Modelo de gestão em saúde do trabalhador: desenvolvimento, validação e aplicação numa indústria do petróleo, Bahia, Brasil

O campo da saúde do trabalhador (ST) visa analisar e intervir nas relações entre o trabalho, a saúde e o ambiente, a partir do processo laboral, incorporando o saber teórico dos profissionais da área ao saber prático dos trabalhadores. As ações devem estar vinculadas ao quotidiano vivenciado pelos indivíduos, considerando os riscos ambientais decorrentes de atividades antropogênicas, bem como os riscos ocupacionais que afetam a ST. Nesse contexto, o objetivo desta tese de doutoramento consiste em propor um modelo de gestão para serviços de ST, sob a ótica da gestão de risco, na indústria do petróleo no estado da Bahia, Brasil. A investigação contemplou avaliação retrospectiva (2006-2018) das informações disponíveis por meio de um banco de dados institucional e as análises foram realizadas como parte da avaliação epidemiológica periódica sobre os riscos à saúde, à segurança do trabalho e à saúde ambiental. Trata-se de um estudo que empreendeu a combinação de diversas estratégias metodológicas, capazes de abarcar a complexidade proposta da investigação-ação, tais como relato de experiência, desenvolvimento e validação de instrumento, índice e modelo, além de estudo longitudinal. A amostra contou com uma média de 1357 trabalhadores (MIN = 965; MAX = 1831). É importante enfatizar que esta é uma amostra de conveniência e que, a cada ano, a população do estudo variava em número e composição; no entanto, essa diferença não é estatisticamente significativa. Em todos os anos pesquisados,prevaleceram, na amostra, trabalhadores do sexo masculino, casados, com média de 44,9 anos (MIN = 23; MAX = 73), em regime de trabalho administrativo, residentes na capital do estado da Bahia, Brasil e com o nível escolar médio. Recorreu-se ao SPSS versão 25.0 para a análise estatística dos dados, nomeadamente para análise estatística univariada e multivariada. Ressaltam-se cinco pesquisas mais relevantes como principais resultados da tese, como a investigação-ação, intitulada Interdisciplinarity: an Articulating Movement in the Field of Worker´s Health, que demonstra os problemas experienciados na prática do campo estudado e ratifica a necessidade de um novo modelo de gestão em ST. Para isso, prosseguiu-se a elaboração e validação de um instrumento de abordagem interdisciplinar da ST, intitulado Interdisciplinary Worker’s Health Approach Instrument (IWHAI). Com a aplicação do IWHAI, foi possível desenvolver um índice capaz de avaliar o risco da ST, focado no desenvolvimento sustentável no local de trabalho, o Worker’s Health Risk Index (WHRI). Com base nessas duas ferramentas, conceptualizou-se um novo e original modelo de assistência em ST, o Workers’ Healthcare Assistance Model (WHAM), que contempla a abordagem interdisciplinar, o gerenciamento de risco e a sustentabilidade econômica em busca da saúde integral e integrada, e que responde ao objetivo central da investigação. De forma a validar a eficácia da implementação dessa estratégia interdisciplinar, procedeu-se à realização de um estudo longitudinal retrospectivo, Implementation of an Interdisciplinary Approach to Promote Workers Global Health Status in the Oil Industry, Brazil (2006–2015), que compara o antes e o depois, podendo constatar uma mudança de paradigma na ST. Os resultados deste estudo mostram que a abordagem interdisciplinar, com foco no gerenciamento de riscos individuais e coletivos, está associada à melhoria dos indicadores globais de saúde analisados. A avaliação do retorno sustentável do investimento (S-ROI) foi analisada e obteve-se um S-ROI de 85,5% para as variáveis estudadas, justificando o amplo sucesso da estratégica de investigação implementada no âmbito da indústria petrolífera em foco. A diversidade e complexidade de temáticas abordadas ao longo desta investigação tornaram possível, para além das publicações centrais, desenvolver estudos complementares com vistas a um aprofundamento dos resultados apresentados, demonstrando a relevância do tema desenvolvido na tese, assim como seu potencial inovador no campo da ST. O modelo de gestão em ST proposto revelou-se válido e robusto, assumindo-se como uma forma de intervenção em gestão de saúde, capaz de responder aos principais desafios que as empresas de grande porte enfrentam na contemporaneidade, melhorando o bem estar dos trabalhadores e aumentando a produtividade dos mesmos de forma sustentável, traduzindo-se ainda num conjunto de relevantes publicações científicas validadas por pares.The field of workers' health (WH) aims to analyze and intervene in the relationships between work, health and the environment, based on the labor process, incorporating the theoretical knowledge of professionals in the field to the practical knowledge of workers. The actions must be linked to the daily life experienced by individuals, considering the environmental risks arising from anthropogenic activities, as well as the occupational risks that affect WH. In this context, the objective of this doctoral thesis is to propose a management model for WH services, from the perspective of risk management, in the oil industry in the state of Bahia, Brazil. The investigation included a retrospective assessment (2006-2018) of the information available through an institutional database and the analyzes were carried out as part of the periodic epidemiological assessment on the risks to health, work safety and environmental health. It is a study that undertook the combination of several methodological strategies, capable of encompassing the proposed complexity of action-research, such as report of experience, development and validation of instrument, index and model, in addition to a longitudinal study. The sample had an average of 1357 workers (MIN = 965; MAX = 1831). It is important to emphasize that this is a convenience sample and that, each year, the study population varied in number and composition; however, this difference is not statistically significant. In all the years surveyed, male workers, married, with an average of 44.9 years (MIN = 23; MAX = 73), under administrative work, living in the state capital of Bahia, Brazil, prevailed in the sample. and the average school level. SPSS version 25.0 was used for the statistical analysis of the data, namely for univariate and multivariate statistical analysis. Five most relevant researches stand out as the main results of the thesis, such as the action-research, entitled Interdisciplinarity: an Articulating Movement in the Field of Worker´s Health, which demonstrates the problems experienced in the practice of the studied field and confirms the need for a new management model in WH. For this, the elaboration and validation of an instrument of interdisciplinary approach of WH, entitled Interdisciplinary Worker’s Health Approach Instrument (IWHAI), continued. With the application of the IWHAI, it was possible to develop an index capable of assessing the risk of WH, focused on sustainable development in the workplace, the Worker’s Health Risk Index (WHRI). Based on these two tools, a new and original WH assistance model was conceptualized, the Workers' Healthcare Assistance Model (WHAM), which contemplates the interdisciplinary approach, risk management and economic sustainability in search of integral and integrated health , and which responds to the central objective of the investigation. In order to validate the effectiveness of the implementation of this interdisciplinary strategy, a retrospective longitudinal study was carried out, Implementation of an Interdisciplinary Approach to Promote Workers Global Health Status in the Oil Industry, Brazil (2006–2015), which compares the before and the after, being able to see a paradigm shift in the WH. The results of this study show that the interdisciplinary approach, with a focus on managing individual and collective risks, is associated with the improvement of the global health indicators analyzed. The evaluation of the sustainable return on investment (S-ROI) was analyzed and an S-ROI of 85.5% was obtained for the variables studied, justifying the broad success of the research strategy implemented within the scope of the oil industry in focus. The diversity and complexity of themes addressed throughout this investigation made it possible, in addition to the central publications, to develop complementary studies with a view to deepening the results presented, demonstrating the relevance of the theme developed in the thesis, as well as its innovative potential in the field of WH . The proposed WH management model proved to be valid and robust, assuming itself as a form of intervention in health management, capable of responding to the main challenges that large companies face today, improving the well-being of workers and increasing their productivity in a sustainable manner, resulting in a set of relevant scientific publications validated by peers.Le domaine de la santé des travailleurs (ST) vise à analyser et à intervenir dans les relations entre travail, santé et environnement, sur la base du processus de travail, en intégrant les connaissances théoriques des professionnels du domaine aux connaissances pratiques des travailleurs. Les actions doivent être liées à la vie quotidienne vécue par les individus, compte tenu des risques environnementaux liés aux activités anthropiques, ainsi que des risques professionnels qui affectent ST. Dans ce contexte, l'objectif de cette thèse de doctorat est de proposer un modèle de gestion des services ST, sous l'angle de la gestion des risques, dans l'industrie pétrolière de l'État de Bahia, au Brésil. L'enquête comprenait une évaluation rétrospective (2006-2018) des informations disponibles via une base de données institutionnelle et les analyses ont été effectuées dans le cadre de l'évaluation épidémiologique périodique des risques pour la santé, la sécurité au travail et la santé environnementale. Il s'agit d'une étude qui a entrepris la combinaison de plusieurs stratégies méthodologiques, capables d'englober la complexité proposée de la recherche-action, comme le rapport d'expérience, le développement et la validation de l'instrument, de l'indice et du modèle, en plus d'une étude longitudinale. L'échantillon comptait en moyenne 1357 travailleurs (MIN = 965; MAX = 1831). Il est important de souligner qu'il s'agit d'un échantillon de convenance et que, chaque année, la population étudiée variait en nombre et en composition; cependant, cette différence n'est pas statistiquement significative. Dans toutes les années de l'enquête, les travailleurs de sexe masculin, mariés, avec une moyenne de 44,9 ans (MIN = 23; MAX = 73), sous travaux administratifs, vivant dans la capitale de l'État de Bahia, au Brésil, ont prévalu dans l'échantillon. et le niveau scolaire moyen. La version 25.0 de SPSS a été utilisée pour l'analyse statistique des données, notamment pour l'analyse statistique univariée et multivariée. Cinq recherches les plus pertinentes se détachent comme les principaux résultats de la thèse, comme la recherche-action, intitulée Interdisciplinarité: un Mouvement Articulé Dans le Domaine de la Santé des Travailleurs, qui démontre les problèmes rencontrés dans la pratique du domaine étudié et confirme la nécessité d'un nouveau modèle de gestion à ST. Pour cela, l‟élaboration et la validation d‟un instrument d‟approche interdisciplinaire des ST, intitulé Instrument d’Approche Interdisciplinaire Pour la Santé des Travailleurs (IWHAI), s‟est poursuivie. L‟application de l‟IWHAI a permis de développer un indice capable d‟évaluer le risque de ST, axé sur le développement durable sur le lieu de travail, le Worker’s Health Risk Index (WHRI). Sur la base de ces deux outils, un nouveau et original modèle d'assistance ST a été conceptualisé, le Workers 'Healthcare Assistance Model (WHAM), qui envisage l'approche interdisciplinaire, la gestion des risques et la durabilité économique à la recherche d'une santé intégrale et intégrée, et qui répond à l'objectif central de l'enquête. Afin de valider l'efficacité de la mise en oeuvre de cette stratégie interdisciplinaire, une étude longitudinale rétrospective a été réalisée, Mise en OEuvre d'une Approche Interdisciplinaire Pour Promouvoir l'État de Santé Mondial des Travailleurs Dans l'Industrie Pétrolière, Bahia, Brésil (2006-2015), qui compare les et l'après, être capable de voir un changement de paradigme dans le ST. Les résultats de cette étude montrent que l'approche interdisciplinaire, centrée sur la gestion des risques individuels et collectifs, est associée à l'amélioration des indicateurs de santé globale analysés. L'évaluation du retour sur investissement durable (S-ROI) a été analysée et un S-ROI de 85,5% a été obtenu pour les variables étudiées, justifiant le large succès de la stratégie de recherche mise en oeuvre dans le cadre de l'industrie pétrolière en focus. La diversité et la complexité des thèmes abordés tout au long de cette enquête ont permis, en plus des publications centrales, de développer des études complémentaires en vue d'approfondir les résultats présentés, démontrant la pertinence du thème développé dans la thèse, ainsi que son potentiel d'innovation dans le domaine des ST . Le modèle de gestion ST proposé s'est avéré valide et robuste, se supposant comme une forme d'intervention dans la gestion de la santé, capable de répondre aux principaux défis auxquels les grandes entreprises sont aujourd'hui confrontées, en améliorant le bien-être des travailleurs et augmenter leur productivité de manière durable, aboutissant à un ensemble de publications scientifiques pertinentes validées par des pairs

Elaboración y validación de un instrumento de enfermería para triaje en servicios de salud ocupacional

This study aimed to develop and validate an instrument for nursing triage in occupational health services (ICEST). Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the ICEST. Validation of the items, content, construct and reliability were also performed. The final ICEST consisted of 14 indicators and 71-graduated indexes. The ICEST showed to be reliable, consistent and satisfactory structure to be applied in occupational health services.info:eu-repo/semantics/publishedVersio

Systematization Of Occupational Health Care: A Person-Centred Proposal

The Systematization of Occupational Health Care (SOHC) is based on the approach of “Person Centered Healthcare”, using the management tool of “Plan, do, check and act”, the model “Systematization of Nursing Care”, the “Interdisciplinary Worker's Health Approach Instrument”, the “Worker’s Health Risk Index”, and health taxonomies, as theoretical references. The SOHC aims at the articulated, intersectoral and interdisciplinary systematization [1] in occupational health from an adequate methodology to integral and integrated care. SOHC is understood as the organization of the conditions necessary to carry out the person-centered care process with regard to method, staff and instruments. The “Process” term makes it possible to identify, understand, describe, explain and/or predict the needs of the human person, family or community at a given time, in the context of health and disease process.info:eu-repo/semantics/publishedVersio

Development and Validation of an Interdisciplinary Worker’s Health Approach Instrument (IWHAI)

The present study aimed to develop and validate an Interdisciplinary Worker’s Health Approach Instrument (IWHAI). The development stage comprised a group of 10 professionals, including physicians, nurses, nutritionists, dentists and physical educators, as well as a judges’ committee, composed by 19 recognized experts in the area of worker’s health (WH). For the validation of the IWHAI, the Spearman’s correlation coefficient (rs) was calculated, the factor analysis to the instrument was applied, and the Cronbach’s alpha (α) and the Intraclass correlation coefficient (ICC) were calculated. The IWHAI was structured in five dimensions, integrating 43 health indicators, on a scale of 0–4, totalling 215 sub-indices with closed response coding. The instrument was validated with a Kappa coefficient (KAPPA) (k), with excellent agreement for all attributes, i.e., k = 0.88 for applicability, k = 0.80 for clarity and k = 0.82 for relevance. p > 0.05 results reveal moderate to strong positive correlations between some variables, i.e., pests, vectors and air quality/drinking water quality (rs = 0.69). A total of 14 components of the factor analysis, explaining 62.6% of the data variance, were extracted. α value is considered moderate to high, α = 0.61, the ICC value also being considered moderate to high, with ICC = 0.61. The IWHAI is considered validated, constituting a technological innovation for an interdisciplinary approach in the field of WH, enabling the prevention and integral promotion of health.info:eu-repo/semantics/publishedVersio

Systematization Of Occupational Health Care: A Person-Centred Proposal

The Systematization of Occupational Health Care (SOHC) is based on the approach of “Person Centered Healthcare”, using the management tool of “Plan, do, check and act”, the model “Systematization of Nursing Care”, the “Interdisciplinary Worker's Health Approach Instrument”, the “Worker’s Health Risk Index”, and health taxonomies, as theoretical references. The SOHC aims at the articulated, intersectoral and interdisciplinary systematization [1] in occupational health from an adequate methodology to integral and integrated care. SOHC is understood as the organization of the conditions necessary to carry out the person-centered care process with regard to method, staff and instruments. The “Process” term makes it possible to identify, understand, describe, explain and/or predict the needs of the human person, family or community at a given time, in the context of health and disease process.info:eu-repo/semantics/publishedVersio

The influence of social relations, leisure and drug use on mental health of oil industry workers in Brazil

The objective of this study was to investigate the influence of social relations, leisure and drug use on the mental health of workers in the oil industry of Bahia, Brazil. It is a descriptive, retrospective research, developed in 2018, involving 622 workers from an occupational health service, to whom the Self Reporting Questionnaire (SRQ-20) and a socioeconomic questionnaire were applied. Men (90.2%), aged between 50-59 years (45.6%), married (54.9%) and with a mean level of schooling (64.2%) prevailed in this study. Of the participants, 50% drink less than once a month and about 90% never smoked. An association between loss of interest in things and increase in alcohol consumption was identified (p < 0.05). Another association can be found between feeling nervous, tense or worried and increasing tobacco consumption (p < 0.05). In almost 95% of the participants, components of the family environment that positively interfere with health were identified, as well as the use of social and leisure environments to maintain and recover health. Social and leisure relations positively influence the mental health of the studied group, and alcohol and tobacco consumption are associated with common mental disorders (CMD).info:eu-repo/semantics/publishedVersio

The influence of social relations, leisure and drug use on mental health of oil industry workers in Brazil

The objective of this study was to investigate the influence of social relations, leisure and drug use on the mental health of workers in the oil industry of Bahia, Brazil. It is a descriptive, retrospective research, developed in 2018, involving 622 workers from an occupational health service, to whom the Self Reporting Questionnaire (SRQ-20) and a socioeconomic questionnaire were applied. Men (90.2%), aged between 50-59 years (45.6%), married (54.9%) and with a mean level of schooling (64.2%) prevailed in this study. Of the participants, 50% drink less than once a month and about 90% never smoked. An association between loss of interest in things and increase in alcohol consumption was identified (p < 0.05). Another association can be found between feeling nervous, tense or worried and increasing tobacco consumption (p < 0.05). In almost 95% of the participants, components of the family environment that positively interfere with health were identified, as well as the use of social and leisure environments to maintain and recover health. Social and leisure relations positively influence the mental health of the studied group, and alcohol and tobacco consumption are associated with common mental disorders (CMD).info:eu-repo/semantics/publishedVersio

Implementation of an Interdisciplinary Approach to Promote Workers Global Health Status in the Oil Industry, Brazil (2006–2015)

This study intends to analyse the behaviour of epidemiological variables of workers in an oil industry of Bahia, Brazil, before and after implementation of interdisciplinary practices in occupational health assessments between 2006 and 2015. This is a retrospective longitudinal study carried out in two time periods. Data were collected from the workers electronic medical record and time trends were analysed before (2006–2010) and after (2011–2015) the implementation of the interdisciplinary practices focusing on health promotion. The data were complementarily compared to a control group from the same industry.A statistically significant reduction for data on the number of smokers, periodontal disease and of days away from work was obtained. A significant increase in the number of physically active subjects was also observed. While not statistically significant, a reduction in the number of workers with obesity and overweight, with caries and altered glycemia, was identified. Coronary risk and high blood pressure indicators have shown aggravation. It can be concluded that an interdisciplinary health approach during the annual occupational assessments, with action directed to the population needs, can be associated with the improvement of the health indicators assessed, contributing to increased worker productivity in the oil industry.info:eu-repo/semantics/publishedVersio

Workers’ Healthcare Assistance Model (WHAM): development, validation, and assessment of Sustainable Return on Investment (S-ROI)

The present study aimed to present and validate the Worker´s Healthcare Assistance Model (WHAM), which includes an interdisciplinary approach to health risk management in search of integral and integrated health, considering economic sustainability. Through the integration of distinct methodological strategies, WHAM was developed in the period from 2011 to 2018, in a workers’ occupational health centre in the oil industry in Bahia, Brazil. The study included a sample of 965 workers, 91.7% of which were men, with a mean age of 44.9 years (age ranged from 23 to 73 years). The Kendall rank correlation coefficient and hierarchical multiple regression analysis were used for the validation of WHAM. The assessment of sustainable return on investment (S-ROI) was made using the WELLCAST ROI™ decision support tool, covering workers with heart disease and diabetes. WHAM can be considered an innovative healthcare model, as there is no available comparative model. WHAM is considered robust, with 86% health risk explanatory capacity and with an 85.5% S-ROI. It can be concluded that WHAM is a model capable of enhancing the level of workers’ health in companies, reducing costs for employers and improving the quality of life within the organization.info:eu-repo/semantics/publishedVersio

Desenvolvimento de um índice inovador para avaliar o risco em saúde do trabalhador: o WHRI aplicado em uma indústria de petróleo na Bahia, Brasil

Purpose: The objective of this study was to assess the worker’s health (WH) risk, focused on sustainable development in a work context and based on the development and application of the Worker’s Health Risk Index (WHRI) in the oil extraction and production industry in Bahia, Brazil.Design/methodology/approach: The sample, obtained by quota sampling, comprised 965 participants. The development stage integrated a group of 10 specialists, including physicians, nurses, nutritionists, dentists and physical educators, all specialists in the WH area, as well as 3 experts in the area of data science. Three risk ranges were defined: "Low", "Moderate" and "High".Findings: The WHRI validation revealed reliability and reproducibility, as well as the ability to identify differences among the population studied according to sex, age group and education level. The results indicate that the WH risk is higher in men, aged above 50 years old and with a low level of education (p &lt; 0.001). 74% of the participants are in the "Low", 21% in the "Moderate" and 5% in the "High" risk ranges. High-risk workers are also those with diabetes mellitus, altered triglyceride or glycemia levels, hypertension, poor oral hygiene and periodontal conditions, tobacco use, low levels of physical activity (all with p &lt; 0.05), or alcohol abuse.Originality/Value: The WHRI’s major contribution is to make available a useful tool for the identification of WH risk, helping to define clearer health promotion, prevention and intervention policies in the context of WH.Objetivo: O objetivo deste estudo foi o de avaliar o risco em saúde do trabalhador, com foco no desenvolvimento sustentável em contexto de trabalho e com base no desenvolvimento e aplicação do Índice de Risco à Saúde do Trabalhador (WHRI) numa indústria de extração e produção de petróleo na Bahia, Brasil.Desenho / metodologia / abordagem: A amostra, obtida por amostragem por cotas, é composta por 965 participantes. A etapa de desenvolvimento integrou um grupo de 10 especialistas, entre os quais médicos, enfermeiros, nutricionistas, dentistas e educadores físicos, todos especialistas na área da saúde do trabalhador, além de 3 especialistas na área de ciência dos dados. Três faixas de risco foram definidas: "Baixo", "Moderado" e "Alto".Resultados: A validação do WHRI revelou confiabilidade e reprodutibilidade, bem como capacidade de identificar diferenças entre a população estudada, segundo sexo, faixa etária e escolaridade. Os resultados indicam que o risco em saúde do trabalhador é maior em homens, com idade acima de 50 anos e baixa escolaridade (p &lt; 0,001). 74% dos participantes estão na faixa de risco "Baixo", 21% na "Moderada" e 5% nas faixa de risco "Alto". Trabalhadores de alto risco são aqueles com diabetes mellitus, triglicerídeos, glicemia e hipertensão alteradas, higiene oral e condição periodontal precárias, tabagismo, menos ativos fisicamente e níveis mais elevados de abstenção (todos com p &lt; 0,05).Originalidade: A principal contribuição do WHRI é o de disponibilizar uma ferramenta útil para a identificação do risco em saúde do trabalhador, contribuindo para definir políticas mais claras de promoção, prevenção e intervenção em saúde no contexto laboral