SAMMANFATTNING Ländryggsbesvär är generellt vanligt förekommande i befolkningen och samhällsekonomiskt kostsamt. Riskfaktorer för ländryggsbesvär beskrivs vara flerdimensionella, där nämns främst arbetsrelaterade och psykosociala faktorer. Poliser är en yrkesgrupp där arbetssjukdomar rapporteras vanligt förekommande oavsett kön. Trots det är polisers arbetssituation dåligt utforskad. Syftet med studien är att kartlägga upplevt hälsotillstånd och arbetssituation bland utryckningspoliser med fokus på ländryggsbesvär, som underlag för preventiva åtgärder. Metoden bestod av en tvärsnittsstudie i form av en omfattande enkätundersökning. Urvalet inom polisens utryckningsenhet i Västerås var totalt. Så många som 60 % angav arbetsrelaterade ländryggsbesvär, en större del med besvär var män och förekomst av tunga lyft var vanligare bland svarande med besvär. Personer med ländryggsbesvär tog i mindre utsträckning pauser, kände sig stressade på arbetet och besvärades oftare av kroppslig värk. Deltagarna själva kopplade sina ländryggsbesvär till dåligt utformad arbetsutrustning, dålig sittställning i yrkesfordonen och till fysiska ingripanden. Av litteraturen beskrivna riskfaktorer för ländryggsbesvär var vanligt förekommande inom enheten. Där nämns ogynnsamma arbetsställningar och arbetsmoment samt psykosociala faktorer i form av hög arbetsbelastning, lågt stöd från arbetsledning och låg möjlighet att påverka sin arbetssituation. Slutsats: För att förbättra arbetsmiljön för utryckningspoliser bör åtgärder inriktas mot belastningsergonomiska- och psykosociala faktorer i arbetet samt utformning av utrustning och arbetsfordon utifrån ergonomi och säkerhet. / ABSTRACT Low back pain is a common disorder which causes high economic costs for the society. Risk factors for back pain are described as multidimensional, including both work related and psychosocial factors. Police-officers belong to an occupational group were work related diseases are frequently reported, irrespective of gender. The work situation for these officers however is poorly covered by targeted research. The purpose of this study is to survey the health- and work situation among police-officers with the focus on low back pain. The hope is that the results can be used as a base for preventive interventions. A cross sectional design with an extensive survey was used for the study. The selection was total within the unit of patrolling police officers in Västerås. As many as 60 % reported low back pain, with an overrepresentation among men. Heavy lifting was more common among those with low back pain. Those reporting low back pain more rarely took breaks during the work day, they felt more stressed at work and were more often troubled with physical pain. The study participants linked their back problems to badly designed work equipment, badly adjusted vehicles and to physical interventions. Risk factors for low back pain, described by the literature, were common within the unit. Especially, work tasks involving unfavorable movements and body positions were singled out. Among psychosocial factors, low social support from management and low ability to influence the work situation were associated with low back pain. Conclusion: To improve the work environment for patrolling police-officers, measures should be focused on load and strain ergonomics, psychosocial factors as well as to develop equipment and vehicles more on the basis of ergonomics and safety measures.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Excessive sunlight exposure can cause several forms of potentially malignant disorders, including actinic cheilitis, a precursor lesion of lip squamous cell carcinoma. The objective of this research was to investigate the actinic cheilitis prevalence among fishermen in the southern coast of Sergipe, Brazil. A cross-sectional study was carried out involving a sample (n = 210) of fishermen on this region. Data related to age, skin type, daily and accumulated solar radiation exposure time, smoking, sun protection and the presence of actinic cheilitis were collected. A Poisson regression model estimated the prevalence ratio of variables. Actinic cheilitis prevalence was 11.4% (95% CI: 7.8 - 16.4%). The disease was more prevalent in fair-skinned fishermen (PR = 3.2), aged 50 years (PR = 2.3), with a time of cumulative exposure to solar radiation more than 30 years (PR = 4.0), duration of daily exposure more than four hours (PR = 8.0) and no using of sun protection (PR = 2.1). In the presence of all independent variables, the probability of finding the disease in a fisherman in this region is 55%. This probability decreases to 6% with the use of sunscreens and with sun exposure of less than four hours daily. Fishermen working at the south coast of Sergipe constitute a population at risk for cancer of the lip, making necessary the establishment of public health policies aimed specifically to encourage the use of sun protection and a lower burden of daily exposure to solar radiation. / A exposição excessiva à radiação solar pode causar várias formas de alterações teciduais cancerizáveis, dentre elas a queilite actínica, uma lesão precursora do carcinoma de células escamosas e de lábio. O objetivo dessa pesquisa foi verificar a prevalência da queilite actínica em pescadores do litoral sul de Sergipe, Brasil. Um estudo transversal foi realizado envolvendo uma amostra (n = 210) de pescadores desta região. Dados relacionados à idade, cor da pele, tempo de exposição diária e acumulada à radiação solar, uso de tabaco, medidas de proteção ao sol e presença de queilite actínica foram coletados. Um modelo de regressão de Poisson foi criado para estimar a razão de prevalência das variáveis. A queilite actínica teve uma prevalência de 11,4% (IC 95%, 7,8 16,4%). A doença foi mais prevalente em pescadores de pele clara (RP = 3,2), com idade superior a 50 anos (RP = 2,3), tempo de exposição acumulada à radiação solar maior do que 30 anos (RP = 4,0); tempo de exposição diária maior do que quatro horas (RP = 8,0) e que não usavam fotoprotetores (RP = 2,1). Na presença de todas as variáveis independentes, a probabilidade de encontrarmos a doença em um pescador nessa região é de 55%. Esta probabilidade decresce para 6% quando do uso de fotoprotetores e uma exposição solar menor do que 4 horas diárias. Os pescadores do litoral sul de Sergipe se constituem em uma população de risco para o câncer de lábio, fazendo-se necessária a implantação de políticas públicas de saúde voltadas especificamente para o estímulo ao uso de fotoprotetores e uma menor carga de exposição diária à radiação solar.

A responsabilidade civil ligada aos acidentes de trabalho e às doenças ocupacionais é fonte de constantes preocupações de magistrados, doutrinadores e estudiosos do Direito do Trabalho, em especial após o advento da Emenda Constitucional nº 45/04. Em particular em sua vertente objetiva, que procura estabelecer a responsabilidade pelo risco da atividade, independentemente de culpa do agente. No entanto, há evidente lacuna no estudo da responsabilidade civil relacionada aos acidentes de trabalho e às doenças ocupacionais ligadas aos esportes profissionais. Conquanto os esportes envolvam elementos lúdicos e recreativos, sua prática profissional movimenta elevadas quantias de dinheiro e inúmeros feixes de contratos de trabalho. O alto índice de acidentes, lesões e enfermidades relacionadas ao esporte, que por vezes encerram prematuramente a carreira de atletas que ainda estão muito longe do estrelato, reclama a análise e a proteção jurídica conferidas pelo direito do trabalho, como direito social e fundamental. Este estudo se propõe a analisar os fundamentos jurídicos, doutrinários e jurisprudenciais, que inter-relacionam os campos da responsabilidade civil, do direito do trabalho e do esporte de alto rendimento, praticado profissionalmente. / The liability related to accidents at work and occupational diseases is a source of constant concern of judges, jurists and scholars of labor law, especially after the enactment of Constitutional Amendment No. 45/04. In particular in its objective aspect, which seeks to establish the liability for the risk of the activity, regardless of the agent\'s fault. However, there is an obvious gap in the study of the liability related to accidents at work and occupational diseases linked to professional sports. Although the playful and recreational elements involving sports, their professional practice moves large sums of money and numerous bundles of labor contracts. The high rate of accidents, injuries and illnesses related to sports, which sometimes prematurely terminate the career of athletes who are still far from stardom, claims analysis and legal protection conferred by labor law, as a social and fundamental right. This study aims to analyze the legal grounds, doctrinal and jurisprudential, which interrelate the fields of civil liability, labor law and high performance sport, practiced professionally.

Compensation for the bereaved in the case of work accidents and occupational diseases Abstract The topic of my diploma thesis is compensation for the bereaved in the case of work accidents and occupational diseases. It is a topic with a relatively settled legislation and a subject which is present - nevertheless, ground-breaking changes in this issue cannot be really anticipated any more. Introductory part of my thesis deals primarily with a theoretical definition of a term liability and liability in labor law. It deals with the conditions of inception of liability, the reasons that allow release from liability and finally, with the obligation of an employer to compensate damages or non-material damage in the cases of work accidents and occupational diseases. I also devote myself to define terms work accident and occupational disease, and for better understanding and explanation of disputable questions, I refer to judicature of the Supreme Court and the Constitutional Court. The mainstay of my thesis is dedicated to the particular types of compensation provided either directly to the aggrieved employees as the consequence of work accident or occupational disease, or to the bereaved in the case of death due to the work accident or occupational disease. I also compare the labor law regulation to the...

Darbo tikslas Aprašyti profesinių ligų tendencijas Lietuvoje 1973-1978 m. Uždaviniai 1. Nustatyti profesinių ligų skaičiaus ir sergamumo rodiklio pokyčius 1973-1978 m. Lietuvoje. 2. Nustatyti profesinių ligų pasiskirstymą Lietuvoje 1973-1978 m. pagal rizikos veiksnius, ligų grupes, ekonominės veiklos rūšis bei apskritis. 3. Nustatyti profesinių ligų pasiskirstymą Lietuvoje 1973-1978 m. pagal lytį ir darbo stažą. Metodika Duomenys apie 1303 profesinių ligų atvejus buvo surinkti iš 6 LCVA bylų, kuriose yra surinktos 1973-1978 m. tuometinės LTSR SAM ketvirtinės profesinių ligų ataskaitos bei teritorinių SES pranešimai apie profesines ligas. Aprašomoji statistika atlikta Microsoft Excel 2003, Microsoft Excel 2003, WinPepi 11.18, SPSS 17.0 programomis, naudojant χ2 ir tikslųjį Fišerio kriterijų. Išvados apie santykinio požymių skirtumo statistinį reikšmingumą buvo daromos, kai p ≤ 0,05. Rezultatai ir išvados Vidutinis sergamumo profesinėmis ligomis Lietuvoje 1973-1978 m. rodiklis buvo 16,3 / 100 tūkst. dirbančiųjų. Daugiausiai profesinių ligų buvo įtakotos fizikinių veiksnių (51,04 proc.). Daugiausiai registruota ausies (35,5 proc.) ir jungiamojo audinio ir skeleto raumenų sistemos (17,2 proc.) ligų. Daugiausiai profesinių ligų registruota Kauno (31,2 proc.) apskrityje bei apdirbamosios gamybos darbuotojams (64,1 proc.). Vyrams daugiau buvo registruota ūmių profesinių ligų, o moterims – lėtinių. Moterys daugiau sirgo ausies bei nervų sistemos ligomis, o vyrai jungiamojo... [toliau žr. visą tekstą] / Purpose of Study Describe tendencies of occupational diseases in Lithuania in 1973-1978. Objectives 1. Set the number of occupational diseases and the incidence rate of change in Lithuania in 1973-1978. 2. Determine the distribution of occupational diseases according to risk factors, disease groups, industry and region in Lithuania in 1973-1978. 3. Determine the distribution of occupational diseases by sex and total experience of working in Lithuania in 1973-1978. Methodology Data on occupational diseases about 1303 cases were collected from LCVA of 6 files, in which Lithuanian SSR Ministry of Health quarterly reports and territorial Sanitary Epidemiological Station reports about occupational diseases are archived. Descriptive statistics performed in Microsoft Excel 2003, Microsoft Excel 2007, WinPepi 11.18, SPSS 17.0 programs using χ2 and Fisher's exact test. Conclusions about the relative signs of the difference between statistical significance were made at p ≤ 0.05. Conclusions and Results The average incidence rate of occupational diseases in Lithuania in 1973-1978 was 16.3 / 100 000 workers. Most occupational diseases have been influenced by physical factors (51.04%). Majority of them was ear (35.5%) and connective tissue and musculoskeletal system (17.2%) diseases. Most occupational diseases registered in Kaunas (31.2%) and for manufacturing workers (64.1%). There have been registered more acute occupational disease for men, and chronic for women. Women had... [to full text]

La veille sanitaire dans le champ de la santé au travail est cruciale pour détecter l’apparition de nouveaux risques. Le réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P), réseau national d’experts opérationnel depuis 2011, y participe activement. Pour cela, le RNV3P a déployé plusieurs méthodes pour détecter les nouveaux risques : émergence clinique et émergence statistique. La méthode des mesures de disproportion couramment utilisée dans le domaine de la pharmacovigilance a déjà été appliquée avec succès aux données du RNV3P. Néanmoins, une limite importante peut être soulevée. Les professionnels de santé déclarant les expositions qui leur semble liées à la pathologie déclarée, nous pouvons légitimement suspecter l'existence d'un biais de sélection de ces expositions : l'exposition la plus reconnue par le monde professionnel sera forcément déclarée. Pour tenter de maîtriser ce biais, nous avons proposé d’appliquer les matrices emploi / exposition (MEE) sur les données du RNV3P et d’examiner leur impact sur les mesures de disproportion. Dans un premier temps, nous avons testé la faisabilité de l’application des MEE au RNV3P et leur apport. Pour cela, 3 MEE issues du programme Matgéné ont été appliquées (benzène, poussières respirables de silice cristalline libre et solvants chlorés). Les données d’exposition rapportées respectivement par les experts et par la MEE ont été comparées en particulier pour des associations bien connues comme la silicose/silice ou les maladies hématopoïétiques/benzène, et pour des associations moins connues ou douteuses comme la sclérose systémique/silice et les maladies hématopoïétiques/solvants chlorés (trichloréthylène). Dans un second temps, nous avons appliqué les mesures de disproportion de type fréquentielle et bayésienne en comparant les résultats obtenus par les experts et les MEE pour trois nuisances : silice, trichloroéthylène et tétrachloroéthylène. Au final, les MEE permettent de rapporter plus d’expositions que les experts pour chaque nuisance testée et ce d’autant plus que l’association est peu connue. Cet apport d’information permet la génération de nouveaux signaux avec les mesures de disproportion qu’il est intéressant de discuter et d’explorer avec des experts / Health surveillance in the field of occupational health is crucial to detect the emergence of new risks The National Network of Vigilance and Prevention of Occupational Pathologies (RNV3P), a national network of experts operating since 2011, actively participates in. The RNV3P has deployed several methods to detect new risks: clinical emergence and statistical emergence. In the latter case, the disproportionate measures used in the field of pharmacovigilance have been successfully applied to RNV3P. Nevertheless, an important limitation can be raised. As health professionals report exposures associated with the declared pathology, we can legitimately suspect the existence of a selection bias: the most well known exposures of the professional community inevitably are most liable to be more frequently declared. To try to control this bias, we proposed to apply job / exposure matrices (JEM) on the data of the RNV3P and to examine their impact on the measures of disproportion. Initially, we tested the feasibility of applying MEE to the RNV3P data and their contribution. For this, 3 JEMs from the Matgéné program were applied (benzene, free crystalline silica breathing dusts and chlorinated solvents). The exposure data reported by the experts and the JEM were compared in particular for well-known associations such as silicosis / silica or hematopoietic / benzene diseases, and for less known or doubtful associations such as systemic sclerosis and hematopoietic diseases / chlorinated solvents (trichloroethylene). Secondly, we applied the frequency and Bayesian disproportion measures by comparing the results obtained for experts and JEM and for three nuisances: silica, trichloroethylene and tetrachloroethylene. In summary, MEE help to provide more exposure than the experts for each tested chemicals and especially if the association is little known. These new data allow the generation of new signals with the disproportion measures that it is interesting to discuss and explore with experts

Le domaine de la santé au travail est complexe car il associe de nombreuses données de différentes natures (secteurs d'activité, métiers, expositions, pathologies), disponibles à des échelles emboitées (entreprises, bassins d'activité, zones d'emploi, régions, etc) et appartenant à différents partenaires (assureurs, préventeurs, systèmes de surveillance). Ces multiples sources de données complémentaires, formalisées ou non, sont toujours analysées de manière indépendante, en ignorant notamment la dimension géographique y étant associée (territoires d'activités sous-jacents).L'objectif de notre travail est de considérer une de ces sources de données, le rnv3p (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles), comme un objet géographique. Grâce à différentes méthodes (explicitées Partie 1) et outils géomatiques, et la prise en compte de la population active sous-jacente, c'est d'abord une description du réseau en termes de recrutement, zones d'ombre et zones de capture préférentielle qui est faite (Partie 2). Dans un second temps, c'est la confrontation de cette base à d'autres sources de données décrivant des maladies professionnelles (en particulier indemnisées) qui est analysée au travers d'approches par secteur d'activité et pathologie (Partie 3). Enfin, des préconisations concernant le développement d'un outil cartographique adossé à la base rnv3p à des fins de vigilance et au service des différents acteurs en santé travail ont été faites (Partie 4).Mots clés: santé-travail, pathologies professionnelles, réseau de surveillance, Systèmes d'Information Géographiques (SIG), analyse spatiale / The field of occupational health is complex because it combines many different types of data (activity sector, occupations, risk exposures, diseases), available at nested scales (communes, activity territories, employment areas, regions, etc.) and from different partners (insurers, stakeholders, monitoring systems). These multiple sources of additional data, formalized or not, are always analysed independently, ignoring in particular the geographic dimension associated therewith (underlying activities territories).The aim of our work is to consider one of these data sources, the rnv3p (French National Occupational Diseases Surveillance and Prevention Network), as a spatial object. Through different methods (explained Part 1) and geomatics tools, and taking into account the underlying workforce, it is primarily a description of the network in terms of recruitment, shadow and preferential recruitment areas that is made (Part 2). Secondly, it is the confrontation of this database to other data sources describing occupational diseases (especially compensated one) which is analyzed through approaches by industry and pathology (Part 3). Finally, recommendations were made regarding the development of a mapping tool, built for the rnv3p database for vigilance purposes and helping various occupational health stakeholders (Part 4).Key words: occupational health, work related diseases, surveillance network, Geographic Information System (GIS), spatial analysis

Esta tese tem por objetivo abordar a ideia de que o acidente do trabalho e a doença ocupacional podem atuar como um fator motivacional para a ocorrência de atos que denotam violência psicológica contra o trabalhador. Em um cenário de transformações societárias em que a produtividade e o consumo são fatores primordiais, trabalhadores que adoecem ou se acidentam poderão ser considerados como “improdutivos”. Tal característica não é aceita pela sociedade contemporânea, a qual pode voltar-se de maneira bastante incisiva contra esses trabalhadores. Tem-se, então, um quadro propício para atos discriminatórios e assédio moral. Trata-se de atos que ferem o direito a um meio ambiente do trabalho psicologicamente saudável, de forma que representam um ataque à dignidade humana, considerada pela Constituição Federal de 1988 como um dos fundamentos do Estado Democrático de Direito. Neste sentido, emprega-se a expressão “dupla vitimização do trabalhador que sofre acidente do trabalho ou doença ocupacional” para defender a tese de que trabalhadores poderão ser duas vezes vítimas de violência durante o contrato laboral. A primeira vitimização se expressa pela própria violência que se constitui o acidente do trabalho ou a doença ocupacional. A segunda vitimização se expressa pelo fato de que esses trabalhadores poderão, ainda, serem vítimas de violência psicológica no trabalho. Através do estudo qualitativo, realizou-se pesquisa de jurisprudência em que nove casos judiciais foram analisados. Verificou-se que a segunda vitimização geralmente constitui-se em um assédio moral em razão do qual o trabalhador busca indenização por danos morais. O assédio moral é um assunto em que o diálogo entre profissionais do Direito e da Psicologia revela-se essencial para a sua abordagem. Pode-se dizer que tal tipo de violência psicológica praticada contra vítima de acidente do trabalho ou de doença ocupacional representa a vulnerabilização de quem já está vulnerável. Conclui-se que em respeito à dimensão constitucional democrática de direito não se pode ignorar essa situação marcada por invisibilidades e silêncios coniventes. A exposição da dupla vitimização do trabalhador não é feita no sentido de incitar o “coitadismo”, mas, sim, visa chamar a atenção sobre a necessidade de um debate no que concerne à premência de políticas públicas de prevenção a tal situação e sobre o respeito às reparações devidas às vítimas. / This dissertation aims to address the idea that the occupational accident and the occupational disease can act as a motivational factor for the occurrence of acts that denote psychological violence against the worker. In a scenario of societal changes in which the productivity and the consumption are major factors, workers who fall ill or have an accident can be considered "unproductive". Such a characteristic is not supported by contemporary society, which in a quite incisively way, becomes against these workers. There is, then, a breeding ground for discriminatory acts and moral harassment. These acts hurt the right to a psychologically healthy workplace, so they represent an attack to human dignity, considered by the Constitution of 1988 as one of the foundations of the Democratic Rule of Law. In this sense, the expression "double victimization of workers who suffer occupational accident or occupational disease" is used to defend the thesis that workers may be double victims of violence during the labor contract. The violence itself expresses the first victimization, which is the occupational accident or the occupational disease. The second victimization is expressed by the fact that these workers may also be victims of psychological violence at work. Through the qualitative study, a jurisprudence research was carried out in which nine court cases were analyzed. It was found that the second victimization is usually a moral harassment because of which the employee seeks compensation for moral damages. The dialogue between professionals of Law and Psychology proves to be essential to approach the moral harassment issue. This type of psychological violence against the victim of occupational accident or occupational disease is the vulnerability of those who are already vulnerable. It is possible to conclude that according to the democratic constitutional dimension of law, it may not be ignored this kind of situation which is marked by invisibility and conniving silences. Exposure of the worker double victimization does not happen in order to incite "poor thing feeling", but aims to draw attention to the need of a debate regarding the urgency of public policies to prevent such a situation and also about the respect to the compensations owned to the victims.

根據行政院主計處2009年人力資源調查統計顯示，當年度自營作業人口約為一百三十三萬餘人，約占我國就業人口百分之十三的比例，高出歐美國家許多，由於國人普遍存在「寧為雞首不為牛後」的文化心態，故自營作業者為我國勞工就業時重要的選項之一。過去，自營作業者一直被當作衡量國家經濟發展落後的指標，這類人口不論是在勞動條件或社會保障方面，向來較不受重視，然而隨著貿易自由化與產業結構轉變的衝擊，農林漁牧業能吸納的就業人口逐漸減少，勞動市場所提供的正職工作也持續減少，在失業率攀升的壓力下，先進國家開始重視自營作業者吸納失業人口、調節勞動市場供需的功能，為了鼓勵失業或一般受僱勞工開創自己的就業機會，近年來歐洲國家已經逐步改善自營作業者的社會安全保障，以降低勞工投入自營作業的風險。 有鑑於自營作業者對我國就業市場之重要性，以及國際間積極改善自營作業者社會保險條件的趨勢，本研究遂以建構我國完善的自營作業者社會保障制度為目的，分別從勞工保險、職災保險與就業保險三方面，分析我國現行社會保險制度所存在之問題與缺失，再針對相關問題提出解決建議。本研究採取深度訪談的方式，瞭解自營作業者參加勞工保險的經驗與實務上所面臨的問題，更進一步透過訪談瞭解自營作業者對於本身失業風險的認知以及參加就業保險的意願。此外，本研究也透過比較研究的方式，進而瞭解其他國家對於自營作業者社會保障所採取的作法，以作為我國自營作業者社會保險政策調整方向之參考。 研究發現，我國自營作業者在勞工保險方面存在以下問題：一、勞工保險所主張的「申報主義」制度，並未一體適用於自營作業者；二、自營作業者投保資格審查責任未作明確劃分；三、自營作業者投保薪資調整的作法可能產生公平性的疑慮；在職災保險方面，目前自營作業者參加職災保險存在著職災保險給付與第三人不法行為損害賠償兼得之問題；在就業保險方面，研究發現自營作業者同樣存在著失業的風險，風險可能來自於景氣影響、同業之間的競爭或是從業地點變動等因素，加上自營作業者普遍具有教育程度偏低和中高齡的特徵，在學歷與年齡的雙重限制下，自營作業者一旦退出自營作業部門，就可能因為轉業困難而導致長期失業，甚至被迫退出勞動市場。 最後，本研究針對目前自營作業者社會保險制度相關問題，分別提出以下建議，包括勞工保險的投保資格審查作業應明確授權由職業工會行使；輔導自營作業者辦理營業登記，以實際所得作為投保薪資調整依據；勞工保險條例應增列保險人代位權之規定；將自營作業者納入就業保險之保障對象；以營業登記之註銷或繳回相關執業證照，作為自營作業者失業之認定標準。

Noise exposure is one of the most prevalent causes of irreversible occupational disease in Sweden and in many other countries. In hearing conservation programs, aimed at preventing noise-induced hearing loss, audiometry is an important instrument to highlight the risks and to assess the effectiveness of the program. A hazardous working environment and persons affected by it can be identified by monitoring the hearing thresholds of individual employees or groups of employees over time. However, in order to evaluate the prevalence of occupational noise-induced hearing loss, relevant reference data of unexposed subjects is needed. The first part of this dissertation concerns the changes in hearing thresholds over three decades in two occupational environments with high noise levels in the province of Östergötland, Sweden: the mechanical and the wood processing industries. The results show a positive trend, with improving median hearing thresholds from the 1970s into the 1990s. However, the hearing loss present also in the best period, during the 1990s, was probably greater than if the occupational noise exposure had not occurred. This study made clear the need for a valid reference data base, representing the statistical distribution of hearing threshold levels in a population not exposed to occupational noise but otherwise comparable to the group under study. In the second part of the dissertation, reference data for hearing threshold levels in women and men aged from 20 to 79 years are presented, based on measurements of 603 randomly selected individuals in Östergötland. A mathematical model is introduced, based on the hyperbolic tangent function, describing the hearing threshold levels as functions of age. The results show an age-related gender difference, with poorer hearing for men in age groups above 50 years. The prevalence of different degree of hearing loss and tinnitus is described for the same population in the third part of the dissertation. The overall prevalence of mild, moderate, severe or profound hearing loss was 20.9% collectively for women and 25.0% collectively for men. Tinnitus was reported by 8.9% of the women and 17.6% of the men. Approximately 2.4% of the subjects under study had been provided with hearing aids. However, about 7.7% were estimated to potentially benefit from hearing aids as estimated from their degree of hearing loss. Noise-induced hearing loss primarily causes damage to the outer hair cells of the inner ear. The fourth and last part of the dissertation evaluates the outer hair cell function, using otoacoustic emission measurements (OAE). Prevalence results from three different measuring techniques are presented: spontaneous otoacoustic emissions (SOAE), transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE). Gender and age effects on the recorded emission levels were also investigated. Women showed higher emission levels compared to men and for both women and men the emission levels decreased with increasing age. The results from the OAE recordings were shown to be somewhat affected by the state of the middle ear. The study included tympanometry, and the relation of the outcome ofthis test to the otoacoustic emissions is described, where high middle ear compliance resulted in low emission level. Reference data for the tympanometric measurements are also presented. The results of this project form an essential part of the important work against noiseinduced hearing loss, which needs continuous monitoring. The reference data presented here will provide a valid and reliable data base for the future assessment of hearing tests performed by occupational health centres in Sweden. This data base will in turn prove useful for comparison studies for Sweden as a responsible fellow EU member country setting high standards for work force safety. The statistical distribution of hearing threshold levels as a function of age for men and women in tabulated form is available on the Swedish Work Environment Authority (Arbetsmiljöverket) web site: http://www.av.se/publikationer/bocker/fysiskt/h293.shtm.