Estresse ocupacional, padrão alimentar e fatores de risco cardiovascular em trabalhadores de um hospital privado do Recôncavo da Bahia: um estudo antes e durante a pandemia da COVID-19

Abstract

Introduction: Hospital environment working is known for presenting unhealthy features that affect the health of its workers - features which have currently been intensified due to the COVID-19 pandemic. Objective: To investigate the association between occupational stress, dietary pattern, and cardiovascular risk factors in workers at a private hospital in the Recôncavo of Bahia, before and during the COVID-19 pandemic. Methods: This work consists of three different studies. Study 1 is a systematic review carried out through searches in PUBMED, WEB OF SCIENCE, EMBASE, SCOPUS, CINAHL, PSCYINFO and LILACS databases, from July to October 2020, and updated in October 2021. Observational studies that evaluated occupational stress as exposure through the Job Content Questionnaire (JCQ), and that investigated its influence on workers' health were included. The risk of bias of the included studies was assessed using the Research Triangle Institute Item Bank on Risk of Bias and Precision of Observational Studies. Studies 2 and 3 are longitudinal studies conducted with 218 workers of legal age (>18 years old) from a private hospital in the Recôncavo of Bahia. Sociodemographic, occupational, anthropometric, dietary, lifestyle and health data were collected by a semi-structured questionnaire. The main exposure was occupational stress assessed through the JCQ and classified according to the Demand-Control Model, and the additional exposures were other occupational characteristics considered to be work stressors. The outcomes were nutritional status, cardiovascular risk factors, self-perceived health, and dietary patterns (A, B, and C). Statistical analysis for Study 2 included binomial logistic regression models, whereas that for Study 3 included Generalized Estimating Equation models. Results: Study 1 - For the qualitative analysis, the search strategy retained 42 studies, including 182,187 participants. Among retained studies, the influence of occupational stress was examined in cardiovascular diseases (CVD) (n=10), as primary outcome, and metabolic syndrome (MS) (n=5), dyslipidemias (n=15), and obesity (n=22), as additional outcomes. Systematized evidence showed that high levels of occupational stress appear to be associated with CVD and MS. The meta-analyses of these clinical conditions showed significant associations between occupational stress and CVD and MS, but no significant effect between stress at work and dyslipidemias and obesity. Studies 2 and 3 - During the COVID-19 pandemic, there was an increase in high occupational stress levels, obesity, and presence of cardiovascular risk factors (p<0.05), as well as changes in pattern A and B, compared with the pre-pandemic period. No association was observed between the changes in occupational stress and in the studied health outcomes; the only association observed was between the stressors of hospital work, the increase of obesity and the changes in A and B workers' dietary patterns (p<0.05). Conclusions: This evidence can help strengthen labour policies to ensure adequate working and health conditions for hospital workers in the context of the COVID-19 pandemic.