Estresse ocupacional segundo o modelo demanda-controle e suas repercussões na saúde do trabalhador de enfermagem: análise das variações de cortisol salivar

• Autor(a) principal: Campos, Juliana Faria
• Data de Publicação: 2013
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/11122
• topic: Occupational stress; Salivary cortisol; Nursing; Estresse ocupacional; Cortisol salivar; Enfermagem; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

The object of study was work stress and levels of salivary cortisol. The overall objective was to evaluate the association between work stress and salivary cortisol variations among nursing workers inserted in hospital care in Rio de Janeiro. The study hypothesis was that there is an association between workers exposed to high strain at work and changes in salivary cortisol. This is an observational epidemiological analytical sectional study held in state hospital located in Rio de Janeiro with a sample of 103 workers. For evaluation of psychosocial hazards at work, it was used the "Job Content Questionnaire". The salivary cortisol was measured by collecting 04 samples from each participant in a workday: at awakening, 30 minutes after, at 12 and 18 pm. Data collection was conducted between March and April 2012. We used SPSS 18.0 for data analysis. The psychological demand and control dimensions and subtraction were used as continuous variable in correlation analyzes with the outcome and covariates. Cortisol levels were quantified by five indices: calculating the area under the curve relative to zero or base (AUCg), area under the curve with respect to increase (AUCi), the mean increase (MnInc), excretion cortisol after waking period (AUCtrab) and area under the curve relative to zero or base diurnal cycle (AUCCD). To evaluate the association between exposure and outcome and covariates, we used the Mann Whitney and Kruskal-Wallis tests. The covariates associated with exposure or outcome at a significance level of 20% (p ≤ 0.20) were tested in a linear regression model. Correlation analysis was done using the correlation coefficient of Spearman's. As a result it was found that the nursing staff had averages for psychological demand and control that tend to the upper limit, as well as for subtraction, featuring high demand and high control, that is active work. The mean cortisol observed upon awakening, 30 minutes after, 12 and 18 pm was 5.82 nmol / L) (± 4.86) 16.60 nmol / L (± 8.31) 7.49 nmol / L (± 6.97) and 3.93 nmol / L (± 3.15) respectively. Cortisol increase between waking and 30 minutes after averaged 64%. For the cortisol´s indices adopted the average to MnInc, AUCg, AUCi, and AUCtrab AUCCD was 10.78 nmol / L (± 6.99) 5.61 nmol / L (± 2.92) 2.69 nmol / L (± 1.75) 32.51 nmol / L (± 21.99) and 107.99 nmol / L (± 61.63) respectively. This study showed that levels of free salivary cortisol are not associated to high strain at work, even when adjusted for potential confounders or effect modifiers. The study hypothesis was not confirmed. The data obtained in this study revealed important aspects of psychosocial hazards that nursing staff are exposed during work process, offering subsidies to be implemented guidance programs and promotion health worker and provide a contribution to understanding the biological pathways by which work stress influences health.