abstract: Construction work is ergonomically hazardous, as it requires numerous awkward postures, heavy lifting and other forceful exertions. Prolonged repetition and overexertion have a cumulative effect on workers often resulting in work related musculoskeletal disorders (WMSDs). The United States spends approximately $850 billion a year on WMSDs. Mechanical installation workers experience serious overexertion injuries at rates exceeding the national average for all industries and all construction workers, and second only to laborers. The main contributing factors of WMSDs are ergonomic loads and extreme stresses due to incorrect postures. The motivation for this study is to reduce the WMSDs among mechanical system (HVAC system) installation workers. To achieve this goal, it is critical to reduce the ergonomic loads and extreme postures of these installers. This study has the following specific aims: (1) To measure the ergonomic loads on specific body regions (shoulders, back, neck, and legs) for different HVAC installation activities; and (2) To investigate how different activity parameters (material characteristics, equipment, workers, etc.) affect the severity and duration of ergonomic demands. The study focuses on the following activities: (1) layout, (2) ground assembly of ductwork, and (3) installation of duct and equipment at ceiling height using different methods. The researcher observed and analyzed 15 HVAC installation activities among three Arizona mechanical contractors. Ergonomic analysis of the activities using a postural guide developed from RULA and REBA methods was performed. The simultaneous analysis of the production tasks and the ergonomic loads identified the tasks with the highest postural loads for different body regions and the influence of the different work variables on extreme body postures. Based on this analysis the results support recommendations to mitigate long duration activities and exposure to extreme postures. These recommendations can potentially reduce risk, improve productivity and lower injury costs in the long term. / Dissertation/Thesis / M.S. Construction 2011

As the work force ages and workers retirement age increases, the number of workers suffering from Work-related Musculoskeletal Disorders (WMSDs) has increased. In a recent study, the U.S Bureau of Labor reported that 6.9% of all WMSDs affected shoulders. Electricians, carpenters, and related construction crafts appear to experience higher incidence of these injuries due the nature of their work that require them often to use Awkward shoulder postures. This research aims to develop a new monitoring system that measure the amount of time workers spend in awkward shoulder postures to help decrease the prevalence of cumulative shoulder injuries and to reduce the number of cases of shoulder WMSDs among construction workers. The monitoring system was designed and a feasibility study was conduct to compare the monitoring system with a state of the art motion tracking system. Overall the monitoring system was able to count the time spent in awkward posture as a discrete state sensor and it can be implemented in the field. However, results showed that the monitoring system in its current configuration require some future work for it to produce quantitatively precise results that can be used in the fields of biomechanics, robotics, and ergonomics.

As the work force ages and workers retirement age increases, the number of workers suffering from Work-related Musculoskeletal Disorders (WMSDs) has increased. In a recent study, the U.S Bureau of Labor reported that 6.9% of all WMSDs affected shoulders. Electricians, carpenters, and related construction crafts appear to experience higher incidence of these injuries due the nature of their work that require them often to use Awkward shoulder postures. This research aims to develop a new monitoring system that measure the amount of time workers spend in awkward shoulder postures to help decrease the prevalence of cumulative shoulder injuries and to reduce the number of cases of shoulder WMSDs among construction workers. The monitoring system was designed and a feasibility study was conduct to compare the monitoring system with a state of the art motion tracking system. Overall the monitoring system was able to count the time spent in awkward posture as a discrete state sensor and it can be implemented in the field. However, results showed that the monitoring system in its current configuration require some future work for it to produce quantitatively precise results that can be used in the fields of biomechanics, robotics, and ergonomics.

No description available.

Key clinical features of cumulative trauma disorders include pain, muscle weakness, and tissue fibrosis, although the etiology is still under investigation. Therefore, we first sought to characterize the temporal pattern of altered sensorimotor behaviors and inflammatory and fibrogenic processes occurring in forearm muscles and serum of young adult, female rats performing an operant, high repetition high force (HRHF) reaching and grasping task for 6, 12, or 18 weeks. Palmar mechanical sensitivity, cold temperature avoidance and spontaneous behavioral changes increased, while grip strength declined, in 18-week HRHF rats, compared to controls. Flexor digitorum muscles had increased MCP-1 levels after training and increased TNFα in 6-week HRHF rats. Serum had increased IL-1β, IL-10 and IP-10 after training. Yet both muscle and serum inflammation resolved by week 18. In contrast, IFNg increased at week 18 in both muscle and serum. Given the anti-fibrotic role of IFNg, and to identify a mechanism for the continued grip strength losses and behavioral sensitivities, we evaluated the fibrogenic proteins CCN2, collagen type I and TGFß-1, as well as the nociceptive/fibrogenic peptide substance P. Each increased in and around flexor digitorum muscles and extracellular matrix in the mid-forearm, and in nerves of the forepaw at 18 weeks. CCN2 was also increased in serum at week 18. At a time when inflammation had subsided, increases in fibrogenic proteins correlated with sensorimotor declines. Thus, muscle and nerve fibrosis may be critical components of chronic work-related musculoskeletal disorders. CCN2 and substance P may serve as potential targets for therapeutic intervention, and CCN2 as a serum biomarker of fibrosis progression. TGFß-1 and CCN2 are important mediators of tissue fibrosis by their stimulatory effect on extracellular matrix deposition, with CCN2 functions as a downstream mediator of TGFß-1. Substance P (SubP), a nociceptor-related neuropeptide, has also been linked to tissue fibrosis, although little work has been done to understand whether SubP directly causes fibrotic responses in tenocytes. Therefore, we sought to determine if SubP induces fibroblast proliferation and collagen production via CCN2 signaling directly or through the TGFß-1/CCN2 signaling pathway. We hypothesized that SubP may act directly through CCN2, independently from the TGFß-1/CCN2 signaling pathway, to increase fibroblast proliferation and fibrogenic and extracellular matrix protein production in vitro. To examine this question, we assayed cell proliferation and production of CCN2, TGFB1 and collagen type 1 in vitro using primary tendon fibroblasts (tenocytes) isolated from flexor digitorum tendons, and using rat dermal fibroblasts (RDF). We observed that cells isolated from flexor digitorum tendons that express proteins characteristic of tenocytes (vimentin and tenomodulin) underwent increased proliferation in a dose dependent manner after TGFß-1 treatment, but not SubP treatment, as did RDF cells. TGFß-1 treatment increased CCN2 production in both tenocytes and RDF cells, while SubP induced CCN2 production only in rat tenocytes. Expectedly, TGFß-1 treatment increased collagen expression in each cell type, as did SubP treatment alone using In-cell Western analysis. Interestingly, preliminary data that needs to be repeated showed that SubP treatment of each cell type enhanced TGFß-1 expression, assayed using In-cell Western and traditional western blot analyses. Our findings suggest that both SubP and TGFß-1 have distinct fibrogenic actions on tenocytes and dermal fibroblast and that both may be involved in tendinosis observed in animal models and patients with fibrosis. Inflammatory pain, muscle weakness, and tissue fibrosis are key clinical features of work-related musculoskeletal disorders. So, lastly, we evaluated the effects of therapeutic interventions on behavioral and cytokine changes in muscle, tendon and serum of HRHF rats that performed the reaching and grasping task for 11 weeks. We compared sensorimotor behavioral changes, and flexor digitorum tissue inflammation and fibrosis in rats receiving anti-TNFα therapy prophylactically during the initial training, or anti-TNFα therapy with or without rest as secondary interventions during the HRHF work task. Untreated or saline only treated animals at the end of the initial training period had decreased grip strength, increased mechanical sensitivity, and increased serum and tissue inflammatory cytokines (TNFα, IL-1ß, IL-6 and VEGF), changes prevented by prophylactic anti-TNFα treatment. Regarding the secondary interventions, four weeks of anti-TNFα therapy with or without rest, provided in HRHF task weeks 4-7, was more effective than rest alone for restoring grip strength; no treatments rescued forepaw mechanical sensitivity. Effectiveness of the 4-week anti-TNFα therapy extended to week 11, despite no further drug treatment after week 7, for maintenance of grip strength. Tissue cytokine analysis in week 11 showed that HRHF rats treated with saline had increased IL-18 in serum, muscle and tendon, and trends for increased muscle CCN2. Each treatment, particularly anti-TNF with or without rest, decreased serum and tendon IL-18 and IL-1alpha. Rats receiving combined rest and anti-TNFα therapy also had increased serum IL-10. Thus, similar short-term anti-TNFα therapy may be a potential intervention in WMSDs. These results demonstrate that both Substance P and CCN2 play important roles in the development of fibrosis in muscle and tendon in WMSDs based on our model of repetition reaching and grasping. Using in vitro methods, it was demonstrated that substance P is capable of inducing CCN2 in isolated tenocytes and rat dermal fibroblasts, independent of TGFß-1 signaling, a novel discovery that make suggest new treatments for fibrotic disorders. Finally, anti-TNFalpha treatment successfully prevented behavioral declines and increases in IL-18 in serum and tissues in our rat model when provided during the course of HRHF task performance. Key clinical features of cumulative trauma disorders include pain, muscle weakness, and tissue fibrosis, although the etiology is still under investigation. Therefore, we first sought to characterize the temporal pattern of altered sensorimotor behaviors and inflammatory and fibrogenic processes occurring in forearm muscles and serum of young adult, female rats performing an operant, high repetition high force (HRHF) reaching and grasping task for 6, 12, or 18 weeks. Palmar mechanical sensitivity, cold temperature avoidance and spontaneous behavioral changes increased, while grip strength declined, in 18-week HRHF rats, compared to controls. Flexor digitorum muscles had increased MCP-1 levels after training and increased TNFα in 6-week HRHF rats. Serum had increased IL-1β, IL-10 and IP-10 after training. Yet both muscle and serum inflammation resolved by week 18. In contrast, IFNg increased at week 18 in both muscle and serum. Given the anti-fibrotic role of IFNg, and to identify a mechanism for the continued grip strength losses and behavioral sensitivities, we evaluated the fibrogenic proteins CCN2, collagen type I and TGFß-1, as well as the nociceptive/fibrogenic peptide substance P. Each increased in and around flexor digitorum muscles and extracellular matrix in the mid-forearm, and in nerves of the forepaw at 18 weeks. CCN2 was also increased in serum at week 18. At a time when inflammation had subsided, increases in fibrogenic proteins correlated with sensorimotor declines. Thus, muscle and nerve fibrosis may be critical components of chronic work-related musculoskeletal disorders. CCN2 and substance P may serve as potential targets for therapeutic intervention, and CCN2 as a serum biomarker of fibrosis progression. TGFß-1 and CCN2 are important mediators of tissue fibrosis by their stimulatory effect on extracellular matrix deposition, with CCN2 functions as a downstream mediator of TGFß-1. Substance P (SubP), a nociceptor-related neuropeptide, has also been linked to tissue fibrosis, although little work has been done to understand whether SubP directly causes fibrotic responses in tenocytes. Therefore, we sought to determine if SubP induces fibroblast proliferation and collagen production via CCN2 signaling directly or through the TGFß-1/CCN2 signaling pathway. We hypothesized that SubP may act directly through CCN2, independently from the TGFß-1/CCN2 signaling pathway, to increase fibroblast proliferation and fibrogenic and extracellular matrix protein production in vitro. To examine this question, we assayed cell proliferation and production of CCN2, TGFB1 and collagen type 1 in vitro using primary tendon fibroblasts (tenocytes) isolated from flexor digitorum tendons, and using rat dermal fibroblasts (RDF). We observed that cells isolated from flexor digitorum tendons that express proteins characteristic of tenocytes (vimentin and tenomodulin) underwent increased proliferation in a dose dependent manner after TGFß-1 treatment, but not SubP treatment, as did RDF cells. TGFß-1 treatment increased CCN2 production in both tenocytes and RDF cells, while SubP induced CCN2 production only in rat tenocytes. Expectedly, TGFß-1 treatment increased collagen expression in each cell type, as did SubP treatment alone using In-cell Western analysis. Interestingly, preliminary data that needs to be repeated showed that SubP treatment of each cell type enhanced TGFß-1 expression, assayed using In-cell Western and traditional western blot analyses. Our findings suggest that both SubP and TGFß-1 have distinct fibrogenic actions on tenocytes and dermal fibroblast and that both may be involved in tendinosis observed in animal models and patients with fibrosis. Inflammatory pain, muscle weakness, and tissue fibrosis are key clinical features of work-related musculoskeletal disorders. So, lastly, we evaluated the effects of therapeutic interventions on behavioral and cytokine changes in muscle, tendon and serum of HRHF rats that performed the reaching and grasping task for 11 weeks. We compared sensorimotor behavioral changes, and flexor digitorum tissue inflammation and fibrosis in rats receiving anti-TNFα therapy prophylactically during the initial training, or anti-TNFα therapy with or without rest as secondary interventions during the HRHF work task. Untreated or saline only treated animals at the end of the initial training period had decreased grip strength, increased mechanical sensitivity, and increased serum and tissue inflammatory cytokines (TNFα, IL-1ß, IL-6 and VEGF), changes prevented by prophylactic anti-TNFα treatment. Regarding the secondary interventions, four weeks of anti-TNFα therapy with or without rest, provided in HRHF task weeks 4-7, was more effective than rest alone for restoring grip strength; no treatments rescued forepaw mechanical sensitivity. Effectiveness of the 4-week anti-TNFα therapy extended to week 11, despite no further drug treatment after week 7, for maintenance of grip strength. Tissue cytokine analysis in week 11 showed that HRHF rats treated with saline had increased IL-18 in serum, muscle and tendon, and trends for increased muscle CCN2. Each treatment, particularly anti-TNF with or without rest, decreased serum and tendon IL-18 and IL-1alpha. Rats receiving combined rest and anti-TNFα therapy also had increased serum IL-10. Thus, similar short-term anti-TNFα therapy may be a potential intervention in WMSDs. These results demonstrate that both Substance P and CCN2 play important roles in the development of fibrosis in muscle and tendon in WMSDs based on our model of repetition reaching and grasping. Using in vitro methods, it was demonstrated that substance P is capable of inducing CCN2 in isolated tenocytes and rat dermal fibroblasts, independent of TGFß-1 signaling, a novel discovery that make suggest new treatments for fibrotic disorders. Finally, anti-TNFalpha treatment successfully prevented behavioral declines and increases in IL-18 in serum and tissues in our rat model when provided during the course of HRHF task performance. / Cell Biology

Injuries of the hands and wrist are prevalent in many occupations requiring repetitive tasks and may be further aggravated by advancing age; these injuries are termed work related musculoskeletal disorders (WMSDs). Prior studies using an innovative operant rat model of reaching and grasping as a model of WMSDs demonstrated exposure dependent changes in forelimb bones of young adult rats performing repetitive tasks ≤ 3 months. No one has yet to examine if aging enhances forelimb bone degradative changes occurring with WMSDs, or if forelimb bones adapt or degrade further in response to moderate versus high demand repetitive tasks performed for prolonged time periods (up to 24 months). Bone remodeling is a normal biological process that allows bones to adjust to strains. Unfortunately, both aging and inflammation can deregulate the balance between bone resorption and formation. Aging mammals display increased baseline inflammatory-cytokine levels, both systemically and at the tissue level. Several inflammatory cytokines have been shown to stimulate osteoclastogenesis leading to bone resorption and reduced bone formation. We have reported increased production of inflammatory cytokines in serum and musculotendinous tissues of aged animals performing a repetitive reaching and grasping tasks for up to 12 weeks, warranting further examination of whether aged rats performing these tasks have increased bone resorptive changes, compared to young adult rats. We hypothesized that aging would enhance bone degradative changes in our model as a consequence of increased bone inflammatory responses to a moderate demand repetitive task. Therefore, our first aim was to examine forearm grip strength, trabecular and cortical bone quality, and inflammatory cytokine levels in radii of mature (14-18 mo of age) and young adult (2.5-6.5 mo of age) female Sprague Dawley rats after performance of a high repetition low force (HRLF) task for 12 weeks, compared to each other and age-matched controls. We found that mature rats performing a moderate demand repetitive task for 12 weeks had decreased bone formation and quality, particularly cortical bone quality, compared to young adult rats performing the same task, with increased inflammatory and decreased anti-inflammatory responses, and perhaps lower grip strength, as likely contributors. An adaptive bone response was observed in young adult animals performing a moderate level task of high repetition low force for 12 weeks. In contrast, a previous study showed bone degradative changes in young adult rats performing a high demand task of high repetition high force task for 12 weeks. Osteocytes are the mechanosensing cells of bones, and disruption or changes to their environment can lead to apoptosis or molecular changes. In models of forced bone loading to bone fatigue, osteocyte apoptosis increases sclerostin levels and osteoclast recruitment. Increased sclerostin also leads to increased RANKL production. In contrast, low level loading for a short period reduces sclerostin levels and encourages bone formation. We hypothesized that long-term muscle loading at high repetition low force loads would induce further bone adaptation, but that long-term high repetition high force muscle loading would result in detrimental bone loss, as well as alterations in these two bone remodeling proteins, RANKL and sclerostin. Therefore, our second aim was to determine if prolonged performance of a moderate demand upper extremity reaching and grasping task by young adult rats would continue to enhance forelimb bone formation and quality. We hypothesized that continued performance of a high repetition low force (HRLF) task for 24 weeks would lead to increased bone formation. We also hypothesized that RANKL and sclerostin, two proteins that have not been investigated in our rat model of WMSDs, would be reduced in rats performing a HRLF task for 24 weeks, as the bones reach adaptation. We found that 24 week HRLF rats showed several indices of bone formation and adaptation to the task; as well as reduced sclerostin immunoexpression, compared to controls, a reduction that likely contributed to the enhanced bone formation. To expand on this investigation, in our third aim, we investigated the impact of performance of a high repetition high force (HRHF) task for 18 weeks on young adult rat forelimb bones, and on sclerostin and RANKL levels. We observed detrimental trabecular bone remodeling in the radius, including decreased trabeculae bone volume, number and thickness, increased trabecular separation and anisotropy, and a transition to rod-shaped trabeculae in 18-week HRHF task animals, compared to food restricted control rats. In the 18-week HRHF rats, osteoclast numbers increased and osteoblast numbers decreased, concomitant with increased osteocyte apoptosis and empty lacunae, compared to control rats. Also, mRNA and protein levels of RANKL increased and sclerostin decreased in the 18-week HRHF rats, compared to to control rats. Thus, prolonged performance of a high demand task of high repetition high force induced detrimental trabecular bone changes. The increased RANKL likely contributed to these changes, and although sclerostin level decreased, a change that should contribute to enhanced osteoblast activity, bone formation was not rescued. In conclusion, prolonged performance of a HRLF task by young adult rats leads to reduced sclerostin levels and increased bone formation and bone quality. Aged rats performing the same HRLF task showed increased bone degradative changes that might increase fracture risk. In contrast, prolonged performance of a HRHF task by young adult rats leads to increased bone resorption and degradation, changes associated with RANKL expression. Sclerostin levels were reduced by the HRHF task, but failed to rescue bone formation. / Cell Biology

Submitted by Leonardo Cavalcante (leo.ocavalcante@gmail.com) on 2018-06-06T14:33:18Z No. of bitstreams: 1 Arquivototal.pdf: 2487080 bytes, checksum: 591670f968f9e384aaa5088500b05b7c (MD5) / Made available in DSpace on 2018-06-06T14:33:18Z (GMT). No. of bitstreams: 1 Arquivototal.pdf: 2487080 bytes, checksum: 591670f968f9e384aaa5088500b05b7c (MD5) Previous issue date: 2016-04-07 / Introduction: The incidence of Work-Related Musculoskeletal Disorders (WMSDs) has increased in various industrial sectors, including the footwear one, relating mainly to the exposition of ergonomic risk. The introduction of systems based on multifunctionality and job rotation has become an alternative to reduce WMSDs. Objective: To analyze the ergonomic risks factors related to musculoskeletal disorders in mono and multifunctional activities in a footwear company. Methodology: Research was conducted with 57 monofunctinoal and 57 multifunctional workers from a footwear company in Northeast Brazil. The Corlett and Manenica Diagram was used to assess pain and the Occupational Repetitive Actions (OCRA) method to categorize the level of ergonomic risk for WMSDs. Ordinal logistic regression models built were related to pain and individuals and work variables; multinomial logistic regression models were related to the levels of risk to variability in tasks executed by worker. Results: (1) Assessment of muscular-joint pain. It was identified that for the monofunctinal, the ocurrence of muscular-joint pain may be connected with length of service. For multifunctional ones, outcomes suggest that beyond length of service, the history of work-related diseases. However, it was ascertained that for length of service, the monofunctional demonstrated to be more vulnerable to pain in periods of exposure to the risk time less than the multifunctional worker; (2) Assessment of the risk level. From the activities performed by the monofunctinals, 14% present acceptable risk; 12.3% very low risk; and 73.7% have potential risk for WMSD (10.5%, mild; 36.8%, medium; and 26.4% high). Regarding the set of activities performed by multifunctionals, 10.5% are within acceptable limit; 8.8% have a very low risk; 80.7% presented a potential risk for WMSDs (10.5%, mild; 54.4% medium; and 15.8%, high). (3) Mathematical modeling according to the type of work. It was determined that for multifunctionals the representative variables covered cycle time (OR=0.92; p=0,0075) and number of activities performed by left upper limb in this cycle (OR=1.21; p=0,0044). For the multifunctional ones, the variable with significant effect was the weighted mean from OCRA index related to left upper limb (OR=1,22*102; p=0,0076). Furthermore, it was verified the significance regarding the range of motion utilized, the use gloves, and requirement of precision during task execution, suggesting that such factors may be associated to exposition of the multifunctional to WMSDs (p<0,05). (4) 10 Mathematical modeling according to the level of multifunctionality. The results were relevant to workers from first level of multifunctional training (OR=6,76*10-2; p=0,0431). Conclusions: It is concluded that (1) workers showed more susceptibility to muscular-joint pain when they perform just one function; (2) the activities carried out by both the workers have a representative risk for WMSDs, with a medium to high tendency risk for monofunctional ones and medium for the multifunctional ones; (3) for the multifunctional ones, there are evidences that more elevated risk are associated with the cycle of activity; (4) for the multifunctional ones, there are evidences that higher level are related with the excessive or inadequate requirement of left upper limb by combination of activities; (5) Specifically for the multifunctional ones, kinesiological aspects and the characteristics of activities can be connected to development of WMSDs; (6) the multifunctional ones, in a early stage of training, are exposed to lower WMSDs risks when compared to the ones who work more time in a same range of functions; and (7) multifunctional ones who perform a combination up to 30% of the total intracellular activities, appear to be less exposed to WMSD risk than the ones who execute a combination of large activities. Keywords: Footwear industry; kind of work; Ergonomics; WMSDs; mathematical modeling. / Introdução: A incidência de Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) aumentou em diversos setores industriais, inclusive o calçadista, relacionando-se, sobretudo a exposição ao risco ergonômico. A introdução de sistemas baseados na multifuncionalidade e na rotação de tarefas tornou-se uma alternativa para redução de DORT. Objetivo: Analisar os fatores de risco ergonômicos associados aos distúrbios osteomusculares em atividades mono e multifuncionais de uma empresa calçadista. Metodologia: A pesquisa foi realizada com 57 trabalhadores monofuncionais e 57 multifuncionais de uma empresa de calçados no Nordeste brasileiro. Utilizou-se o Diagrama de Corlett e Manenica para a avaliação da dor e o método Occupational Repetitive Actions (OCRA) para categorização do nível de risco ergonômico para DORT. Construíram-se modelos de regressão logística ordinal relacionando a dor às variáveis individuais e ao trabalho e modelos de regressão logística multinomial relacionando os níveis de risco à variabilidade das tarefas executadas pelo trabalhador. Resultados: (1) Avaliação da dor miorarticular. Identificou-se que para os monofuncionais a ocorrência de dor mioarticular pode estar interligada ao tempo de serviço. Para os multifuncionais, os resultados sugerem além do tempo de serviço, o histórico de doenças relacionadas ao trabalho. Todavia, averiguou-se que para o tempo de serviço, o monofuncional demonstrou ser mais vulnerável a dor em períodos de tempo de exposição aos riscos menores do que o trabalhador multifuncional; (2) Avaliação do nível de risco. Das atividades realizadas pelos monofuncionais, 14% apresentam risco aceitável; 12,3%, muito pequeno; e 73,7% possuem risco potencial para DORT (10,5%, leve; 36,8%, médio; e 26,4%, elevado). Quanto ao conjunto de atividades realizadas pelos multifuncionais, 10,5% estão dentro do limite de aceitabilidade; 8,8% possuem um risco muito pequeno; 80,7% apresentam risco potencial para DORT (10,5%, leve; 54,4%, médio; e 15,8%, elevado); (3) Modelagem matemática conforme o tipo de trabalho. Constatou-se que para os monofuncionais as variáveis representativas abrangeram tempo de ciclo (OR=0,92; p=0,0075) e número de ações realizadas pelo membro superior esquerdo dentro deste ciclo (OR=1,21; p=0,0044). Já para os multifuncionais, a variável com efeito significativo foi a média ponderada do índice OCRA referente ao membro superior esquerdo (OR=1,22*102; p=0,0076). Ademais, verificou-se significância quanto à amplitude de 8 movimento empregada, uso de luvas e exigência de precisão na execução das atividades, sugerindo que tais fatores podem estar associados à exposição do multifuncional ao risco para DORT (p<0,05). (4) Modelagem matemática conforme o nível de multifuncionalidade. Os resultados foram relevantes para os trabalhadores do primeiro nível de treinamento multifuncional (OR=6,76*10-2; p=0,0431). Conclusões: Conclui-se que (1) os trabalhadores demonstram mais susceptibilidade às dores mioarticulares quando realizam apenas uma função; (2) as atividades desempenhadas por ambos os trabalhadores possuem um risco representativo para DORT, com uma tendência de risco médio a elevado para os monofuncionais e médio, para os multifuncionais; (3) para os monofuncionais há indícios de que níveis mais elevados de risco estão associados ao ciclo da atividade; (4) para os multifuncionais há evidências de que níveis mais altos relacionam-se com o requerimento excessivo ou inadequado do membro superior esquerdo pela combinação de atividades; (5) Especificamente, para os multifuncionais aspectos cinesiológicos e as características das atividades podem estar interligados ao desenvolvimento de DORT; (6) os multifuncionais em estágio inicial de treinamento estão expostos a riscos para DORT menores quando comparados aos que trabalham há mais tempo em um mesmo conjunto de funções; e (7) multifuncionais que realizam uma combinação de até 30% do total de atividades intracelular aparentam estar menos expostos ao risco para DORT do que os multifuncionais que executam uma combinação de atividades maior.

Introdução: As Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) são afecções músculo esqueléticas. A enfermagem é uma das categorias da área da saúde mais atingidas por estas, devido aos fatores de risco da profissão. Apresentar desconforto e dor em regiões específicas do corpo, faz parte do cotidiano de muitos destes trabalhadores, que acabam apresentando alterações em sua qualidade de vida. Estes fatores levam ao aparecimento do presenteísmo observado quando o trabalhador está presente no trabalho apesar de doente ou com algum problema físico ou psicológico e ao absenteísmo que ocorre quando este trabalhador falta ao trabalho. Objetivo: Avaliar o impacto de um Curso de Ensino à Distância (EAD) de Prevenção em LER/DORT na qualidade de vida destes trabalhadores e avaliar também desconforto e dor, presenteísmo e absenteísmo. Métodos: Sessenta funcionários da enfermagem de um hospital geral universitário participaram do ensaio clínico, randomizados aleatoriamente em dois grupos.Os critérios de inclusão foram: ser contratado do hospital nas categorias profissionais enfermeiros, técnicos e auxiliares de enfermagem e atuarem em unidades de internação. Foram excluídos trabalhadores com diagnóstico de LER/DORT auto-referido.O grupo intervenção participou de um curso em EAD com duração de 8 horas, composto por estratégias e dicas laborais para a prevenção de LER/DORT, literaturas disponíveis e provas teóricas, o grupo controle foi submetido a uma palestra educativa com duração de 30 minutos, com os mesmos conteúdos do curso em EAD. Foram avaliados antes da intervenção, duas e oito semanas após. Resultados: Quando comparada a qualidade de vida entre os grupos não observamos melhores resultados na percepção do grupo intervenção. O domínio de dor apresentou pior percepção. Presenteísmo foi observado em ambos os grupos, observamos redução do presenteísmo nos grupos sendo no grupo controle uma diferença significativa.Em relação ao desconforto e dor, ambos os grupos apresentaram alta prevalência, houve mudança significativa no grupo controle, com redução na escala do basal para a 8ª semana depois na região das costas inferior. No grupo intervenção não há uma diferença estatisticamente significativa, apesar de haver uma importante redução. Já o absenteísmo apresentou diferença entre os grupos, sendo que no vii grupo intervenção teve redução do número de horas de afastamento por doença. Conclusão: Não há evidência do impacto de um curso de ensino a distância (EAD) de prevenção em LER/DORT na melhora da percepção de qualidade de vida de um grupo de enfermagem. / Introduction: Repetitive Strain Injuries (RSI) or Work-Related Musculoskeletal Disorders (WMSDs) are musculoskeletal disorders. Nursing is one of the health categories that area most affected by these, due to the profession risk factors. Many of these workers show discomfort and pain in specific regions of the body as part of the daily life that end up presenting changes in their quality of life. These factors lead to the appearance of presenteeism observed when the worker is present at work despite being ill or with some physical or psychological problem and to absenteeism that occurs when this worker is absent from work. Objective: To evaluate the effects of a distance learning (DL) course on prevention of RSI and WMSDs in the quality of life of these workers and also to assess discomfort and pain, presenteeism and absenteeism. Methods: Sixty nursing staff from a general university hospital participated in the randomized trial, randomly divided into two groups. The inclusion criteria were: to be a hospital employee in the categories professional nurses, technicians, nurse assistants and to work in hospitalization units. Workers with self-reported diagnosis of RSI/WMSDs were excluded. The intervention group participated in an 8h DL course, consisting of strategies and work tips for the prevention of RSI/ WMSDs, available literature and theoretical evidence, the control group was submitted to a 30 minute educational lecture, with the same content of the DL course. They were evaluated before the intervention, two and eight weeks after. Results: When comparing the quality of life between the groups, the we did not observe better results in the perception of the intervention group. The pain domain presented worse perception. Presenteeism was observed in both groups, we observed reduction of presenteeism in the groups being a significant difference in the control group. Regarding to discomfort and pain, both groups presented a high prevalence, there was a significant change in the control group, with a reduction in the baseline scale to the 8th week later in the lower back region. In the intervention group there is no significant difference statistically, although there is a significant reduction. On the other hand, absenteeism presented a difference between the groups and in the intervention group there was a reduction in the number of hours of sick leave. Conclusion: There is no evidence of the impact of a distance learning prevention course on RSI/WMSDs on the improvement of the perception of the quality of life of a nursing group

Introdução: As Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) são afecções músculo esqueléticas. A enfermagem é uma das categorias da área da saúde mais atingidas por estas, devido aos fatores de risco da profissão. Apresentar desconforto e dor em regiões específicas do corpo, faz parte do cotidiano de muitos destes trabalhadores, que acabam apresentando alterações em sua qualidade de vida. Estes fatores levam ao aparecimento do presenteísmo observado quando o trabalhador está presente no trabalho apesar de doente ou com algum problema físico ou psicológico e ao absenteísmo que ocorre quando este trabalhador falta ao trabalho. Objetivo: Avaliar o impacto de um Curso de Ensino à Distância (EAD) de Prevenção em LER/DORT na qualidade de vida destes trabalhadores e avaliar também desconforto e dor, presenteísmo e absenteísmo. Métodos: Sessenta funcionários da enfermagem de um hospital geral universitário participaram do ensaio clínico, randomizados aleatoriamente em dois grupos.Os critérios de inclusão foram: ser contratado do hospital nas categorias profissionais enfermeiros, técnicos e auxiliares de enfermagem e atuarem em unidades de internação. Foram excluídos trabalhadores com diagnóstico de LER/DORT auto-referido.O grupo intervenção participou de um curso em EAD com duração de 8 horas, composto por estratégias e dicas laborais para a prevenção de LER/DORT, literaturas disponíveis e provas teóricas, o grupo controle foi submetido a uma palestra educativa com duração de 30 minutos, com os mesmos conteúdos do curso em EAD. Foram avaliados antes da intervenção, duas e oito semanas após. Resultados: Quando comparada a qualidade de vida entre os grupos não observamos melhores resultados na percepção do grupo intervenção. O domínio de dor apresentou pior percepção. Presenteísmo foi observado em ambos os grupos, observamos redução do presenteísmo nos grupos sendo no grupo controle uma diferença significativa.Em relação ao desconforto e dor, ambos os grupos apresentaram alta prevalência, houve mudança significativa no grupo controle, com redução na escala do basal para a 8ª semana depois na região das costas inferior. No grupo intervenção não há uma diferença estatisticamente significativa, apesar de haver uma importante redução. Já o absenteísmo apresentou diferença entre os grupos, sendo que no vii grupo intervenção teve redução do número de horas de afastamento por doença. Conclusão: Não há evidência do impacto de um curso de ensino a distância (EAD) de prevenção em LER/DORT na melhora da percepção de qualidade de vida de um grupo de enfermagem. / Introduction: Repetitive Strain Injuries (RSI) or Work-Related Musculoskeletal Disorders (WMSDs) are musculoskeletal disorders. Nursing is one of the health categories that area most affected by these, due to the profession risk factors. Many of these workers show discomfort and pain in specific regions of the body as part of the daily life that end up presenting changes in their quality of life. These factors lead to the appearance of presenteeism observed when the worker is present at work despite being ill or with some physical or psychological problem and to absenteeism that occurs when this worker is absent from work. Objective: To evaluate the effects of a distance learning (DL) course on prevention of RSI and WMSDs in the quality of life of these workers and also to assess discomfort and pain, presenteeism and absenteeism. Methods: Sixty nursing staff from a general university hospital participated in the randomized trial, randomly divided into two groups. The inclusion criteria were: to be a hospital employee in the categories professional nurses, technicians, nurse assistants and to work in hospitalization units. Workers with self-reported diagnosis of RSI/WMSDs were excluded. The intervention group participated in an 8h DL course, consisting of strategies and work tips for the prevention of RSI/ WMSDs, available literature and theoretical evidence, the control group was submitted to a 30 minute educational lecture, with the same content of the DL course. They were evaluated before the intervention, two and eight weeks after. Results: When comparing the quality of life between the groups, the we did not observe better results in the perception of the intervention group. The pain domain presented worse perception. Presenteeism was observed in both groups, we observed reduction of presenteeism in the groups being a significant difference in the control group. Regarding to discomfort and pain, both groups presented a high prevalence, there was a significant change in the control group, with a reduction in the baseline scale to the 8th week later in the lower back region. In the intervention group there is no significant difference statistically, although there is a significant reduction. On the other hand, absenteeism presented a difference between the groups and in the intervention group there was a reduction in the number of hours of sick leave. Conclusion: There is no evidence of the impact of a distance learning prevention course on RSI/WMSDs on the improvement of the perception of the quality of life of a nursing group

Made available in DSpace on 2016-06-02T20:19:21Z (GMT). No. of bitstreams: 1 DissTOS.pdf: 1026563 bytes, checksum: 3084e32eb13447dd885b2643417f39a5 (MD5) Previous issue date: 2005-02-22 / Financiadora de Estudos e Projetos / Work-related musculoskeletal disorders (WMSDs) constitutes a group of disturbs, with multifactorial origin, mainly promoted by workplace factors (physical, organizational and psychosocial). WMSDs cause high human, social and economic costs, which justifies effort to determine more efficient prevention strategies. However, for an effective prevention is necessary to establish the main risk factors, and create or aprimorate assessment tools. It was proposed a new tool for risk assessment Checklist for musculoskeletal risk assessment (RARME). The objective of this study was to evaluate the consistency of this checklist in relation to other physical load indicators: discomfort and exertion ratings, sick leave and Ergonomic Workplace Analysis. Thirty-one subjects took part in this study. They performed fifteen different tasks involving repetitive motion pattern and manual material handling. Checklist was applied by direct observation in the workplace. No relation between the results from checklist and the other physical load indicators was identified. Several factors might have contributed to the lack of consistency between indicators. Exposure variability, cognitive overload of the observer, bias in observation methods, and instruments for risk measurement are important factors to be considered when analyzing the present results. Thus, although it was not possible to check the protocol validity, relevant methodological aspects when using theses types of checklists were discussed. Besides this, an improved version of RARME protocol is presented. / As Lesões por Esforços Repetitivos/Distúrbios Osteomusculares Relacionados ao Trabalho (LER/DORT) constituem um grupo de distúrbios, de origem multifatorial, promovidos ou agravados por características do local de trabalho (físicas, organizacionais ou psicossociais). As LER/DORT causam alto custo humano, social e econômico, o que justifica esforços para determinar estratégias de prevenção mais eficazes. Porém, para uma prevenção efetiva é necessário que se identifique as principais causas destes distúrbios, além de se criar ou aprimorar ferramentas de avaliação dos riscos presentes no trabalho. Diante disto foi proposto o Roteiro para Avaliação de Riscos Músculo-Esqueléticos (RARME). O objetivo deste estudo foi avaliar a consistência deste Roteiro em relação a outros indicadores de sobrecarga física: escalas de desconforto e esforço, afastamento do trabalho e Análise Ergonômica do Local de Trabalho. Foram avaliados 31 indivíduos que realizavam 15 atividades diferentes com padrões de movimento repetitivos e manuseio de cargas. A aplicação do RARME foi feita por observação direta. Não foi identificada relação entre o RARME e os outros indicadores de sobrecarga física. Vários fatores podem ter contribuído para esta inconsistência. A variabilidade da exposição; sobrecarga cognitiva do observador e erros inerentes à observação; e características dos instrumentos usados para medir o risco são fatores importantes a serem considerados quando se analisam os presentes resultados. Portanto, embora não tenha sido possível checar a validade deste novo Roteiro, foi possível determinar uma série de considerações metodológicas importantes para o uso de protocolos de registro postural. Além disso, uma versão aprimorada do RARME foi proposta.