Beliefs and Sociodemographic and Occupational Factors Associated with Vaccine Hesitancy among Health Workers.

Introduction: Vaccine hesitancy has been implicated in the low-vaccination coverage in several countries. Knowledge about vaccine hesitancy predictors in health workers is essential because they play a central role in communication about the importance and safety of vaccines. This study aimed to assess beliefs and sociodemographic and occupational factors associated with vaccine hesitancy in health workers. Methods: This was a cross-sectional study among 453 health workers in primary and medium complexity services in a municipality in the state of Bahia, Brazil. The variable vaccine hesitancy was operationalized based on the answers related to incomplete vaccination against hepatitis B, measles, mumps and rubella, and diphtheria and tetanus. Associations between variables were expressed as prevalence ratios (PR) and their respective 95% confidence intervals (CI). Results: Endemic disease combat agents, administrative service workers, and support staff had the highest levels of vaccine hesitancy. Among the analyzed variables, the following were associated with vaccine hesitancy: working in secondary health care services (PR: 1.21; CI: 1.07-1.36), working as an endemic disease combat agent (PR = 1.42; 95% CI: 1.165-1.75), not sharing information about vaccines on social media (PR = 1.16; 95% CI: 1.05-1.28), distrusting information about vaccinations (PR: 0.86; CI: 0.75-0.99), and not feeling safe receiving new vaccines (PR = 1.16; 95% CI: 1.06-1.28). Conclusions: Strategies to enhance confidence in vaccination among health workers should consider differences in occupations and their working settings. Improving vaccination-related content in training and continuing education activities and facilitating access to onsite vaccinations at the workplace are crucial elements to reduce vaccine hesitancy among health workers.

Distribution and spatial density of viral hepatitis cases in Brazil due to occupational accidents.

Introduction: Viral hepatitis, an infectious disease endemic to Brazil, can be transmitted by occupational accident. Objectives: To analyze the distribution and spatial density of viral hepatitis due to occupational accidents in Brazil from 2007 to 2014. Methods: This ecological study of multiple groups used data from the Brazilian Sistema de Informação de Agravos de Notificação (Disease Information Notification System). Spatial analysis of cluster detection and point density was performed using kernel techniques and estimates. Results: The recorded cases were concentrated in the southeastern (40.6%) and southern regions (28.1%), and a small increase occurred between 2011 and 2014 (53.9%). The etiological classification was predominantly hepatitis C virus (45.3%) and B virus (45.1%). Conclusions: Reports of viral hepatitis due to occupational accidents have increased in Brazil in recent years, with a higher density in the southeastern and southern regions, especially viruses B and C. Thus, occupational health surveillance must be intensified, including vaccination cards for worker admission to the public or private companies.

Occupational stress and common mental disorders: how do coping strategies work?

Introduction: Coping strategies are described as devices capable of minimizing the effects of occupational stress on workers' mental health. Objectives: To evaluate the association between occupational stressors and occurrence of common mental disorders and how coping strategies work in this relationship. Methods: This is a cross-sectional study with 3,343 healthcare workers from six municipalities in the state of Bahia, Brazil. Common mental disorders were measured by the Self-Reporting Questionnaire, and occupational stressors by the Job Content Questionnaire. Coping strategies included physical activity, leisure activities, social support at work, alcohol consumption, and smoking. Bivariate and multivariate analyses were performed, stratified by sex. Results: Occupational stressors were associated with common mental disorders, more strongly among women. The practice of physical activity contributed to reduce the prevalence of common mental disorders, regardless of occupational stressors. Leisure activities were associated with lower prevalence of common mental disorders, but without statistical significance, losing relevance in the presence of occupational stressors. Social support and smoking or drinking habits were not associated with common mental disorders and did not influence the relationship with occupational stressors. Conclusions: Occupational stressors are associated with common mental disorders, with emphasis on high demand, even after adjusted for coping strategies. The relationship between occupational stressors and mental is corroborated, with greater female vulnerability, as well as the role of positive coping strategies in protecting mental health. The pertinence of adopting measures that reduce stress at work, promote the adoption of positive coping strategies, and consider gender inequalities in these relationships.

Influence of Sociodemographic and Emotional Factors on the Relationship between Self-Compassion and Perceived Stress among Men Residing in Brazil during the COVID-19 Pandemic.

The analysis of sociodemographic and emotional factors is essential to understanding how men perceive stress and practice self-compassion. In health crises, this problem becomes an emergency for public health. This study aimed to analyze the influence of sociodemographic and emotional factors on the relationship between self-compassion and the perceived stress of men residing in Brazil during the COVID-19 pandemic. This is a nationwide cross-sectional study carried out between June and December 2020 with 1006 men who completed a semi-structured electronic questionnaire. Data were collected using the snowball technique. Perceived stress was measured by the Perceived Stress Scale (PSS-14), and self-compassion was assessed using the Self-Compassion Scale. Most men had low self-compassion (51.5%; n = 516) and a moderate level of perceived stress (60.9%; n = 613), while 15.9% (n = 170) had a high level of stress. The prevalence of men in the combined situation of low self-compassion and high perceived stress was 39.4% (n = 334). Living with friends had a higher prevalence of low self-compassion and high perceived stress. The prevalence of common mental disorders was high (54.3%). Men with low levels of self-compassion reported higher levels of perceived stress; however, this association was moderated by emotional and sociodemographic variables. These findings highlight the importance of considering individual and contextual factors in public policies promoting men's mental health.

The Salvador Primary Care Longitudinal Study of Child Development (CohortDICa) Following the Zika Epidemic: Study Protocol.

This article describes the Salvador Primary Care Longitudinal Study of Child Development (CohortDICa). The exposed group was defined by confirmation of Congenital Zika Syndrome (CZS) diagnosed through computed tomography, magnetic resonance or transfontanellar ultrasound. A random selection of the 169 exposed children led to a subgroup of 120 children who were paired with children from the Live Birth Information System, according to birthdate, residence in the same street or neighborhood, and gestational age, resulting in 115 subjects in the non-exposed group. Following recruitment and before the participants completed 42 months, three measures were applied to assess cognitive, motor, and language performance, corresponding to three home visits. Social characteristics of the families and children, and the neurocognitive development of the children will be compared across the CZS exposed group (n = 147), the typical children with no exposure to CZS (n = 115) and the STORCH exposed group (Syphilis, Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex) (n = 20). Primary Health Care (PHC) should include long-term care strategies for the care of children and family members, and might benefit from the research, teaching, and extension activities provided in this study. In the face of the consequences of the Zika virus epidemic, an opportunity arose to intervene in the integrated care of child development within PHC, including, on an equal basis, typical children and those with delays or disabilities in the first six years of life.

Association between physical and psychosocial demands and musculoskeletal pain in health workers.

Introduction: The physical and psychosocial demands of work are important factors in the genesis of musculoskeletal pain. Identification of these dimensions and their interfaces with workers' individual characteristics could improve understanding of these outcomes. Objectives: To analyze the associations between the physical and psychosocial demands of work and occurrence of musculoskeletal pain in health care workers. Methods: This was a cross-sectional study conducted with health care workers. The exposure variables were psychosocial aspects and physical demands, investigated using the Job Content Questionnaire, and the outcomes were musculoskeletal pain in lower limbs, upper limbs, and the back, investigated as self-report of pain. A multivariate analysis was conducted to investigate associations between exposures and outcomes. Results: The factors associated with musculoskeletal pain in the three areas of the body studied were female sex, physical inactivity, and "poor" self-rated health status. Additionally, being a contract worker was associated with musculoskeletal pain in the lower limbs and back. Not participating in leisure activities and being responsible for direct provision of health care were associated with pain in the lower limbs. Being the person responsible for the housework and doing the housework were associated with pain in upper limbs. Differences between the demands of tasks, poor availability of the technical resources to perform activities, and absence of leisure activities were associated with back pain. Conclusions: It was concluded that both physical demands and psychosocial demands are associated with musculoskeletal pain in health care workers.

Introdução: As demandas físicas e psicossociais do trabalho constituem importantes fatores para a ocorrência de dor musculoesquelética. Conhecer essas dimensões e suas interfaces com as características individuais do trabalhador pode ajudar a compreender a ocorrência desses desfechos. Objetivos: Analisar a associação entre demandas físicas e psicossociais do trabalho e a ocorrência de dor musculoesquelética em trabalhadores da saúde. Métodos: Tratou-se de um estudo de corte transversal com trabalhadores da saúde. As variáveis de exposição foram os aspectos psicossociais e as demandas físicas investigadas por meio do Job Content Questionnaire, e o desfecho foi a dor musculoesquelética em membros inferiores, superiores e na região dorsal, investigada pela queixa de dor autorreferida. A análise multivariável foi utilizada para investigar a associação entre as exposições e os desfechos. Resultados: Os fatores associados a dor musculoesquelética nos três segmentos corporais foram ser do sexo feminino, não praticar atividade física e perceber o estado de saúde como "ruim". O vínculo de trabalho "não efetivo" esteve associado a dor musculoesquelética em membros inferiores e na região dorsal. A não participação em atividades de lazer e a prestação de assistência direta à saúde estiveram associadas a dor em membros inferiores. Ser o principal responsável pelas atividades domésticas e realizá-las mostraram-se associados a dor em membros superiores. As diferenças entre as exigências das tarefas, os recursos técnicos disponíveis ruins para a execução das atividades e a ausência de atividades de lazer estiveram associados a dor na região dorsal. Conclusões: Conclui-se que tanto as demandas físicas quanto as psicossociais estão associadas à dor musculoesquelética em trabalhadores da saúde.

Determinants of COVID-19 Vaccine Hesitancy in Portuguese-Speaking Countries: A Structural Equations Modeling Approach.

COVID-19 vaccine hesitancy (VH) has caused concerns due to the possible fluctuations that may occur directly impacting the control of the pandemic. In this study, we aimed to estimate the prevalence and factors associated with COVID-19 VH in Portuguese-speaking countries. We developed a web survey (N:6,843) using an online, structured, and validated questionnaire. We used Measurement Models, Exploratory Factor Analysis, Exploratory Structural Equation Models, and Confirmatory Factor Analysis for the data analysis. The overall prevalence of COVID-19 VH in Portuguese-speaking countries was 21.1%. showed a statistically significant direct effect for VH: vaccine-related conspiracy beliefs (VB) (ß = 0.886), perceived stress (PS) (ß = 0.313), COVID-19 Misinformation (MIS) (ß = 0.259) and individual responses to COVID-19 (CIR) (ß = -0.122). The effect of MIS and CIR for VH was greater among men and of PS and VB among women; the effect of PS was greater among the youngest and of VB and CIR among the oldest. No discrepant differences were identified in the analyzed education strata. In conclusion, we found that conspiracy beliefs related to the vaccine strongly influence the decision to hesitate (not to take or to delay the vaccine). Specific characteristics related to gender, age group, social and cognitive vulnerabilities, added to the knowledge acquired, poorly substantiated and/or misrepresented about the COVID-19 vaccine, need to be considered in the planning of vaccination campaigns. It is necessary to respond in a timely, fast, and accurate manner to the challenges posed by vaccine hesitancy.

Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June).

Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions.

Psychological Distress in Men during the COVID-19 Pandemic in Brazil: The Role of the Sociodemographic Variables, Uncertainty, and Social Support.

OBJECTIVE: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. METHODS: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. RESULTS: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. CONCLUSIONS: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.

Psychosocial risk factors at work associated with the level of physical activity among motorcycle taxi drivers.

Objective: To analyze the association of psychosocial risk factors at work, sociodemographic, and occupational characteristics with the level of physical activity among motorcycle taxi drivers.Methods: Cross-sectional study with 750 male motorcycle taxi drivers from the municipality of Jequié, Bahia, Brazil. A form containing sociodemographic and occupational characteristics was utilized. The psychosocial risk factors at work were evaluated by the Job Content Questionnaire and the level of physical activity by the International Physical Activity Questionnaire. The adjusted associations were analyzed by means of the Poisson regression with robust variance. Results: the prevalence of an insufficiently active level of physical activity was of 59.6%. The crude prevalence ratios (PR) showed an association between physical inactivity in motorcycle taxi drivers and high strain job (PR: 1.31), with 5 or more years of experience (PR: 1.67), in night shifts (PR: 1.36) and 40 or more years old (PR: 1.77). In the multivariate model, adjusted by income, work in high strain is kept associated to a situation of being insufficiently active (PR: 1.13), duration of employment of five or more years raised by 51.0% the frequency of insufficiently active physical activity (PR: 1.51) and the work in predominantly nocturnal shifts increased it by 26.0% (PR: 1.26). It is made evident that age was an effect modifier (p < 0.001) and its interaction was evaluated by including the corresponding product term (job Demand-Control model), which shows that the association between highly straining work and being insufficiently active was observed only among the youngest (21-39 years old) (PR: 1,21).Conclusions: the age and exposure to unfavorable working conditions, like long duration of employment, night work and work under high psychological demand and low control, have an influence on the insufficient physical activity among motorcycle taxi drivers.

Effort-Reward Imbalance, Over-Commitment and Depressive Episodes at Work: Evidence from the ELSA-Brasil Cohort Study.

A growing burden of mental illness, and in particular depression, among workers is a concern of occupational public health. Scientific evidence has revealed consistent associations of work-related stress, as measured by theoretical models, with depression, but mostly so in developed countries. This contribution explores these associations in a developing Latin American country, Brazil, by applying an internationally established work stress model, the effort-reward imbalance (ERI). This model focuses on the work contract where unjust exchange between high efforts spent and low rewards received in turn contributes to stress-related disorders. The model's extrinsic ('effort', 'reward') and intrinsic components ('over-commitment'), as well as their combination, are hypothesized to be related to a higher risk of depressive episodes (DE). Using cross-sectional data from the ELSA-Brasil study, including 10,034 workers from the public sector, we observed increased prevalence ratio (PR) of DE according to ERI scales. The quartiles of highest 'effort' (PR = 1.85; 1.44-2.37), highest 'over-commitment' (PR = 3.62; 2.80-4.70) and lowest 'reward' (PR = 3.44; 2.55-4.64) were associated with DE, on adjusted models, as well was the E-R ratio (PR = 2.47; 1.92-3.17). An additive interaction was identified between the E-R ratio and 'over-commitment'. The results support the use of ERI as a screening tool for work stress in the Brazilian context and will offer guidance for worksite health promotion programs.

Disability and functioning assessment of women with RSI/WRMSDs: the use of the ICF checklist.

BACKGROUND: Comprehensive approaches using the International Classification of Functioning, Disability and Health (ICF) Checklist have been adopted to give more visibility to demands related to specific health situations. OBJECTIVE: To analyze the incapacity and functioning associated with activity/participation and environmental factors of female workers with repetitive strain injury/work-related musculoskeletal disorders (RSI/WRMSDs) using workers' narratives, ICF codes and the RSI/WRMSDs Checklist developed as a part of the present research project. METHODS: A qualitative analysis of in-depth interviews with 15 female workers diagnosed with RSI/WRMSDs was completed. Functioning and disability were assessed by linking ICF codes identified in the participants' narratives to those included in the RSI/WRMSDs Checklist. RESULTS: Fifty-three of 60 ICF codes included in the RSI/WRMSDs Checklist were detected in the participants' narratives. Related to activity/participation, 26 codes were identified and 27 related to environmental factors. CONCLUSION: These results highlight the significance of the RSI/WMSDs Checklist to detect clinical and social problems experienced by workers during the rehabilitation and return-to-work process. They also reinforce the relevance of expanding the application of the checklist to male and female workers with RSI/WRMSDs undergoing rehabilitation to attain other levels of validation.

INTRODUÇÃO: As abordagens compreensivas utilizando o modelo do checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) vêm sendo utilizadas para dar visibilidade às demandas em situações de saúde específicas. OBJETIVO: Avaliar a incapacidade e funcionalidade relacionadas à atividade/participação e a fatores ambientais apresentadas por trabalhadoras com lesões por esforço repetitivo/distúrbios osteomusculares relacionados ao trabalho (LER/DORT) por meio da associação entre suas narrativas, os códigos da CIF e o do checklist LER/DORT criado por profissionais. MÉTODOS: Foi realizado um estudo qualitativo com 15 trabalhadoras com diagnóstico de LER/DORT que responderam a uma entrevista em profundidade. A avaliação da incapacidade e funcionalidade deu-se pela ligação entre os códigos da CIF identificados nas entrevistas e os que constavam do checklist. RESULTADOS: Cinquenta e três dos 60 códigos da CIF presentes no checklist para LER/DORT foram identificados nas entrevistas. Acerca da atividade/participação, foram reconhecidos 26 códigos, e dos fatores ambientais, foram identificados 27 códigos. CONCLUSÕES: Esses resultados apontam que o checklist LER/DORT é um importante instrumento cujo uso pode facilitar a identificação dos aspectos clínicos e sociais vivenciados pelos trabalhadores no seu processo de reabilitação e retorno ao trabalho. Os achados deste estudo reforçam a importância da ampliação da aplicação do checklis tem trabalhadores e trabalhadoras com ­LER/­DORT em processo de reabilitação para que alcancemos outros níveis de sua validação.

Occupational stress and job dissatisfaction with health work.

OBJECTIVE: The purpose of this study is to evaluate the association between psychosocial aspects at work and dissatisfaction among health workers in five cities in Bahia, Brazil. METHODS: The evaluation was based on different models proposed to measuring occupational stress and possible combinations between them: demand-control model (DCM) and effort-reward imbalance (ERI). We conducted a cross-sectional epidemiological study including 3084 health workers. The analysis considered the association between partial/full/partial (combined) occupational stress models (the variable "exposure") and job dissatisfaction (the variable "outcome"). RESULTS: Dissatisfaction rate was 26%. Full DCM and ERI models were better than partial ones to investigate job dissatisfaction. After adjustments, the combined models presented more robust measures of prevalence ratio than models evaluated separately (PR 2.93; CI 2.26-3.80). CONCLUSIONS: The combination of models has shown greater capacity to identify situations of job dissatisfaction and provided more potential information to support actions for workers' health.

Intersectionality of Race, Gender, and Common Mental Disorders in Northeastern Brazil.

This study applies the perspective of intersectionality, defined as social identities combining with one another and with structural societal factors to produce health inequities, to assess the interaction between race, gender, and common mental disorders (CMD) in northeastern Brazil. The Self-Reporting Questionnaire was used to assess CMD among a representative sample of adults in Feira de Santana, Bahia, Brazil (N=3273). Four groups (Black men, Black women, White women, White men) represented the intersection of race and gender. We used a Chi square test to compare the four groups and Poisson regressions to determine prevalence ratios (PR). White men had the lowest prevalence of CMD (11.1%) and Black women had the highest (37.2%). After adjusting for covariates, Black women had a statistically significantly higher prevalence of CMD than White men (PR=2.43; 95% CI: 1.39-4.25), though the prevalence among White women was not statistically significantly different from White men (PR=1.74; 95% CI: .93-3.30). Interaction tests were conducted on the multiplicative and additive scale, although the results were not statistically significant. These findings indicate that the experience of being both Black and a woman in Brazil is associated with elevated prevalence of CMD. Programs and interventions are needed to address this burden and research is needed to further explore its cause.

Occupational exposure and hepatitis B vaccination among health care workers.

BACKGROUND: Through its vaccination schedules, the National Immunization Program ensures immunization against hepatitis B gratis to health care professionals at high risk for infection at the workplace. OBJECTIVE: To analyze the association between variables related to occupational exposure and complete hepatitis B vaccination schedule. METHOD: Cross-sectional study with 3,084 primary care and medium complexity health care workers from five municipalities in the state of Bahia, Brazil. RESULTS: The factors associated with complete hepatitis B vaccination schedule on bivariate analysis were: contact with biological materials, preparation of medications, use of personal protective equipment (PPE), search for orientation after a work accident and skill demands. CONCLUSIONS: Workers in the health sector resist adhering to some preventive measures. Strategies to encourage vaccination might be enhanced by creating room for discussion at work on the burden to which employees are exposed. Plans and policies for workers' health should be formulated in the light of governmental policies set for the overall population.

CONTEXTO: O Programa Nacional de Imunização (PNI), por meio dos calendários vacinais, garante imunização gratuita contra hepatite B para os profissionais de saúde que possuem risco aumentado para infecção relacionada aos processos laborais. OBJETIVO: Analisar a associação entre a vacinação completa para hepatite B e as variáveis relacionadas à exposição ocupacional. MÉTODO: Estudo de corte transversal realizado com 3.084 trabalhadores da atenção primária e média complexidade de cinco municípios da Bahia. RESULTADOS: Os fatores associados à vacinação completa para hepatite B na análise bivariada foram: contato com material biológico, preparo de medicação, utilização de equipamento de proteção individual (EPI), procura de orientação após acidente de trabalho e exigência de habilidade no trabalho. CONCLUSÕES: Os trabalhadores do setor da saúde ainda apresentam resistência em aderir a algumas medidas de prevenção. Por isso, estratégias de incentivo à vacinação podem ser potencializadas com a abertura de espaços de discussão no trabalho a respeito das cargas laborais às quais o grupo está exposto. Reais planos e políticas de enfrentamento relacionadas à saúde do trabalhador precisam ser definidos à luz das políticas governamentais que têm sido constituídas para a população geral.

Factors associated with common mental disorders among female nursing professionals in primary health care.

OBJECTIVE: To analyze the factors associated with common mental disorders (CMD) in primary care female nursing professionals. METHODS: We performed exploratory cross-sectional study, using a structured questionnaire, applied to 451 primary care female nursing professionals from five municipalities of Bahia, Brazil, in a randomly selected sample. The outcome variable (CMD) was evaluated by SRQ-20. To analyze the factors associated with the prevalence of CMD, logistic regression analysis was used in blocks. RESULTS: The prevalence of CMD was 16.2% and the exposure factors were professional category (PR 0.56, CI 0.34-0.90, p = .01), having a workload of more than 60 h per week (PR 2.53, CI 1.55-4.11, p < .01), personal insecurity at work (PR 1.92, CI 1.28-2.88, p = .00), high domestic overload (PR 1.94, CI 1.25-2.98, p < .01), effort-reward imbalance at work (PR 1.78, CI 0.98-3.23, p = .05), dissatisfaction with oneself (PR 2.30, CI 1.52-3.46, p < .01), poor quality of life (PR 1.69, CI 1.07-2.65, p = .02), and negative health status self-assessment (PR 1.77, CI 1.12-2.77, p = .01). CONCLUSIONS: The results reinforce the evidences of the relation between the health-disease process and work, be it professional or domestic. They also highlight the importance of changes in the organization of the nursing activities in the context of primary care, aiming to minimize stress and occupational dissatisfaction and promote the health of this category. It is noteworthy that domestic work should be considered and incorporated into investigations regarding the mental health of female population.

Protective Strategies Against Dysphonia in Teachers: Preliminary Results Comparing Voice Amplification and 0.9% NaCl Nebulization.

OBJECTIVE: This study aimed to compare the effects of two protective strategies, voice amplification (VA) and 0.9% NaCl nebulization (NEB), on teachers' voice in the work setting. METHODS: An interventional evaluator-blind study was conducted, assigning 53 teachers from two public high schools to one of the two protective strategy groups (VA or NEB). Vocal function was assessed in a sound-treated booth before and after a 4-week period. Assessment included the severity of voice impairment (Consensus Auditory-Perceptual Evaluation of Voice [CAPE-V]), acoustic analysis of fundamental frequency (f0), sound pressure level (SPL), jitter, shimmer, glottal-to-noise excitation ratio (GNE), noise (VoxMetria), and the self-rated Screening Index for Voice Disorder (SIVD). Data were statistically analyzed using SPSS Statistics (version 22) with a significance level of P ≤ 0.05. Effect size was calculated using Cohen's d coefficient. RESULTS: There were no statistical differences between groups at baseline in terms of age, sex, time of teaching, teaching workload, and voice outcomes, except for SPL. During postintervention between groups, NEB displayed lower SIVD scores (VA = 3; NEB = 0; P = 0.018) and VA had lower acoustic irregularity (VA = 3.19; NEB = 3.69; P = 0.027), with moderate to large effect size. Postintervention within-groups decreased CAPE-V for VA (pretest = 31.97; posttest = 28.24; P = 0.021) and SIVD for NEB (pretest = 3; posttest = 0; P = 0.001). SPL decreased in both groups, NEB decreased in men only, and VA decreased in both men and women. NEB increased f0 for female participants (P ≤ 0.001). CONCLUSION: Both VA and NEB may help mitigate dysphonia in different pathways, being potential interventions for protecting teachers' voices in the work setting. An ongoing study with a control group will further support these preliminary results.

Simultaneity of leisure behaviors and common mental disorders among healthcare workers.

The objective of this study was to investigate the aggregation of four leisure behaviors and the association between the number of leisure behaviors and common mental disorders (CMD). A cross-sectional study was carried out with a representative sample of healthcare workers of Brazil. The aggregation of the types of leisure activities was assessed by comparing the observed prevalence with the expected prevalence. The logistic regression analysis evaluated the association between the number of leisure behaviors and CMD. Leisure behaviors tended to show aggregation (<0.05). The multivariate analysis showed a negative association between the number of leisure behaviors and the CMD, only among women. The results indicate that the association between the number of leisure behaviors and the CMD is different depending on sex.

Work-related Mental Health Surveillance in Brazil: characteristics, difficulties, and challenges. / Vigilância em Saúde Mental e Trabalho no Brasil: características, dificuldades e desafios.

This paper addresses the challenges and difficulties in Work-related Mental Health (WMH) Surveillance in Brazil, based on a review of the bibliographic literature. From the compilation of identified academic research, it seeks to foster reflections about the current landscape of surveillance actions, its main obstacles, and possibilities for improvement. A survey of national publications was carried out using Scielo, Lilacs and PUBMED databases from 2002 until 2017. Systematizing the results allows us to group the following themes: Epidemiology of WMH in Brazil; Policies for WMH and VISAT; Work Environment for Mental Health; and, Actions and Interventions in the VISAT and WMH. The surveillance actions are still in the early stages; however, there is an effort to strengthen the RENAST, materialized in the creation of protocols and the promotion of national meetings which reflect the construction of a new surveillance model for worker health. We noted a search for new conceptual models of mental illness, a redefinition of the focus of care, and of intervention approaches highlighting the active role of workers, who are essential players in facing the challenges in this area.

Resumo Este artigo aborda as dificuldades e os desafios da Vigilância em Saúde Mental Relacionada ao Trabalho (SMRT) no Brasil, com base em levantamento de produção bibliográfica. Busca-se, a partir da compilação da produção identificada, fomentar reflexões sobre o panorama atual em que se encontram as ações em Vigilância nesse campo, seus principais entraves e possibilidades de avanços. Efetuou-se levantamento de publicações nacionais nas bases do Scielo, Lilacs e PubMed, de 2002 a 2017. A sistematização dos dados permitiu a sua estruturação nas seguintes temáticas: Epidemiologia da SMRT no Brasil; Políticas para a SMRT e a VISAT; Organização do Trabalho e Saúde Mental; e, Ações e Intervenções em VISAT e SMRT. As ações para Vigilância encontram-se, ainda, em estado incipiente, porém há esforços para o fortalecimento da RENAST, materializado na construção de protocolos e na promoção de encontros nacionais que visam à reflexão e à construção de um novo modelo de Vigilância em Saúde do Trabalhador. Registra-se a busca por novos modelos e concepções de adoecimento mental, de redefinição do foco de atenção, de modos de intervenção com destaque para o papel ativo dos trabalhadores, protagonistas imprescindíveis ao enfrentamento dos desafios nesse campo.

Common Mental Disorders among Occupational Groups: Contributions of the Latent Class Model.

Background. The Self-Reporting Questionnaire (SRQ-20) is widely used for evaluating common mental disorders. However, few studies have evaluated the SRQ-20 measurements performance in occupational groups. This study aimed to describe manifestation patterns of common mental disorders symptoms among workers populations, by using latent class analysis. Methods. Data derived from 9,959 Brazilian workers, obtained from four cross-sectional studies that used similar methodology, among groups of informal workers, teachers, healthcare workers, and urban workers. Common mental disorders were measured by using SRQ-20. Latent class analysis was performed on each database separately. Results. Three classes of symptoms were confirmed in the occupational categories investigated. In all studies, class I met better criteria for suspicion of common mental disorders. Class II discriminated workers with intermediate probability of answers to the items belonging to anxiety, sadness, and energy decrease that configure common mental disorders. Class III was composed of subgroups of workers with low probability to respond positively to questions for screening common mental disorders. Conclusions. Three patterns of symptoms of common mental disorders were identified in the occupational groups investigated, ranging from distinctive features to low probabilities of occurrence. The SRQ-20 measurements showed stability in capturing nonpsychotic symptoms.