*3.2. Global Sickness Absenteeism Data*

The work absences of civil servants from the three Legislative Houses (LH) were counted by the number of medical leaves (ML) granted and working days lost, which was taken as the parameter to portray absenteeism due to illness. In the study period (2016 to 2019), LHs issued a total of 37,690 ML, involving 4149 servants, which resulted in 144,902 working days lost. Table 2 presents a summary of these absences.


**Table 2.** Sickness absenteeism in the 3 Legislative Houses, from 2016 to 2019.

As shown in Table 2, The number of working days lost is quite different among the three LHs, probably due to the number of servants in these Legislative Houses and the criteria used by these organizations to measure absenteeism. The House of Deputies and the Federal Senate issue ML for absences starting from 1 day of absence due to health problems, while ALEGO recorded only absences of more than 3 days. The other cases of non-attendance at work, less than 4 days, were managed by the immediate superior. It is worth mentioning the annual average of working days lost per server (d/s/yr), as shown in the last column of Table 2, as it represents the real average of sickness absenteeism. In this sense, ALEGO and the House of Deputies had a very similar performance, around 10 d/s/yr, while the Federal Senate positioned well above these figures, with an average absence of 6.2 d/s/yr. It should be noted that, except for very few cases, ALEGO did not compute absences of 1 to 3 days in its general absenteeism register, which may have affected its average work absences. On the other hand, the much more favorable situation of the Federal Senate may be associated with a more adequate general working condition, among other factors.

#### *3.3. Individual Health Condition (Comorbidities)*

The individual health status of the servants regarding the presence of active or chronic health problems was evaluated using an electronic questionnaire (self-administered comorbidity questionnaire—SCQ), which allows the calculation of the CI. This index allows for estimating the situation of individuals regarding the existence or absence of permanent or long-term morbidities. An individual who declares no pathology or health problem has a CI score of 0.00. An individual with a pathology or chronic health problem without the need for medical treatment or restrictions in the performance of any type of activity receives a CI score of 0.02. Table 3 shows the CI scores determined in the three LHs.

A total of 154 servants (34.5%) declared no chronic health problems. In contrast, most respondents (65.5%) reported at least one chronic problem/illness. The highest frequency score (CI = 0.04) was registered in 77 cases and may correspond to the presence of two comorbidities or only one morbidity combined with the need for medical treatment, or difficulties to perform activities. The most serious situation, CI = 0.44, was declared by only one servant and corresponds to a health condition that can show a significant vulnerability. However, all cases with CI scores above 0.20 deserve more attention because it implies the presence of at least 4 pathologies/health problems combined with medical treatment and difficulties to perform activities.

Table 4 presents the distribution of individuals according to the number of diseases or health problems. Among those who declared a diagnosis of chronic diseases (293 individuals), 44.4% reported a single occurrence, while the remaining individuals, 55.6%, reported having two or more comorbidities.


**Table 3.** Comorbidity index (CI) for all LHs.

**Table 4.** Distribution of comorbidity events.


Among the items suggested in the SCQ and those included by the participants, 622 records of diseases were reported, 362 referring to those in the questionnaire, and 260 new items informed by the servants. Among the chronic health problems included in the questionnaire, back pain was the most frequent, with 126 records, followed by hypertension and depression, with 70 and 54 records, respectively. On the other hand, the pathologies/chronic health problems directly declared by the respondents as "Other Health Problems", in the categories of Problem-1, Problem-2, and Problem-3, resulted in 156, 74, and 30 records, respectively. Figure 2 presents a graph with the frequency of the diseases/health problems, in percentages, resulting from the CI estimation among the servants from all LHs. All diseases/health problems reported by the participants (differing from those in the questionnaire) are represented by the categories Other Health Problems 1, 2, and 3, considering the vast list of specific pathologies reported by the servants. Figure 3 shows an overview of self-reported chronic diseases, in the form of a word cloud, highlighting back pain, hypertension, depression, and other musculoskeletal disorders (Other-DME) with higher frequencies.


**Figure 2.** Frequency of chronic diseases/health problems.

**Figure 3.** Chronic diseases/health problems among civil servants.

Other pathologies and health problems reported by the servants also proved to be very important in the estimation of the CI score. In order, the cases of diabetes, ulcers, anxiety, and hypothyroidism stand out. It is also worth noting the cases of cancer and kidney disease.

The CI score becomes more significant when it also reflects the need for the respective medical treatment, which denotes a condition that requires permanent control. Moreover, the health condition can evolve and become more serious when the comorbidity situation prevents or makes it difficult for individuals to perform work activities. Figures 4 and 5, respectively, show the percentage of servants with chronic diseases/health problems requiring medical treatment and those who have difficulties in performing work activities.

As shown in Figure 4, the vast majority of the civil servants with CI scores above zero (83%) received some type of treatment for their health situation. Moreover, 54% of these servants with comorbidities reported no difficulty performing any activity given their health condition. In contrast, 46% informed that the presence of chronic pathologies/health problems causes restrictions in performing activities.

**Figure 4.** Individuals with CI > 0.00 with medical treatment.

The presence of chronic diseases or health problems can make individuals more vulnerable due to several factors, including a risk to personal health, and greater susceptibility of these individuals, due to daily exposures, to risk factors (at work or outside work), which can increase the degree of severity of the effects resulting from exposure.
