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Revista Psicologia Organizações e Trabalho

versão On-line ISSN 1984-6657

Rev. Psicol., Organ. Trab. vol.22 no.1 Brasília jan./mar. 2022 

10.5935/RPOT/2022.1.22829 ARTIGOS


Presenteeism in the footwear industry: an analysis of the workloads


Presenteísmo na indústria calçadista: uma análise das cargas de trabalho


Presenteismo en la industria del calzado: un análisis de las cargas de trabajo



Wilza Karla dos Santos LeiteI; Anísio José da Silva AraújoI; Luiz Bueno da SilvaI; Jonhatan Magno Norte da SilvaII; Erivaldo Lopes de SouzaI; Arielson Santos Alves da SilvaI; Robson da Fonseca NevesI; Elamara Marama de Araujo VieiraI

IUniversidade Federal da Paraíba (UFPB), Brasil
IIUniversidade Federal da Alagoas (UFAL), Brasil

Information about the main author




Presenteeism represents the fact of being at work in adverse health and well-being conditions. The objective was to analyze the factors related to health complaints and severity of recurrence among workers in the footwear industry over a two-year period. A total of 9106 cases were investigated, in which the physical loads were assessed using the Occupational Repetitive Actions method, and the psychological loads using the Job Stress scale. Univariate models were used to verify the risk of illness and the effects in terms of recurrence. Tasks present a risk for musculoskeletal disorders and low decision latitude for workers; women, productive sectors, and the second shift of work have a higher recurrence estimate; dysfunctions of the neuromusculoskeletal system and prescription of muscle relaxants are among the most recurrent; and, the illness is seasonal, increasing with time and demands. Complaints may be related to inappropriate range of motion, short cycles, repetitiveness, and low autonomy.

Keywords: occupational diseases; working conditions; musculoskeletal disorders; pain.


Presenteísmo corresponde ao fato de estar no trabalho em condições adversas de saúde e bem-estar. Objetivou-se analisar os fatores relacionados às queixas de saúde e gravidade de recorrência em trabalhadores da indústria calçadista durante dois anos. Foram averiguados 9106 casos, cujas cargas físicas foram avaliadas pelo Occupational Repetitive Actions e as psicológicas, pela Job Stress Scale. Foram utilizados modelos univariados para verificar o risco de adoecimento e os efeitos em termos de recorrência. As atividades apresentam risco para distúrbios osteomusculares e os trabalhadores, baixa latitude decisória; mulheres, setores produtivos e segundo turno de trabalho apresentam uma estimativa de recorrência maior; disfunções do sistema neuromusculoesquelético e prescrição de relaxantes musculares estão entre os mais recorrentes; e, o adoecimento é sazonal, aumentando conforme o tempo e as demandas. As queixas podem estar relacionadas a amplitudes de movimentos não recomendadas, ciclos curtos, repetitividade e baixa autonomia.

Palavras-chave: doenças ocupacionais; condições de trabalho; desordens musculoesqueléticas; dor.


El Presenteismo es el hecho de estar en el trabajo bajo condiciones adversas de salud y bienestar. El objetivo ha sido analizar los factores relacionados con las quejas de salud y la gravedad de la recurrencia en trabajadores de la industria del calzado durante dos años. Se investigaron 9106 casos, cuyas cargas físicas fueron evaluadas mediante el Occupational Repetitive Actions y las psicológicas mediante la Job Stress Scale. Se utilizaron modelos univariados para verificar el riesgo de enfermedad y los efectos en términos de recurrencia. Las actividades presentan riesgos de trastornos osteomusculares y los trabajadores baja latitud decisoria; las mujeres, los sectores productivos y el segundo turno de trabajo presentan una estimación de recurrencia mayor; las disfunciones del sistema neuromusculoesquelético y la prescripción de relajantes musculares se encuentran entre los más recurrentes; además, la enfermedad es estacional, aumentando con el tiempo y las demandas. Las quejas pueden estar relacionadas con amplitudes de movimientos no recomendados, ciclos cortos, repetitividad y baja autonomía.

Palabras clave: enfermedades ocupacionales; condiciones de trabajo; trastornos musculoesqueléticos; insecto; dolor.



The consumption of footwear industry products has been growing in recent years. The production process of a shoe demands different raw materials that generate intermediate, accessory, ornamental, and packaging products. These processes are confined to different sectors with intense manual, repetitive and low variability tasks (Carvalho Filho, Nunhes, & Oliveira, 2019). The footwear industry is interconnected to other industrial branches and is strongly influenced by seasonal collections and by the seasonality of the hot and cold seasons of the year. The production volume varies according to the orders and the footwear model. Traditional models tend to keep stable volumes and stocks while modern models are custom made and differ each season or over shorter periods (Sadeghi, Rebelo, & Ferreira, 2018). Work in the footwear industry presents several occupational risks, low technological investment, low compensation, and high prevalence of occupational diseases (Leite et al., 2019).

Presenteeism is the condition in which the worker continues to perform his or her professional activities even when one or more bodily functions are compromised. It has a multifactorial origin and can be related to diseases or injuries, affecting the ability to work with consequences for workers and companies. Symptoms can present in acute, episodic, or chronic forms (Freeling, Rainbow, & Chamberlain, 2020; Rainbow & Steege, 2017). This topic is recent, as research on work-related illness traditionally emphasizes absenteeism. However, studies suggest that presenteeism precedes absenteeism and is a risk management indicator used to prevent sick leave (Dietz et al., 2020).

Health complaints in workplaces provide information for surveillance of workers' health and clues about presenteeism. The risk of working ill varies according to the nature of these complaints (Rainbow & Steege, 2017). In this sense, longitudinal research is recommended to better assess the factors related to presenteeism and to direct effective actions for organizations and social institutions. More than understanding the relationship between presenteeism and health complaints, these studies provide evidence of the association between presenteeism and absenteeism (Lohaus & Habermann, 2019). This study has two main objectives. First, it seeks to evaluate the physical and psychological burdens of work in the footwear industry. Second, it seeks to understand the association between workers' reported complaints and individual, labor, and seasonal factors over a two-year period. It intends to investigate (1) which physiological and psychological dysfunctions are associated with these factors, and (2) what the effects of these factors are in terms of the recurrence of health complaints.




Workers from a shoe production unit located in Brazil participated in this study. This study evaluated the physical and psychological burdens of the activities performed by these workers. Due to the number of workers in the production unit, it was necessary to stipulate a representative number of participants for conducting the interviews (including a questionnaire and conversational action) and for the delimitation in terms of observation, filming and photography. There are 1750 employees working in this unit. From January/2018 to December/2019, 1517 workers were admitted to the unit's outpatient service. For the interviews, the number of workers was calculated to provide a representative sample of the population of the unit (Hedayat & Sinha, 1991):

in which n = size of the sample; N= total population of the production unit studied;

with a confidence interval of 95% (CI); p = expected frequency (when unknown, a value of 50% is used, maximizing the sample size); q = 1-p; d = acceptable error (d = 5.55% for CI 95% and p = 0.50). Therefore, a minimum of 264 workers is required as detailed below:

Workers of both sexes aged 18 years or older, who did not undergo surgery in a period less than or equal to 6 months from the start of this research and who signed the Free and Informed Consent Form were included. Those who underwent surgery during the research, pregnant women, workers undergoing training and minor apprentices were excluded. Although the representativeness of the sample was satisfied with 264 workers, a total of 307 were eligible and accepted to participate in evaluation phase of work-related physical and psychological loads.

Mapping of health complaints. The health complaints of the medical sector of the production unit notified by the Specialized Service in Engineering and Occupational Medicine in the period from January/2018 to December/2019 were mapped. The medical sector consists of a doctor, a nurse, and two nursing technicians. It is located inside the production unit and receives workers by spontaneous demand.


Workload assessment. As the most required body segment in the footwear industry is the upper limb, the physical workloads were evaluated by the Occupational Repetitive Actions (OCRA) Index. The OCRA is described in the standard ISO 11228-3 and the ergonomic risk is classified into five categories: (1) acceptable, whose index ranges from 0 to 2.2; (2) doubtful or very slight, from 2.3 to 3.5; (3) slight, from 3.6 to 4.5; (4) medium, from 4.6 to 9.0; and, (5) intense, with indices above 9.0 (Micheli & Marzorati, 2018). The psychological workloads were evaluated by the short and adapted to Portuguese version of the Job Stress Scale (JSS). The JSS allows categorizing the work in high job strain, passive, active and low job strain besides indicating possible moderating effects of social support (Alves, Choe, Faerstein, Lopes, & Werneck, 2004; Karasek, 1979).

Data Collection Procedures and Ethical Considerations

Observational and interactional methods were mobilized in the different sectors of the production unit. For observational methods, recording techniques involved instantaneous and continuous observations, photographic resources, video recordings and manual recordings. For the interactional methods, conversational actions were carried out with the workers to understand the unobservable aspects of their activities and the conditions under which they are carried out (Guérin, Laville, Daniellou, Duraffourg, & Kerguelen, 2001). The objective was to understand the functioning and integration of the different work sectors as well as the characteristics, production flow, constraints, variability, and the possible consequences for the health and performance of the tasks that constitute each of the sectors in the production unit. The methods were conducted simultaneously with the mapping of health complaints over the two years.

Variables. This study analyzed individual, labor and seasonal variables (Table 1). The International Classification of Functioning, Disability and Health (ICF, 2001) was considered for the motivation to go to the outpatient clinic. The medication administered by the outpatient clinic staff was categorized into groups, according to their active agents and effects on the body, according to information from each manufacturer. The commercial names of the medications were suppressed.

This study was approved by the Research Ethics Committee of the Federal University of Paraíba (Reference number: 89029818.0.0000.5188). All participants voluntarily agreed to participate in the research and signed the informed consent form, ensuring anonymity.

Data Analysis Procedures

The data were analyzed in R software version R 3.4.4 (Team, 2018). To analyze the factors associated with health complaints, we used a binary logistic regression model, whose dependent variable was the occurrence of body dysfunctions. Thus, the odds ratio expresses the risk for an impairment in health status in a given category compared to a reference category. The recurrence of complaints was analyzed using Poisson models, representing the expected effect in terms of severity. In this case, we took as dependent variable the recurrence of the complaint in terms of event records (Fávero, 2015). Recurrence is understood as the same worker going to the outpatient clinic more than once with the same health problem during the period delimited in this study. The events in which the visit to the outpatient clinic was related to the request for personal hygiene products and adhesive dressings were excluded from the models. The reference categories adopted were male gender, administrative sector, third work shift, month of January, year 2018, medication group 7, and neuromusculoskeletal and movement-related functions.



Work in the Footwear Industry

The production unit is responsible for manufacturing footwear. The shoes are produced in men's and women's versions, while the safety boots have a unisex standard. In the company there are two types of production units: head office and satellite. This study took place in the head office, the most complex in terms of production. The satellites are smaller units and produce part of the uppers. The headquarters operates six days a week, five of them in three production shifts. Generally, the production target is 600 pairs of shoes/production cell/shift. The work in the sheds is organized according to their constituent units. A shed is divided into work sectors and these, in turn, into production cells. Most tasks are sequential and interdependent. Most cell operators are monofunctional (one worker/one task/one workstation). The process in the cells can be manual, semi-automatic or automated.

Workloads in the Footwear Industry

Regarding physical workloads, 104 tasks developed by the workers were evaluated. Of these, only 8.7% were within the acceptable risk limits for WMSD in the upper limbs. The averages for cycle time and exposure indices for the left and right limbs were 22.20 (SD = 28.45) seconds, 5.09 (SD = 4.30), and 6.40 (SD = 5.93), in that order. The number of actions per cycle obtained an average of 15.77 (SD = 21.87) for the left limb and 22.20 (SD = 28.45) for the right limb. It was found that workers spend an average of 284.98 (SD = 81.27) minutes of their shift performing repetitive movements. It was observed that 75% of the tasks presented repetitiveness greater than or equal to 51%. As for the psychological workloads, 307 workers responded to the JSS, being for most of them passive work with high social support (Table 2).

Health Complaints Reported by the Workers

No complaints regarding the functions of sound and speech production were reported. All outpatient complaints are listed in Table 3.

Women are at higher risk for genitourinary and reproductive disorders; mental disorders; and disorders of the digestive, metabolic, and endocrine systems. In contrast, they have a lower risk for developing dysfunctions of the skin and related structures; the cardiovascular, haematological, immunological, and respiratory systems; neuromusculoskeletal and movement-related; and, sensory and pain (Table 4).

For the work sector the reference was the administrative one. The storage area presents a 53% higher risk for the occurrence of dysfunctions of the cardiovascular, haematological, immunological, and respiratory systems. In contrast, the rubber, cutting, assembly and finishing, and injection molding sectors have on average a 40% lower risk for the same body dysfunction. Moreover, there is a 47% lower risk for the occurrence of sensory dysfunctions and pain in the storage sector for the occurrence of sensory dysfunctions and pain (Table 4).

For mental disorders, the risk is on average about seven times higher in the months of November and December; for disorders of the cardiovascular, haematological, immunological, and respiratory systems, it is about 48% higher considering the months of March through September (except August); and for genitourinary and reproductive disorders, six times higher for the months of August through September. Other dysfunctions not included in the ICF (2001) present a higher risk only for the month of November. The average risk for sensory dysfunctions and pain is around 14% lower considering the months of March and April; 45% lower for dysfunctions of the digestive, metabolic and endocrine systems in the months of June to December (except July), 62% lower for neuromusculoskeletal and movement-related dysfunctions in the months of July to December. In 2019 the risk was higher for dysfunction of the digestive, metabolic and endocrine systems and for skin and related structures; and, lower for sensory and pain dysfunction and for neuromusculoskeletal and movement-related dysfunction (Table 4).

Recurrence of the Health Complaint

The number of visits to the clinic ranged from 1 to 108, with an average of 25 visits/worker. Female workers present a 23% higher estimate for the recurrence of health complaints. Compared to the administrative staff, the estimate of recurrence of complaints is higher in almost all the other sectors, with an average of 31%. Similar estimates were verified for the zero, first, and second shift. With reference to neuromusculoskeletal and movement-related functions, it was found that the estimate of recurrence of complaints is higher for only two body functions. As for the use of medication, taking as reference the group of muscle relaxants, anti-inflammatories, and analgesics, the estimate of recurrence of complaints is lower for most of the other groups, ranging from 5% to 63%. There is a trend of greater recurrence of complaints in the last quarter of the year and 2019 showed an estimate twice as high compared to the previous year. The analysis of the production demands pointed out that for every thousand pairs of shoes produced in a given month, the estimate of a worker making more than one visit to the outpatient clinic with a health complaint increases by 0.09% (Table 5).



Presenteeism is a worldwide phenomenon that tends to grow due to work intensification. Identifying the risk factors is important for developing strategies that can reduce them. This includes medicais measures, improvements in workers' health status, or modifying working conditions. It has consequences for the physical and mental health of workers and the productivity of organizations. The main perspectives of presenteeism are North American and European. This study is based on the European one, i.e., to being at work under adverse health and well-being conditions (Lohaus & Habermann, 2019).

More than 90% of the tasks present a risk for WMSD, and most of them are in the medium and high levels. The OCRA exposure index showed that this risk is highest for the right upper limb. Several factors contributed to these results. The right upper limb is more exposed to shoulder flexion, elbow flexion and extension, wrist radial and ulnar deviation, finger movements, and narrow and pincer grip movements. Only forearm pronation is required at the same frequency for both limbs. Exposure to complementary factors is also more frequent for the right upper limb. In addition, the right upper limb performs a greater number of technical actions than the left in the same time interval.

The higher the demand and the lower the social control and support, the higher the occupational stress (Alves et al., 2004; Arjona-Fuentes, Ariza-Montes, Han, & Law, 2019; Karasek, 1979) and the higher the costs with lost productivity, health care, and medicals expenses. Having control over one's work means having independence to plan and organize tasks, time, participation, communication, and forms of cooperation of one's own work. High control provides the means necessary for coping with fluctuations in unexpected demands in a satisfactory manner (Xiao et al., 2017). Studies have associated job control with job performance (Du, Zhang, & Tekleab, 2018) and worker physical and emotional distress (Waddimba, Mohr, Beckman, Mahoney, & Young, 2019), including depression and suicidal ideation (Xiao et al., 2017). For most workers, work is of the passive type with high social support. In other words, although demand is low, control of the work process is also low. The high social support provided at the horizontal and vertical levels can mitigate the distress experienced by workers.

In this study, differences between men and women were verified. Health perceptions, behavior, susceptibility to disease, prevention strategies, and use of health services vary by gender. Generally, men underestimate occupational risks to physical and mental health. However, associating gender alone with certain types of illness may be questionable given the very horizontal and vertical segregation of work between men and women creates a bias regarding different exposures in the workplace (Raulf, Brüning, Jensen-Jarolim, & van Kampen, 2017). For example, a study done in Korea found that men are predominant in the manufacturing and construction segments. Women are concentrated in human health, social service, hospitality, restaurants, and education. Trade and administrative sectors, meanwhile, employ men and women similarly (Park, Kim, & Han, 2018). This suggests that exposure to occupational risk factors may differ considerably between these groups (Raulf et al., 2017). It is worth noting that regardless of gender, workers are exposed to several risks simultaneously (Golmohammadi & Darvishi, 2019) and the same risk factor may produce different effects on more than one physiological and psychological function.

Women had a higher estimated recurrence of health complaints and greater susceptibility to genitourinary and reproductive dysfunction, mental health, and dysfunctions related to the digestive, metabolic and endocrine systems. Physical differences between genders may explain why women tend to present genitourinary and reproductive problems related mainly to complications during pregnancy and to menstrual symptoms accentuated by adverse working conditions (Kordi, Mohamadirizi, Shakeri, Salehi Fadardi, & Hafizi, 2011). Mental disorders may vary by gender, but technological, social, and organizational conditions of work are prevalent in the incidence of the disease in both low- and high-income countries. Job stress and insecurity (Bericht, 2006), double work hours (Peristera, Westerlund, & Hanson, 2018), biological factors (Savic, Perski, & Osika, 2018), work-life imbalance (Starmer et al., 2019), role differences, conservative social arrangements, and occupational stress (Vieira et al., 2015) appear to influence women's greater vulnerability to mental illness. Mental disorders and pregnancy-related illnesses have been reported as one of the leading causes of sick leave in female private sector workers in Japan (Nishiura et al., 2017). Some tasks involving welding or contact with solvent mixtures in degreasers, cleaners, primers, and adhesives can generate complications in various physiological functions, including the digestive system, of which the symptoms are like those found in this study (Usmani, 2016).

Men seem to be more affected in their sensory and pain functions; neuromusculoskeletal and work-related functions; cardiovascular, haematological, immunological, and respiratory systems; and skin and related structures. These results corroborate with studies developed in other countries. In Germany, in men working in the industrial sector, sensory dysfunctions have been related to exposure to noisy machinery and equipment while painful dysfunctions have been related to heavy lifting (Bericht, 2006). In Korea, men were observed to have a high risk for musculoskeletal disorders when assigned to manufacturing positions (Park et al., 2018). In Germany, similar results were also found for dermatological and respiratory occupational allergies, finding differences between men and women in both the number of diseases and the type of exposure at work. The authors noted, for example, that almost twice as many men are affected by allergic obstructive diseases as women (Raulf et al., 2017). In Brazil, a study showed that the profile of workers most exposed to chemicals is male, aged between 25 and 54 years and with low education (Assunção, Abreu, & Souza, 2020). In Iran, it was observed that men have been more affected by cardiovascular events both in administrative workers and in those who develop manual activities, such as assemblers (Ghahramani et al., 2020).

Almost all production-related sectors presented a higher incidence of health complaints compared to the administrative sector. Recent research has shown similar results. These studies have divided workers into two major groups: white-collar and blue-collar. The former includes managers, professionals, technicians and associate professionals, clerks, and service and trade workers. The latter include craftsmen and similar occupations, factory and machine operators, assemblers, and workers engaged in elementary occupations (Grinza & Rycx, 2020). The group to which the worker belongs and the qualification influence the risk of illness differently. Blue-collar workers are exposed to a larger cluster of health risks than white-collar workers. Among the latter, low-skilled workers seem to be exposed to similar risks as highly skilled blue-collar workers (Väisänen et al., 2020). Blue-collar workers are also more vulnerable to occupational injuries and illnesses than white-collar workers. The negative effects are greater when in the case of workers with interdependent activities and those in the capital-intensive industry (Grinza & Rycx, 2020), as is the case in the present study.

The workers responsible for cutting and assembling the shoe components and finishing the final product are the most affected. Lourinho, Negreiros, Almeida, Vieira, and Quemelo (2011) found a high risk for musculoskeletal disorders in the cutting, assembly and finishing sectors in the footwear industry. The authors found that the burden rate is three times higher for assembly and that the prevalence of pain among workers in this sector is 80%. Bernardes and Renner (2017) demonstrated that the main risk factors in the footwear assembly sector include overtime, repetitiveness, inadequate postures, insufficient recovery time, monotony, high temperatures and noise above tolerance levels. Taylorist and Fordist production systems generate negative effects on the health conditions and operational performance of workers in the footwear industry due to work fragmentation, time constraint, and pre-established goals. Organizational changes reduce not only cases of occupational diseases, but also work accidents, rework and scrap rates, absenteeism, and medicals consultations (Guimarães, Ribeiro, Renner, & Oliveira, 2014).

Workers on the second production shift seem to be more susceptible to recurrences of health complaints. Studies have pointed out differences related to workers' illness according to work shifts in various occupational groups. Trindade, Schuh, Krein, Ferraz, & Amestoy (2012) observed that afternoon and evening shifts present more health complaints compared to morning shifts in workers from the production sector of a textile industry. Martínez-Zaragoza, Fernández-Castro, Benavides-Gil and García-Sierra. (2020) found that afternoon and night shifts cause more fatigue and mood swings in nurses gradually increasing as the shift ends. Gumasing and Ilagan (2019) pointed out the following risk factors related to work shifts in telemarketers: work relationships, irregular meal times, number of rest days, noise level, workplace temperature and configuration, and disruption of social and home life.

It was observed that sensory functions and pain represent the majority of health complaints, similar to previous studies on working in the footwear industry (Leite et al., 2019; Vieira et al., 2015). Higher rates of painful symptomatology have been observed in upper limbs (shoulders, elbows, wrists, hands, and fingers), spine (cervical, thoracic, and lumbar), and lower limbs (thighs, knees, and feet). Factors such as experience, length of daily work day, frequency of breaks, work pressure, inadequate postures, perceived stress, triple shifts, repetitiveness and low social support are associated with musculoskeletal symptoms in different body regions in the footwear industry workers (Bernardes & Renner, 2017; Kanniappan & Palani, 2020; Lourinho et al., 2011; Vieira et al., 2015).

Neuromusculoskeletal and movement-related functions have one of the worst effects on recurrence severity, below only genitourinary and reproductive functions and skin and related structures. However, the fact that sensory functions and pain account for the majority of complaints provides the hypothesis of an upward trend in cases involving the neuromusculoskeletal system. This is because there is a close relationship between these two bodily functions. Sensory disturbances are reported in the early phase of neuromusculoskeletal injuries, characterized by inflammation, hypersensitivity, pain, discomfort, numbness, tingling, stiffness, and muscle weakness. Pain is one of the most frequent symptoms and represents an alert system of the body (Pangarkar, Pham, & Eapen, 2020).

The group that includes muscle relaxants/anti-inflammatory/analgesics represents the majority of the drug administration performed in the company's outpatient clinic and presents one of the worst effects in terms of severity of recidivism. It is below group 3 and group 8, for which the estimates were only 13% and 9% higher. A variety of inflammatory and non-inflammatory health conditions can cause musculoskeletal pain (Kvien & Viktil, 2003). When the pain is acute, the muscle relaxant/anti-inflammatory/analgesic group is usually prescribed in treatments. However, it should be administered with caution due to adverse effects such as drowsiness and hepatic metabolization, which can cause work accidents in the case of machine operators or health problems in workers with previous kidney or liver disease (Sullivan et al., 2007). In addition, there are reports that some drugs (e.g., carisoprodol) can cause abuse and dependence and therefore should be administered in a short term (Kvien & Viktil, 2003).

This study evaluated health complaints over the course of two years. Guimarães et al. (2014) observed that, generally, January is the month in which the production and production support sector works only at minimum capacity, i.e., it is a month of low production. Compared to January, the other months show a higher recurrence of complaints, increasing from August to December and ranging from 18% to 87%. The last quarters of the years evaluated concentrate the highest estimates of illness. In 2019 the recurrence of complaints was about twice as high as in the previous year. It is likely that these results are related to production demands, since this study observed that the number of pairs produced is associated with the recurrence of workers' health complaints.

As a large part of the company's production is of models whose market request presents stability and a certain frequency, it is possible to consider that in the period before January there may be a tendency to produce in stock (Sadeghi, Rebelo, & Ferreira, 2018) increasing the workload. Another hypothesis is based on the results of the psychological workloads found in this study. For most workers, the work is passive with high social support. Since the psychological demands in this type of work are low, increases in production demands could generate peaks of high stress levels. In fact, the footwear industry is characterized by the occurrence of seasonal patterns concerning the creation of new collections, fashion, sales, and orders, generating periods of high and low production demand. This also reflects in employment instability with periods of high layoff and hiring rates (Ulutas & Islier, 2015). Job instability and fear of dismissal have been pointed out as risk factors related to the occupational stress.

Seasonal patterns have been explored in illness studies and are important for estimating the effects of exposure to situations that can cause or exacerbate long-term health problems. These investigations also make it possible to understand why certain populations are more susceptible, how exposure to the stressor can be reduced, which control measures should be administered, and in what situations the results can be generalized (Kim, Lee, Fong, & Bell, 2021). Many of these studies seek to understand the associations between weather conditions or seasons and illness (respiratory and cardiovascular problems) without necessarily involving work-related relationships (Shashar et al., 2020). Research with industrial work has addressed the relationship between temporal patterns of disease incidence and exposure to occupational risk in workers and nearby residents, e.g., pruritus, nonspecific dermatitis, and rhinitis in the ferronickel industry (Han & Hong, 2018); musculoskeletal disorders in the meat industry (Tappin, Vitalis, & Bentley, 2011), and cancer in construction industry (McClean et al., 2007).

Although the footwear industry has evolved considerably in terms of market demands, business models, and product quality, footwear production still comprises many operations that require great manual skill. The manufacturing of a shoe is performed linearly, its tasks are simple, repetitive, cadenced, and highly fragmented (Ulutas & Islier, 2015). Usually, each worker performs only one task during the entire workday, which decreases their control over the process and understanding of their own work and generates occupational diseases (Guimarães et al., 2014). As the production of a shoe involves several types of workers (Ulutas & Islier, 2015), different health problems can occur varying in form and severity. Assessing how working conditions influence illness is fundamental to target specific interventions.

Future research should associate health complaints with ergonomic risk factors arising from the work environment. It is also suggested to collect additional information about other individual factors and organizational factors. Furthermore, it is recommended that the assessment of physical workload include other body regions not explored in this study. Although the tasks are performed almost exclusively by the upper limbs, the work involves prolonged periods in the standing position. This factor is related to the occurrence of WMSDs in the lower back and lower limbs (Anderson, Williams, & Nester, 2021). The investigation of these factors is important since presenteeism is a phenomenon with less visibility, since most workers omit health-related problems. It is possible to assume that presenteeism only becomes apparent when it also impacts work performance (Arjona-Fuentes et al., 2019). As there is a relationship between presenteeism and absenteeism (Lohaus & Habermann, 2019), such measures are critical. This need is reinforced by the high absenteeism rates in the footwear industry (Guimarães et al., 2014), evidencing that work processes must be replanned. Moreover, absenteeism rates may be higher due to deficient recording and reporting systems.



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Information about the authors:
Wilza Karla dos Santos Leite
Universidade Federal da Paraíba, Campus I, Cidade Universitária,
Programa de Pós-Graduação em Psicologia Social
58051-900 João Pessoa, PB, Brasil

Anísio José da Silva Araújo

Luiz Bueno da Silva

Jonhatan Magno Norte da Silva

Erivaldo Lopes de Souza

Arielson Santos Alves da Silva

Robson da Fonseca Neves

Elamara Marama de Araujo Vieira

Submission: 04/03/2021
First Editorial Decision: 07/12/2021
Final Version: 06/03/2022
Accepted in: 10/03/2022

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