil workers became sick for an average of 8.7 days in 2005. In Chile, health workers belong to the category that has the highest rates of disability due to illness, with 14.3 days of absence per worker per year; unlike the university workers, who present 6 days of work lost per year, similar to the results of this research [13]. These findings highlight the data shown in Fig. 1.

Studies found an average of 7.5 lost days of work per year per worker in the nursing area of a university hospital in Brazil [14]. Santos and Mattos [15] observed 9.3 days of absenteeism due to disease for each municipal worker of the city of Porto Alegre in 2005. The studies reported 9.1 and 10.3 days of absence due to illness for each public worker of the municipalities of Goiânia and São Paulo, respectively [16, 17].

Furthermore, the implementation of strategies to reduce absenteeism is a great challenge for employers, and it is necessary to analyze the events in the workplace in order to delineate situational diagnoses and guarantee actions to promote worker health. For the authors, the change in the epidemiological profile of illness and the increase in the prevalence of chronic diseases, as shown in Fig. 2, reveal concern for the global scenario regarding the impact of these diseases on workers' health, due to the growth in the number of lost workdays [18].

The epidemiological profile of morbidity and mortality in Brazilian workers is characterized by the coexistence of diseases that have an intrinsic relation with working conditions, and in addition, diseases common to the population as a whole are observed, which are not etiologically related to the work [3]. In this reality, it is important to emphasize the importance of the employees performing the Periodic Medical Examination (PME), for the prevention and/or possible early detection of the pathologies that generate the greatest impact on the lost days of work, highlighting the neoplasms [19].

The importance of performing the PME in the screening of risk factors for chronic non-communicable diseases, such as dyslipidemia, sedentary lifestyle, obesity, arterial hypertension, diabetes mellitus, alcoholism, and smoking is highlighted. In addition, through the PME, the workers will be guided and sent to participate in the various health promotion programs offered by the institution. Through these strategies, it is possible to reduce the prevalence of diseases of the circulatory system, another important cause of absenteeism, as shown in Fig. 2.

As for Fig. 3, which shows data on the PME, despite weaknesses, it is evident that the most satisfactory results of PME adherence occurred in the year 2012, a time when workers composed the Integrated Subsystem Unit (SIASS in Portuguese), as well as the constant discussion in forums, national meetings, and events related to the PASS, in a context of articulation in defense of the strengthening of the actions of attention to workers' health, which may have contributed to the results [20–22].

On the other hand, the situational diagnosis of low PME adherence throughout the historical series was possibly influenced by the recent history of PASS construction and the negative impact of the lack of structuring, planning, and evaluation of the actions. Plus, the largest investments and training, by the Ministry of Planning of Brazil, were related to the expert area which reflects as the main activity of the PASS [4].

The implementation of actions of health surveillance and promotion are major challenges for the consolidation of SIASS, since it is still a recent practice to promote health in public sector workplaces. It is necessary to elaborate indicators to support the actions and allow the evaluation of the results, considering that the information generated through indicators consolidates the control and planning of the organizational processes, as well as supports the decision making [22, 23].

In order to meet the proposed objective, there was the occurrence of neoplasms, mental disorders, and diseases of the circulatory system in terms of duration of absenteeism (IDA), which were the causes of the absences with a longer duration, which ratifies the epidemiological importance and the impact of non-communicable chronic diseases on workers' health. The gravity index of absenteeism revealed that the number of lost days of work per year per worker increased over the historical series, as well as the frequency of absences.

With regard to the epidemiological profile of the employees who underwent the PME throughout the historical series, it was possible to identify a significant prevalence of overweight in the population. The working conditions were considered satisfactory in the perception of the workers. It should be noted that this study presented some limitations, since the use of self-reported data by the workers may underestimate or overestimate the presented results.

Also observed through this study is the need to maintain and strengthen the PASS with emphasis on surveillance, aiming at the promotion and protection of the health of the workers, based on the elaboration of the epidemiological health profile and, consequently, the implementation of strategies of positive impact for HOS.

CID: Classification of Diseases; DM: diabetes mellitus; FML: Medical Frequency Leave; FWML: Frequency of Workers on Sick Leave; HOS: Occupational Health and Safety; IDA: Absenteeism Duration Index; IGA: Absence Severity Index; OIT: International Organization of Work; PASS: Occupational Safety and Health Care Policy; PME: Periodic Medical Examinations; SAH: Systemic Arterial Hypertension; SIASS: Integrated Subsystem Unit; SPSS: Statistical Package for Social Science.

Ethics approval and consent to participate

This project was submitted to the Research Ethics Committee where it was appraised and subsequently approved under opinion no. 1.707.691, from the principles of ethical and legal aspects that govern scientific research on human beings, as recommended by Resolution no. 466/12 [8], and the principles expressed in the Declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and materials

All data used in this study are included in this article and its Additional files.

Competing interests

The authors have declared that no competing interests exist.

Funding

This study will be partially funded by the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Financial Code 001. Funders will have no role in the study design, data collection and analysis, publication decision or preparation of the manuscript.

Authors’ contributions

All authors conceptualized the study, gathered, analyzed and interpreted the data. LM wrote the draft of this manuscript. All authors visualized the data in figures. FB was responsible for the project administration. All authors contributed in further revisions and editing of this project. All mentioned authors meet the authorship criteria, read and approved the final manuscript.

Acknowledgements

Not applicable.

Medeiros Júnior A. Representação social sobre o acidente de trabalho na área da saúde. 172f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Ciências da Saúde, Natal, 2005. Accessed 10 Oct 2016.
Costa D, et al. Saúde do Trabalhador no SUS: desafios para uma política pública. Revista Brasileira de Saúde Ocupacional, 2013, 38 (127): 11–21. Available from: https://doi.org/10.1590/S0303-76572013000100003. Accessed 10 Oct 2016.
Dias EC, Ribeiro EEN (Cord.). Construindo ações de Saúde do Trabalhador no âmbito das superintendências e gerências regionais de saúde. Belo Horizonte: Secretaria do Estado da Saúde de Minas Gerais, 2011. Available from: https://www.nescon.medicina.ufmg.br/biblioteca/imagem/2839.pdf. Accessed 10 Oct 2016.
Bizarria FPA, et al. Ações públicas voltadas para a promoção da saúde do trabalhador: Análise da política destinada à saúde do servidor público federal. Revista Eletrônica Gestão e Saúde, 2014, 5(3):2019-30. Available from: https://periodicos.unb.br/index.php/rgs/article/view/669/565. Accessed 10 Oct 2016.
Carneiro SAM. Saúde do trabalhador público: questão para a gestão de pessoas – a experiência na Prefeitura de São Paulo. Revista do Serviço Público, 2006, 57(1): 23–49. Available from: https://doi.org/10.21874/rsp.v57i1.188. Accessed 10 Oct 2016.
Permanent Commission and International Association on Occupational Health. Subcommittee on absenteeism: draft recommendations. British Journal of Industrial Medicine. 1973, 30(4): 402-3. Available from: http://dx.doi.org/10.1136/oem.30.4.402. Accessed 10 Oct 2016.
Hensing G, et al. How to measure sickness absence? Literature review and suggestion of five basic measures. Scandinavian Journal of Social Medicine, 1998, 26(2): 133 – 44. Available from: https://doi.org/10.1177/14034948980260020201. Accessed 10 Oct 2016.
Ministério da Saúde (BR). Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Aprova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Brasília: Ministério da Saúde, 2012. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html. Accessed 10 Oct 2016.
Mendes R. O impacto dos efeitos da ocupação sobre a saúde de trabalhadores: I. morbidade. Revista de Saúde Pública, 1988, 22 (4): 311–326. Available from: https://doi.org/10.1590/S0034-89101988000400007. Accessed 10 Oct 2016.
Oenning NSX, Carvalho FM, Lima VMC. Indicadores de absenteísmo e diagnósticos associados às licenças médicas de trabalhadores da área de serviços de uma indústria de petróleo. Revista Brasileira de Saúde Ocupacional, 2012, 37(125): 150 – 58. Available from: https://doi.org/10.1590/S0303-76572012000100018. Accessed 10 Oct 2016.
Organización Internacional del Trabajo (OIT). Absentismo: causa y control. Enciclopedia de salud y seguridad en el trabajo. Madrid: OIT, 1989, 1:pp. 5–12. Accessed 10 Oct 2016.
National Audite Office. Managing Sickness Absencein the States of Guernsey. Report by the national audit office for the public accounts committee. 2006. Available from: https://gov.gg/CHttpHandler.ashx?id=5139&p=0. Accessed 10 Oct 2016.
Mesa MFR, Kaempffer RAM. 30 años de estudio sobre ausentismo laboral en Chile: una perspectiva por tipos de empresas. Revista Médica de Chile, 2004, 132(9):1100-08. Available from: http://dx.doi.org/10.4067/S0034-98872004000900012. Accessed 10 Oct 2016.
Silva DMPP, Marziale MHP. Absenteísmo de trabalhadores de enfermagem em um hospital universitário. Revista Latino-americana de Enfermagem, 2000, 8(5): 44–51. Available from: https://doi.org/10.1590/S0104-11692000000500007. Accessed 10 Oct 2016.
Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Revista Brasileira de Saúde Ocupacional, 2010, 35(121): 148 – 56. Available from: https://doi.org/10.1590/S0303-76572010000100016. Accessed 10 Oct 2016.
Leão ALM, et al. Absenteísmo-doença no serviço público municipal de Goiânia. Revista Brasileira de Epidemiologia, 2015, 18(1): 262 – 77. Available from: https://doi.org/10.1590/1980-5497201500010020. Accessed 10 Oct 2016.
Sala A, et al. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cadernos de Saúde Pública, 2009, 25(10): 2168-78. Available from: https://doi.org/10.1590/S0102-311X2009001000008. Accessed 10 Oct 2016.
Andrade TB, et al. Prevalência de absenteísmo entre trabalhadores do serviço público. Scientia Medica, 2008, 18(4): 166 – 71. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-503535. Accessed 10 Oct 2016.
Instituto Nacional de Câncer (INCA). Coordenação de Prevenção e Vigilância. Estimativa 2014: Incidência de Câncer no Brasil. Rio de Janeiro: INCA; 2014. Available from: http://www.inca.gov.br/bvscontrolecancer/publicacoes/Estimativa_2014.pdf. Accessed 10 Oct 2016.
Universidade Federal do Rio Grande do Norte. Pró-Reitoria de Gestão de Pessoas. Subsistema Integrado de Atenção à Saúde do Servidor. Relatório Anual 2013 de gestão da COVEPS/UFRN. 2013. Available from: https://ufrn.br/resources/documentos/relatoriodegestao/RelatoriodeGestao2013.pdf. Accessed 10 Oct 2016.
Zanin FC, et al. Política de atenção à saúde e segurança do trabalho do servidor público no Brasil. Associação dos Professores da Universidade Federal do Paraná - Seção Sindical do ANDES-SN (APUFPR-SSind), 2015. Available from: http://portal.andes.org.br/imprensa/publicacoes/imp-pub-226911099.pdf. Accessed 10 Oct 2016.
http://www.uff.br/sites/default/files/servicos/legislacao/poltica_de_aten_o_siass.pdf. Accessed 10 Oct 2016.
Assunção AÁ. (Org.). Promoção e vigilância em saúde: guia para as ações no setor público federal. 1.ed. Belo Horizonte: [s.n.]. 2012. Available from: https://www.medicina.ufmg.br/wp-content/uploads/sites/79/2018/07/SIASS_promocao-e-vigilancia-em-saude.pdf. Accessed 10 Oct 2016.

Occupational health and safety: a study on worker illness

Status:

Version 1

Abstract

Figures

Introduction

Materials And Methods

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Status:

Version 1