Diss. (sammanfattning) Lund : Univ. / Härtill 5 uppsatser.

Objective: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. Materials and Methods: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for age-adjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). Results: No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to refect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. Conclusions: Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Made available in DSpace on 2016-06-02T19:48:23Z (GMT). No. of bitstreams: 1 5945.pdf: 1511308 bytes, checksum: ddde59660f0ecb257281d840dd8647df (MD5) Previous issue date: 2014-02-24 / Family Health Strategy (FHS), which has the objective to reorient the assistance health model, redefined both work organization and nurse´s professional practice. This health professional has an important role to the consolidation of the FHS, because it must perform managerial, assistance and educational actions. Thus, it is important to understand the organization of working process on Family Health Unit (FHI) and how it affects nurses life quality (LQ). Thereby, this research aims to: identifying the constructive elements of working process which are perceived by nurses; analyzing the nurses perceptions regarding the influence of work process in their LQ; identifying the actions which have been realized to health promotion ofthe health of the workers.Twelve nurses who worked in the FHS in Ilhéus BA participated in this study as volunteers. This study had a quanti-qualitative approach, and it is classified as analytic descriptive type. Two different methods were utilized to data collection: semistructure interview and the WHOQOL -brief questionnaire instrument administered to evaluate the LQ. The data from WHOQOL-brief were tabulated by Microsoft EXCEL®, where were calculated the averages and SD of the WHOQOL-brief domains. Inferential statistical analysis were performed by BioEstat® 5.3. The interviews were transcribed, and the lexical analysis were performed by ALCESTE® software 4.10 version. Four classes were identified from ALCESTE s analysis:Service demand, for both nurses and entire health team, as well as its organization on working process; 2) Educational Dimension in the nurses working process;3) Management as negative point of the working process and as stress factor to the nurses; and 4) Elements of the working process and the worker´s health. Scores from WHOQOL-brief showed that the social relations domain presented the greatest value (4,1), followed by physical domain (3,9), psychological domain (3,8) and, at last, environment domain (3,4).There was significant difference from environment domain (p<0.05) to both physical and social relations domains. There wasno significant correlation between the independent variables (age, working time and children) and the WHOQOL-brief domains (p>0.05).The results showed that,even though the nurses recognized that some elements of the health working process affectsnegatively in their LQ, they evaluated their LQ as satisfactory. Understanding of nurses perceptions concerning the working process, and its influence on their LQ, enabled an approach to the reality experienced by these health professionals. Most important contributions of this study were to provide better knowledge regarding working process of the nurses on FHS, and how that working process can affect their LQ. Furthermore, immersion into nurses life work brought up some interesting elements that might be useful to construct new strategies to improve the healthcare on FHS and the LQ of the health professionals there. / Com a Estratégia de Saúde da Família (ESF), que tem como objetivo reorientar o modelo de assistência à saúde redefiniu-se a organização do trabalho e a prática do profissional enfermeiro. Este profissional exerce papel crucial para a consolidação da ESF, pois dentre suas ações incluem-se as gerenciais, as assistenciais e as educativas. Desse modo, faz-se importante conhecer a organização do trabalho nas unidades de saúde da família (USF) e suas influências na qualidade de vida (QV) dos enfermeiros. Esta pesquisa tem como objetivos: analisar a percepção do enfermeiro quanto à organização do processo de trabalho; identificar os elementos constitutivos do processo de trabalho percebidos pelos enfermeiros; analisar a percepção dos enfermeiros quanto à influência do processo de trabalho em sua qualidade de vida; identificar ações voltadas para a atenção à saúde dos trabalhadores de saúde. Trata-se de pesquisa quanti-qualitativa, do tipo descritiva analítica, que utilizou duastécnicas de coleta de dados: entrevista semi-estruturada e aplicação do WHOQOL-bref - instrumento de avaliação da QV. Participaram da pesquisa 12 enfermeiros que atuavam na ESF do município de Ilhéus-BA.As entrevistas foram transcritas e a análise lexical foi feita pelo software ALCESTE® versão 4.10. Os dados do WHOQOL-brefforam tabulados em planilha do Microsoft EXCEL®, onde foram calculadas as médias e DP dos seus respectivos domínios. A análise estatística inferencial foi realizada no programa estatístico BioEstat® 5.3. A partir da interpretação dos dados analisados pelo ALCESTE®, foi possível denominar 4 classes: 1) As demandas de atendimento do profissional enfermeiro e da equipe de saúde e sua organização no processo de trabalho; 2) A dimensão educativa no processo de trabalho dos enfermeiros; 3) A gestão como dificultadora do processo de trabalho e fator de estresse do enfermeiro e 4) Os elementos do processo de trabalho e a saúde do trabalhador.Os escores do WHOQOL-bref evidenciaram que, o domínio relações sociais obteve a maior média (4,1), seguido do domínio físico (3,9), domínio psicológico (3,8) e, por último, o domínio meio ambiente (3,4). Houve diferença significativa apenas do domínio meio ambiente (p<0.05) em relação aos domínios: &#8213;físico&#8214; e &#8213;relações sociais&#8214;.Os resultados estatísticos demonstraram não haver correlação significativa entre as variáveis independentes (idade, tempo de experiência e filhos) e os domínios (p>0.05). Os resultados mostraram que apesar dos enfermeiros da presente pesquisa reconhecerem que alguns elementos do processo de trabalho em saúde interferem negativamente em sua QV, os mesmos a avaliaram como satisfatória. Conhecer as percepções dos enfermeiros atuantes na ESF sobre o processo de trabalho e a influência deste na sua QV possibilitou uma aproximação da realidade vivenciada por estes profissionais. Este estudo teve como suas maiores contribuições proporcionar o conhecimento do processo de trabalho dos enfermeiros que atuam na ESF e de que forma sua QV é influenciada por esse processo de trabalho, além de promover a aproximação com as vivências dos enfermeiros nas USF, de modo a fornecer subsídios para implementação de estratégias que visem a mudança de práticas e a melhoria da QV destes profissionais.

L’importance des facteurs de risque professionnels dans l’asthme est bien établie, mais le rôle de certains agents doit être clarifié. Les objectifs de la thèse sont d’évaluer les liens entre les expositions aux produits de nettoyage et l’asthme, et d’étudier l’impact et la prise en compte du biais du travailleur sain, dans l’étude Epidémiologique des facteurs Génétiques et Environnementaux de l’Asthme (EGEA, 2047 sujets dont 1477 adultes avec des données professionnelles). L’exposition aux produits de nettoyage a été estimée par une expertise et une matrice emploi-exposition. Chez les femmes, l’asthme actuel était associé à l’exposition aux détartrants (OR=2.4 (1.1-5.3)), et aux sprays (2.9 (1.0-8.1)) et à l’ammoniac (3.1 (1.2-7.8)) chez les aides-soignantes. Les détartrants et l’ammoniac sont des irritants. L’exposition aux produits de nettoyage était associée à l’asthme sévère et sans sensibilisation allergique. Deux analyses ont souligné l’importance du biais du travailleur sain dans l’asthme. Un biais de sélection à l’embauche a été observé chez des sujets avec un asthme sévère dans l’enfance. Un modèle marginal structural a permis de prendre en compte le biais du travailleur sain dans l’étude de l’effet des expositions professionnelles sur l’expression clinique de l’asthme au cours de la vie. En plus du rôle d’asthmogènes connus, le rôle d’agents moins bien établis, comprenant des irritants (1.6 (1.0-2.4)) était suggéré. Les résultats sont cohérents avec un rôle des irritants dans l’asthme lié au travail. Ils soutiennent une utilisation plus large d’approches d’analyse causale pour contrôler le biais du travailleur sain dans les études des risques professionnels. / It is well-recognized that workplace exposures importantly contribute to the burden of asthma, but the role of some agents needs to be clarified. The aims of the thesis are to evaluate the relationships between occupational exposure to cleaning products and asthma, and to study the impact and the control of the healthy worker effect bias, in the Epidemiological study on the Genetics and Environment of Asthma (EGEA, 2047 subjects including 1477 adults with data regarding occupations).Exposure to cleaning products was estimated by an expert assessment and a job-exposure matrix. In women, current asthma was associated with exposure to decalcifiers (OR=2.4 (1.1-5.3)), and to sprays (2.9 (1.0-8.1)) and ammonia (3.1 (1.2-7.8)) in personal care workers. Decalcifiers and ammonia are irritants. Exposure to cleaning products was associated with severe asthma, and asthma without allergic sensitization. Two analyses underlined the important impact of the healthy worker effect in asthma. A healthy worker hire effect was observed in subjects with severe asthma in childhood. Using a marginal structural model, we studied the effect of occupational exposure on asthma clinical expression over a lifetime, while controlling for the healthy worker effect bias. Elevated risks of asthma were observed, not only for known asthmagens, but also for other agents which role in asthma is less established, including irritants (1.6 (1.0-2.4)). The results are consistent with a role of irritants in work-related asthma. They support a broader use of causal inference approaches, to control the healthy worker effect bias in studies of occupational risk factors.

Health and reducing disparities in health between and within countries are among the principal global sustainable development objectives for the period 2016-2030. The incidence of Occupational Diseases (OD) is characterized by very distinct differentiation, both regional and sectoral, and has considerable dynamics in time and place. Given that Czechia is at the top among all EU member states in terms of employment in the automotive industry and production of new vehicles, new research on OD in the automotive industry acquires importance. The Ph.D. Thesis is conceived as an ecological correlation study focusing on the study of the determinants of OD in automotive industry. Its own core work is to analyze 32,646 cases of OD (in the past 20 years) and a set of data from a survey of 247 companies of the automotive industry (employing nearly 110,000 employees, i.e. 78 % of the economically active population working in this sector). In the present work are used available data from routine statistics, data from registers and basic sanitation data from a questionnaire survey. The study innovatively links research of Global production networks and medical-geographical approach. At the end of the Ph.D. Thesis, specific outcomes for praxis and discusses possible topics for further research in this area are...