Introdução: A Doença Ocupacional relacionada à pele é um importante problema de Saúde Pública atingindo milhares de trabalhadores industriais no Brasil e no mundo, trazendo sérias conseqüências econômicas e sociais, como custos com cuidados médicos, ações trabalhistas, afastamento do trabalhador do seu posto de trabalho e queda na produtividade. O objetivo geral deste estudo é realizar um levantamento bibliográfico sobre a ocorrência de dermatoses ocupacionais em trabalhadores industriais, em particular, da indústria do cimento, bem como sobre suas causas, consequências, medidas preventivas e de promoção da saúde. O objetivo específico é propor um Programa de Promoção da saúde da pele e sua possível avaliação. Materiais e Métodos - levantamento bibliográfico e elaboração de uma proposta de um programa de promoção da saúde da pele do trabalhador na indústria do cimento no Brasil. Resultados - a pesquisa registrou a literatura existente no campo da promoção da saúde do trabalhador industrial e problemas de pele relacionados ao trabalho, nesses trabalhadores. A proposta do programa foi elaborada na forma de um modelo lógico, que consistiu no reconhecimento da exposição do trabalhador aos agentes químicos presentes nos ambientes de trabalho e nos pontos de higienização das mãos, educação em saúde e implantação de um sistema adequado e específico de higienização, restauração e proteção da pele. A avaliação do resultado foi sugerida com base no monitoramento do nível de hidratação da pele dos trabalhadores, avaliações visuais da pele e fotografias das mãos, além de questionários de percepção respondidos pelos trabalhadores. / Occupational Skin Disease is an important issue in Public Health involving million of industrial workers ìn Brazil and worldwide, bringing serious economic and social consequences like healthcare assistance costs, labour proceedings, worker absence and decrease of production. The general objective of this study is to carry out a bibliographical survey on industrial workers affected by occupational dermatosis, particularly those linked to cement industry correlating causes, consequences, preventive measures and health promotion approaches. The specific objective is to propose a skin health promotion program and its possible evaluation. Methods and Material - bibliographical survey and a skin health promotion program proposal at a cement industry in Brasil. Results - the research has showed the currently literature in health promotion for industrial workers and skin problems related to the developed activities. The program suggestion was constructed in a logical model in relation to recognizing the worker exposure to chemical agents that can exist in the occupational environment and at handwashing stations, education health and one specific hand care system for hand hygiene, skin restoration and protection. The result evaluation was suggested considering the worker's skin hydration level, as well as visual evaluations and hand pictures, besides the perception questionnaires answered by the workers.

Introdução: A Doença Ocupacional relacionada à pele é um importante problema de Saúde Pública atingindo milhares de trabalhadores industriais no Brasil e no mundo, trazendo sérias conseqüências econômicas e sociais, como custos com cuidados médicos, ações trabalhistas, afastamento do trabalhador do seu posto de trabalho e queda na produtividade. O objetivo geral deste estudo é realizar um levantamento bibliográfico sobre a ocorrência de dermatoses ocupacionais em trabalhadores industriais, em particular, da indústria do cimento, bem como sobre suas causas, consequências, medidas preventivas e de promoção da saúde. O objetivo específico é propor um Programa de Promoção da saúde da pele e sua possível avaliação. Materiais e Métodos - levantamento bibliográfico e elaboração de uma proposta de um programa de promoção da saúde da pele do trabalhador na indústria do cimento no Brasil. Resultados - a pesquisa registrou a literatura existente no campo da promoção da saúde do trabalhador industrial e problemas de pele relacionados ao trabalho, nesses trabalhadores. A proposta do programa foi elaborada na forma de um modelo lógico, que consistiu no reconhecimento da exposição do trabalhador aos agentes químicos presentes nos ambientes de trabalho e nos pontos de higienização das mãos, educação em saúde e implantação de um sistema adequado e específico de higienização, restauração e proteção da pele. A avaliação do resultado foi sugerida com base no monitoramento do nível de hidratação da pele dos trabalhadores, avaliações visuais da pele e fotografias das mãos, além de questionários de percepção respondidos pelos trabalhadores. / Occupational Skin Disease is an important issue in Public Health involving million of industrial workers ìn Brazil and worldwide, bringing serious economic and social consequences like healthcare assistance costs, labour proceedings, worker absence and decrease of production. The general objective of this study is to carry out a bibliographical survey on industrial workers affected by occupational dermatosis, particularly those linked to cement industry correlating causes, consequences, preventive measures and health promotion approaches. The specific objective is to propose a skin health promotion program and its possible evaluation. Methods and Material - bibliographical survey and a skin health promotion program proposal at a cement industry in Brasil. Results - the research has showed the currently literature in health promotion for industrial workers and skin problems related to the developed activities. The program suggestion was constructed in a logical model in relation to recognizing the worker exposure to chemical agents that can exist in the occupational environment and at handwashing stations, education health and one specific hand care system for hand hygiene, skin restoration and protection. The result evaluation was suggested considering the worker's skin hydration level, as well as visual evaluations and hand pictures, besides the perception questionnaires answered by the workers.

La mise en œuvre de programmes de santé publique complexes est particulièrement délicate en milieu scolaire. Des différences sont fréquemment observées entre ce qui était attendu du programme et ce qui en résulte en réalité. Ces différences sont dues à un certain nombre de facteurs contextuels, en lien avec les caractéristiques propres du milieu, de la communauté et des acteurs concernés. Développer des programmes de prévention efficaces, implique de prendre en compte l’impact de ces facteurs sur le processus d’implantation des projets. Par conséquent, il convient de s’intéresser à deux questions majeures : la première est celle de la transférabilité des programmes, dont les effets sont difficiles à prévoir dans une telle variabilité contextuelle. La seconde question concerne la généralisation à l’échelon régional ou national de la mise en œuvre de tels programmes de prévention en milieu scolaire qui, loin d’être une évidence, est également sujette à de nombreux déterminants variables en fonction des situations. Alors que l’implantation et la mise en œuvre des programmes est un champ largement investigué dans le soin comme dans le management, il s’agit d’un champ de recherche en expansion dans le domaine de la prévention, de l’éducation à la santé et de la promotion de la santé. Cette thèse propose de s’intéresser aux modalités d’implantation des programmes avec un objectif double : une visée épistémique par une réflexion théorique sur les concepts à mobiliser, puis une confrontation empirique de cette approche dans trois études ; une visée transformative s’appuyant sur des propositions d’opérationnalisation de notre approche. Chaque étude contribuera à explorer et expliciter un aspect de l’implantation : des processus générés, aux effets observés, en prenant en compte les facteurs déterminants en jeu. Les résultats de ce travail mettent l’accent sur le fait que les caractéristiques initiales des différents contextes ont un impact majeur sur le processus d’implantation, à différents niveaux de mise en œuvre. Les interactions entre les facteurs sont complexes, elles s’inscrivent dans des boucles d’action-rétroaction. L’introduction d’un programme dans un contexte peut agir comme un révélateur de certaines conditions favorables ou défavorables, un élément perturbateur imposant de nouvelles contraintes, ou, au contraire, un nouvel élan stimulant la motivation des équipes. Il apparaît que les programmes sont « instrumentalisés » par les acteurs pour servir leurs propres objectifs en fonction des conditions de départ. Il s’agit par conséquent de questionner le statut et le potentiel des programmes implantés au sein de contextes d’une extrême complexité. Nous ne prônons pas un changement de paradigme, mais plutôt un déplacement du curseur d’une focalisation sur l’amélioration de la fidélité avec laquelle les programmes sont mis en œuvre, vers un ancrage fort dans les différents contextes. Cette stratégie nous semble particulièrement adaptée à une démarche de réduction des inégalités sociales de santé. Dans cette perspective, nous proposons l’élaboration de « patterns » d’implantation sur la base d’une analyse détaillée des éléments déterminants préexistant dans les contextes considérés. Pour développer cette approche, il est nécessaire de poursuivre les recherches afin d’analyser les combinaisons de facteurs contextuels dans différents types d’écoles comme dans d’autres milieux. / Implementing health-related interventions is challenging in school settings. Discrepancies, between expected and actual programme outcomes, are often reported. They are, at least partly, due to contextual factors in the setting, the community and the stakeholders involved. The impact of these factors sets two challenges for the development of successful health promotion programmes: first, transferability and generalization, as end effects are in reality difficult to predict; second, the scaling up of interventions cannot be taken for granted, as the determinants involved are numerous and variable, depending on situations. While implementation research is substantial in healthcare or management, it is an emerging and growing field in health promotion. This work proposes to produce knowledge on implementation in health promotion, with a twofold approach based on a theoretical reflection, and its confrontation with three empirical studies. Each study contributes to understand a different aspect of implementation, namely the processes involved, the outputs resulting from the process and the influential factors in play. Findings put forward that specific characteristics of the context, which exist prior to implementation, influence the implementation process greatly, on various levels and according to complex loops of interactions. The new programme introduced sometimes acts as a revealer, a constraint, or a motivator. It is used as a tool, a guideline or a vision, depending on initial conditions, expectations and potentiality of the context of implementation. This work also discusses the way in which school stakeholders tend to “instrumentalize” programmes and guidelines for their own purpose. Questioning the design, status and potentiality of programmes is essential. Rather than proposing a paradigm shift, our suggestion is to move towards implementation research and programme design that focus on interactions between contexts and programmes, to reduce health inequities. It is about moving the cursor from evidence-base and fidelity, to a focus on contextual influencing implementation. Implementation patterns, based on a detailed understanding of contextual factors, could serve as guiding directions to support the implementation process, in a transformational change perspective. More research is needed on combinations of contextual factors in different types of school, and other types of settings, to further develop the approach presented in this work.