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La santé des travailleurs et la santé mentale spécifiquement liés au travail sont la base pour la discussion de cette thèse. Son objectif était de construire des propositions pour une clinique de santé mental et travail pour les services du Sistema Único de Saúde (SUS) et à cette fin a été utilisé, de manière complémentaire, le Self Reporting Questionnaire (SRQ-20) . Les entrevues ont été menées auprès de 24 travailleurs masculins et féminins, soignés aux Service de Maladies du travail de l'Hospital de Clínicas de Porto Alegre (ADT / HCPA). En outre, nous avons cherché à identifier la maladie en santé mentale liés au travail aujourd'hui; comprendre comment les formes de gestion influencent la maladie en milieu de travail et proposont d'autres possibilités pour le soin à la santé mentale des travailleurs et travailleuses du SUS. L'utilisation de la Psychodynamique du Travail a permis la compréhension de la situation de souffrance / maladie mentale liés au travail, en soulignant dans la plupart des cas, la violence psychologique subi dans l'environnement de travail comme un déclencheur pour la maladie actuelle. Seulement 10 de ces travailleurs interrogés sont accompagnés par des professionnels de la santé mentale, pas toujours avec la fréquence necessaire, seulement 01 dans le service du SUS, mais 20 font l'usage de médicaments psychiatriques. Avec les histoires racontées de leur travail et maladie, les travailleurs et les travailleuses ont demandé l'écoute de leur souffrance et le soin par des professionnels qui pouvaient comprendre ce qu'ils ont vécu à l'époque. En ce sens, penser la Clinique du Travail dans le SUS, non seulement mobilisé le développement de la souffrance / maladie des travailleurs, mais collabore à l'avancement de la mise en oeuvre de ce qui est recommandé dans la Politique Nationale de Santé de travailleurs et Travailleuses, ce qui signifie jeter un coup d'oeil le réseau de la santé et les services qui peuvent potentiellement rendre les soins de santé mentale et travail, la compréhension du processus de modulation, de métamorphoses et de transformations qui ont eu lieu dans l'organisation du travail, et par conséquent dans les relations de travail. La construction d'une Ligne de Soins (LC) en Santé Mentale du Travailleur peut alors être l'expression de la Clinique du travail dans le SUS et doit être insérée dans le système de santé existant, à condition d'avoir été construits possibilités pour cette insertion. Il est entendu que le LC devrait être dans la discussion de la mise en oeuvre de la politique publique nationale comme une possibilité de soins aux travailleurs et travailleues. / A saúde do trabalhador e especificamente a saúde mental relacionada ao trabalho são a base de discussão dessa tese. Seu objetivo foi o de construir propostas para uma clínica em saúde mental e trabalho para os serviços do Sistema Único de Saúde (SUS) e, para tanto foi organizado roteiro de entrevista e utilizado o Self Reporting Questionnaire (SRQ-20), de forma complementar. Foram realizadas entrevistas com 24 trabalhadores e trabalhadoras atendidos no Ambulatório de Doenças do Trabalho do Hospital de Clínicas de Porto Alegre (ADT/HCPA). Além disso, buscou-se identificar o adoecimento em saúde mental relacionado ao trabalho na atualidade; compreender como as formas de gestão influenciam o adoecimento nos ambientes de trabalho na atualidade e propor outras possibilidades para a atenção à saúde mental dos trabalhadores e das trabalhadoras atendidos no SUS. A utilização da Clínica Psicodinâmica do Trabalho permitiu a compreensão da situação de sofrimento/adoecimento psíquico relacionado ao trabalho, destacando-se na maioria dos casos, a violência psicológica sofrida no ambiente laboral como desencadeante para o atual adoecimento. Apenas 10 desses trabalhadores entrevistados são acompanhados por profissional de saúde mental, nem sempre com periodicidade, apenas 01 em serviço do SUS, mas 20 fazem uso de medicação psiquiátrica. Com o relato das histórias vividas no trabalho e de seu adoecimento, os trabalhadores e as trabalhadoras solicitavam escuta ao seu sofrimento e a possibilidade de atendimento por profissionais que pudessem compreender o que haviam sofrido ou estavam vivendo no momento. Nesse sentido, pensar a Clínica do Trabalho no SUS, mobiliza não apenas a elaboração do sofrimento/adoecimento dos trabalhadores, mas colabora no avanço da implantação do que está preconizado na Política Nacional de Saúde do Trabalhador e Trabalhadora, o que significa lançar um olhar para a rede de saúde e os serviços que potencialmente podem realizar atendimento em saúde mental e trabalho, entendendo os processos de modulações, metamorfoses e transformações que tem ocorrido na organização do trabalho, e consequentemente nas relações de trabalho desenvolvidas. A construção de uma Linha de Cuidado (LC) em Saúde Mental do Trabalhador pode ser então a expressão da Clínica do Trabalho no SUS e deve estar inserida na rede de saúde já existente desde que sejam construídas possibilidades para essa inserção. Entende-se que a LC deve estar na discussão da implantação da política pública nacional como uma possibilidade de atendimento para os trabalhadores e as trabalhadoras. / Workers health, and more specifically, mental health related to work, is the basis of the discussion of this thesis. The main goal was to set up proposals for a workers mental health clinic within the Sistema Unico de Saude (SUS), that is, the Brazilian Universal Health Care System. For that, an interview guide was organized and the Self Reporting Questionnaire (SRQ-20) was used as a complement. Interviews were performed with 24 workers, male and female, that were receiving care at the Hospital de Clinicas of Porto Alegre, Brazil, at the Workers Disease Unit. Moreover, it was intended to identify mental health illness as related to work in today’s world; to understand how management influence ailment in the work place today, and to propose different ways of attending to the workers mental health who receive treatment in the SUS. The use of the Psychodynamic Workers Clinic allowed for a better understanding of the psychological suffering/illness related to work, and, for the majority of the cases, it was highlighted the psychological violence experienced in the work premises as what was the beginning of the current illness. Only 10 of these interviewed workers receive mental health care, though not always periodically, only 01 within SUS services, but 20 use psychiatric medications. With the life portrayals of the work related stories and their ailment, workers requested their sorrows be heard and the possibility of getting treated by professionals that could understand what they had gone through or were going through at the moment. In this sense, to think of a Workers Clinic in the SUS system, mobilizes not only the formulation of the suffering/ailment of the workers, but also helps in the advancement of the implementation of recommendations in the National Policies of Workers Health, which means taking a look at the health services that can potentially provide mental health and care to workers, understanding the processes of modulation, metamorphosis and transformations that have been taking place in the work place, and consequently understanding the work relations developed thereafter. The elaboration of a Line of Care (LC) for the Workers Mental Health can be the expression of the Workers Clinic at SUS and needs to be inserted in the health system already existing as long as possibilities for this insertion are constructed. It is understood that the LC needs to be in the discussion in the implementation of the national public policies as a possibility of treatment for the workers.

Cette thèse s’intéresse au travail collectif d’opérateurs de montage travaillant en « îlot de production » et à la construction de la santé dans ce contexte de transformations du monde ouvrier. Lors d’une intervention dans une entreprise de logistique, dernier maillon de la chaîne de sous-traitance de l’industrie automobile, nous avons proposé d’installer un cadre clinique de l’activité en psychologie du travail. Ainsi, les opérateurs volontaires ont pu découvrir combien les expériences des autres - même ceux croisés ponctuellement de par le turn-over des intérimaires - et les débats autour des façons de faire des collègues, pouvaient devenir une ressource pour leur propre travail. Malgré la difficulté de maintenir un travail de co-analyse avec un fort turn-over, les opérateurs ont aussi pris conscience de la fonction sociale de leur collectif au sein de l’entreprise, lors du dernier comité de pilotage de notre intervention. Ce double processus psychologique et social de la fonction du collectif chez les opérateurs leur permet de créer de nouvelles manières de transformer le travail, participant ainsi au développement de leur santé. / This thesis speaks about collective work of the operators of assembly in modular manufacturing unit and health building in this context of industrial work transformations. During an intervention in a company of car logistics, the last link of the chain of subcontracting at car industry, we proposed them to construct a clinical frame of activity in work psychology. So, volunteers’ operators were able to discover how much the experiences of the others - even those crossed punctually due to the turnover of the temporary workers - and the debates around the manners to make the other colleagues could become a resource for their own work. In spite of the difficulty to maintain a work of co-analysis with temporary operators, the operators could also became aware of their collective social function, during the last steering committee of our intervention. This double psychological and social process of the collective function at the operators allows creating new ways to transform their work, so participating in the development of their health.

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-09-23T13:28:36Z No. of bitstreams: 1 DissFTM.pdf: 1884333 bytes, checksum: 6d73a357db41241d350b7ce7605a8dbb (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-26T20:38:44Z (GMT) No. of bitstreams: 1 DissFTM.pdf: 1884333 bytes, checksum: 6d73a357db41241d350b7ce7605a8dbb (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-26T20:38:51Z (GMT) No. of bitstreams: 1 DissFTM.pdf: 1884333 bytes, checksum: 6d73a357db41241d350b7ce7605a8dbb (MD5) / Made available in DSpace on 2016-09-26T20:38:57Z (GMT). No. of bitstreams: 1 DissFTM.pdf: 1884333 bytes, checksum: 6d73a357db41241d350b7ce7605a8dbb (MD5) Previous issue date: 2011-08-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The Safety and Health at Work (SHW) management is recognized as one of the main factors so the enterprises may be able to fulfill their basic goals of coast, term and quality. One of the latest management strategies is the Resilience Engineering (RE) approach that considers the presence of four main principles for appliance: Top Management Commitment, Apprenticeship, Flexibility and Consciousness. Considering the intensive use of the concrete precast building systems it becomes substantial to study this section about the SHW aspects on the RE focus and record the good practices held by the companies. This work is based on the proposal elaborated by Costella (2008) which presents an Evaluation Method of the Safety and Health at Work based on the safety management principles and the RE. The case study method was adopted, a concrete precast producer enterprise was searched, which had a qualified management system, and it accepted to collaborate with the research. It was concluded that the researched Enterprise presents evidence of the application of the RE principles, mainly due to the existence of the SHW management. It was verified that there are ordinary and complementary concerns, such as the operation of critical sectors and the maintenance of the equipment currently used in factories and construction sites. / A gestão da Segurança e Saúde do Trabalho (SST) é reconhecida como um dos elementos essenciais para que os empreendimentos cumpram suas metas básicas de custo, prazo e qualidade. Uma das estratégias mais modernas de gestão é a abordagem da Engenharia de Resiliência (ER) que considera a presença de quatro princípios para aplicação: Comprometimento da Alta Direção, Aprendizagem, Flexibilidade e Consciência. Dado o uso intensivo dos sistemas construtivos pré-fabricados de concreto torna-se importante estudar este setor sobre os aspectos de SST sobre o enfoque da ER e registrar as boas práticas realizadas pelas empresas. Este trabalho se baseia na proposta elaborada por Costella (2008) que apresenta um Método de Avaliação da Segurança e Saúde do Trabalho, com base nos princípios de gestão da segurança e da ER. Foi adotado o método de estudo de caso e pesquisada uma empresa fabricante do setor de pré-fabricados de concreto que se prontificou a colaborar com a pesquisa e possuía sistema de gestão de qualidade certificado. Concluiu-se que a Empresa pesquisada apresenta indícios de aplicação dos princípios da ER, devido principalmente ao fato de haver a gestão da SST. Verificou-se que existem preocupações em comuns e complementares, como a operação de setores críticos e a manutenção dos equipamentos em uso nas fábricas e canteiros. Palavras chave: Construção Civil. Segurança e Saúde do Trabalho. Engenharia de Resiliência.

La santé des travailleurs et la santé mentale spécifiquement liés au travail sont la base pour la discussion de cette thèse. Son objectif était de construire des propositions pour une clinique de santé mental et travail pour les services du Sistema Único de Saúde (SUS) et à cette fin a été utilisé, de manière complémentaire, le Self Reporting Questionnaire (SRQ-20) . Les entrevues ont été menées auprès de 24 travailleurs masculins et féminins, soignés aux Service de Maladies du travail de l'Hospital de Clínicas de Porto Alegre (ADT / HCPA). En outre, nous avons cherché à identifier la maladie en santé mentale liés au travail aujourd'hui; comprendre comment les formes de gestion influencent la maladie en milieu de travail et proposont d'autres possibilités pour le soin à la santé mentale des travailleurs et travailleuses du SUS. L'utilisation de la Psychodynamique du Travail a permis la compréhension de la situation de souffrance / maladie mentale liés au travail, en soulignant dans la plupart des cas, la violence psychologique subi dans l'environnement de travail comme un déclencheur pour la maladie actuelle. Seulement 10 de ces travailleurs interrogés sont accompagnés par des professionnels de la santé mentale, pas toujours avec la fréquence necessaire, seulement 01 dans le service du SUS, mais 20 font l'usage de médicaments psychiatriques. Avec les histoires racontées de leur travail et maladie, les travailleurs et les travailleuses ont demandé l'écoute de leur souffrance et le soin par des professionnels qui pouvaient comprendre ce qu'ils ont vécu à l'époque. En ce sens, penser la Clinique du Travail dans le SUS, non seulement mobilisé le développement de la souffrance / maladie des travailleurs, mais collabore à l'avancement de la mise en oeuvre de ce qui est recommandé dans la Politique Nationale de Santé de travailleurs et Travailleuses, ce qui signifie jeter un coup d'oeil le réseau de la santé et les services qui peuvent potentiellement rendre les soins de santé mentale et travail, la compréhension du processus de modulation, de métamorphoses et de transformations qui ont eu lieu dans l'organisation du travail, et par conséquent dans les relations de travail. La construction d'une Ligne de Soins (LC) en Santé Mentale du Travailleur peut alors être l'expression de la Clinique du travail dans le SUS et doit être insérée dans le système de santé existant, à condition d'avoir été construits possibilités pour cette insertion. Il est entendu que le LC devrait être dans la discussion de la mise en oeuvre de la politique publique nationale comme une possibilité de soins aux travailleurs et travailleues. / A saúde do trabalhador e especificamente a saúde mental relacionada ao trabalho são a base de discussão dessa tese. Seu objetivo foi o de construir propostas para uma clínica em saúde mental e trabalho para os serviços do Sistema Único de Saúde (SUS) e, para tanto foi organizado roteiro de entrevista e utilizado o Self Reporting Questionnaire (SRQ-20), de forma complementar. Foram realizadas entrevistas com 24 trabalhadores e trabalhadoras atendidos no Ambulatório de Doenças do Trabalho do Hospital de Clínicas de Porto Alegre (ADT/HCPA). Além disso, buscou-se identificar o adoecimento em saúde mental relacionado ao trabalho na atualidade; compreender como as formas de gestão influenciam o adoecimento nos ambientes de trabalho na atualidade e propor outras possibilidades para a atenção à saúde mental dos trabalhadores e das trabalhadoras atendidos no SUS. A utilização da Clínica Psicodinâmica do Trabalho permitiu a compreensão da situação de sofrimento/adoecimento psíquico relacionado ao trabalho, destacando-se na maioria dos casos, a violência psicológica sofrida no ambiente laboral como desencadeante para o atual adoecimento. Apenas 10 desses trabalhadores entrevistados são acompanhados por profissional de saúde mental, nem sempre com periodicidade, apenas 01 em serviço do SUS, mas 20 fazem uso de medicação psiquiátrica. Com o relato das histórias vividas no trabalho e de seu adoecimento, os trabalhadores e as trabalhadoras solicitavam escuta ao seu sofrimento e a possibilidade de atendimento por profissionais que pudessem compreender o que haviam sofrido ou estavam vivendo no momento. Nesse sentido, pensar a Clínica do Trabalho no SUS, mobiliza não apenas a elaboração do sofrimento/adoecimento dos trabalhadores, mas colabora no avanço da implantação do que está preconizado na Política Nacional de Saúde do Trabalhador e Trabalhadora, o que significa lançar um olhar para a rede de saúde e os serviços que potencialmente podem realizar atendimento em saúde mental e trabalho, entendendo os processos de modulações, metamorfoses e transformações que tem ocorrido na organização do trabalho, e consequentemente nas relações de trabalho desenvolvidas. A construção de uma Linha de Cuidado (LC) em Saúde Mental do Trabalhador pode ser então a expressão da Clínica do Trabalho no SUS e deve estar inserida na rede de saúde já existente desde que sejam construídas possibilidades para essa inserção. Entende-se que a LC deve estar na discussão da implantação da política pública nacional como uma possibilidade de atendimento para os trabalhadores e as trabalhadoras. / Workers health, and more specifically, mental health related to work, is the basis of the discussion of this thesis. The main goal was to set up proposals for a workers mental health clinic within the Sistema Unico de Saude (SUS), that is, the Brazilian Universal Health Care System. For that, an interview guide was organized and the Self Reporting Questionnaire (SRQ-20) was used as a complement. Interviews were performed with 24 workers, male and female, that were receiving care at the Hospital de Clinicas of Porto Alegre, Brazil, at the Workers Disease Unit. Moreover, it was intended to identify mental health illness as related to work in today’s world; to understand how management influence ailment in the work place today, and to propose different ways of attending to the workers mental health who receive treatment in the SUS. The use of the Psychodynamic Workers Clinic allowed for a better understanding of the psychological suffering/illness related to work, and, for the majority of the cases, it was highlighted the psychological violence experienced in the work premises as what was the beginning of the current illness. Only 10 of these interviewed workers receive mental health care, though not always periodically, only 01 within SUS services, but 20 use psychiatric medications. With the life portrayals of the work related stories and their ailment, workers requested their sorrows be heard and the possibility of getting treated by professionals that could understand what they had gone through or were going through at the moment. In this sense, to think of a Workers Clinic in the SUS system, mobilizes not only the formulation of the suffering/ailment of the workers, but also helps in the advancement of the implementation of recommendations in the National Policies of Workers Health, which means taking a look at the health services that can potentially provide mental health and care to workers, understanding the processes of modulation, metamorphosis and transformations that have been taking place in the work place, and consequently understanding the work relations developed thereafter. The elaboration of a Line of Care (LC) for the Workers Mental Health can be the expression of the Workers Clinic at SUS and needs to be inserted in the health system already existing as long as possibilities for this insertion are constructed. It is understood that the LC needs to be in the discussion in the implementation of the national public policies as a possibility of treatment for the workers.

Cette thèse explore les processus soutenant l’action des encadrants en santé au travail. Nous avons utilisé nos terrains d’interventions professionnels auprès d’encadrants d’équipes pour questionner les processus soutenant l’action des encadrants en santé au travail. Une première étude questionne les impasses de la notion de risques psychosociaux pour envisager l’action des encadrants en santé au travail. Puis, une deuxième étude a permis d’interroger l’opérationnalité du concept psychologique du métier et sa dynamique par la discussion du travail avant de tester différents espaces de discussion lors d’une recherche action dans un Etablissement d’Hébergement pour Personnes Agées Dépendantes (EHPAD). L’analyse des résultats de cette troisième étude a fait émerger les résistances à la discussion. Celle-ci nécessite un apprentissage individuel, collectif et organisationnel à la discussion du travail auprès des encadrants, des équipes et des acteurs impliqués en santé au travail (direction, professionnels en santé au travail, partenaires sociaux). Sur la base de ces résultats, nous définissons les conditions que les espaces de discussion, animés par les encadrants, doivent réunir pour développer la santé des équipes. / This thesis explores the processes supporting the action of managers and supervisors on occupational health. We used our experiences of professional interventions with team supervisors to question this issue. A first study questions the impasses of the concept of psychosocial risks to consider the action of managers on occupational health of the team members. Then, a second study investigates the operational concept of the psychological dynamics of the job related to discussion about work. For the third study, we test different management devices through discussion using a research-action methodology in an establishment for elderly dependents (EHPAD). Analysis of the results of this third study brings out the resistance to discussion. This requires individual learning, collective and organizational work for discussion with supervisors, teams and stakeholders involved in health at work (management, health professionals at work, social partners). Based on these results, we define the requirements for discussion spaces and the role of supervisors in order to develop psychological health of team members.

Cette recherche se compose de trois études. La première, qualitative, met en exergue la transition culturelle qu’a connue le groupe La Poste durant cette dernière décennie. Ainsi, les effets de l’intégration progressive d’une culture de marché sont investigués à travers le discours de cadres, d’encadrants et de facteurs. La transformation de la culture organisationnelle est mise en avant ainsi que les répercussions de cette évolution sur le travail, la dimension axiologique et la santé des employés. La deuxième étude transpose dans le domaine de l’organisation des modèles d’intégrations identitaires habituellement associés à la santé et utilisés le plus souvent pour mettre en perspective le processus acculturatif de migrants avec des dimensions liées à la santé psychologique. Ainsi, le modèle de l’acculturation (Berry, 1990), le modèle de l’intégration biculturelle (Benet-Martinez & Haritatos, 2005) et le modèle cognitivo-développemental de l’intégration des identités sociales (Amiot et al., 2007) permettent d’expliquer, en partie, le bien-être et la détresse psychologique au travail ainsi que l’absentéisme des employés du groupe La Poste. Un pan de l’étude est consacré à expliquer les différentes identifications par le biais des motivations identitaires, de la menace perçue et des valeurs. Ces trois dimensions jouent un rôle prépondérant dans l’intégration culturelle des employés. Enfin, une dernière étude, utilisant des méthodes d’évaluations implicites, est réalisée dans le but de mettre à jour de potentielles dissonances cognitives, pouvant impacter la santé des individus, en mesurant des différences significatives entre l’identification implicite et l’identification autodéclarée. Cette étude montre des résultats contrastés ne pouvant être retenus, l’efficacité de la manipulation n’ayant pu être validée. Toutefois, certains indicateurs poussent à poursuivre les recherches en ce sens. / This research consists of three studies. The first study is qualitative. It highlights the cultural transition within the La Poste Group during the last decade. The effects of the gradual integration of a market culture are investigated through the speeches of executives, supervisors and postmen. The transformation of the corporate culture is highlighted as well as its impact on the work, the axiological dimension and the employees’ health. The second study transposes into the field of the organization of identity integration’s models. These models, usually associated with health, are often used to put into perspective the acculturative process of migrants with psychological health’s dimensions. Thus, the acculturation model (Berry, 1990), the bi-cultural integration model (Benet-Martinez & Haritatos, 2005) and the cognitive developmental model of social identities’ integration (Amiot et al. 2007 ) may explain, partly, the well-being and the psychological distress at work as well as the absenteeism of employees of La Poste Group. A section of the study focuses to explain the different identifications through identity motivations, perceived threat and values. These three dimensions play a major role in the cultural integration of employees. At last, a final study using methods of implicit assessment is performed in order to update potential cognitive dissonance which could affect the health of individuals. It measures significant differences between the implicit identification and self-declared identification. This study shows contrasting results that won’t hold because the effectiveness of the manipulation has not been proven. However, some indicators urge to continue research in this direction.

Bakgrund: Risken att utveckla hjärt- och kärlsjukdom samt diabetes typ 2 ökar vid ohälsosamma levnadsvanor. Ett av distriktssköterskans uppdrag är att arbeta hälsofrämjande för att förebygga dessa sjukdomar. Sörmlands hälsoprogram är en del i ett hälsofrämjande arbete och riktar sig till 40-, 50- och 60-åringar inom Region Sörmland. Syfte: Att identifiera och beskriva inbjudna deltagares erfarenheter av hälsosamtalet i Sörmlands hälsoprogram. Metod: Deskriptiv design med kvalitativ ansats. Semistrukturerade intervjuer genomfördes med stöd av en intervjuguide. Tio personer som deltagit i hälsosamtalet är informanter i föreliggande studie. Datan analyserades med tematisk analys enligt Braun och Clarke. Resultat: Analysen resulterade i två övergripande teman; Deltagarnas erfarenheter av samtalets kringliggande faktorer och Samtalets olika dimensioner och dess betydelse. Under vardera temat finns två underliggande subteman som skildrar resultatet. Slutsats: Sörmlands hälsoprogram som helhet och hälsosamtalet som en del i detta uppskattas av de som deltar. Hälsosamtalet upplevs som respektfullt och neutralt där informanterna beskriver att de får tid att reflektera och komma till insikt om sina levnadsvanor och att det skapar en ökad motivation. / Background: The risk of developing cardiovascular disease and type 2 diabetes increases with unhealthy living habits. One of the district nurse's tasks is to work in health promotion to prevent these diseases. Sörmland's health program is part of a health promotion work and is aimed at 40-, 50-and 60-year-old in the Region of Sörmland. Aim: To identify and describe invited participants' experiences of the health dialogue in Sörmland's health program. Method: Descriptive design with qualitative approach. Semi-structured interviews were conducted with the help of an interview guide. Ten people who participated in the health dialogue are informants in the present study. The data were analyzed using thematic analysis according to Braun and Clarke. Results: The analysis resulted in two overall themes; The participants' experiences of the surrounding factors of the health dialogue and the different dimensions of the health dialogue and its significance. Under each theme, there are two underlying subthemes that depict the result. Conclusion: Sörmland's health program as a whole and the health dialogue as part of this are appreciated by those who participate. The health dialogue is perceived as respectful and neutral where the informants describe that they are given time to reflect and gain insight into their living habits and that it creates an increased motivation.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

La seguridad y salud en el trabajo para una empresa de construcción, forma parte importante de los procesos misionales, visto desde la perspectiva humana, así como económica. En tal sentido, con el presente proyecto se propone una solución informática, tomando como punto de partida la información del negocio (mapa de procesos) para con esta realizar el análisis y diseño de un sistema de monitoreo de seguridad y salud en el trabajo empleando inteligencia artificial redes neuronales MLP para el análisis de imágenes en obras. De forma general, la propuesta tiene como objetivo reducir los accidentes y con esto los gastos (7% de ingresos) que se vienen presentando en la ejecución de obras por pagos de multas, penalidades o por incumplimiento de contratos. En la primera etapa se realiza el análisis de la información de la empresa, se emplea el marco de trabajo de Zachman y TOGAF, de esta manera se conoce la situación actual del proceso de gestión y control de obras identificando los problemas o debilidades que se presenten en este, con esta información se procede a realizar en análisis de la propuesta de mejora. La siguiente etapa se basa en diseñar la propuesta de solución partiendo por la identificación de requerimientos del sistema junto al usuario del negocio, teniendo esta información se identifican los drivers funcionales y no funcionales del sistema, finalmente se pasa a realizar el diseño del sistema empleando el modelo C4, plasmando la arquitectura de software a 4 niveles de aproximación. / Occupational safety and health for a construction company is an important part of missionary processes seen from a human perspective, as well as an economic one. In this sense, with this project a system solution is proposed, taking as a starting point the business information (process map) to carry out the analysis and design of a monitoring system for safety and health at work using artificial intelligence neural networks MLP for the analysis of images in construction sites. In general, the objective of the proposal is to reduce accidents and with this the expenses (7% of income) that have been presented in the execution of works for payment of fines, penalties or for breach of contracts. In the first stage, the analysis of the company's information is carried out with the help of Zachman and TOGAF framework, in this way the current situation of the process “Management and control of construction sites” is known, identifying the problems or weaknesses that it has, with this information, the analysis of the improvement proposal is carried out. The next stage is based on designing the solution proposal starting from the identification of system requirements together with the business user, having this information, the functional and non-functional drivers of the system are identified, finally the system design is carried out using the model C4, expressing the software architecture at 4 levels of approximation. / Tesis