Thesis (M.Sc.). / Written for the Département de Neurologie et Neurochirurgie. Title from title page of PDF (viewed 2009/09/07). Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1976.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Abstract The potential health effects of employee control over working times are poorly known in the field of work stress research. In this study, worktime control was hypothesized to buffer against stress by promoting successful combination of a full-time job with non-work demands and by enabling the work to be done at times of optimal resources. The participants were from the 10-Town Study, an ongoing longitudinal cohort study exploring employee health in ten Finnish towns. The survey responses on worktime control and health (baseline survey in 1997: n = 6442, 67%; follow-up survey in 2000–01: n = 32299, 67%) were linked to registered sickness absences from the employers' records. Employee worktime control covered the perceived possibilities to influence the starting and ending times of a workday, the breaks, handling private matters during the workday, the scheduling of shifts, vacations and days off, and the taking of unpaid leaves, each of which was rated on a 1–5 scale. In the follow-up survey, influence on the length of the workday was also assessed. After a factor analysis, the subdimensions of control over daily working hours and control over days off were focused. It turned out that low worktime control predicted poor subjective health, psychological distress, and medically certified sickness absences for women. For men, low worktime control was not associated with subjective health, but predicted medically certified sickness absences for those with dependent children or employed in manual occupations. With respect to work stress, the men and women suffering from job strain or effort-reward imbalance had less medically certified sickness absences if they at least had control over their working times. The men and women with long domestic and total working hours and long commuting hours gained most from high worktime control in that their medically certified sickness absences were reduced. Vulnerability to long domestic and total working hours in terms of such absences was seen among both men and women, but there were few men working long domestic hours. Long paid working hours as such were not associated with sickness absences. In sum, high worktime control appeared to buffer against health problems and to promote a successful integration of domestic responsibilities with a full-time job. The findings expand the focus of work stress research and emphasize the importance of taking conditions at home into account when analysing employee health. / Tiivistelmä Työaikojen hallinnan merkitys terveydelle tunnetaan työstressitutkimuksen alalla huonosti. Tässä väitöskirjatyössä oletettiin, että työaikojen hallinta voisi vähentää stressiä ja edistää terveyttä helpottamalla kokopäivätyön ja kotona tehtävän työn yhteensovittamista sekä mahdollistamalla työn tekemisen parhaiden voimavarojen vallitessa. Tutkimus toteutui osana Työterveyslaitoksen Kunta10 -tutkimusta, joka seuraa kymmenen suomalaisen kaupungin henkilöstön työolojen ja terveyden kehittymistä. Koettua työaikojen hallintaa ja terveyttä koskevat kyselyvastaukset (alkukysely v. 1997: n = 6442, 67 %; seurantakysely vv. 2000–01: n = 32299, 67 %) linkitettiin palkanmaksurekistereistä saatuihin sairauspoissaolotietoihin. Työaikojen hallinnan mittari sisälsi alkukyselyssä 5-luokkaisella asteikolla vastaajien kokemat vaikutusmahdollisuudet työpäivän alkamis- ja päättymisajankohtiin, taukoihin, yksityisasioiden hoitamiseen työpäivän kuluessa, työvuoroihin, lomien ja vapaapäivien ajankohtiin sekä palkattomien vapaiden pitämiseen. Seurantakyselyssä kartoitettiin myös vaikutusmahdollisuudet työpäivän pituuteen. Summamuuttujan faktorianalyysin jälkeen arvioitiin erikseen päivittäisten työaikojen hallintaa sekä loma-aikojen hallintaa. Tuloksissa huono työaikojen hallinta ennusti naisilla huonoksi koettua terveyttä, psyykkistä rasittuneisuutta sekä lääkärintodistusta vaativia yli kolmen päivän mittaisia sairauspoissaoloja. Miehillä huono työaikojen hallinta ei vaikuttanut itsearvioituun terveyteen, mutta ennusti lääkärintodistusta vaativia sairauspoissaoloja, jos heillä oli lapsia kotona tai jos he tekivät ruumiillista työtä. Hyvä työaikojen hallinta vähensi työstressiin liittyviä sairauspoissaoloja. Stressiä kuvattiin työn kovien vaatimusten ja huonon hallinnan yhdistelmällä sekä koettujen ponnistelujen ja palkkioiden epäsuhdalla. Eri elämänalueilla tehtyihin työtunteihin suhteutettuna hyvä työaikojen hallinta vähensi sairauspoissaoloja erityisesti niillä naisilla ja miehillä, joilla oli paljon kotityötunteja, työmatkatunteja tai totaalityötunteja. Sairauspoissaoloilla mitattuna naiset ja miehet olivat yhtä haavoittuvia pitkille kotityö- työmatka- ja totaalityötunneille, mutta miehillä pitkät kotityötunnit olivat harvinaisia. Pitkät palkkatyötunnit sinänsä eivät lisänneet sairauslomia. Tutkimus tuo työstressikirjallisuuteen vallitsevia malleja täydentävää tietoa työn ulkopuolisten tekijöiden merkityksestä työntekijöiden terveydelle. Tulokset kannustavat edistämään työntekijöiden mahdollisuuksia työaikojensa hallintaan sekä terveyden edistämisen että kokopäivätyön ja muun elämän menestyksellisen yhdistämisen näkökulmista.

Orientador: Heleno Rodrigues Corrêa Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T02:50:44Z (GMT). No. of bitstreams: 1 Stenger_Eunice_D.pdf: 85030272 bytes, checksum: a69c9a0f209ac8b7f2341213f4f8a023 (MD5) Previous issue date: 2014 / Resumo: O presente trabalho partiu do questionamento sobre a tendência temporal e ecológica das morbidades mentais entre metalúrgicos e trabalhadores da educação. Investigamos o possível relacionamento dessas tendências com as mudanças que intensificaram o processo de trabalho em dois setores de atividade econômica muito diferentes. Esta tese combinou método de estudo de caso do setor metalúrgico com estudo ecológico nacional sobre trabalhadores da metalurgia e da educação. Realizamos o estudo de caso com observação direta e entrevistas no ambiente de trabalho sucedida por estudo documental histórico sobre empresa metalúrgica transnacional utilizando fontes públicas oficiais: _ Ministério do Trabalho e Emprego ¿ MTe, Ministério Público do Estado de São Paulo ¿ MP e o Ministério Público do Trabalho ¿ MPT. Numa segunda etapa os trabalhadores da educação foram comparados com metalúrgicos em estudo ecológico que usou bases nacionais brasileiras de dados sobre benefícios do Instituto Nacional de Seguridade Social ¿ INSS. Os desfechos epidemiológicos foram diagnósticos concedidos no Brasil aos trabalhadores para Licenças do Trabalho para tratamento de Saúde ¿ LTS e as exposições estudadas foram as categorias econômicas classificadas na Classificação Nacional de Atividades Econômicas ¿ CNAE, versão 2.0, para período de doze anos entre 2000-2011. O primeiro artigo abordou riscos psicossociais decorrentes da introdução de um novo modelo de gestão, o Lean Production, em uma indústria metalúrgica. O Lean passou a ser objeto de observação do trabalho de campo realizado no ano de 1996, quando a empresa passava por processo de fusão e internacionalização. Foram feitas entrevistas chave de trabalhadores e gerentes, complementadas posteriormente com análise documental. Anos depois, entre 2004 e 2009 voltamos a estudar a empresa, refazendo entrevistas a sindicatos e analisando processo judicial no MPT que lhe atribuía más condições trabalhistas, riscos à saúde e ao xx ambiente do trabalho. Essa metodologia criou oportunidade inédita de confrontar observação direta com resultantes posteriores sobre o trabalho e a saúde dos trabalhadores. O questionamento fundamental foi sobre relações entre o modelo de gestão - lean-production - e sua possível associação com riscos psicossociais à saúde dos trabalhadores. Constatamos nos processos judiciais que aquela multinacional de autopeças foi questionada pelo uso de jornadas excessivas com horas extras de trabalho, trabalho sem descanso semanal e jornadas com duração acima de dez horas. Essas condições de trabalho foram consideradas pelo MTe, MP e MPT como fontes de riscos psicossociais associados com afastamentos relacionados a adoecimento pelo trabalho. Os artigos Dois e Três analisamos adoecimentos de trabalhadores no setor da metalurgia no Brasil no período de 2000 a 2011. Nestes artigos descrevemos as doenças às quais foram atribuídas as LTS analisando fontes brasileiras de dados para todo o mercado formal de trabalho (celetista) no país. Os numeradores foram extraídos dos diagnósticos que motivaram as LTS classificados pela Classificação Internacional de Doenças (CID10) no Sistema Único de Benefícios (SUB) do INSS. Os denominadores foram retirados da GFIP ¿ Guia de Recolhimento do Fundo de Garantia por tempo de Serviço (FGTS) e de Informações à Previdência Social cobrindo doze anos no período 2000 a 2011. Estes artigos apresentam estudo ecológico descritivo sobre uma coorte nacional dinâmica não concorrente dos trabalhadores de cada setor da economia formal e traçaram as tendências das doenças mais prevalentes (artigo 2), detalhando posteriormente a comparação entre as incidências de LTS por doenças mentais e cardiovasculares entre os trabalhadores das duas categorias de atividades econômicas (artigo 3). O artigo 2 descreve as causas principais de LTS. As lesões externas foram a principal causa de afastamentos entre trabalhadores da metalurgia ¿ variando de 125,4 a 221,6 por 10.000 trabalhadores com vínculo celetista. A segunda causa foram os distúrbios musculoesqueléticos com 85,5 a 207.1 benefícios por 10.000 xxi trabalhadores. Seguiram-se os transtornos mentais com 19,8 a 58,8 / 10.000 na metalurgia e 11,5 a 38,9 / 10.000 entre os trabalhadores da educação. O câncer apareceu como a única categoria de doenças com incidência mais alta de LTS entre os trabalhadores da educação comparados aos da metalurgia. Os transtornos mentais atingiram mais os metalúrgicos que aos trabalhadores do ensino. Esse foi o achado mais importante e reforçou a hipótese de que o `Lean Production¿ trouxe estressores aos ambientes de trabalho e contribuiu para aumentar os adoecimentos e trazer os metalúrgicos a um nível de adoecimento psíquico mais elevado que o dos trabalhadores da educação. Estudamos no artigo 3 os adoecimentos mentais e cardiovasculares entre trabalhadores da educação e metalúrgicos. A força de trabalho média anual da metalurgia variou entre 268.759 e 468.613 no período de 2000 a 2011. Um total de 19.722 trabalhadores sofreram afastamento por transtornos mentais e 10.787 tiraram LTS por doenças do aparelho circulatório. Entre os transtornos mentais predominaram os transtornos do humor com curvas de afastamento superiores para os trabalhadores da metalurgia com pico de 29,2 comparados a 25,7 / 10.000 entre trabalhadores da educação em 2006. Os transtornos mentais por abuso de substâncias psicoativas apresentam tendência de elevação mais importante entre os trabalhadores da metalurgia (15,9 v.g. 2,4 / 10.000 em 2011). Também os transtornos neuróticos relacionados com o stress predominam entre os metalúrgicos até 2008 (11,0 v.g. 9,2 / 10.000). Entre as doenças do aparelho circulatório predominaram as doenças das veias e linfáticos principalmente entre trabalhadores da metalurgia (19,1 v.g. 8,7 / 10.000). As doenças hipertensivas predominaram entre trabalhadores do ensino com picos de 6,5 / 10.000 em 2002 e 2004 comparados a 4,5 / 10.000 entre metalúrgicos em 2005 com tendência decrescente até 1,4 e 1,0 respectivamente em 2011. As doenças isquêmicas do coração flutuam entre valores próximos de 2,5 e 4,1 por 10.000 trabalhadores, sendo que a curva em geral é mais elevada para os trabalhadores da metalurgia e ambas categorias apresentaram tendências de queda a partir de 2008 / Abstract: The present research departed from questioning the time trends and the ecology of mental morbidities amongst workers in metallurgy and education. We investigated the possible relationships of those trends with the increased work process intensity, which changed these two sectors of the economy with so different settings. This thesis combined the method of a case study in the metallurgy sector with a national ecologic study on workers of metallurgy and education. We conducted the case study with direct observation and interviews at the work environment followed by a historic and documental study on a transnational metallurgical company using official public records from the: _ National Department of Labor and Employment ¿ MTe, São Paulo State Department of Public Attorneys ¿ MP and the Federal Department of Labor Public Attorneys ¿ MPT. In a second step, we compared education workers with metallurgists in an ecologic design that used Brazilian national databases of workers¿ compensations from the National Institute of Social Security ¿ INSS. The epidemiologic outcome was the diagnosed morbidity recorded in Brazil when workers claimed sick leaves ¿ LTS and the exposure studied was presumed to working in the economic sectors classified according the National Classification of Economic Activities ¿ CNAE, version 2.0, for the twelve years period of 2000-2011. The first article addressed psychosocial risks arising from the introduction of the de Lean Production method in a metallurgic industry. This method combined a field observation conducted in the year 1996 with key interviews of workers and managers. It was complementary added to a historical documental analysis long afterwards the moment of the field observation when the company was undergoing the merging and internationalization process. Years later, from 2000 through 2009, we analyzed the litigation process put by the MPT that attributed to the company the responsibility for bad working conditions, with risks to workers¿ health and work xxvi environment. This methodology created the unprecedented opportunity of confronting results from direct observation with late results on workers¿ health and work environment inspection. Our fundamental question was on the relationships between the managing model of - lean-production and its possible association with psychosocial risks at work. We found that the multinational auto parts company was sued after using excessive journeys with long extra working hours, the lack of weekly days of resting, and work journeys longer than then hours a day. The MTe, MP and the MPT considered these working conditions as a source of psychosocial risks associated with sick leaves and working related morbidity. Articles 2 and 3 described the diseases to which sick leaves (LTS) were attributed after analyzing the Brazilian database sources for the total of the national formal labor market in the country. Numerators were taken from the diagnosed morbidity classified according to the International Classification of Diseases - (ICD10 /CID10) that were considered the reasons for the LTS at the National Unified Compensations¿ System (SUB) of the INSS. Denominators came from the GFIP ¿ a database that combined the Tax Report Form of the Worker¿s Savings Fund of Working Time (FGTS) together with the Labor Force Reports to the Department of National Social Security that covered a twelve years period from 2000 to 2011. These two articles reported a descriptive ecologic study on a national dynamic and non-concurrent cohort of workers in each sector of the formal economy. They traced the twelve years trend of the most prevalent diseases (article 2), detailing at last the comparison between the LTS incidences due to mental and cardiovascular diseases among workers of the two categories of economic activity (article 3). Article 2 describes main causes for LTS. External causes were the most incident reasons for sick leaves among metalworkers ¿ varying from 125.4 to 221.6 by 10,000 formally registered jobs. The second group were musculoskeletal disorders with 85.5 to 207.1 LTS for 10,000 workers. Mental disorders followed in both sectors with 19.8 to 58.8 / 10,000 in metallurgy and 11.5 to 38.9 / 10,000 among xxvii education workers. Cancer appeared as the only disease group¿s category with high LTS incidence among educators compared to metalworkers. Mental disorders affected more metalworkers than those in education. This was the most important finding that reinforced the hypothesis that the `Lean Production¿ method brought more stressors to the work environment and contributed to increase morbidity of metalworkers to levels of mental disorders above those in the educational economic sector. Article 3 studied the LTS due to mental and cardiovascular diseases comparing educational and metalworkers. The yearly mean employed work force in metallurgy varied from 268,759 to 468,613 job places in the period 2000 through 2011. About 19,722 metalworkers took LTS due to mental disorders and 10,787 were affected by circulatory disorders. Mental disorders were mostly specified as affective and mood disorders with sick leaves¿ trends of metallurgy well above with peaks of 29.2 compared to 25.7 / 10,000 among education workers in 2006. Mental disorders due to psychoactive drugs¿ abuse (F10- F19) showed an increasing trend more important among metalworkers (15.9 vs. 2.4 / 10,000 in 2011). Stress related neurotic disorders were also predominant among metalworkers until 2008 (11.0 vs. 9.2 / 10,000). Diseases of lymphatic vessels and veins were the main causes of LTS in the cardiovascular diseases¿ group especially among metalworkers (19.1 vs. 8.7 / 10,000). Hypertensive diseases predominate among education workers with peaks of 6.5 / 10,000 in 2002 and 2004 compared to 4.5 / 10,000 among metalworkers in 2005 both with a decreasing trend until 1.4 and 1.0 respectively in 2011. Ischemic heart diseases drifted among figures close to 2.5 and 4.1 / 10,000 workers with the metalworkers running always above despite both economic sectors showed a noticeable decrease from 2008 on. Our conclusions were discrepant from the preliminary hypothesis that supposed to find greater psychic risks among education workers once metalworkers would expose themselves mostly to physical workloads with a consequence of higher xxviii incidence of musculoskeletal diseases in LTS. The analysis of both ecologic studies turned this forecast down. The main finding of this research was that metalworkers showed increasing trends of LTS incidence by prevalent morbidity above those found among education workers of the education economic sector due to affective and mood disorders, as well as mental disorders due to psychoactive drugs¿ abuse, the somatoform and stress related neurotic disorders. The twelve years period under analysis showed a trend of increasing the incidence of LTS in both groups of economic activity with the exception of cardiovascular diseases. Keywords: Government Regulation; Work Schedule Tolerance; Working Conditions; Psychosocial Impact; Working Environment - analysis ¿ adverse effects - policies / Doutorado / Política, Planejamento e Gestão em Saúde / Doutora em Saúde Coletiva