The modern comprehensive approach in problem solving was adopted in this study to resolve the analytical problems associated with the differential diagnosis of various degrees of exposure to lead. Thorough investigation of all the analytical steps was undertaken starting with the sampling procedure, through the proper choice of the analytical methods for the analysis of indicators of dose and indicators of effect, to the data reduction and evaluation. Reliable, selective and sensitive analytical techniques were developed for the direct analysis of lead, bismuth, antimony and the porphyrin carboxylic acids in body fluids. The sampling step was arbitrarily re-defined on the basis of the lead metabolic model to include two sampling conditions: the non-steady state and the steady state conditions. For diagnostic purposes the results obtained when sampling is done in the non-steady state proved to be more valuable. Analytical results obtained from the steady state condition were also quite revealing. A direct, sensitive, selective and reliable potentiometric stripping analysis method for the trace determination of lead as an indicator of dose in blood,plasma and urine was developed. The various parameters and experimental conditions were investigated. The signals obtained from dearated solutions of the samples using Hg(II) as the oxidant were compared with those obtained from nondearated solutions in which dissolved oxygen acted as the oxidant. The low detection limits of the former method ensured that during the analysis of control specimens in particular, the analyst ',\/ill not be working near the detection limits of the method. Freedom from organic and inorganic interferences coupled with enhancement of the sensitivity due to matrix effects rendered the method particularly useful. By slight modification of the pro- xcedure a wide working range can be attained. Good correlation coefficients bet'ofJeen added and measured Pb(Il) were obtained and method comparison with the thermal ionization stable isotope dilution mass spectrometry and the atomic absorption spectrometry gave a correlation of 0.9999. The adopted PSA in dilute dearated samples of body fluids was adapted for the determination of trace concentrations of Bi(!Il) and Sb(IlI) in body fluids. Slight modifications of the electrolyzing potential using the in situ plating procedure and longer deposition periods were necessary. The results indicated that in subjects highly exposed to lead, high concentrations of Si(lIl) and Sb(III) were detected. An ion pair reversed phase HPLC method coupled with fluorescence detection proved valuable for the analysis of blood and urinary porphyrin carboxylic acids. By optimization of the chromatographic conditions using either the fast RP-C18 Ultrasphere XL-DDS column or the Lichrosorb RP-C2 column and multinear gradient eiution with a mobile phase consisting of methanol/water, both containing 5 mMol/1 tetrabutylammonium phosphate as the counter ion, we were able to detect the earliest biochemical changes that occur in the haem biosynthetic pathway resulting from exposure to lead. The developed method permitted the detection of porphyrins in trace concentrations of 0.2 ng directly in urine samples without tedious sample pretreatment. A wide linear response curve was obtained. The method allows the differential diagnosis of the various diseases that produce derangements in the haem biosynthetic pathway.

Sick Building Syndrome (SBS) has been defined as a variety of symptoms (including lethargy, headache, sore, dry eyes, nasal congestion and chest problems) associated with occupancy of certain buildings. The thesis aimed to look at a number of areas of SBS including the use of surveys, stress and SBS and the interaction of lighting with SBS. The first area examined was a survey of two buildings to ascertain what the occupants attributed their health complaints to. It was found that there was a high prevalence of symptoms in both buildings but it was not possible to attribute health complaints to any direct cause. The survey suggested that the interaction between different environmental and personal factors had an effect on symptom prevalence but it is still ambiguous as to what factors are causing specific health problems. The second area of research examined SBS and occupational stress among emergency control room staff. Using questionnaire data, environmental surveys, sickness absence data and an occupational stress questionnaire it was found firstly that ill health was attributed on the whole to air quality. Other symptoms also found were those associated commonly with shift work (indigestion and sleep problems). The research also found that there was a stress effect occurring at work but this was due to organisational and managerial stress and not job stress. It was not possible to assess how much the stress effect was affecting SBS symptom reporting. There were no common patterns found in sickness absence but the recording methods used by companies were inadequate to collect data relating to SBS. The final area of research examined SBS and lighting. Two experiments were carried out to compare health responses, stress and arousal levels, critical flicker fusion and choice reaction times. Two experimental conditions were used, the first, warm white fluorescent lighting, the second full-spectrum fluorescent lighting. No significant differences were found in either of the lighting conditions.

Following a review of the stress, distress and coping reported by student health professionals and students in higher education, see Chapters 2 and 3, the hypothesis that a problem existed with distress early in training was confirmed by screening two cohorts of first year student nurses, see Chapter 4. Some 50.5% of students, in Cohort one (N=109, Week 40) and 67.9% of students in Cohort two (N=111, Week 24) suffered significant levels of affective distress. All students were enrolled on the newly implemented 1992 scheme of nurse education in Tayside. The underlying dimensions of situational sources reported by student nurse stress were clarified with the development of the Student Nurse Stress Index, see Chapter 5. A reliable 22 variable solution with oblique structure and non-orthogonal factors of "academic load", "clinical sources", "intet/ace worries", "personal problems" was obtained. This measure showed cross sample factor congruence, good internal reliabilities, and concurrent and discriminant validity across a range of reporting conditions. A stress reduction/management intervention set at individual and interface levels, designed to reduce levels of student nurse distress revealed by the earlier screening study, was implemented during a second series of hospital placements, see Chapter 6. A randomised controlled trial revealed the success of this programme in reducing affective distress in 73 student nurses shown to have experienced significant levels of distress earlier in training. A series of significant treatment x time interactions were found with a range of context-free measures of affective distress, e.g. General Health Questionnaire-30 (Goldberg, 1972), State and Trait Anxiety Inventory (Speilberger, et aI., 1983), Beck Depression Inventory (Beck, et aI., 1987), with situational sources of stress (Beck & Srivastava, 1991), and Domestic Satisfaction (Derogatis, 1980). Similar treatment x time interactions were found with Direct Coping (Parkes, 1984), and Relaxation Potential (Derogatis, 1980). Adaptive changes were confmed to the experimental group alone. In addition, State Anxiety on the morning of an important exam was lower for students receiving stress management (Treatment X= 45.88, Control X =59.09). The intervention had no detectable effect on organisational variables of sickness, absence and examination performance. However, logistic regression and hierarchical multiple regression analysis showed that initial distress at screen did not predict pre or post-treatment changes in sickness or absence, or subsequent examination performance. Stress management delivered in groups reduced affective distress and increased adaptive coping use in both clinical and academic settings. Possible future directions for this research targeting student nurses are outlined in Chapter 7.

Orientador: Maria Ines Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T03:15:58Z (GMT). No. of bitstreams: 1 Ornellas_ThueCamargoFerrazde_M.pdf: 8780117 bytes, checksum: 160d41f689fb620c616fb203ecc160ca (MD5) Previous issue date: 2004 / Resumo: A expansão do capitalismo em escala global está criando novos cenários econômicos e sociais ocasionando repercussões no mundo do trabalho. A metalurgia no agronegócio do Brasil é um setor que tem apresentado grande dinamismo e obtido resultados financeiros positivos nos últimos anos. Esta pesquisa tem por objetivo avaliar o índice de capacidade para o trabalho, traçar o perfil sociodemográfico e de estilo de vida entre trabalhadores de uma empresa metalúrgica do ramo de agronegócio, no interior paulista. Foram utilizados dois questionários: o índice de Capacidade para o Trabalho - ICT (Tuomi et ai, 1997); e outro, com dados sociodemográficos, trabalho e estilo de vida (Monteiro-Cocco, 1996). Estes estudos foram complementados através da Análise Ergonômica do Trabalho (Rhomert & Landau, 1983). É um estudo de caráter epidemiológico transversal com população de 200 trabalhadores e amostra composta por 142, com idade entre 18 e 66 anos; sendo a maioria (87,3%) do sexo masculino. A capacidade para o trabalho foi ótima para 66,9% dos indivíduos, boa para 29,6% e, moderada, para 3,5%. Foi encontrada associação estatisticamente significativa para as variáveis etilismo, movimento repetitivo, tabagismo e escolaridade. Os resultados demonstraram que pessoas que não fumavam tinham 2,3 vezes maior chance de ter um ICT melhor do que as que fumavam; as com maior escolaridade tinham chance 2,3 vezes maior de ter um ICT melhor do que as com menor escolaridade. Os principais resultados obtidos foram divulgados para os trabalhadores e diretores da empresa, visando a implementação de ações para a promoção à saúde no trabalho / Abstract: The capitalism expansion in global scale is creating new economic and social scenarios with effects on the working conditions. The metallurgy in the Brazilian agribusiness has showed great dynamism and positive financial results for the country in the last years. The aim of this study is to evaluate the working capacity, the socio-demographic profile, and the lifestyle of workers in a metallurgical industry in the agribusiness sector, located in inland São Paulo state. Two health survey questionnaires were used: the Work Ability Index - WAI (TUOMI et ai, 1977), and a questionnaire with socio-demographic, work and life style data elaborated by Monteiro-Cocco (1996). These surveys were complemented through the Ergonomic Work Analyses (RHOMERT ANO LANOAU, 1983). l1's a crosssectional epidemiological study with a sample of 142 workers out of a total population of 200 workers, with an average age of 34,04 years, most of them (87,3%) males. The work ability was considered excellent for 66,9% of the workers in the sample, good for 29,6% and moderate for 3,5%. Significant statistical association was found for the variables alcoholism, repetitive movement, tobacco addiction, and schooling. Results showed that non-smoking persons had 2,3 times more chances to have a betterWAI than the smoking ones, while those with higher number of school years attendance had a 2,3 higher chance of having a better WAI than those with less school years. The main results of the research were communicated to the workers and directors, aiming the implementation of actions to improve healthy working conditions / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem