A atenção à saúde do trabalhador exposto ao ruído intenso na rede de atenção à saúde de Curitiba

Abstract

Introduction: The Basic Health Unit, as a gateway for the user who works in the Unified Health System, should welcome him, include him, insert him and recognize him as part of the territory-area to which he belongs, in a way to integrate it in the Health Care of the worker. However, in relation to workers with suspected Noise-Induced Hearing Loss, there are still difficulties both in their reception and in Primary Care. The low notification in the Information System of Notifiable Diseases of NIHL cases in Curitiba, considering the existence of jobs exposed to otoaggressive agents, needs to be better understood. Objective: To analyze the comprehensiveness of health care for workers exposed to otoaggressive agents in the Health Care Network in the city. Methods: This is the first research of a cross-sectional study, analyzing the records of NIHL cases registered in SINAN, in the main sentinel unit in Curitiba-PR, between 2016 and 2018. In the second exploratory research with an approach qualitative, we sought to understand the professional life of the NIHL worker user, the phenomenon in their work environment as a natural form of noise, where it occurs and of which it is part. And in the third research, an evaluative study with a quantitative approach, developed with health professionals from Primary Care, who participated in educational workshops on the identification and notification of NIHL. Results: In the first research, 33 individual notification forms (FIN) were analyzed by NIHL, mean age 59.3 years, mean exposure time 27 years, male predominance, (21.2%) of workers were drivers. Tinnitus and difficulty in understanding speech were the most reported complaints in the acoustic notch audiometric exam, with worsening in auditory thresholds at frequencies of 6000Hz in the right ear and 4000Hz in the left ear, late diagnosis and its treatment, which shows the neglect, the lack of consideration, care, attention to the health of workers with NIHL. In the second survey, seven elected workers from the FIN were interviewed, with an average age of 56 years, who were mostly male and retired. The economic income of each one ranged from one to six minimum wages. Six were covered by the CLT regime, however, it was observed that the approach to their hearing health problems occurred in primary care linked to their territory and not in social security assistance. They started their work activities exposing themselves to noise in their childhood/adolescence, however, the perception of hearing difficulties in these workers only occurred over time. In the third survey, a pre- and post-action test was applied with 48 health professionals working in the basic unit, 91.7% were female; with 11 a mean age of 49.7 years; with 20 years of training time; stay in public service for 24 years. The nursing team represented 50% of the participants, it is noteworthy that most health professionals work in an area of high risk of social vulnerability. At the end of the educational action, it was possible to point out that the results of the averages in the post-action regarding the identification of symptoms, as well as the hearing complaints related to the effects of exposure to loud noise at work and also to the user/worker's guidelines in relation to prevention of PAIR and its notification were positive. Conclusion: The professional trajectory of the working user with NIHL can be described as a set of events that underlie a person's life. It is usually determined by the frequency of events, such as exposure to noise, the duration and location of these lifetimes over a lifetime. Working users who are suspected of having NIHL should be notified in primary health care, avoiding damage to the working user's hearing and delaying their treatment and follow-up. Educational actions developed with primary care health professionals can help to identify, prevent and report NIHL, contributing to the improvement of workers' health and public policies in the studied municipality