Condiciones de trabajo en la producción de comidas como factores de riesgo para la insuficiencia venosa de miembros inferioresanálisis comparativo entre Brasil y España

Resumo

INTRODUCTION: The traditional food service process is characterized by intensive use of labor. A particularity of food services is their great dependence on the performance of their labor force and sometimes this is one of their main problems. Chronic venous insufficiency is an important public health problem, affecting the individual’s personal and work life. It may lead to missing work and hospitalizations, thereby indirectly affecting production quality and consequently decreasing operational efficiency. Contrary to many other chronic diseases, patients and health professionals often demonstrate little concern for the presence and severity of venous diseases. Although there are no conclusive evidences indicating that work causes venous disease, today there is consensus among clinicians and scientists that work can be a great promoter of venous diseases. The main factors that support this premise are the standing upright position, excessively hot and humid environments, carrying heavy objects and overweight and obesity. The scientific literature reports the existence of these factors in the food service sector. OBJECTIVES: The present study assesses which factors promote the development or worsen venous disease of the lower limbs in a hospital food service unit, correlating the occurrence and pathological severity of the disease with work conditions and comparing Brazilian and Spanish hospital kitchens. METHODS: A cross-sectional study with a quantitative and qualitative approach was done using an Ergonomic Work Analysis (EWA) in accordance with its stages: Analysis of the Demand, Analysis of the Request, Analysis of the Activities, Diagnosis and Ergonomic Recommendations. Data was collected from female workers of the two kitchens using a semi-structured interview. The data included their body mass index (BMI) and a specific test to diagnose venous disease based on the CEAP classification (clinical, etiological, anatomical and pathophysiological). The volumetric variations of the lower limbs at the beginning and end of a day’s work of each employee were determined by the water displacement method. The activities performed at the workplace were followed by direct observation with image registration, use of pedometers, stopwatches, decibel meter and digital thermo-hygrometer.The field research was done in the production sector of a reference hospital kitchen in Madrid, Spain. The data were analyzed by integrating the statistical analysis (p<0.05) with the qualitative analysis, and confronting the different stages of the Ergonomic Work Analysis. The results were compared with the results obtained previously while studying a reference hospital kitchen located in the south of Brazil. RESULTS: The results indicated a positive association between the work conditions in the studied hospital food services and venous disease in their workers. There are no significant differences between Spanish and Brazilian workers regarding the diagnoses of venous disease according to the CEAP classification. There are no significant differences regarding the nutritional status of the two groups. The body mass indices of Spanish and Brazilian workers were 27.42 and 28.76, respectively. The volumetric variation of the lower limbs after a day’s work was significantly higher among Brazilian workers (5.13% for Brazilian workers and 1.29% for Spanish workers), showing that only this group presented edema. The Spanish workers’ mean age and length of time working in a food service (51.87 years and 25.26 years, respectively), are significantly greater than those of the Brazilian workers (40.21 years and 11 years, respectively). On average, the Spanish workers worked 5.8 hours and the Brazilian workers worked 11.23 hours – 82.85% and 93.58% of the formal workday in Spain and Brazil, respectively. The difference between the two countries for this variable is significant. They had to be standing most of the time, in both countries, to perform their activities, but in Spain the workers had to move around more and performed fewer repetitive movements. The mean amount of time spent standing (still or walking) was 5.2 hours in Spain and 9.38 hours in Brazil, corresponding to 89.6% and 83.5% of the total work time for each country, respectively. Time spent sitting down represented 16.44% and 10.82% of their workday in Brazil and Spain, respectively, and was mostly associated with meal time in both food services. In Brazil, some activities were performed sitting down. The difference found between the two countries for the variable distance walked during a workday was of 11.04 m/min in Brazil and 7.30 m/min in Spain. This difference was significant, evidencing that the work done in the Spanish environment was more dynamic than that done in the Brazilian environment. Only in Brazil workers carried heavy objects without assistance. Despite both studies having been done during the winter months, the Brazilian food service still presented an environmental temperature and humidity above those recommended by the literature for comfort and prevention of venous disease. Again, the difference between the two countries was significant. CONCLUSIONS: The prevalence of venous disease of lower limbs in the studied hospital food services workers is high. Working in hospital food service is associated with circulatory disorders of lower limbs, such as edema and venous disease. The quantitative and qualitative method used in this study evidenced that the workers of both countries had some similar personal characteristics, since no statistically significant differences were found between the two groups for nutritional status, number of children and family history of varicose disease. However, when the work-related variables were compared, such as environmental temperature, relative humidity, workday and distance walked during the workday, the findings show that the differences were statistically significant. In Spain, the mean edema value did not exceed the physiological value reported in the literature but in Brazil this value was roughly 5 times greater. The Ergonomic Work Analysis proved to be capable of evidencing the risk factors for venous disease in the studied environments, namely the workers standing upright for long periods of time, having to carry heavy objects, high environmental temperature and humidity and some organizational issues. Direct observation allowed access to the universe of these employees in their work environment and to the abundance of details that are usually missed with other methodological instruments. Considering that work conditions played an important role in the development and worsening of venous disease of the lower limbs, this cause and effect relationship is a promising field for research, since these exogenous factors (posture, temperature, carrying heavy weights, workday, equipment, among others) can be influenced and modified by administering preventive measures.