EDITORIAL

Challenges in research into workers’ health: stress, work intensification and use of biomarkers

The changes of recent decades have unquestionably affected the working class by introducing new modes of work and imposing new conditions on work processes. In the service sector, which has expanded continuously since the last century, healthcare and the work of nursing are strongly affected by these changes, which can be listed briefly as the flexibilisation of labour contracts and the expectation that workers be committed, versatile and willing to contend with continuous professional development, unstable, changeable working conditions, less non-working time, increasingly exacting technical skill requirements and so on.

The already highly-demanding work process of nursing is further affected by changes entailed by processes of reorganisation in national and global economies. To these, moreover, are added changes that ultimately beset the citizenry of countries like Brazil, which are experiencing, on the one hand, unprecedented economic growth and, on the other, persistent chronic problems and a State with difficulty in meeting the challenges and problems that impair collective wellbeing. In this light, health care constitutes one of our nation’s Achilles heels.

Work-related stress, which is increasingly affecting nursing personnel, can be conceived as resulting from disparities among working conditions, workers’ ability to cope in performing their tasks, associated with how far they are allowed to control demand and what social support they receive from collaborators and superiors¹. There are also an increasing number of studies directed to identifying and analysing this phenomenon, which seek to identify determinants and risk factors. The difficulty of capturing a condition often expressed subjectively by workers poses the additional challenge of including biomarkers in prevalence and risk identification studies as a way of assuring more specific results.

Psychobiological studies suggest that the paths by which stress influences health are mediated by the hypothalamic–pituitary–adrenal (HPA) axis, which regulates the organism’s adaptation to stressors. Since 1985, measures of activity on the HPA axis, and particularly salivary cortisol as a marker for HPA axis activity, have become a standard procedure in stress response evaluation studies, where cortisol awakening response (CAR) and daytime cortisol secretion are examined².

Salivary cortisol is important in workers’ health research given its potential for evaluating physiological responses in groups exposed to overwork and job stress. Although this biomarker has been chosen successfully in a series of large-scale studies, study design, and collection and interpretation of data on salivary cortisol still pose numerous challenges.

Our recent studies have shown that salivary cortisol can contribute significantly to understanding the biological pathways by which job stress influences nursing workers’ health, but this still needs to be explored further with a view to standardising methodologies and consequently increasing reliability in the use of this biomarker.

This is a field of research that nursing is only just starting to explore. There is a need for more studies of subjects working in the profession’s various settings, so that the analyses can categorise more clearly the determinants related to the specific characteristics of these work environments and also capture those associated with the major changes currently affecting health workers as a whole in Brazil.

In response to this demand, the journal Revista Enfermagem UERJ encourages research in this field and, at the same time, offers space for publishing original articles and methodological discussions on the use of stress biomarkers that draw on research in health science fields. In this way, it reaffirms its commitment to spreading new knowledge that contributes to the field of workers’ health and related areas.

Helena Maria Scherlowski Leal David

Juliana Faria Campos