<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2183-8453</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Saúde Ocupacional online]]></journal-title>
<abbrev-journal-title><![CDATA[RPSO]]></abbrev-journal-title>
<issn>2183-8453</issn>
<publisher>
<publisher-name><![CDATA[Ajeogene Serviços Médicos Lda]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2183-84532025000100711</article-id>
<article-id pub-id-type="doi">10.31252/rpso.24.05.2025</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[DETERMINANTES DA CAPACIDADE DE TRABALHO NO DOENTE COM ESCLEROSE MÚLTIPLA E ESTRATÉGIAS DE ADAPTAÇÃO - UMA REVISÃO DA LITERATURA A PROPÓSITO DE UM CASO CLÍNICO]]></article-title>
<article-title xml:lang="en"><![CDATA[DETERMINANTS OF WORK CAPACITY IN PATIENTS WITH MULTIPLE SCLEROSIS AND ADAPTATION STRATEGIES - A LITERATURE REVIEW BASED ON A CLINICAL CASE]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Teófilo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Matos]]></surname>
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<name>
<surname><![CDATA[Moreira]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ribeiro]]></surname>
<given-names><![CDATA[Rui]]></given-names>
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<name>
<surname><![CDATA[Pinelas]]></surname>
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<contrib contrib-type="author">
<name>
<surname><![CDATA[Miller]]></surname>
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<surname><![CDATA[Azevedo]]></surname>
<given-names><![CDATA[C]]></given-names>
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<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
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</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinho]]></surname>
<given-names><![CDATA[P]]></given-names>
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<surname><![CDATA[Norton]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,ULS Alto Ave  ]]></institution>
<addr-line><![CDATA[Guimarães ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af4">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af5">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af6">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af7">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af8">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="Af9">
<institution><![CDATA[,ULS de São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<aff id="A10">
<institution><![CDATA[,ULS São João  ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>01</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>01</month>
<year>2025</year>
</pub-date>
<volume>19</volume>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2183-84532025000100711&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2183-84532025000100711&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2183-84532025000100711&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Introdução A esclerose múltipla é uma doença neurodegenerativa desmielinizante que acomete o sistema nervoso central. Manifesta-se tipicamente entre os 20 e 45 anos, coincidindo frequentemente com o início da idade ativa. O tempo médio entre os primeiros sintomas e a redução da capacidade de trabalho é de cerca de sete anos, estando associada a importante presenteísmo, absentismo e desemprego voluntário ou involuntário. Os sintomas mais comuns incluem dificuldade na marcha, disfunção neuropsicológica, alterações sensitivas, desequilíbrio, disfunção intestinal ou urinária, défice visual, intolerância ao calor e fadiga. O curso da doença é extremamente variável e imprevisível, incluindo-se no espectro desde surto-remissão até progressivo.  Descrição do caso clínico Enfermeira de 32 anos a exercer funções no Hospital Dia na Pediatria. Antecedentes de esclerose múltipla surto-remissão desde os 19 anos. Último surto com envolvimento cerebeloso direito e consequente incapacidade para a marcha autónoma, tendo sido internada para realização de ciclo de corticoterapia, evidenciando melhoria do quadro clínico. Pelo surto incapacitante, iniciou terapêutica imunomoduladora com ocrelizumab. Avaliada em exame ocasional após doença, referindo episódios de tonturas e desequilíbrio sequelares. Apresentava força muscular nos membros inferiores G4. Referia dificuldade na mobilização de doentes e na realização de turnos longos por fadiga. Foi atribuída aptidão condicionada, com limitação na mobilização de cargas e doentes dependentes, redução da duração dos turnos de trabalho e isenção de trabalho noturno e reforço da utilização de equipamento de proteção individual contra agentes biológicos. Foi reavaliada em exame ocasional três meses após, tendo referido boa adaptação ao trabalho e melhor gestão da fadiga.  Discussão/Conclusão A capacidade de trabalho do doente com esta patologia depende da interação de fatores pessoais, relacionados com a doença e com o trabalho. As principais dificuldades da enfermeira resultaram da disfunção da marcha e fadiga agravada pelo contexto laboral, caracterizado pela necessidade de realização de esforço físico, longas jornadas de trabalho e trabalho noturno. A limitação das cargas mobilizadas, redução da duração dos turnos e a isenção do trabalho noturno são medidas reconhecidas na melhoria da capacidade de trabalho. Fatores protetores, como a idade jovem, o nível de educação elevado e o apoio dos colegas, poderá ter potenciado a eficácia das medidas instituídas pelo médico do trabalho. Pela ausência de evidência científica do potencial carcinogénico do ocrelizumab, não foi necessária a restrição do contacto com agentes citotóxicos. O uso de equipamento de proteção individual foi reforçado devido ao aumento do risco de infeção associado. Fatores de mau prognóstico, como os sinais cerebelares e surtos precoces frequentes devem motivar uma vigilância regular da trabalhadora. O Serviço de Saúde Ocupacional deve identificar e gerir precocemente as características clínicas do trabalhador, para a implementação de medidas de prevenção e proteção individualizadas para fomentar a saúde e participação ativa no trabalho, proporcionando sentimentos de utilidade e autovalorização.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction Multiple sclerosis is a neurodegenerative demyelinating disease that affects the central nervous system. It typically manifests between the ages of 20 and 45, often coinciding with the onset of active professional life. The average time between the first symptoms and a reduction in work capacity is about seven years, which is associated with significant presenteeism, absenteeism, and voluntary or involuntary unemployment. The most common symptoms include difficulty in walking, neuropsychological dysfunction, sensory changes, imbalance, bowel or urinary dysfunction, visual deficits, heat intolerance, and fatigue. The course of the disease is highly variable and unpredictable, ranging from relapsing-remitting to progressive forms.  Case Description A 32-year-old nurse working in a Pediatric Day Hospital with a history of relapsing-remitting multiple sclerosis since age 19. Her most recent relapse involved right cerebellar symptoms and consequent inability to walk independently, leading to hospitalization for a course of corticosteroid therapy, resulting in clinical improvement. As a result of the disabling relapse, immunomodulatory therapy with ocrelizumab was initiated. Following the illness, she was evaluated by occupational health service and reported episodes of dizziness and imbalance as sequelae from the latest relapse. She presented with grade 4 muscle strength in the lower limbs. She mentioned difficulties in patient mobilization and performing long shifts due to fatigue. She was given conditional fitness for work, with limitations on lifting loads and mobilizing dependent patients, reduced working shift durations, exemption from night shifts and bolster the use of personal protective equipment against biological agents. She was re-evaluated during an occasional examination three months later, reporting good adaptation to work and improved management of fatigue.  Discussion/Conclusion The work capacity of patients with this pathology depends on the interaction of personal, disease-related, and work-related factors. Disease-related factors commonly associated with work difficulties include progressive disease course, increasing age, presence of fatigue, pain, gait difficulties, and neuropsychological disturbances. Fatigue is one of the most common complaints and can worsen with physical exertion, long work hours, and night shifts. Night work may have implications for the etiology and progression of multiple sclerosis due to circadian rhythm disruption. Tasks requiring significant physical effort have also been associated with work difficulties. Work conditions and organization that provide greater flexibility, control over work pace, and support from colleagues can contribute to maintaining work capacity. Poor prognostic predictors include cerebellar or pyramidal signs, frequent early relapses, progressive disease course, and onset after age 40, which may warrant more frequent monitoring of these workers. Occupational Health Services should identify and manage the worker&#8217;s clinical characteristics early to implement personalized preventive and protective measures, promoting health and active participation in work, and fostering feelings of usefulness and self-worth.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Esclerose múltipla]]></kwd>
<kwd lng="pt"><![CDATA[aptidão para o trabalho]]></kwd>
<kwd lng="pt"><![CDATA[capacidade de trabalho]]></kwd>
<kwd lng="pt"><![CDATA[medicina do trabalho]]></kwd>
<kwd lng="pt"><![CDATA[enfermagem do trabalho]]></kwd>
<kwd lng="pt"><![CDATA[segurança no trabalho]]></kwd>
</kwd-group>
</article-meta>
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