• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 72
  • 57
  • 15
  • 8
  • 4
  • 2
  • 2
  • 2
  • 2
  • 2
  • 1
  • 1
  • 1
  • 1
  • 1
  • Tagged with
  • 193
  • 193
  • 76
  • 69
  • 39
  • 38
  • 37
  • 32
  • 32
  • 30
  • 30
  • 29
  • 27
  • 24
  • 23
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
171

Vyhodnocení ekonomických přínosů jednotlivých systémů managementu jakosti / Evaluation of economic contributions of quality management systems

Komárová, Marianna January 2008 (has links)
Master's thesis is deals with integrated system. In theoretic part is described quality management system, environmental management system and occupational health and safety management system, main attention paid to quality in supplies. Suggestion of solving consists in proposition of new process purchase - choice of supplier, classification of supplier and index for measuring of process purchase.
172

Návrh strategie jakosti u společnosti B-projekting,spol.s.r.o. / Proposal of quality system in B-projekting Ltd.

Kostková, Adriana January 2008 (has links)
The graduation theses are elaborated in compliance with the assignment formulated by the VUT Brno FP from 19/2007. A company's strategy, taking into account the mainstreams and trends in the sphere of QMS/EMS and HSMS, has been proposed on the basis of the analysis of the present state of B-projekting, spol.s.r.o. Zlín, with utilization of the latest knowledge, trends, experiences, klient requirements and corporate practise. The strategy solves, above all, the questions connected with the work safety and health protection at work implementation and certification systém according to OHSAS 18001:1999, hereafter the information safety management systém and a conception of the project preparation and implemantation integreated systém.
173

Säkerhet eller produktion först? : En kvalitativ studie om säkerhetsarbete på en processindustri i Sverige / Safety or Production first? : A qualitative study about safety work on a process industry in Sweden

Aalto, Johanna, Gårner, Paulina January 2020 (has links)
Ett fungerande arbetsmiljö och säkerhetsarbete är viktigt för att förebygga olyckor i arbetet. Därför är det intressant att undersöka hur säkerhetsarbetet i en processindustri upplevs, en organisation där medarbetare dagligen utsätts för risker i arbetet. Genom kvalitativa intervjuer har problemområdet undersökts i syfte att identifiera aspekter som påverkar säkerhetsarbetets förutsättningar. Studiens resultat visar att säkerhetsarbete är ett komplext område där organisatoriska, tekniska och kulturella aspekter kontinuerligt samspelar. Att säkerhet ständigt tävlar om prioritet mot produktionen är dessutom en ständig utmaning.
174

Propuesta de rediseño de puesto de camarógrafos para reducir a inseguridad ocupacional mediante técnicas ergonómicas y seguridad basada en el comportamiento en una empresa de radio y televisión / Workstation redesign model with ergonomic techniques and behavior-based safety to reduce occupational insecurity

Sagastizábal Vergara, Alvaro Rodrigo, Segura Zúñiga, Guillermo Manuel Nickolas 18 December 2020 (has links)
El sector de servicios comunitarios sociales y privados donde se encuentra la industria de radio y televisión, se registró que las causas principales de los accidentes del 2018 fueron los falsos movimientos y esfuerzos físicos (23.47%). Estudios realizados al entorno en mención se enfocan en la implementación, mas no en la continuación a través del tiempo interactuando con las condiciones y actos subestándar. Por tal motivo, el presente trabajo de investigación está orientado a una propuesta de rediseño del puesto de trabajo de camarógrafos, validándose mediante un piloto e indicadores. El modelo consta de seis fases: análisis de carga laboral, de ergonómica actual, rediseño del puesto, análisis ergonómico del puesto modificado, inducciones de seguridad y comparación de indicadores, usando herramientas de ingeniería para el diagnóstico como RULA, REBA, antropometría, seguridad basada en comportamiento y la metodología de los 7 pasos. Se tomo como muestra representativa la cantidad de 60 camarógrafos donde se logró reducir un nivel de riesgo ergonómico medio-alto, a bajo, la tasa de accidentes a un 46.7%, el índice de gravedad en un 31.21% y el de seguridad en un 50%. Además, se logró reducir un 55.40% de los costos por accidente, y un 45% la cantidad de actos subestándares. / ABSTRACT The sector of social and private community services where the radio and television industry are located, it was registered that the main causes of accidents in 2018 were false movements and physical efforts (23.47%). Studies carried out in the environment in question focus on implementation, but not on continuation through time interacting with substandard conditions and acts. For this reason, this research work is aimed at a proposal to redesign the job of cameramen, validating it through a pilot and indicators. The model consists of six phases: workload analysis, current ergonomics, job redesign, ergonomic analysis of the modified job, safety inductions and comparison of indicators, using engineering tools for diagnosis such as RULA, REBA, anthropometry, security based in behavior and the 7-step methodology. The number of 60 cameramen was taken as a representative sample, where it was possible to reduce a level of ergonomic risk from medium-high to low, the accident rate at 46.7%, the severity index at 31.21% and the safety rate at 50 %. In addition, it was possible to reduce 55.40% of the costs per accident, and 45% the number of substandard acts. / Trabajo de investigación
175

Propuesta de un modelo de gestión de seguridad y salud ocupacional para mejorar la productividad de la Asociación AAPABU ubicado en el distrito de Bella Unión - Arequipa / Occupational Health and Safety Model to increase productivity of olive farmers from AAPABU association of Bella Union District – Department of Arequipa – Peru

Correa Panduro, César Arturo 21 July 2020 (has links)
La presente investigación tiene como objetivo mejorar las condiciones de trabajo seguras y saludables para incrementar la productividad de la Asociación Agrícola de Pequeños Agricultores de Bella Unión (AAPABU) que tiene como actividades más relevantes el proceso de cultivo y comercialización de aceitunas en rama. Se expone la propuesta del diseño de un modelo de seguridad y salud ocupacional basada en gestión por procesos y el cumplimiento de la Ley 29783: Ley de Seguridad y Salud en el Trabajo. En el presente trabajo se realiza una revisión de la literatura poniendo de manifiesto la importancia de las MYPE, sobre todo las relacionadas al subsector agrícola, así como la trascendencia de la gestión de seguridad y salud ocupacional dentro de las organizaciones en la actualidad que les permita ser más productivas y competitivas, mediante la recopilación de información por visitas in situ, recopilación de datos estadísticos y entrevistas a profundidad que permitieron identificar oportunidades de mejora. A partir de ello, se propone el diseño de un modelo de gestión de seguridad y salud ocupacional. Finalmente, se realiza las conclusiones y recomendaciones de la propuesta, enfatizando la importancia de crear una cultura de prevención de riesgos. / The objective of this research is to improve safe and healthy working conditions to increase the productivity of the Agricultural Association of Small Farmers of Bella Unión (AAPABU), whose most important activities are the process of growing and marketing olives on the branch. The proposal for the design of an occupational health and safety model based on process management and compliance with Law 29783: Occupational Health and Safety Law. In this paper, a review of the literature is carried out, highlighting the importance of MYPEs, especially those related to the agricultural subsector, as well as the importance of occupational health and safety management within organizations that currently allow them be more productive and competitive, through the collection of information by on-site visits, collection of statistical data and in-depth interviews that allowed us to identify opportunities for improvement. Based on this, the design of an occupational health and safety management model is proposed. Finally, the conclusions and recommendations of the proposal are made, emphasizing the importance of creating a culture of risk prevention. / Tesis
176

Occupational health and safety engineers' support of clients' OHS management systems / Arbetsmiljöingenjörers stöd till kunders systematiska arbetsmiljöarbete

Strohmayer, Henrik, Ljusterdal, Ellen January 2018 (has links)
Background: Swedish law demands a systematic work environment management system (SWEM) and establishes the employer as responsible for this. In 2016, 44 % of Swedish Work Environment Authorities’ submissions regarded lack of SWEM. The law defines occupational health and safety services (OHSS) as an objective part with expert knowledge within the fields of work environment and rehabilitation. Aim of the study: The purpose of this study is to investigate how OHS engineers employed in OHSSs assist customer enterprises in the work of developing and maintaining OHS management systems. The study further aims to identify resources, factors of success, necessary skills and other factors that facilitate this work. Method: Six semi-structured interviews were conducted with OHS engineers employed in one of the top five largest OHSS companies in Sweden. Result and analyses: Respondents were found to apply similar methods in supporting clients’ OHSM although working in different regional branches and no nationwide training program exists. In working with OHSM support the OHS engineers mainly used self-produced, flexible tools along with external checklists and templates. Dialogue, an active involvement of the client in developing the OHSMS, internal motivation of the company and experience and competence of the OHS engineer was described as the most essential factors of success. Conclusions: Our study shows that the OHS engineers interviewed to a large extent work with OHSM support in a way that is consistent with what is found in other studies to be a successful way of collaborating with client companies. Areas of improvement for the OHSS company include deepening relations with clients, contracts better supporting collaboration and procedures for spotting client’s OHSM shortcomings earlier.There is a challenge to find a balance between giving OHS engineers freedom in choosing how they work, providing clients flexible solutions and assuring that certain standards of service are met.We identify the need of a mentorship program for OHS engineers within the OHSS company that would include tutoring both in OHS interventions and the consultant role.Finally, OHS engineers may need to develop their skills in OHS related business economy and how to integrate OHS interventions with the business strategies of the client companies. / Bakgrund: Svensk lagstiftning kräver att arbetsgivare arbetar med systematiskt arbetsmiljöarbete (SAM). Under 2016 ledde 44 % av Arbetsmiljöverkets inspektioner till anmärkningar på grund av brister i SAM. Lagen definierar företagshälsovård (FHV) som en objektiv part med expertkunskap inom arbetsmiljö och rehabilitering. Syfte: Syftet med studien är att undersöka hur arbetsmiljöingenjörer inom FHV hjälper kundföretag med arbetet att utveckla och underhålla ledningssystem för arbetsmiljö. Studien syftar också till att identifiera resurser, framgångsfaktorer, nödvändig kompetens samt andra faktorer som främjar arbetet med SAM. Metod: Sex semi-strukturerade intervjuer utfördes med arbetsmiljöingenjörer anställda i ett av Sveriges fem största företag inom företagshälsovård. Resultat och analys: Respondenterna använde liknande arbetssätt i arbetet med att stötta kunders SAM. Detta trots att de arbetade i olika regioner inom företaget samt avsaknad av nationella riktlinjer. I arbetet med SAM använde arbetsmiljöingenjörerna framförallt egenproducerade, flexibla verktyg samt externa checklistor och mallar. Dialog, aktiv deltagande av kund under utveckling av SAM, intern motivation hos kundföretaget samt erfarenhet och kompetens hos arbetsmiljöingenjören beskrevs som de viktigaste framgångsfaktorerna. Slutsatser: Studien visar att de intervjuade arbetsmiljöingenjörernas arbete med SAM i stor utsträckning överensstämmer med vad andra studier funnit vara ett framgångsrikt samarbete med kundföretag. Förbättringsområden för FHV-företaget inkluderar fördjupande av kundrelationer, kontrakt som bättre stödjer sådant samarbete och rutiner för att upptäcka brister i SAM tidigare.En utmaning är att hitta en lämplig balans mellan arbetsmiljöingenjörens behov av fritt arbetssätt, erbjuda kunden flexibla lösningar och samtidigt säkerställa en likartad service inom företaget.Behov av ett mentorprogram, som inkluderar handledning inom både arbetsmiljöarbete och konsultrollen, för arbetsmiljöingenjörer inom FHV-företaget identifierades.Slutligen kan arbetsmiljöingenjörer behöva utveckla kompetens inom arbetsmiljöekonomi samt hur arbetsmiljöarbetet kan integreras med affärsstrategier inom kundföretagen.
177

Exploring the delivery of antiretroviral therapy for symptomatic HIV in Swaziland: threats to the successful treatment and safety of outpatients attending regional and district clinics

Armitage, Gerry R., Hodgson, Ian J., Wright, J., Bailey, K., Mkhwana, E. January 2011 (has links)
To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.
178

Improving the safety of chemotherapy administration: an oncology nurse-led failure mode and effects analysis

Ashley, L.J., Dexter, R., Marshall, F., McKenzie, B., Ryan, M., Armitage, Gerry R. January 2011 (has links)
No / PURPOSE/OBJECTIVES: To assess and improve the safety of hospital-based adult chemotherapy administration. DESIGN: Prospective, systems-focused clinical risk assessment. SETTING: An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom. SAMPLE: 8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers. METHODS: Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them. MAIN RESEARCH VARIABLES: The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected. FINDINGS: Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication. CONCLUSIONS: Although time and resource intensive, FMEA is a useful safety improvement tool. IMPLICATIONS FOR NURSING: Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.
179

Analyse d’implantation d’un système de gestion intégrée en environnement et en santé et sécurité du travail

Savary, Saôde 09 1900 (has links)
Les systèmes de gestion intégrée en environnement et en santé et sécurité du travail (SGI) sont un nouveau paradigme de gestion dans les organisations modernes. Ces systèmes sont construits à partir des normes ISO 14001 et d’OHSAS 18001, basées sur la prévention des risques et le principe de précaution. La littérature sur les SGI témoigne d’un marasme conceptuel prédominant depuis plus de 10 ans; elle insiste sur l’urgence d’un consensus taxinomique et conceptuel afin de définir les systèmes de gestion intégrée et de différencier le mécanisme d’intégration de celui de l’implantation. Cette lacune conceptuelle enlise les connaissances dans un fossé épistémologique, retardant ainsi le débat dans ce nouveau champ d’études. Les rares connaissances dont nous disposons dans ce domaine proviennent de quelques études théoriques et de six études empiriques, toutes préoccupées par la compatibilité des multiples systèmes et des avantages économiques de leur intégration. Les évidences engendrées par ces études sont insuffisantes pour appréhender la dynamique du nouveau paradigme dont les effets demeurent peu connus. Cette situation révèle l’urgence d’agir dans un contexte où l’utilisation des SGI se multiplie, et où leur tendance à minimiser l’importance des risques devient de plus en plus préoccupante. Aucune étude ne s’est encore penchée sur l’implantation d’un SGI en environnement et en santé et sécurité du travail construit uniquement à partir des normes ISO 14001 et d’OHSAS 18001. Cette connaissance est importante pour expliquer les effets de tels systèmes. C’est dans cette perspective que nous avons réalisé cette première étude empirique d’un SGI selon les normes ISO 14001 et d’OHSAS 18001. Nos questions de recherche portent sur le mode, le degré d’implantation, les effets du SGI, ainsi que sur les facteurs contextuels qui interviennent pour expliquer les variations dans le degré d’implantation et les effets du SGI. Il s’agit d’une recherche à prélèvement qualitatif qui repose sur un devis d’étude de cas, avec des niveaux d’analyse imbriqués, et comportant une double visée descriptive et explicative. Notre échantillon, de type raisonné, regroupait trente-cinq intervenants provenant de différentes instances hiérarchiques ; il incluait également des représentants syndicaux. Notre échantillon était composé de 7 usines, accréditées aux normes ISO 14001, OHSAS 18001, et dispersées dans différentes villes du Québec. Ces usines différaient tant par leur technologie, leur âge, leur taille, et leurs types de production. Nos données ont été recueillies en 2004; elles sont basées sur des entrevues semi dirigées, sur des observations directes lors de la visite des lieux; elles s’appuient aussi sur des consultations de documents internes et sur des outils électroniques implantés. La transcription des entrevues effectuée, le contenu des discours a été catégorisé selon les cinq dimensions du SGI: engagement, planification, mise en opération, contrôle et revue de la direction. Une condensation horizontale avait précédé l’analyse de chaque cas et l’analyse transversale des cas selon une approche à la fois inductive et déductive. Les résultats de notre recherche ont révélé deux modes d’implantation : le mode d’enrichissement et le mode de fusion. Ces modes dépendaient de la nature des structures fonctionnelles en place. La visée d’amélioration continue à la base du SGI n’avait pas réussi à concilier les approches traditionnelles bottom up et top down qui ont dominé cette implantation; son mécanisme était guidé par 4 types de stratégies : l’économie des ressources, le contrôle des forces d’influences, la stratégie des fruits faciles à cueillir et la stratégie à petits pas. Pour analyser le degré d’implantation, nous avons tenu compte de l’effort de structuration du SGI et de la force d’utilisation des processus implantés à chacune des cinq dimensions du SGI. Les résultats de notre recherche révèlent une variabilité certaine du degré d’implantation entre les usines d’une part, et entre les processus associés aux cinq dimensions du SGI d’autre part. L’analyse des discours a permis de produire cinq hypothèses qui soutiennent l’effort de structuration et la force d’utilisation du SGI: (i) l’hypothèse de la force de cohésion, (ii) l’hypothèse de la spécificité du processus, (iii) l’hypothèse de la portée du processus, (iv) l’hypothèse de la capacité organisationnelle, (v) l’hypothèse de l’acceptation du changement. L’implantation du SGI était soumise à l’influence de multiples facteurs; ils étaient de nature politique, structurelle et organisationnelle. Ces facteurs avaient agi sur le processus d’implantation en amorçant une cascade d’interactions au cours desquelles leurs forces d’influences se renforçaient, se neutralisaient ou s’additionnaient pour affecter le degré d’implantation. Les facteurs facilitant touchaient surtout l’effort de structuration ; ils incluaient : l’expérience des systèmes de gestion, l’implication de la direction, celle du syndicat ou du CSS, la structure organisationnelle, le niveau d’éducation, l’âge et la taille de l’usine. Quant aux facteurs contraignants, ils agissaient sur la force d’utilisation ; ils incluaient : la lourdeur procédurale, le manque de temps, le manque de formation, le manque de ressources, la culture organisationnelle, la structure organisationnelle, le fossé intergénérationnel, l’absence du syndicat et l’âge de l’usine. Trois effets proximaux escomptés par l’entreprise ont été observés. (i) La rigueur de la gestion était associée à l’application des exigences du SGI; elle touchait la gouvernance en environnement et en santé et sécurité du travail, les mécanismes de gestion et les procédés de production. (ii) La standardisation était reliée au mode d’implantation du SGI; elle concernait les pratiques, les outils, les méthodes de travail et l’organisation des ressources. (iii) La rupture des silos est un effet relié au mode d’implantation du SGI; elle touchait les structures départementales, les frontières professionnelles, les relations et climat de travail. Ces effets proximaux avaient provoqué plusieurs effets émergents, plus distaux: une augmentation du pouvoir de contrôle syndical, un renforcement de la légitimité des recommandations soumises par les spécialistes professionnels, la création de réseaux inter organisationnels et le transfert du savoir. L’implantation du SGI avait transformé la gouvernance et les pratiques en environnement et en santé et sécurité du travail dans les sept usines. Toutefois, elle ne semblait pas garantir l’immunité du processus de gestion des risques à l’environnement ni à la santé et sécurité du travail. Sa capacité à diluer les risques devait retenir l’attention des politiques de santé publiques et des programmes de prévention des risques à l’environnement et à la santé et sécurité du travail. L’amélioration de la gestion des risques demeurait un effet attendu non observé et soumis à des facteurs contextuels qui pourraient l’empêcher de se concrétiser. À cet égard, le transfert du savoir, renforcé par l’émergence des réseaux inter organisationnels, semblait offrir une avenue beaucoup plus prometteuse et accessible. C’est l’une des contributions de cette recherche. Elle a aussi (i) proposé une typologie des modes d’implantation et des effets du SGI (ii) préconisé une méthode détaillée d’une meilleure appréciation du degré d’implantation (iii) précisé le rôle des facteurs contextuels dans l’explication des variations du degré d’implantation et dans la production des effets, (iv) proposé des hypothèses sur la structuration et l’utilisation du SGI (v) offert une perspective plurielle et approfondie de la dynamique de l’implantation du SGI grâce à la variété de l’échantillon des répondants et des usines. Il s’agit de la première étude de terrain dans le domaine. À notre connaissance, aucune autre étude n’a eu de tels résultats. Mots Clés : ISO 14001, OHSAS 18001, gestion intégrée, environnement, santé et sécurité du travail, risques environnementaux, risques en santé et sécurité du travail, analyse d’implantation, degré d’implantation, SGI, transfert du savoir. / Integrated environmental, health and safety management systems (IMS) are a new management paradigm of modern organizations. These systems are built mainly from the ISO 14001 and OHSAS 18001 norms, which are based on risk prevention and the precautionary principles. For the past ten years, the literature on IMS has been governed by a conceptual stagnation, which is now begging for a taxonomic consensus in order to define IMS, clarify both integration and implementation processes, and to move beyond structures to address processes. As a result, the knowledge about IMS has been embroiled in an epistemological ditch, thus delaying debates in this emerging field of study. Scarce publications about IMS come from a few theoretical papers and six empirical investigations, all preoccupied by systems compatibility and the economic advantages of management systems integration. Evidence generated by these studies is not sufficient to apprehend the dynamics of the new paradigm, whose effects remain little known about until now. This situation is becoming alarming in a context where the use of integrated environmental health and safety management systems is increasing and where these IMS are raising concerns about their capacity to minimize risk in one domain or another. So far, no study has investigated the implementation of integrated environmental health and safety management systems built from ISO 14001 and OHSAS 18001 norms. Such knowledge is cardinal to help explain the effects of such IMS. It is in this perspective that we have undertaken this first empirical study of an IMS built from ISO 14001 and OHSAS 18001. Our research questions address the mode of implementation, the degree of implementation and the effects of the IMS, as well as the contextual factors whose influence on the implementation help explain the variations in the degree of implementation and the effects of the IMS. This qualitative inquiry uses a single case study with multiple levels of analysis. Our purposeful sample of thirty five participants was drawn from different levels of hierarchy, including union executives and representatives. Our purposeful sample of plants consisted of seven ISO 14001 and OHSAS 18001 certified plants located in different cities in Quebec, Canada. These plants differed by their technology, their age, their size and their types of production. Our data were collected in 2004 from semi-directed interviews, direct observation during site visits, and consultation of documentation and assessment of functionalities of implemented management tools. Interviews were transcribed verbatim and their content was categorized based on the five dimensions of the IMS: commitment policy, planning, deployment, control and management review. Horizontal condensation preceded within case and transversal analysis, using both inductive and deductive approaches. Our results indicate two implementation modes: the enrichment mode and the fusion mode, both related to the functional structures in place. Despite its aim of continuous improvement, the IMS was unable to reconcile the two traditional approaches of top down and bottom up, which have dominated this implementation which was supported by four strategies: economy of resources, control of influence, low hanging fruits and the small steps strategy. In order to analyze the degree of the IMS implementation, we have taken into consideration two aspects of the process: The effort of structuring the IMS and the scope of utilization of the implemented processes. Our results showed evidence of variation in the degree of IMS implementation; this variation was observed among the plants as well as among the processes implemented at each one of the five IMS steps. The analysis of discourses has allowed the production of five hypotheses that support IMS structuring and utilization (i) Cohesion forces hypothesis (ii) Process specificity hypothesis (iii) Scope of process hypothesis (iv) Organizational readiness hypothesis (v) Acceptance of change hypothesis. IMS implementation was influenced by political, structural and organizational factors. These factors have played their influence by catalyzing non -linear interactions, during which their influence could be neutralized, added or reinforced, hence generating variations in the degree of implementation. Facilitating factors have affected the effort of IMS structuring and included: experience working with management system, upper management commitment, implication of union or of health and safety committee representatives, organizational structure, level of education, plant age and plant size. Inhibiting factors have affected mainly the utilization of implemented processes. These factors included: procedural heaviness, lack of time, lack of training, lack of resource, organizational culture, organizational structure, intergeneration gap and lack of union implication. Three proximal effects anticipated by the organization under study were observed. (i) Increase in the rigor of management is an effect which was associated with the application of IMS requirements. It implied EHS governance, integrated management mechanisms and production processes (ii) Standardization is an effect which was associated rather with the implementation mode. It implied EHS practices, tools, work methods and organization of resources. (iii) Rupture of departmental silo is an effect associated with the mode of implementation. It involved organizational structures, professional boundaries and the working relations and climate. These proximal effects have induced several emerging effects, which were more distal. These were: increased control power of the union; increased legitimacy of recommendations by EHS professionals; creation of inter-organizational network and knowledge transfer. The implementation of an integrated management system in environment, occupational health and safety has transformed EHS governance and practice in all seven plants. However, this was not sufficient to grant immunity to EHS risk management processes. The potential of IMS to dilute risks should be of concern to public health policies, as well as to risk prevention programs on environment and on occupational health and safety. Improvement of EHS risk management was an expected effect but was not observed at the moment of our study. Several contextual factors may have intervened to alter its occurrence. To this regard, knowledge transfer, reinforced by the emergence of intra-organizational networks, seem to offer a very promising and affordable alternative. This is one of the contributions of our study research, which, in addition has (i) proposed a nomenclature to classify the modes of implementation and effects of IMS (ii) proposed a detailed method to appreciate the degree of implementation (iii) stated the roles played by contextual factors in explaining variations in the degree of IMS implementation and in the production of effects (iv) proposed a hypothesis on IMS structuring and utilization (v) through the diversity of our sample, offered a plural and sound perspective on the dynamics of IMS implementation. This is the first field study of this new paradigm. To our knowledge, no other study has produced such results. Keywords : ISO 14001, OHSAS 18001, integrated management system, IMS, environment, Occupational Health and Safety, environmental risks, occupational health and safety risks, implementation analysis, implementation level, knowledge transfer.
180

Análise da função renal em idosos com comprometimento cognitivo leve usuários de lítio em baixa dosagem: um estudo randomizado, duplo cego, placebo-controlado / Analysis of the renal function in elderly with mild cognitive impairment using lithium in low dose: a randomized, double-blind, placebo- controlled study

Aprahamian, Ivan 25 June 2013 (has links)
Introdução: segundo a literatura, sais de lítio podem produzir redução da função renal. A magnitude dessa informação é debatível, uma vez que não há estudo clínico randomizado e controlado entre usuários de lítio, em sua maioria pacientes com depressão ou transtorno bipolar. A possibilidade do uso do lítio para o tratamento da demência de Alzheimer prodrômica reforça a necessidade de maior investigação de efeitos adversos atribuídos ao lítio, especialmente com relação à função renal. Objetivos: avaliar a segurança da utilização do lítio em baixa dosagem com relação à função renal de pacientes idosos. Como objetivos secundários serão avaliadas: a segurança clínica através de exame e questionário específico, as funções tireoidiana, imunológica e o metabolismo glicêmico. Métodos: estudo randomizado e placebo controlado de 2 anos, seguido de fase aberta por mais 2 anos. Foram avaliados 59 idosos com comprometimento cognitivo leve com seguimento mínimo de dois anos (fase controlada). A função renal foi estimada através das fórmulas aMDRD e CKD- EPI, a partir de exames laboratoriais e dados clínicos coletados durante o estudo. As funções tireoidiana, imunológica e glicêmica foram avaliadas respectivamente através de TSH, T4 livre, leucócitos total, neutrófilos, linfócitos, glicemia e insulinemia de jejum, e HOMA-IR. A segurança clínica foi avaliada através de entrevista sistemática realizada a cada 3 meses, utilizando exame físico e a escala UKU para efeitos adversos. Resultados: não houve piora da função renal com o uso do lítio (litemia entre 0,25-0,5 mmol/l) tanto pela aMDRD (p=0,453) como pela CKD-EPI (p=0,181). Houve aumento significativo de neutrófilos (p=0,038) e do TSH (p=0,034). O grupo lítio apresentou incidência significativamente maior de diabetes mellitus (p=0,037) e arritmias (p=0,028), maior ganho de peso (p=0,015), mais sintomas na escala UKU (p=0,045), e maior interferência dos efeitos adversos do lítio em atividades diárias (p<0,001). Houve correlação entre a opinião de médico e do paciente nas interferências das atividades diárias atribuídas aos sintomas adversos (p<0,001). Conclusões: o uso de lítio em baixa dose não alterou a função renal, produziu alterações no sistema imunológico e tireoidiano sem impacto clínico, e foi seguro clinicamente. As razões do aumento de incidência de diabetes e arritmias merecem investigação posterior / Introduction: according to the literature, lithium salts may produce a reduction in kidney function. The magnitude of this information is debatable because there is no randomized and controlled clinical trial among lithium users, being mostly patients with depression or bipolar disorder. The possibility of using lithium for the treatment of prodromal Alzheimer\'s disease dementia increases the need for further investigation of adverse effects attributed to lithium, especially regarding to renal function. Objectives: To evaluate the safety of using low-dose lithium with respect to renal function in elderly patients. Secondary objectives were the evaluation of the clinical safety through specific questionnaire and clinical assessment, and to assess thyroid, immunological and glycemic function. Methods: a randomized and placebo controlled study for 2 years, followed by an open label follow-up of 2 years. We evaluated 59 elderly patients with mild cognitive impairment with accomplishment of at least two years of the controlled phase. Renal function was estimated by the aMDRD and CKD-EPI equation, and by laboratory and clinical data collected during the trial. The thyroid, immunological and glycemic functions were respectively evaluated by TSH, free T4, leukocyte count, neutrophil count, lymphocyte count, fasting plasma glucose and insulin, and the HOMA-IR. The clinical safety was evaluated through systematic examination performed every 3 months, with physical examination, clinical interview and UKU scale for adverse effects. Results: There was no decline of renal function with the use of lithium (litemia between 0.25-0.5 mmol/l) both in the aMDRD (p=0.453) and CKD-EPI (p=0.181) equations. A significant increase of neutrophils (p=0.038) and TSH (p=0.034) were observed. The lithium group showed significantly higher incidence of diabetes mellitus (p=0.037), arrhythmias (p=0.028), weight gain (p=0.015), more symptoms of UKU scale (p=0.045), and greater interference from the adverse effects of lithium during daily activities (p<0.001). There was an observed correlation between the opinion of the attending physician and the patient in respect to the interference in daily activities secondary to the adverse symptoms (p<0.001). Conclusions: The use of lithium in low doses did not result in renal function impairment, produced subtle changes in the immunological system and thyroid function, and was clinically safe for adverse effects. The reasons for the increased incidence of arrhythmias and diabetes mellitus deserve further investigation

Page generated in 0.1006 seconds