Stressrelaterad ohälsa är en av de vanligaste sjukskrivningsorsakerna i västvärlden. I Sverige diagnostiseras vanligen långvarig stressrelaterad ohälsa som utmattningssyndrom. Vid utmattningssyndrom är kognitiva besvär ett framträdande symptom som kan vara långvarigt.  Kognitiv nedsättning vid utmattningssyndrom har tidigare fastställts utifrån en normativ ansats, vilket innebär att jämförelse görs med en icke-klinisk normgrupp. En annan metod är att använda en ideografisk ansats, vilket innebär att jämförelse görs med personens premorbida kognitiva nivå. Syftet med denna studie var att undersöka hur stor andel av patienter med utmattningssyndrom som uppvisar kognitiv nedsättning, utifrån en normativ respektive ideografisk ansats, samt hur kognitiv funktion relaterar till arbetsförmåga i patientgruppen. Data i denna studie utgörs av pretestmätningen från RECO-studien i Västerbotten. Patientgruppen bestod av 127 deltagare med utmattningssyndrom och normgruppen av 60 friska deltagare. Samtliga genomförde ett kognitivt testbatteri. Data analyserades med hjälp av olika gränsvärden för att undersöka frekvensen och andelen procent kognitivt nedsatta. Resultatet visade att andelen som uppvisade kognitiv nedsättning ökade då ideografisk ansats användes, men att majoriteten, oavsett ansats, var kognitivt intakta. Vidare sågs signifikanta samband mellan självskattad arbetsförmåga och kognitiv funktion utifrån ideografisk ansats, men inte utifrån normativ ansats. Dessa resultat tyder på att premorbid kognitiv nivå kan vara viktigt att ta hänsyn till vid bedömning av kognitiv funktion vid utmattningssyndrom. Vidare forskning inom området behövs, exempelvis där en större normgrupp används. / Stress-related illness is one of the most common sick leave causes in the Western world. In Sweden long term stress-related illness is usually diagnosed as exhaustion disorder. In exhaustion disorder, cognitive deficits are a prominent symptom that can be long-lasting. Cognitive impairment in exhaustion disorder has previously been determined based on a normative approach, which means that comparison is made with a non-clinical norm group. Another method is to use an idiographic approach, which means that comparison is made with the person's premorbid cognitive level. The aim of this study was to investigate the proportion of patients with exhaustion disorder who display cognitive impairment, based on both normative and idiographic approaches, and how cognitive function relates to work ability in the patient group. The data in this study consists of the pretest measurement from the RECO study in Västerbotten. The patient group consisted of 127 participants with exhaustion disorder and the norm group of 60 healthy participants. All participants completed a cognitive test battery. The data were analysed using different cut-offs ​​to examine the frequency and percentage of cognitively impaired. The results showed that the proportion who showed cognitive impairment increased when the idiographic approach was used, but that the majority, regardless of the approach, were cognitively intact. Furthermore, significant relationships were seen between self-estimated work ability and cognitive function based on an idiographic approach, but not based on a normative approach. These results suggest that premorbid cognitive level may be important to consider when assessing cognitive function in exhaustion disorder. Further research in the area is needed, for example where a larger norm group is used.

En stor del av den arbetsföra befolkningen drabbas någon gång under sitt arbetsliv av hälsobesvär. För att möjliggöra ett hållbart arbetsliv finns det lagstadgade krav på arbetsgivaren att genomföra arbetsanpassningar, för att motverka hälsobesvär och för att sjukskrivna medarbetare ska kunna återgå i arbetet. Dock omfattar forskningen sällan HR-funktionen och därför har vi valt att undersöka hur individer i en HR-funktion upplever sin roll vid arbetsanpassning för sjukrivna medarbetare. Studien är avgränsad till att endast omfatta arbetsanpassning vid återgång i arbete. Med en kvalitativ metod har åtta intervjuer genomförts med informanter i en HR-funktion. Resultatet i studien visar att individer i HR-funktionen är en högst delaktig och viktig aktör med en samordnande funktion. / A large part of the workforce suffers from health issues at some point during their work life. As a result, there are statutory requirements for the employer to carry out work adjustments, partly to counteract health problems and so that employees on sick leave can return to work. However, research rarely covers the HR-function and therefore we have chosen to investigate how individuals in the HR-function perceives its role when work is modified for employees on sick leave. This study is limited to modified work when an employee on sick leave will return to work. Through a qualitative method were eight interviews conducted with informants in an HR-function. The results of the study show that individuals in an HR-function is a highly involved and important actor with a coordinated function.

Objetivos. Este estudo teve como objetivos avaliar a capacidade para o trabalho, a estrutura temporal do sono, da 6-sulfatoximelatonina e do cortisol em trabalhadores em turnos da área de enfermagem. Métodos. Foram realizados dois estudos. Um estudo transversal para analisar a capacidade para o trabalho e o envelhecimento funcional precoce, através de questionários de condições de vida e trabalho e sintomas de saúde, da qual participaram 696 profissionais da área de enfermagem. E um cronobiológico com 19 trabalhadores do sexo feminino. Neste foram avaliados: o ciclo vigília-sono, através de actígrafos e protocolos diários de atividades; as concentrações da 6-sulfatoximelatonina e do cortisol; e a ritmicidade circadiana (avaliada utilizando a metodologia do ajuste dos parâmetros ritmométricos pela curva cosseno, método cosinor). Foi realizada coleta de urina em dois períodos de 4 dias consecutivos (com dias de trabalho e de folga,) para os trabalhadores noturnos, submetidos a turnos de 12 horas seguidas de 36 horas de descanso; e em um período de 8 dias consecutivos para os trabalhadores diurnos (6 dias de trabalho e 2 de folga). O grupo de 19 pessoas também foi analisado segundo a maior e menor tolerância ao trabalho em turnos. A tolerância ao trabalho em turnos foi avaliada utilizando 9 indicadores de saúde (escore de sonolência e fadiga, escore de concentração e atenção, escore da fadiga projetada sobre o corpo, escore geral da fadiga, SRQ20, escore de insônia, sonolência no trabalho, escore de problemas de sono) e disponibilidade do tempo livre. Resultados. A idade média da população era de 34,9 anos (dp + 9,5 anos), e esta era predominantemente feminina (87,8%), sendo que 40,6% começou a trabalhar antes dos 18 anos. As variáveis ligadas à capacidade para o trabalho inadequada foram: 1) sócio-demográficas: ter a responsabilidade pela renda familiar sozinho (OR=1,922), ter filhos ou menores sob a guarda (OR=1,558) e ter menos de 40 anos (OR=1,400). 2) ligadas ao trabalho: referir desconforto térmico (OR=1,548), referir ter sofrido abuso verbal pelo menos duas vezes no último ano (OR=1,670). 3) variáveis ligadas à saúde foram referir obesidade (OR=2,714), doenças de sono (OR=1,681), e fadiga (OR>3,771). No segundo estudo, as trabalhadoras noturnas apresentaram maior duração, e também melhor qualidade de sono noturno. Estas também referiram níveis de alerta significantemente mais elevados quando puderam cochilar durante o turno de trabalho. Foi encontrada uma grande variabilidade nos parâmetros rítmicos ao longo dos dias de trabalho e de folga. As concentrações médias de 6-sulfatoximelatonina e cortisol das trabalhadoras noturnas foram estatisticamente menores do que as encontradas em trabalhadores diurnos (p<0,001). Quando as trabalhadoras foram classificadas como mais e menos tolerantes ao trabalho em turnos, as trabalhadoras noturnas menos tolerantes referiram menor qualidade de sono e menores níveis de alerta. As concentrações médias de 6-sulfatoximelatonina e cortisol ao longo dos dias de trabalho e de folga variaram de modo distinto nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos. Conclusões. A capacidade de trabalho inadequada é resultado da associação de variáveis de múltiplas naturezas, tais como condições de vida e trabalho, hábitos e estilos de vida e à organização do trabalho. O cochilo durante o turno noturno de trabalho mostrou ser efetivo na manutenção dos níveis de alerta durante o trabalho noturno. As trabalhadoras noturnas apresentaram menores concentrações médias de 6-sulfatoximelatonina quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à exposição à luz durante o turno noturno de trabalho. As trabalhadoras noturnas apresentaram menores concentrações de cortisol quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à maior fadiga referida por estas trabalhadoras. Os ritmos de 6-sulfatoximelatonina e cortisol têm comportamentos diferentes nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos, mas nenhum padrão pode ser definido, uma vez que existe uma grande variabilidade individual. / Objectives. The aim of this study was to evaluate work ability and biological rhythms of health care shiftworkers. Methods. To evaluate the work ability it was designed an epidemiological approach using a comprehensive questionnaire which included working and living conditions and health symptoms. 696 health care shiftworkers participated in this study. A sub sample of 19 female registered nurses and nurse aides/technicians were invited and agreed to participate in the chronobiological evaluation. Workers answered daily logs and wore actigraphs (Ambulatory Monitoring) to monitor activity and evaluate rest and waking periods along data collection. Urine samples were collected and voided volumes were measured during two periods of four consecutive days (working days and days off) of night workers, submitted to 12 hour night shifts followed by 36 hour off, and during one period of 8 consecutive days (six working days and two days off). It was also evaluated the 6-sulphatoxymelatonin and cortisol concentration, and their circadian rhythmicity using the Cosinor method. These 19 nurses were evaluated as more or less tolerant to shiftwork. The tolerance to shiftwork was evaluated by 9 health scores(dull and sleepy score, decline of working motivation, projection of fatigue to some parts of the body, general fatigue score, Self-Report Questionnaire (SRQ-20 score), insomnia score, sleepiness score, sleep disturbances score) and availability of free time. Results. Mean age of the respondents was 34.9 years, most of them female (87.8%) and 40.6% entered labor force before 18 years old. The socio-demographic factors associated to inadequate work ability were: income responsibility - sole breadwinner (OR=1.922), raising kids (OR=1.558), age group (under 40 years old) (OR=1,400). Factors associated with working conditions were: thermal discomfort (OR=1.548), and verbal abuse (OR=1.670). Obesity (OR=2.14), sleep problems (OR=1.681) and fatigue (OR>3.771) were health outcomes associated to inadequate work ability. Night workers showed longer mean sleep duration and referred better sleep quality to nocturnal sleep. These workers also reported higher alertness level when they nap during the night shift. Mean concentration of 6-sulphatoxymelatonin and cortisol among night workers were significantly lower than the day workers concentrations (p<0,001). When workers were classified into more and less tolerant to shiftwork, the less tolerant night workers referred worst sleep quality and lower alertness levels. The mean concentration of 6-sulphatoxymelatonin and cortisol, during working days and days off, showed distinct behavior in the two groups. It was found a great variability of the rhythmic parameters during working days and days off. Conclusions. Inadequate work ability was associated with a number of variables present at work and living conditions. Strategy of taking naps during night work was effective to maintain the alertness levels during work. Night workers 6-sulphatoxymelatonin mean concentrations were lower than day workers concentration. This might be related to light exposure during the night shift. The higher reported fatigue by these workers might explain the lower cortisol mean concentration presented by night workers when compared to day workers. The rhythms of 6-sulphatoxymelatonin and cortisol showed different behaviors when compared more and less tolerant workers, but any standard behavior could be observed since there is a great individual variability.

Este estudo pretendeu colaborar com a análise das relações entre satisfação com aspectos psicossociais no trabalho e saúde do trabalhador. Método: Realizou-se estudo transversal junto aos empregados de uma empresa de auto-gestão em saúde e previdência privada em São Paulo. O estudo incluiu três etapas: (a) 42 entrevistas exploratórias para verificar a semelhança entre referências da literatura com percepções dos empregados quanto ao conceito e às fontes de satisfação no trabalho; (b) questionários auto-aplicados respondidos por 224 empregados para análise das associações entre satisfação no trabalho e saúde: a escala Satisfação no Trabalho do Occupational Stress Indicator, o SF-36, e o Índice de Capacidade para o Trabalho; e (c) análise ergonômica de 43 postos de trabalho por meio da técnica AET - Análise Ergonômica do Trabalho de Rohmert e Landau, visando identificar aspectos da organização do trabalho interferindo na satisfação no trabalho. Resultados: As percepções dos empregados quanto ao conceito e fontes de satisfação no trabalho foram semelhantes aos conhecimentos da literatura adotada como referencial teórico. Satisfação no trabalho esteve associada com aspectos da saúde mental e com capacidade para o trabalho e estas associações ocorrem independentes de aspectos sócio-demográficos e funcionais. As condições e a organização do trabalho apresentaram características que podem configurar elevada carga mental no trabalho. Conclusões: Foram discutidas as relações entre satisfação no trabalho e saúde do trabalhdor e feitas considerações referentes a mudanças visando melhorias quanto aos aspectos psicossociais no trabalho, favorecendo a satisfação no trabalho e a saúde do trabalhador. / This study intends to collaborate with the analysis of the relationships among satisfaction with psychosocial factors at work and the worker's health. Methods: It took place a cross-sectional study close to the employees of a self-administration company in health and providence private. The study included three stages: (a) 42 exploratory interviews to verify the similarity among references of the literature with the employees' perceptions about the concept and sources of job satisfaction; (b) self-applied questionnaires answered by 224 employees for analysis of the associations among job satisfaction and health: the Job Satisfaction scale of the Occupational Stress Indicator – OSI, the SF-36, and the Work Ability Index; and (c) ergonomic analysis of 43 workstations by AET technique - Job Ergonomics Analysis of Rohmert and Landau, looking for identify spectos of work organization interfering on the job satisfaction. Results: The employees’ perceptions about the concept and sources of job satisfaction are similar to the knowledge of the literature adopted as theoretical framework. Job satisfaction was associated with aspects of the workers' mental health, and with work ability, and this associations happens independent of social-demographic and functional aspects. The job conditions and organization presented characteristics that can configure high mental load at the work. Conclusions: the relationships among job satisfaction and worker’s health were discussed, and made considerations regarding changes seeking improvements of the psychosical aspects at work, favoring job satisfaction and worker’s health.

Introdução – A capacidade para o trabalho é influenciada por vários fatores, incluindo a condição de saúde, características sócio-demográficas, estilo de vida e fatores relacionados ao trabalho. Objetivo – Analisar os fatores associados à capacidade para o trabalho em uma população de eletricitários. Métodos – Estudo transversal onde foram analisados 475 trabalhadores, voluntários, de uma empresa privada no setor eletricitário do Estado de São Paulo, Brasil. Os dados foram coletados por meio de questionários auto-preenchidos (Índice de Capacidade para o Trabalho - ICT, Escala Estresse no Trabalho - EET, Medical Outcomes Study 36 – Item short form health survey – SF-36, Questionário de Baecke, Questionário de tolerância de Fagerström e Questionário AUDIT). A relação entre as variáveis foi analisada por meio do coeficiente de correlação de Spearman, e para comparação das médias foram utilizados os testes Mann-Whitney e Kruskal-Wallis. A análise conjunta das variáveis foi feita por meio de regressão linear múltipla. Resultados – Foi identificada uma diminuição progressiva do valor do ICT significativamente associada aos aumentos da idade (r=-0,16, p<0,001), do índice de massa corporal (r=-0,17, p<0,001), do consumo de álcool (r=-0,11, p=0,019), do tempo na empresa (r=-0,17, p<0,001) e da intensidade do estresse no trabalho (r=-0,37, p<0,001). O valor do ICT apresentou elevação associada ao incremento da prática de atividade física (r=0,19, p<0,001). A média do valor do ICT esteve associada à unidade de trabalho (p=0,043). O ICT esteve associado significativamente com as diversas dimensões do estado de saúde físico e mental (p<0,001 em todas as dimensões). A análise múltipla, ajustada por sexo e tempo na empresa, evidenciou que os fatores que melhor explicaram a variação do ICT foram o estresse no trabalho e as dimensões da saúde física. Uma segunda análise, excluídas as dimensões da saúde, mostrou que o estresse no trabalho, a unidade de trabalho e características do estilo de vida foram os fatores que melhor explicaram a variação do ICT. Conclusões – A pesquisa evidenciou que o estresse decorrente de fatores psicossociais do trabalho, a elevação do índice de massa corporal, o consumo de bebida alcoólica e o local de trabalho podem contribuir para a diminuição da capacidade para o trabalho, e que uma boa qualidade do estado da saúde física e a prática de atividade física podem contribuir para a manutenção da capacidade para o trabalho dos eletricitários. / Introduction – The work ability receives influence of several factors, including the health state, social and demographic characteristics, the lifestyle, and factors related to work. Aim – To analyze the factors associated with work ability in a population of electric sector workers. Methods – This is a cross-sectional study. There have been analyzed 475 volunteers workers of a private company of the electric sector of São Paulo, Brazil. They answered the questionnaires: Work Ability Index - WAI, Work Stress Scale – WSS, Medical Outcomes Study 36 – Item short form health survey – SF-36, Baecke Questionnaire, Fagerström Tolerance Questionnaire and AUDIT test. These questionnaires got information regarding work ability, stress related to psychosocial factors at work, health state, smoking, alcohol intake and practice of physical activities. The statistical analyses were done using Spearman correlation coefficient, Mann-Whitney test, Kruskal-Wallis test, and multiple linear regression models. Results – There was a significant progressive decrease of the WAI value associated to the increase of the age (r=-0,16, p<0,001), body mass index (r=-0,17, p<0,001), alcohol intake (r=-0,11, p=0,019), time at company (r=-0,17, p<0,001) and intensity of work stress (r=-0,37, p<0,001). The WAI value presented elevation associated to the increment of the practice of physical activities (r=0,19, p<0,001). The mean of WAI was associated to workplace (p=0,043). The WAI had significant association with the several dimensions of the physical and mental health state (p<0,001 in all dimensions). The multiple analyses, adjusted for sex and time at company, showed that the factors that better explained the variability of WAI were work stress and the physical health dimensions. Another analysis, excluded the health dimensions, showed that work stress, local of work and lifestyle characteristics were those that better explained the variability of WAI. Conclusions – The stress related to psychosocial factors of the work, the body mass increase, the alcohol intake and the workplace can contribute to the decrease of work ability, and a good physical health state and the practice of physical activity can contribute to the maintenance of the work ability of the electric sector workers.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2018-09-24T16:44:15Z No. of bitstreams: 1 Mariana Farias Mendonça.pdf: 2160140 bytes, checksum: 3922ec44b836d67d7d17d466c116fa58 (MD5) / Made available in DSpace on 2018-09-24T16:44:15Z (GMT). No. of bitstreams: 1 Mariana Farias Mendonça.pdf: 2160140 bytes, checksum: 3922ec44b836d67d7d17d466c116fa58 (MD5) Previous issue date: 2018-08-09 / Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq / Introdução: O advento da terapia antirretroviral (TARV) aumentou a expectativa de vida entre as pessoas vivendo com HIV (PVHIV), o que facilitou também sua inserção ou manutenção no ambiente de trabalho. Por outro lado, as PVHIV carregam consigo o peso do diagnóstico, o estigma atribuído à doença, infecções e tumores oportunistas e dificuldades quanto às oportunidades profissionais. Objetivo: Avaliar os fatores associados à capacidade para o trabalho entre as pessoas vivendo com HIV (PVHIV), bem como estimar a prevalência da capacidade para o trabalho, do bem-estar subjetivo e da qualidade de sono em pessoas vivendo com HIV. Métodos: Trata-se de uma pesquisa epidemiológica observacional, de corte transversal em uma amostra de 122 PVHIV, que possuíam trabalho remunerado, formal ou informal, com idade igual ou superior a 18 anos e em tratamento com antirretrovirais (TARV), assistidas pelo serviço de assistência especializada em aids, do município de Santos/SP. Para avaliar os fatores associados à capacidade para o trabalho moderada ou baixa, foi realizada a análise de regressão logística. O modelo múltiplo foi ajustado pela jornada de trabalho diária, tempo de infecção pelo HIV e marcadores biológicos (carga viral, contagem de células CD4 e relação entre CD4/CD8). Resultados: A idade média dos foi de 43,7 anos (DP 10,6 anos), sendo a maioria do sexo masculino (55,7%), solteiro (58,2%), com o ensino médio incompleto (65,6%) e com vínculo empregatício informal (52,1%). A média de tempo do uso da TARV foi de 7,2 anos (DP 6,6anos). A maioria apresentou capacidade para o trabalho ótima ou boa (55,7%), qualidade de sono ruim, tanto nos dias de trabalho quanto nos dias de folga (53,3% e 50,8%, respectivamente). O pior bem-estar subjetivo foi verificado em 41% das PVHIV. Independentemente da jornada de trabalho, do tempo de infecção pelo HIV e dos marcadores biológicos (carga viral, contagem de células CD4 e relação entre CD4/CD8), verificou-se que ter um trabalho informal, qualidade de sono ruim nos dias de trabalho e pior bem-estar subjetivo aumentou cerca de duas vezes a chance de se ter uma capacidade para o trabalho moderada ou baixa entre as PVHIV. Conclusão: O trabalho com vínculo informal, a qualidade de sono de ruim e o pior bem-estar subjetivo estão associados à pior capacidade para o trabalho entre pessoas vivendo com HIV, sendo elevadas as prevalências de capacidade moderada ou baixa para o trabalho, do bem-estar subjetivo e da qualidade de sono. / Introduction: The advent of antiretroviral therapy (ART) increased life expectancy among people living with HIV (PLWHIV), which also facilitated their insertion or maintenance in the work environment. On the other hand, PLWHIV carry the burden of diagnosis, the stigma attached to the disease, opportunistic infections and tumors, and difficulties in career opportunities. Objective: To evaluate the factors associated with work ability among people living with HIV (PLWHIV), as well as to estimate the prevalence of work ability, subjective well-being and quality of sleep in people living with HIV. Methods: This was a observational cross-sectional epidemiological study in a sample of 122 PLWHIV, who had formal or informal employment contract, aged 18 years or over and treated with antiretrovirals (ART), assisted by the service of specialized assistance in AIDS, of the municipality of Santos / SP. To evaluate the factors associated with moderate or low work ability, the logistic regression analysis was performed. The multiple model was adjusted for the working hours, time of HIV infection and biological markers (viral load, CD4 cell count and CD4/CD8 ratio). Results: The mean age was 43.7 years (SD 10.6 years); the majority were male (55.7%), single (58.2%), with incomplete secondary education (65.6% %) and with informal employment contract (52.1%). The mean time to use ART was 7.2 years (SD 6.6 years). The majority presented great or good work ability (55.7%), poor sleep quality, both on workdays and on days off (53.3% and 50.8%, respectively). The worst subjective well-being was seen in 41% in PLWHIV. Regardless of the working hours, time of HIV infection and biological markers, it has been found that having informal employment contract, poor sleep quality on working days, and worse subjective well-being has increased about twice the chance of having a moderate or low work ability among PLWHIV. Conclusion: Informal work, poor sleep quality, and worse subjective well-being are associated with worse work ability among people living with HIV, being high the prevalence of moderate or low work ability, subjective well-being and quality of sleep.

Objetivos. Este estudo teve como objetivos avaliar a capacidade para o trabalho, a estrutura temporal do sono, da 6-sulfatoximelatonina e do cortisol em trabalhadores em turnos da área de enfermagem. Métodos. Foram realizados dois estudos. Um estudo transversal para analisar a capacidade para o trabalho e o envelhecimento funcional precoce, através de questionários de condições de vida e trabalho e sintomas de saúde, da qual participaram 696 profissionais da área de enfermagem. E um cronobiológico com 19 trabalhadores do sexo feminino. Neste foram avaliados: o ciclo vigília-sono, através de actígrafos e protocolos diários de atividades; as concentrações da 6-sulfatoximelatonina e do cortisol; e a ritmicidade circadiana (avaliada utilizando a metodologia do ajuste dos parâmetros ritmométricos pela curva cosseno, método cosinor). Foi realizada coleta de urina em dois períodos de 4 dias consecutivos (com dias de trabalho e de folga,) para os trabalhadores noturnos, submetidos a turnos de 12 horas seguidas de 36 horas de descanso; e em um período de 8 dias consecutivos para os trabalhadores diurnos (6 dias de trabalho e 2 de folga). O grupo de 19 pessoas também foi analisado segundo a maior e menor tolerância ao trabalho em turnos. A tolerância ao trabalho em turnos foi avaliada utilizando 9 indicadores de saúde (escore de sonolência e fadiga, escore de concentração e atenção, escore da fadiga projetada sobre o corpo, escore geral da fadiga, SRQ20, escore de insônia, sonolência no trabalho, escore de problemas de sono) e disponibilidade do tempo livre. Resultados. A idade média da população era de 34,9 anos (dp + 9,5 anos), e esta era predominantemente feminina (87,8%), sendo que 40,6% começou a trabalhar antes dos 18 anos. As variáveis ligadas à capacidade para o trabalho inadequada foram: 1) sócio-demográficas: ter a responsabilidade pela renda familiar sozinho (OR=1,922), ter filhos ou menores sob a guarda (OR=1,558) e ter menos de 40 anos (OR=1,400). 2) ligadas ao trabalho: referir desconforto térmico (OR=1,548), referir ter sofrido abuso verbal pelo menos duas vezes no último ano (OR=1,670). 3) variáveis ligadas à saúde foram referir obesidade (OR=2,714), doenças de sono (OR=1,681), e fadiga (OR>3,771). No segundo estudo, as trabalhadoras noturnas apresentaram maior duração, e também melhor qualidade de sono noturno. Estas também referiram níveis de alerta significantemente mais elevados quando puderam cochilar durante o turno de trabalho. Foi encontrada uma grande variabilidade nos parâmetros rítmicos ao longo dos dias de trabalho e de folga. As concentrações médias de 6-sulfatoximelatonina e cortisol das trabalhadoras noturnas foram estatisticamente menores do que as encontradas em trabalhadores diurnos (p<0,001). Quando as trabalhadoras foram classificadas como mais e menos tolerantes ao trabalho em turnos, as trabalhadoras noturnas menos tolerantes referiram menor qualidade de sono e menores níveis de alerta. As concentrações médias de 6-sulfatoximelatonina e cortisol ao longo dos dias de trabalho e de folga variaram de modo distinto nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos. Conclusões. A capacidade de trabalho inadequada é resultado da associação de variáveis de múltiplas naturezas, tais como condições de vida e trabalho, hábitos e estilos de vida e à organização do trabalho. O cochilo durante o turno noturno de trabalho mostrou ser efetivo na manutenção dos níveis de alerta durante o trabalho noturno. As trabalhadoras noturnas apresentaram menores concentrações médias de 6-sulfatoximelatonina quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à exposição à luz durante o turno noturno de trabalho. As trabalhadoras noturnas apresentaram menores concentrações de cortisol quando comparadas as trabalhadoras diurnas, o que pode estar relacionado à maior fadiga referida por estas trabalhadoras. Os ritmos de 6-sulfatoximelatonina e cortisol têm comportamentos diferentes nos grupos de trabalhadoras mais e menos tolerantes ao trabalho em turnos, mas nenhum padrão pode ser definido, uma vez que existe uma grande variabilidade individual. / Objectives. The aim of this study was to evaluate work ability and biological rhythms of health care shiftworkers. Methods. To evaluate the work ability it was designed an epidemiological approach using a comprehensive questionnaire which included working and living conditions and health symptoms. 696 health care shiftworkers participated in this study. A sub sample of 19 female registered nurses and nurse aides/technicians were invited and agreed to participate in the chronobiological evaluation. Workers answered daily logs and wore actigraphs (Ambulatory Monitoring) to monitor activity and evaluate rest and waking periods along data collection. Urine samples were collected and voided volumes were measured during two periods of four consecutive days (working days and days off) of night workers, submitted to 12 hour night shifts followed by 36 hour off, and during one period of 8 consecutive days (six working days and two days off). It was also evaluated the 6-sulphatoxymelatonin and cortisol concentration, and their circadian rhythmicity using the Cosinor method. These 19 nurses were evaluated as more or less tolerant to shiftwork. The tolerance to shiftwork was evaluated by 9 health scores(dull and sleepy score, decline of working motivation, projection of fatigue to some parts of the body, general fatigue score, Self-Report Questionnaire (SRQ-20 score), insomnia score, sleepiness score, sleep disturbances score) and availability of free time. Results. Mean age of the respondents was 34.9 years, most of them female (87.8%) and 40.6% entered labor force before 18 years old. The socio-demographic factors associated to inadequate work ability were: income responsibility - sole breadwinner (OR=1.922), raising kids (OR=1.558), age group (under 40 years old) (OR=1,400). Factors associated with working conditions were: thermal discomfort (OR=1.548), and verbal abuse (OR=1.670). Obesity (OR=2.14), sleep problems (OR=1.681) and fatigue (OR>3.771) were health outcomes associated to inadequate work ability. Night workers showed longer mean sleep duration and referred better sleep quality to nocturnal sleep. These workers also reported higher alertness level when they nap during the night shift. Mean concentration of 6-sulphatoxymelatonin and cortisol among night workers were significantly lower than the day workers concentrations (p<0,001). When workers were classified into more and less tolerant to shiftwork, the less tolerant night workers referred worst sleep quality and lower alertness levels. The mean concentration of 6-sulphatoxymelatonin and cortisol, during working days and days off, showed distinct behavior in the two groups. It was found a great variability of the rhythmic parameters during working days and days off. Conclusions. Inadequate work ability was associated with a number of variables present at work and living conditions. Strategy of taking naps during night work was effective to maintain the alertness levels during work. Night workers 6-sulphatoxymelatonin mean concentrations were lower than day workers concentration. This might be related to light exposure during the night shift. The higher reported fatigue by these workers might explain the lower cortisol mean concentration presented by night workers when compared to day workers. The rhythms of 6-sulphatoxymelatonin and cortisol showed different behaviors when compared more and less tolerant workers, but any standard behavior could be observed since there is a great individual variability.

Este estudo pretendeu colaborar com a análise das relações entre satisfação com aspectos psicossociais no trabalho e saúde do trabalhador. Método: Realizou-se estudo transversal junto aos empregados de uma empresa de auto-gestão em saúde e previdência privada em São Paulo. O estudo incluiu três etapas: (a) 42 entrevistas exploratórias para verificar a semelhança entre referências da literatura com percepções dos empregados quanto ao conceito e às fontes de satisfação no trabalho; (b) questionários auto-aplicados respondidos por 224 empregados para análise das associações entre satisfação no trabalho e saúde: a escala Satisfação no Trabalho do Occupational Stress Indicator, o SF-36, e o Índice de Capacidade para o Trabalho; e (c) análise ergonômica de 43 postos de trabalho por meio da técnica AET - Análise Ergonômica do Trabalho de Rohmert e Landau, visando identificar aspectos da organização do trabalho interferindo na satisfação no trabalho. Resultados: As percepções dos empregados quanto ao conceito e fontes de satisfação no trabalho foram semelhantes aos conhecimentos da literatura adotada como referencial teórico. Satisfação no trabalho esteve associada com aspectos da saúde mental e com capacidade para o trabalho e estas associações ocorrem independentes de aspectos sócio-demográficos e funcionais. As condições e a organização do trabalho apresentaram características que podem configurar elevada carga mental no trabalho. Conclusões: Foram discutidas as relações entre satisfação no trabalho e saúde do trabalhdor e feitas considerações referentes a mudanças visando melhorias quanto aos aspectos psicossociais no trabalho, favorecendo a satisfação no trabalho e a saúde do trabalhador. / This study intends to collaborate with the analysis of the relationships among satisfaction with psychosocial factors at work and the worker's health. Methods: It took place a cross-sectional study close to the employees of a self-administration company in health and providence private. The study included three stages: (a) 42 exploratory interviews to verify the similarity among references of the literature with the employees' perceptions about the concept and sources of job satisfaction; (b) self-applied questionnaires answered by 224 employees for analysis of the associations among job satisfaction and health: the Job Satisfaction scale of the Occupational Stress Indicator – OSI, the SF-36, and the Work Ability Index; and (c) ergonomic analysis of 43 workstations by AET technique - Job Ergonomics Analysis of Rohmert and Landau, looking for identify spectos of work organization interfering on the job satisfaction. Results: The employees’ perceptions about the concept and sources of job satisfaction are similar to the knowledge of the literature adopted as theoretical framework. Job satisfaction was associated with aspects of the workers' mental health, and with work ability, and this associations happens independent of social-demographic and functional aspects. The job conditions and organization presented characteristics that can configure high mental load at the work. Conclusions: the relationships among job satisfaction and worker’s health were discussed, and made considerations regarding changes seeking improvements of the psychosical aspects at work, favoring job satisfaction and worker’s health.

This essay addresses and treats the employer's obligation to work adaptation for people with a physical disability according to discrimination law and the work environment law. Furthermore it also treats the employer's obligation to rehabilitation of employees that has a reduced working ability as consequence of their work. The essay also intends to investigate if there are any differences in the employer’s obligation to work adaptation when recruiting and the employer’s obligation to work adaption for an existing employment.   In this work, there is a background chapter which describes the UN and the European Union's approach to work reduction ability and disability. Furthermore, there is a detailed description of the work environment law, the discrimination law, the social insurance code and the employment protection legislation. A description of the laws and the legal practice on work adaptation and rehabilitation is presented where relevant judgments from labor court are described and a preliminary ruling from the European Court.   The work includes an analyzing part which summarizes important parts of the work. Here I have analyzed the legislative texts, the legal usage and the preliminary work of the laws and there content. In the end the conclusions are presented. For a person with a physical disability the employer has an obligation to take appropriate support - and adaptation measures. What is legitimate is depending on which possibility the employer have to take the measures, what effect the measures will provide, how extensive the employee's disability is, what economic situation the employer is located in, what resources that are necessary to take, how cost requiring the measures become and which kind of employment it is. What obligations a employer has to rehabilitation of an employee with reduced working ability is different from one situation to another. Factors to considerate are the size on the workplace, if the employee agreed to go through the rehabilitation and had a good attitude and if a proper rehabilitation, work adaptation and reassignment investigation is done. The employer can become forced to reorganize the work in order to make the employee able to resume his work. The obligation to reorganize the organization is depending on whether or not it is legitimate to require this of the employer. What are essential is which possibilities there is to make reorganization, what viable and organizational means there is and whether or not reorganization can mean that other employees are exposed to risks. As a rule, reduced working ability or a disability is not at justified dismissal ground if the employee can carry out work of significance for the employer. / Denna uppsats behandlar och tar upp arbetsgivarens skyldighet till arbetsanpassning för personer med fysisk funktionsnedsättning enligt diskrimineringslagen och arbetsmiljö lagen. Dessutom behandlar uppsatsen också arbetsgivarens skyldighet till rehabilitering av anställda som har en reducerad arbetsförmåga som följd av sitt arbete. Uppsatsen avser också att undersöka om det finns några skillnader i arbetsgivarens skyldighet till arbetsanpassning vid rekrytering respektive arbetsgivarens skyldighet till arbetsanpassning vid en befintlig anställning. I detta arbete finns det en bakgrund som beskriver FN och EU: s syn på nedsatt arbetsförmåga och funktionsnedsättning. Dessutom finns det en detaljerad beskrivning av arbetsmiljön lagen, diskrimineringslagstiftningen, socialförsäkringsbalken och lagen om anställningsskydd. En beskrivning av de lagar och den juridiska praxis om arbetsanpassning och rehabilitering presenteras där relevanta domar från arbetsdomstolen beskrivs och ett förhandsavgörande från EG-domstolen. I arbetet ingår en analys del som sammanfattar viktiga delar av arbetet. Här har jag analyserat lagtexterna, den juridiska användningen och förarbeten till lagarna och dess innehåll. I slutet presenteras slutsatserna som arbetet har lett fram till. För en person med ett fysiskt funktionshinder har arbetsgivaren en skyldighet att vidta lämpliga stöd - och anpassningsåtgärder. Vad som är legitimt beror på vilken möjlighet arbetsgivaren har att vidta de åtgärder som är nödvändiga, vilken effekt åtgärderna kommer att ge, hur omfattande den anställdes funktionshinder är, vilken ekonomisk situation arbetsgivaren befinner sig i, vilka resurser som behövs, hur kostnadskrävande åtgärderna blir och vilken typ av arbete det är. Vilka skyldigheter en arbetsgivare har till rehabilitering av en medarbetare med nedsatt arbetsförmåga skiljer sig från en situation till en annan. Faktorer att ta hänsyn till är storleken på arbetsplatsen, om arbetstagaren gått med på att gå igenom rehabiliteringen och har en bra attityd, och om en ordentlig rehabilitering, arbetsanpassning och omplaceringsutredning utförts. Arbetsgivaren kan bli tvungen att omorganisera arbetet för att möjliggöra för den anställde att återgå till sitt arbete. Skyldigheten att omorganisera organisationen är beroende av huruvida det är legitimt att kräva detta av arbetsgivaren. Vad som är viktigt är vilka möjligheter det finns att göra en omorganisation, vilken livskraftiga och organisatoriska medel som finns och huruvida en omorganisation kan innebära att andra anställda blir utsatta för risker. Som regel utgör nedsatt arbetsförmåga eller funktionshinder inte saklig grund för uppsägning om arbetstagaren kan utföra arbete av betydelse för arbetsgivaren.

Σκοπός της διατριβής ήταν η διερεύνηση του φαινομένου της απουσίας (για λόγους υγείας) από την εργασία στον ιδιωτικό τομέα και ιδίως στη βαριά βιομηχανία, και τη πιθανή επίδραση στην ικανότητα εργασίας. Η παρούσα διδακτορική διατριβή στηρίχτηκε κυρίως στη μελέτη του αρχείου αναρρωτικών αδειών (μιας κοόρτης) εργαζομένων σε ένα από τα μεγαλύτερα ναυπηγεία της χώρας, καθώς και στις ετήσιες στατιστικές αναφορές του Ιδρύματος Κοινωνικών Ασφαλίσεων (ΙΚΑ) της τελευταίας 20ετίας. Τα χαμηλά επίπεδα απουσιασμού ασθενείας στον ιδιωτικό τομέα στην Ελλάδα επιβεβαιώθηκαν από τη μελέτη που έγινε στα πλαίσια αυτής της διατριβής, αν και τα αποτελέσματα υποδεικνύουν ότι ο απουσιασμός ασθενείας στην Ελλάδα είναι ελαφρώς μεγαλύτερος από ότι υποδείκνυαν οι πρόσφατες διεθνείς συγκριτικές μελέτες. Το ποσοστό απουσιασμού (Absenteeism rate) βρέθηκε περίπου 2.5%, από τα χαμηλότερα στην Ευρώπη. Παρόλα αυτά, επειδή περιλαμβάνει τον εργάσιμο χρόνο που διαφέρει από χώρα σε χώρα, δεν χρησιμοποιείται συχνά στις μελέτες αν και ίσως είναι ο πιο έγκυρος δείκτης απουσιασμού. Η μέση διάρκεια απουσίας για κάθε εργαζόμενο ανά έτος ήταν 5.8 ημέρες( μέγιστη τιμή 8 ημέρες προς το τέλος της περιόδου μελέτης) με ένα αντίστοιχο μέσο όρο που ξεπερνούσε κατά πολύ τις 10 ημέρες στην υπόλοιπη Ευρώπη. Ενδιαφέρον εύρημα αποτελεί το γεγονός ότι οι μικρής διάρκειας απουσίες (<4 ημέρες) αντιστοιχούσαν στο 25% της συνολικής διάρκειας των απουσιών, κάτι που μέχρι τώρα δεν μπορούσε να υπολογιστεί από τα εθνικά στατιστικά δεδομένα του ΙΚΑ. Κατά τη μελέτη των δεδομένων του ΙΚΑ τις δυο τελευταίες δεκαετίες, βρέθηκε μια κυματοειδής πορεία του απουσιασμού, επιδεικνύοντας πτωτική πορεία μέχρι τα τέλη τις δεκαετίας του 1990, σε συμφωνία με τις προηγούμενες μελέτες και εν συνεχεία μια ανοδική πορεία, αν και μέχρι το τέλος της περιόδου μελέτης τα επίπεδα παρέμειναν χαμηλότερα από τα αρχικά. Σίγουρα οι παρατηρήσεις αυτής της μελέτης χρήζουν περαιτέρω διερεύνησης, καθώς ο χαμηλός απουσιασμός μόνο μερικώς μπορεί να αποδοθεί στα χαμηλά επίπεδα αποζημίωσης μισθού σε περίπτωση αναρρωτικής άδειας ή τα υψηλά ποσοστά ανεργίας. Βασικός σκοπός πρέπει πάντα να είναι η διατήρηση και προώθηση της καλής υγείας των εργαζομένων, μέσω όσο το δυνατόν καλύτερων εργασιακών συνθηκών. Καθώς τόσο οι εργασιακές συνθήκες όσο και η υγεία των εργαζομένων είναι σε μια δυναμική κατάσταση, χρειάζονται εργαλεία παρακολούθησης. Η μέτρηση του απουσιασμού ασθενείας είναι ένας παράγοντας που πάντα θα πρέπει να εκτιμάται από τον ιατρό εργασίας και τον εργοδότη, χρησιμοποιώντας τους διάφορους δείκτες που έχουν καθιερωθεί. Σαν συμπληρωματικό εργαλείο παρακολούθησης προτείνεται η χρήση του Δείκτη Ικανότητας Εργασίας (Work Ability Index), που είναι ένα ερωτηματολόγιο, το οποίο σταθμίστηκε στα Ελληνικά και εκτιμά γενικά τη λειτουργική ικανότητα των εργαζομένων, όντας άμεσα συνδεδεμένο με τον απουσιασμό ασθενείας. Η ελληνική έκδοση του Δείκτη Ικανότητας Εργασίας έδειξε ικανοποιητικές ψυχομετρικές ιδιότητες και συνοχή, και μπορεί να αποτελέσει μια αξιόπιστη εναλλακτική επιλογή στα εργαλεία αξιολόγησης της ικανότητας εργασίας σε ατομικό και ομαδικό επίπεδο. Ο παράγοντας Bradford είναι ένας ακόμα δείκτης που η προγνωστική του δύναμη όσον άφορα το βραχυπρόθεσμο απουσιασμό φάνηκε σε αυτή τη μελέτη. Προτείνεται επίσης η χρήση και των δυο αυτών δεικτών με την μορφή ενός νέου δείκτη (Δείκτης Πρόβλεψης Πιθανής Απουσίας), για την ανίχνευση εργαζομένων και τομέων εργασίας με αυξημένη πιθανότητα απουσίας για λογούς υγείας τα αμέσως επόμενα χρόνια. Στα πλαίσια της στάθμισης έγινε επίσης φανερό το πρότυπο νοσηρότητας του πληθυσμού των ναυπηγείων, όπου κυριαρχούν οι μυοσκελετικές και αναπνευστικές παθήσεις μαζί με το τραύμα, ενώ τη μεγαλύτερη επίδραση στην ικανότητα εργασίας φαίνεται να έχουν οι καρδιαγγειακές και ψυχικές παθήσεις. Αναδείχτηκε επίσης η υποδιάγνωση των ψυχικών παθήσεων, που είναι ένα γενικότερο πρόβλημα στην Ελλάδα. Οι ραδιοτεχνίτες και οι φλογοχειριστές φαίνονται να εμφανίζουν τα μεγαλύτερα επίπεδα απουσιασμού. Οι παράγοντες που βρέθηκαν να συσχετίζονται θετικά με αυξημένα επίπεδα απουσιασμού είναι η μικρή ηλικία, οι χειρωνακτικές εργασίες, το χαμηλό επίπεδο εκπαίδευσης και η εργασιακή εμπειρία άνω των 3 ετών. Συμπερασματικά, χρειάζονται περαιτέρω μελέτες για να κατανοηθεί πλήρως ο απουσιασμός ασθενείας, σε όλους τους εργασιακούς τομείς και βεβαίως εκπαίδευση του ιατρικού προσωπικού στο θέμα της χορήγησης αναρρωτικών αδειών, όπου θα βοηθούσε η χρήση εργαλείων όπως αυτά που μελετήθηκαν σε αυτή τη διατριβή(πχ Disability Guidelines), και ήδη βρίσκουν εφαρμογή σε άλλες χώρες. / The aim of this study was to estimate the levels and analyse sickness absence in the private sector in Greece, using shipyard and national insurance data. Field data were collected in a cohort of shipyard employees in the period between 1999 and 2006. In addition, national sickness absenteeism data (compensated days) of employees insured at the Social Insurance Institute (IKA, the largest insurance scheme in Greece) were retrieved from the Institute’s annual statistical reports for the period 1987-2006. Low levels of sickness absence in the private sector in Greece have been confirmed by this study, although the findings show that sickness absence in Greece is slightly higher than what the recent international comparative studies indicate. The absenteeism rate was 2.5%, which is one of the lowest in Europe. Nevertheless, due to the fact that it involves working hours which differ from one country to another, it is not often used in the studies despite being the most valid indicator of absence. The average duration of absence for every employee per year was 5.8 days (maximum number was 8 days towards the end of the study). In Europe, the average number of days of sickness absence exceeded 10 days. An interesting finding is the fact that short period absences (<4 days) constituted 25% of the total duration of absences, which could not be calculated until now by the national statistical data of the Social Insurance Institute (IKA). While studying the data of IKA of the last two decades, a sinusoidal-like trend was recorded regarding absenteeism. Declining trend by the end of the 1990s was observed, in accordance with previous studies and then an increasing trend, although at the end of the study period the levels remained lower than those at the beginning. Further research is needed concerning the observations of this study since the low absenteeism levels can only be partially attributed to the low compensation rate in case of sick-leave or to the high levels of unemployment. The primary objective should always be health preservation and promotion of the employees by means of the best possible working conditions. As both working conditions and employees’ health are dynamic situations, monitoring tools are required. Sickness absence should always be monitored by the occupational health physician as well as the employer, using the various established tools. The use of Work Ability Index is recommended as an additional monitoring tool. It is a questionnaire, directly linked to sickness absence, which generally evaluates the employees’ functional ability. The Greek version of Work Ability Index displayed satisfactory psychometric properties and consistency thus constituting an appropriate option for evaluating work ability in both individual and population-based settings. The Bradford factor is another index whose prognostic strength concerning short-term absenteeism was evident in this study. The use of both these tools in the form of one new index (Sickness Absence Probability Factor) is also recommended in order to identify employees and work areas with an increased tendency for sickness absence. During the validation process, the morbidity pattern of the shipyard population also became obvious. Musculoskeletal, respiratory diseases as well as trauma are most prevalent, whereas cardiovascular and mental diseases seem to have the biggest impact on work ability. The underdiagnosis of mental diseases was also revealed, which is a general problem in Greece. Radiomen and flame-cutters seem to have the highest levels of absence, while the factors which were found to be positively linked to high levels of absenteeism are young age, manual labor, low educational level and working experience over 3 years. In conclusion, further research is necessary to fully describe and understand the phenomenon of sickness absence in various work fields. Medical staff training in the area of issuing sick-leave is essential and has already been implemented in other countries. Tools, like the ones studied in this dissertation should be utilized.