Miriam Silvestre
Repetitive strain injury epidemics.
A
demand study from the ERSA.6 SES northean district
workers health program
Centro de Referenda
em Salide do Trabalhador
da
Secretaria de Estado da Salide de Slio Paulo
R e p e titiv e stra in in ju ry (R S I) h a s g e n e ra te d a g re a t d e a l
o f c o n c e rn in th e W o rk e rs H e a lth C e n te rs n a tio n w id e , m a in ly
b e c a u se o f th e g ro w th in th e ra te o f o c c u rre n c e , its c h ro n ic
c h a ra c te r a n d its e ffe c ts o n th e liv e s o f w o rk e rs w h o a c q u ire d
R S I.
T h e a u th o r w ill b e e m p lo y in g th e n a m e R S I to d e fin e
c lin ic a l situ a tio n s w h o se o rig in s w e re o c c u p a tio n a l. T h e se
c lin ic a l situ a tio n s a re c a u se d b y o rg a n ic o r fu n c tio n a l d iso
rd e rs rd u e to lo c a l fa tig u e . T h e y c a n a lso b e rd u e to a rd y sfu n c
tio n in th e m u sc le s, te n d o n s, sy n o v ia , fa sc ia s, n e rv e s o r lig a
-m e n ts. T h e y c a n o c c u r in a n iso la te d fo r-m o r in a sso c ia tio n
w ith o th e r d iso rd e rs.
U n til th is tim e , th e re a re n o d a ta c o m p ile d c o n c e rn in g th e
in c id e n c e o r p re v a le n c e o f R S I in c o u n tie s, sta te s a n d e v e n in
th e c o u n try . T h e IN S S d a ta a re in c o m p le te , a lth o u g h R S I h a s
in u n d a te d m e d ic a l re q u e sts fo r p h y sic a l d isa b ility , a n d it is w e ll
k n o w n th a t th e ra te o f o c c u n o e n c e is la rg e ly u n d e r-re p o rte d . O n e
o f th e m o st so u g h t a lte rn a tiv e s b y w o rk e rs to o b ta in a m e d ic a l
d ia g n o sis a n d tre a tm e n t h a s b e c o m e p u b lic h e a lth re so u rc e s.
R e fe rra ls a re m a d e b y la b o r u n io n s, sp o n ta n e o u sly o r o th e r ty p e s
o f re fe rra ls. T h e a n a ly sis o f th e d e m a n d fo r p u b lic h e a lth re
-so u rc e s d o e s n o t re v e a l th e re a l in c id e n c e o f R S I, b u t it m a y
d e m o n stra te th a t a sig n ific a n t in c re a se o f R S I h a s ta k e n p la c e
a m o n g d iffe re n t c la sse s o f w o rk e rs. D e sp ite th e fa c t th e title o f
th is m a n u sc rip t re fe rs to th e d e m a n d o f o n ly o n e h e a lth c e n te r,
th e a u th o r c o n sid e rs it re le v a n t to p re se n t th e d a ta fro m tw o
o th e r n o n -p riv a te w o rk e rs h e a lth c e n te rs: R e fe re n c e C e n te r fo r
W o rk e rs H e a lth in C a m p in a s - S P (C R S T -C a rn p in a s) a n d th e
W o rk e rs H e a lth P ro g ra m in lu n d ia ! - S P (P S T -lu n d ia f).
M e th o d s :
T h e o c c u p a tio n a l m o rb id ity w a s a n a ly z e d fro m th e d a ta
b a n k c o n ta in in g a ll m e d ic a l v isits. S p e c ia l e m p h a sis w a s
p la c e d d u rin g th e a n a ly sis o f th e c h a ra c te riz a tio n o f su b je c ts
w ith a d ia g n o sis o fR S I. T h e tim e p e rio d fo r C R S T -C a m p in a s
w a s 1 9 9 3 -9 4 . T h e tim e p e rio d fo r P S T -Ju n d ia ! a n d N o rth e rn
D istric t W o rk e rs H e a th P ro g ra m (P S T -Z N ) w a s 1 9 9 4 . A lso
a n a ly z e d w a s th e d a ta b a n k o f p a tie n ts w ith R S I se e n a t th e
P S T -Z N b e tw e e n 1 9 8 8 a n d 1 9 9 3 .
R e su lts:
W o rk e rs H e a lth P ro g ra m fro m J u n d ia f S P (P S T
-Ju n d ia f):
In 1 9 9 4 ,5 7 6 d ia g n o se s o f o c c u p a tio n a l d iso rd e rs w e re
m a d e . T h o se h a v in g R S I w e re 1 8 6 su b je c ts (3 2 .2 9 % ), th e
se c o n d m o st-p re v a le n t o c c u p a tio n a l d ia g n o sis. F e m a le s
c o m p rise d 6 5 .6 % o f th e c a se s, w ith a m e a n a g e o f 3 2 .3 9
y e a rs. M e a n e m p lo y m e n t tim e w a s se v e n y e a rs a n d 9 .2 3
y e a rs in th e p o sitio n . R S I o c c u rre n c e ra te w a s a lso a n a ly z e d
se p a ra te ly in th e first a n d se c o n d h a lf o f 1 9 9 4 . In th e first
se m e ste r, R S I ra n k e d a s th e th ird m o st-p re v a le n t d ia g n o sis,
w ith 1 9 .0 3 % o f a ll 3 0 8 d ia g n o se s. It ra n k e d first in th e se c
-o n d se m e ste r w ith 4 3 .8 3 % . In th e first se m e ste r, 2 9 .4 % w e re
ste e l w o rk e rs a n d 2 1 .6 % w e re b a n k c le rk s. In th e se c o n d
se m e ste r, 3 9 .3 % w e re ste e l w o rk e rs a n d 2 3 .7 % w e re sh o e
in d u stry w o rk e rs.
R e fe re n c e C e n te r fo r th e W o rk e rs H e a lth fro m C a m p in a s
- S P (C R S T -C a m p in a s):
In 1 9 9 3 -9 4 , 9 9 4 d ia g n o se s w e re m a d e . A m o n g th e m ,
2 8 0 (2 8 .1 7 % ) w e re R S I a n d 7 9 .3 % w e re fe m a le s, w ith a m e a n
a g e o f 3 3 .8 y e a rs. In 1 9 9 3 , h e a rin g p ro b le m s c o m p rise d th e
m o st fre q u e n t d ia g n o sis, a n d R S I fo llo w e d w ith 2 0 .3 5 % o f
th e 3 9 8 c o n firm e d o c c u p a tio n a l d ia g n o se s. B a n k c le rk s p re
-d o m in a te -d w ith 5 0 .6 % o f a ll c a se s. In 1 9 9 4 , R S I to o k th e
le a d , w ith 3 3 .5 5 % o f 5 9 6 v a lid o c c u p a tio n a l d ia g n o se s, 3 2 .1 %
o f th e m b a n k c le rk s, a n d 3 0 .4 % w e re ste e l w o rk e rs.
N O R T H E R N D IS T R IC T W O R K E R S H E A L T H P R O
-G R A M (P S T -Z N ):
R S I h a s b e e n th e m o st p re v a le n t d ia g n o sis in P S T -Z N
sin c e 1 9 9 2 . O u t o f 1 ,6 0 9 c o n firm e d o c c u p a tio n a l d ia g n o se s
.in 1 9 9 4 , 1 ,0 4 7 (6 5 .0 7 % ) w e re R S I. A m o n g th e m , 8 9 3 c a se s
(8 5 .4 % ) w e re fe m a le s, w ith a m e a n a g e o f 3 5 .5 y e a rs. B a n k
c le rk s w e re th e m o st a ffe c te d w ith 3 1 .8 % , ste e l w o rk e rs se c
-o n d w ith 2 6 .7 % a n d o th e r se rv ic e s m a d e u p 1 4 .4 % . M e a n
e m p lo y m e n t tim e w a s 7 .2 0 y e a rs, a n d m e a n tim e in th e p o
si-tio n w a s 7 .3 3 y e a rs.
In a sa m p le o f 6 5 4 p a tie n t6 w ith a n in itia l e v a lu a tio n
b e tw e e n 1 9 8 9 a n d 1 9 9 3 , 5 8 .3 % h a d a p o sitiv e h isto ry o f e x
-p o su re to re p e titiv e m o v e m e n ts in a p re v io u s jo b . P a in w a s
p re se n t in 5 3 .8 % . P a in fu l site s m o st c o m m o n ly re p o rte d w e re :
w rists (2 0 % ), c e rv ic a l re g io n (1 1 .5 % ), a n d h a n d s (1 1 % ). T h e
m o st c o m m o n c lin ic a l d ia g n o se s w e re : te n d in itis, sy n o v itis
a n d u p p e r lim b s te n o sy n o v itis (4 0 % ).
C o n c lu s io n :
In a ll c e n te rs, th e a n a ly sis h a s d e m o n stra te d th a t R S I h a s
b e e n th e first d ia g n o sis a n d th a t it sh o w s sim ila r g e n d e r a n d a g e
d istrib u tio n s. T h e p ro fe ssio n a l c a te g o rie s v a ry a m o n g c e n te rs,
b u t th e ste e l w o rk e rs a n d b a n k c le rk s w e re c o n siste n tly th e m o st
a ffe c te d in a ll c e n te rs.T h e se fin d in g s in d ic a te th e d e m a n d fo r
th e im m e d ia te e sta b lish m e n t o f a p re v e n tio n p ro g ra m o f n e w
R S I c a se s a n d o f a re h a b ilita tio n p ro g ra m fo r R S I p a tie n ts w ith
a sp e c ia l e m p h a sis o n th e se c o n d a ry a n d te rtia ry se c to rs.
T h e P S T -Z N c lin ic a l fin d in g s c a ll fo r th e tra in in g o f sk ille d
p ro fe ssio n a ls fo r th e c a re o f u p p e r lim b c h ro n ic p a in p a tie n ts in
w o rk e rs h e a lth c e n te rs a s w e ll a s in th e n o n -p riv a te h e a lth c a re
sy ste m a s a w h o le .
