Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and PDF

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ISSN Fisioter. Mov., Curitiba, v. 27, n. 3, p , jul./set Licenciado sob uma Licença Creative Commons DOI: [T] Absenteeism for low

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ISSN Fisioter. Mov., Curitiba, v. 27, n. 3, p , jul./set Licenciado sob uma Licença Creative Commons DOI: [T] Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and 2009 [I] Absenteísmo por lombalgia na prefeitura de Goiânia nos anos de 2008 e 2009 [A] Cristina Aparecida Neves Ribeiro [a], Demóstenes Moreira [b] [a] [b] MSc, Universidade de Brasília, Brasília, DF - Brazil, PhD, professor, Universidade de Brasília, Brasília, DF - Brazil, [R] Abstract Objective: To establish and evaluate the indicators of absenteeism for low back pain among municipal public servants of the city of Goiania in 2008 and Material and methods: This is a descriptive, epidemiological, retrospective study. We used secondary data provided by the Municipal Medical Board of Goiânia. The sample was composed by active, statutory and commissioned civil servants of the executive branch, of both sexes, who took sick leaves for health care in the period from January 2008 to December We analyzed all cases of sick leave for health care which were taken for a period of more than 3 days and caused by low back pain. Frequency and severity indexes, proportion of lost time and average length of absences were calculated. The data were statistically analyzed using descriptive and inferential statistics. Results: 625 sick leaves were analyzed. In 2008, 32% of public servants took sick leave for health care. 2.83% of these leaves were for low back pain, generating 3541 days of absence. In 2009, the total percentage of sick leaves was 30%. 5.38% of these were due to low back pain, leading to 6890 lost working days. The indicators of absenteeism for 2008 and 2009 were, respectively: frequency index = and 0.015; severity index = 0.14 and 0.26, proportion of lost time = 13.89% and 27.34%; average length of absences = and days. Conclusion: The results indicate the need for the creation of intervention policies on work organization, since low back pain is a disorder that can be prevented at the primary level. [P] Keywords: Low back pain. Absenteeism. Public sector. Occupational health. Health profile. 350 Ribeiro CAN, Moreira D. Resumo Objetivo: Estabelecer e avaliar os indicadores de absenteísmo por lombalgia entre os servidores públicos municipais da cidade de Goiânia nos anos de 2008 e Material e métodos: Estudo retrospectivo, descritivo, de caráter epidemiológico realizado na Junta Médica Municipal de Goiânia. A amostra foi composta por todos os servidores públicos municipais ativos do poder executivo, de ambos os gêneros, civis estatutários e comissionados afastados por licença para tratamento de saúde no período de janeiro de 2008 a dezembro de Foram analisadas as Licenças Tratamento Saúde superiores a três dias ocasionadas por lombalgia e calculados os índices de frequência, gravidade, proporção de tempo perdido e a duração média das ausências. Os dados foram tratados estatisticamente, por meio de análise descritiva e inferencial. Resultados: Foram analisados 625 afastamentos. Em 2008, 32% dos servidores afastaram-se por Licença Tratamento Saúde e destes 2,83%, por lombalgia, gerando 3541 dias de ausência. Em 2009, o percentual total de afastamentos por doença foi de 30% e destes 5,38% aconteceu por lombalgia levando a 6890 dias de trabalho perdidos. Os indicadores de absenteísmo foram respectivamente para 2008 e 2009: índice de frequência = 0,009 e 0,015; índice de gravidade = 0,14 e 0,26; proporção de tempo perdido = 13,89% e 27,34%; duração média das ausências = 16,39 e 16,84 dias. Conclusão: Os resultados apontam para a necessidade de criação de políticas de intervenção sobre a organização do trabalho, pois a lombalgia é uma afecção passível de prevenção em nível primário. [K] Palavras-chave: Dor lombar. Absenteísmo. Setor público. Saúde do trabalhador. Perfil de saúde. Introduction In 2007, there were approximately 8.5 million public servants at all levels of government in Brazil. A study conducted by the Institute for Applied Economic Research (IPEA) indicated that public employment, considering direct and indirect administration and state enterprises, accounted for about 11% of the total number of employed persons between the years 1995 and And, within this amount, the majority works at municipal level, which shows a clear increasing trend (1). This category of workers is directly involved in the preparation of projects and provision of various services to the population, especially in the areas of education and health. Thus, they play an important role in Brazilian society. Nevertheless, there is still not much information on this social segment, especially from the point of view of labor relations and sickness (2). Public servants do not differ at all from other classes of employees in what regards their susceptibility to acquire a disease or to have a disease aggravated by work. According to Schilling s classification, there are two groups of occupational diseases: category II are diseases to which work is a contributory factor; and category III are pre-existing disorders or diseases for which work is a causing or aggravating factor. They are represented by arterial hypertension, chronic respiratory diseases, mental disorders and diseases of the locomotor system (3). This last group of diseases includes back pain, osteoarthrosis, cervicobrachialgias, tenosynovitis, among others. All of them are important causes of morbidity and have a great social and economic impact. However, low back pain can be highlighted due to its high prevalence (4). It is defined as pain and discomfort in the region located between the margin of the last rib and the gluteal folds, with or without radiation to the legs (5). A large number of people suffers from low back pain. A systematic review found point prevalences ranging from 12% to 33%. These figures increased when the whole life period of the individual was studied, ranging from 11% to 84% (6). Consequent social costs are high and the aggravating factor is that a small number of persons affected by low back pain generate excessive costs, besides the loss of several days of work. Therefore, once added up, its direct and indirect expenses amount to an alarming proportion, when compared to other pathologies (7). A significant share of expenditures is due to the loss of working days, which is known as absenteeism (8). A study conducted by the European Foundation for the Improvement of Living and Working Conditions (9) defined the concept of absenteeism as: ... temporary, prolonged or permanent disability to work as a result of disease or infirmity... . Absenteeism due to illness is the most common cause of absenteeism among the working population and has negative repercussions for employees, employers and, consequently, for the whole society (9). Given the above, the aim of this study was to establish and evaluate the indicators for absenteeism due to low back pain among municipal public servants of the city of Goiania in 2008 and Material and methods This is a descriptive, epidemiological, retrospective study on absenteeism for low back pain among municipal public servants of the city of Goiania in the period from January 2008 to December The study sample was composed of cases of sick leave for health care (SLHC) for a period of more than three days, for active puclic servants of both sexes who were permanent workers, permanent workers on probation, or commissioners of secretariats, Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and 2009 agencies and companies of the municipal executive power. All leaves have to be certified by the Municipal Medical Board (MMB). We used secondary data provided by the MMB, where all absenteeism for more than three days related to the municipal executive power must be registered. The information regarding the registration of the public servant, the reason for the SLHC and the number of absence days were collected from books of manual records. The Goiânia Urbanization Company (COMURG) and the Metropolitan Company for Collective Transportation services of Goiânia (CMTC) were excluded from the study because almost all of its staff members are employees hired under the Consolidation Work Laws (CLT) regime. The list of all organs and entities included in the study is shown in Table 1. Our goal was to analyze sickness absenteeism. Therefore, all absenteeism due to maternity leave, leave due to illness in the family and other types of leaves that public servants are entitled to take according to their statute were excluded from the analysis. As the object of study here are low back pain cases, we included in the study all SLHC with the codes M54; M54.3; M54.4; M54.5; M Table 1 - List of bodies and entities of the municipal executive power included in the study (To be continued) Direct administration Bodies and entities of the municipal executive power Indirect administration Municipal Government Secretariat (SEGOV) Municipal Communication Secretariat (SECOM) Municipal General Procuratorate (PGM) Municipal Secretariat of Planning and Urbanism (SEPLAM) Municipal Health Secretariat (SMS) Municipal Secretariat of Administration and Human Resources (SMARH) Municipal Agency for Traffic, Transportation and Mobility (AMT) Municipal Urban Constructions Agency (AMOB) Municipal Environment Agency (AMMA) Social Security Institute for Municipal Public Servants of Goiânia (IPSM) Institute for Health and Social Care of Municipal Public Servants of Goiânia (IMAS) Data Processing Company of the Municipality of Goiânia (COMDATA) Municipal Secretariat of Finances (SEFIN) Municipal Secretariat of Labor, Employment and Earnings (SETRAB) Municipal Education Secretariat (SME) Municipal Housing Secretariat (SMHAB) 352 Ribeiro CAN, Moreira D. Table 1 - List of bodies and entities of the municipal executive power included in the study Bodies and entities of the municipal executive power (Conclusion) Direct administration Indirect administration Municipal Culture Secretariat (SECULT) Municipal Secretariat for Economic Development (SEDEM) Municipal Tourism Secretariat (SEMTUR) Municipal Infrastructure Secretariat (SEINFRA) Municipal Secretariat for Sports and Leisure (SEMEL) Municipal Secretariat of Social Assistance (SEMAS) Source: Goiânia. Lei complementar n. 183 de 19 de dezembro de Two dependent variables were created: number of sick leaves (events or cases) and number of absence days. For the study of absenteeism, we used the recommendations of the Subcommittee on Absenteeism of the International Society for Occupational Health (10), addressing three indicators represented by the following formulas: Frequency Index = Number of sick leaves per year Number of public servants (average annual number) Number of lost days per year Severity Index = Number of public servants (average annual number) Number of lost days per year Proportion of lost time = Expected number of working days per year Moreover, due to its importance, another indicator by Quick and Lapertosa (11) was used: Average length of absences = Number of lost days per year Number of sick leaves per year The data were statistically analyzed using descriptive and inferential statistics. The research followed the ethical guidelines outlined in Resolution 196/96 of the National Health Council. The research project was approved by the Research Ethics Committee of the Faculty of Health Sciences of the University of Brasilia (Opinion number 046/10). To protect the confidentiality of those involved in the study, we changed the functional number by the order number. All authors declare that there was no conflict of interest in this study. Results In both years surveyed a total number of 650 SLHC occurred due to low back pain. We collected data regarding 625 sick leaves of 482 public servants, who had been absent for 10,431 days. Twenty five records of SLHC were excluded from the sample because not all variables could be extracted due to inconsistencies in the system, which probably resulted from the fact that the data were not completely filled in. In 2008, the average population among the sites studied was 23,846 public servants. They generated 7,625 SLHC, with a percentage of 32% of cases of sick leave and the loss of 173,859 days of work. Of these, 181 (2.83%) public servants took sick leaves from work for low back pain, generating 216 cases of sick leave (given the fact that the same person may have taken sick leave more than once). This amounted for a total of 3,541 days of absence. Analyzing the proposed indicators in Table 2, it can be seen that the frequency index was low, which was expected, mainly because we selected only one condition from a very large set of diseases that can lead to sick leaves. On the other hand, the severity index, the proportion of lost time and the average length of absences showed values that deserve to be highlighted and will be discussed later. The following year, the average population increased to 25,496 public servants. Even with the increase in the population studied, the percentage of people who took SLHC did not rise. On the contrary, it was slightly lower, accounting for 30% of cases of sick leave, 7596 occurrences of SLHC and the loss of 204,235 days of work. Conversely, the number of cases of sick leave for low back pain increased to 409 (5.38%). These were generated by 301 people and caused the loss of 6,890 working days. The frequency index remained low. However, the severity index, the proportion of lost time and the average length of absences were even higher, as can be seen in Table 2. We highlight the proportion of lost time, which went from 13.89% in 2008 to 27.34% in These indicators of absenteeism were also calculated according to each evaluated secretariat (Table 3), except for the frequency index, which was not relevant to the analysis because its results were all lower than Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and 2009 Of the 22 agencies studied, four (SEMTUR, SEMEL, SECOM and IMAS) had no records of sick leave for low back pain in two consecutive years. This fact calls into question the possibility of underreporting, i.e., there may have been episodes of low back pain, but they did not generate SLHC. The SEMAS, which has a large number of employees working in functions that fall into the category operational service, showed the highest severity index and the highest average length of absences in The COMDATA is a body responsible for data processing, thus, administrative functions are prevalent. It showed the highest severity index and the third highest average length of absences in Regarding the proportion of lost time, the two secretariats with the highest rates were those of education and health, respectively. It is important to highlight that the figures found in these two secretariats are quite superior to those found in other organs or entities. This reveals that in these two organs the relation between the number of lost days and the expected number of working days is compromised due to episodes of low back pain. 353 Table 2 - Indicators of absenteeism among municipal public servants on leave due to low back pain in the years 2008 and 2009 in Goiânia Year Total population (annual average) Number of sick leaves for low back pain Number of days of sick leave for low back pain Frequency index Severity index Proportion of lost time Average length of absences Note: Proportion of lost time is expressed in %; average length of absences is expressed in days. Expected number of working days: 2008 = 255; 2009 = 252. Source: Research data. Table 3 - Indicators of absenteeism due to low back pain according to each body and entity of the municipal Executive power of Goiânia in the years 2008 and 2009 (To be continued) Bodies and entities SI* % lost time** ALA*** SMS SME SECULT SEDEM 354 Ribeiro CAN, Moreira D. Table 3 - Indicators of absenteeism due to low back pain according to each body and entity of the municipal Executive power of Goiânia in the years 2008 and 2009 (Conclusion) Bodies and entities SI* % lost time** ALA*** SEINFRA PGM SEMTUR SEMEL SECOM SMHAB SETRAB SEMAS SEFIN SEGOV SEPLAM SMARH AMOB AMMA IMAS COMDATA AMT IPSM Note: *SI = severity index; **% lost time = proportion of lost time; ***ALA= average length of absences. Source: Research data. It is also important to note that the situation of these two secretariats substantially deteriorated between 2008 and The rates of lost time more than quadrupled in the Health Secretariat in this period. Regarding the number of absences per public servant, the vast majority % and 76.41% in 2008 and 2009, respectively - was absent only once in each year of the study, as can be seen in Figure 1. Next, we present, in descending scale, the records of two to six sick leaves taken by the same public servant and for the same reason: back pain. Discussion Before deepening the discussion of these data, it is important to stress that only sick leaves longer than three days were analyzed in this study. Public servants may have used these days to take care of their own health, which may cause underreporting. In addition, we found a variety of methodological criteria that were used to establish the study sample in the national and international literature. This is due to the fact that the databases which support this type of study have diverse objectives and are organized differently. Thus, the comparisons and discussions presented below were based on the problems' context and not exclusively on the figures found. On the percentage of sick leaves for low back pain, Ghaffari et al. (12) found similar results to this study. The authors reported 5% of sick leaves related to low back pain among a population of 18,031 Iranian industrial workers. In 2009, the municipal service of Goiania showed 5.38% of sick leaves, including all professional categories. Thus, the reality found in this city is not really different from that reported internationally. Absenteeism for low back pain in the municipal administration of Goiânia in the years 2008 and Figure 1 - Distribution of the number of absences per municipal public servant with SLHC for low back pain in the years 2008 and 2009 in Goiânia Source: Research data. A study conducted in order to investigate sickness absenteeism among public servants of Montevideo found: frequency index of 1.08; severity index of 6.84; and average length of absences of 6.28 days (13). Five hundred forty-one cases of sick leave registered in the medical service of a mining company in Peru were evaluated and the following indices were reported: frequency of 0.45; severity of 5.41; and average length of absences of days. We compared our results with those found in the study conducted in Montevideo. Even though most figures are lower, we conclude that they are high, due to the loss of time and money caused by the absences (14). In the case of Goiânia, it is worth highlighting that the average length of sick leave for low back pain was 16 days, which is well above the results of the two studies previously mentioned. A study conducted at Porto Alegre evaluated sick leaves longer than 15 days in all secretariats of the municipal government in 2004 and The average length of absences in 2004 was 21.1 days and the Municipal Secretary of Sports was the most affected entity (15). This rate was higher than that found in Goiania, probably due to methodological differences, since in this study we only considered sick leaves longer than three days. The severity indexes were 9.7 and 9.3 in 2004 and 2005, respectively (15). In Goiânia, the indexes found in 2008 and 2009 were 0.15 and 0.27, respectively. Still, in the study conducted in Porto Alegre, it was found that diseases of the musculoskeletal system and connective tissue represented the third cause o
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