A temática da segurança do paciente é uma preocupação antiga, porém, só assumiu relevância nos últimos anos com a divulgação de dados sobre incidentes no cuidado em saúde e suas consequências. Um desses eventos, denominado evento adverso, corresponde à queda. As quedas são eventos não planejados quem levam o paciente ao solo, com ou sem lesão, sendo responsáveis por sofrimento aos pacientes e suas famílias, maior tempo de internação, custos aos sistemas de saúde e até mesmo óbitos. Vários fatores podem levar o paciente ao solo, porém, o foco dos estudos se concentra na população com mais de 65 anos, principalmente em unidades de internação. Embora os padrões de morbimortalidade tenham provocado mudanças na configuração do atendimento em saúde, elevando consideravelmente os casos de urgência e a complexidade da assistência, pouco ainda se sabe sobre quedas em ambientes não hospitalares, especialmente na atenção primária. As alterações nos fluxos de atendimento provocaram transformações nos cenários de trabalho da atenção básica, especialmente para a enfermagem, que realiza a maior parte das ações de cuidado. Estresse, insegurança e falhas estruturais são alguns fatores que contribuem para o comprometimento da segurança do paciente, especialmente na identificação de risco para quedas. Este estudo busca mapear os fatores de risco de quedas identificados por enfermeiros do serviço de urgência pré-hospitalar fixo, profissionais responsáveis pela elaboração, implementação e avaliação de processos para prevenção de incidentes, a partir de importantes instrumentos, como linguagem padronizada em escala mundial North American Nursing Diagnosis Association International (NANDA-I) e a Escala de Quedas de Morse (MFS) / The issue of patient safety is an old concern, but it has only become relevant in recent years with the dissemination of data on incidents in health care and its consequences. One of these events, called an adverse event, corresponds to the fall. Falls are unplanned events that take the patient to the ground, with or without injury, being responsible for suffering to patients and their families, longer hospitalization, costs to health systems and even death. Several factors can lead the patient to the ground, however, the focus of the studies is concentrated in the population over 65, mainly in hospitalization units. Although morbidity and mortality patterns have caused changes in the configuration of health care, considerably increasing urgency and complexity of care, little is known about falls in non-hospital settings, especially in primary care. Changes in care flows have led to changes in the work scenarios of primary care, especially for nursing, which performs most of the care actions. Stress, insecurity and structural failures are some factors that contribute to compromising patient safety, especially in identifying a risk for falls. This study seeks to map the risk factors for falls identified by nurses in the fixed prehospital emergency department, professionals responsible for the design, implementation and evaluation of processes for incident prevention, using important instruments such as standardized language on a global scale North American Nursing Diagnosis Association International (NANDA-I) and the Morse Falls Scale (MFS)

Les chutes touchent un tiers des personnes âgées de 65 ans et plus et conduit à une perte de mobilité. La détection des risques facteurs de chutes est essentielle pour une intervention précoce.Six facteurs intrinsèques de chute : vision, système vestibulaire, amplitude articulaire, force musculaire, proprioception articulaire et plantaire ont été évalué par des tests cliniques avant et après une dégradation temporaire. L’équilibre a été évalué sur une plateforme de force pour le calcul de 198 paramètres.Les paramètres ont été utilisés comme variables pour la construction de modèle de réseaux de neurones et de régression logistique avec pour objectif de diagnostiquer les détériorations des facteurs testés. Les paramètres pertinents ont été sélectionnés pour être inclus aux modèles. Des modèles comprenant entre 3 et 10 conditions ont été développé, néanmoins seuls les modèles de 5 conditions et moins se sont révélés efficaces. La précision a réussi à atteindre 92% pour le modèle incluant l’amplitude de la cheville, la fatigue et la vision des contrastes.Les mesures de qualité d’équilibre ont permis de détecter des détériorations des facteurs intrinsèques testés. Cependant, ces modèles ne sont efficaces qu’avec peu de conditions. Pour construire un modèle performant avec plusieurs conditions il est nécessaire d’inclure plus de participants lors de la construction du modèle. Un outil de la sorte est intéressant pour la mise en place de programmes de prévention et de rééducation / Falls concern a third of the people aged over 65y and lead to the loss of functional ability. The detection of risks factors of falls is essential for early intervention. Six intrinsic risk factors of fall: vision, vestibular system, joint range of motion, leg muscle strength, joint proprioception and foot cutaneous proprioception were assessed with clinical tests before and after temporarily degradation. Standing balance was recorded on a force plate.From the force plate, 198 parameters of the centre of pressure displacement were computed. The parameters were used as variables to build neural network and logistic regression model for discriminating conditions. Feature selection analysis was performed to reduce the number of variables.Several models were built including 3 to 10 conditions. Models with 5 or less conditions appeared acceptable but better performance was found with models including 3 conditions. The best accuracy was 92% for a model including ankle range of motion, fatigue and vision contrast conditions. Qualities of balance parameters were able to diagnose impairments. However, the efficient models included only a few conditions. Models with more conditions could be built but would require a larger number of cases to reach high accuracy. The study showed that a neural network or a logistic model could be used for the diagnosis of balance impairments. Such a tool could seriously improve the prevention and rehabilitation practice

Byggindustrin är idag en av våra mest olycksdrabbade branscher i Sverige sett tillantalet sysselsatta inom branschen. Olycksfrekvensen ligger idag kring 11/1000sysselsatta och år. Statistiken visar att byggindustrin har fler sjukskrivningar på grundav olyckor än andra branscher, vilket givetvis leder till större utgifter i förhållande tillde andra på denna punkt. Ett sätt att öka intresset för säkerhet och arbetsmiljöfrågorinom byggverksamheten kan vara att undersöka de ekonomiska aspekterna. Det ärtydligt att sjukskrivningar är en stor kostnad för byggföretagen men finns det egentligennågon motsättning mellan lönsamhet och säkerhet?Syftet med studien är att undersöka kopplingen mellan arbetsmiljöarbete,sjukskrivningar och kostnader inom byggsektorn. Studien utförs för att kunna ge enoberoende rekommendation på vilka åtgärder inom arbetsmiljö och säkerhet som kanminska antalet sjukskrivningar på grund av arbetsolyckor. Tanken är att undersökavilka olyckor som bidrar till flest sjukdagar och därmed störst kostnader för företagen,samt se vilka grundorsaker som går att förknippa med dessaStudien tar endast upp sjukskrivningar där bakomliggande orsak är en arbetsolycka.Det innebär att arbetssjukdommar orsakat av arbetshygieniska förhållanden intekommer att beaktas. Detta för att begränsa studien till den typ av olyckor inombyggindustrin som bidrar till flest sjukskrivningar.Undersökningen har gjorts i form av en omvärldsanalys med avsikt att samlainformation och kartlägga ämnet. Information och statistik i detta arbete har i störstamöjliga mån baserats på vetenskapligt säkerhetsställd litteratur ochmyndighetsinformation. Rapporten baseras i stor del på den nuägesbeskrivning sompresenteras i kapitel 4 som redogör bakgrund och den nuvarande situationbyggverksamheten befinner sig i när det gäller arbetsmiljöarbete, olycksstatiastik samtorsaker och kostnader för sjukskrivningar vid arbetsolyckor. I kapitel 3 presenteras denlagstiftning som i Sverige ligger till grund för arbetsmiljöarbete.I denna studie har olika undersökningar kombinerats för att få fram ett resultat på hurmycket sjukskrivningar, orsakade av arbetsolyckor, kostar. Kostnaderna baseras påarbetsmiljöverkets och försäkringskassans olycksfallstatistik samt försäkringskassanskalkylunderlag för sjukskrivning [25]. För att uppskatta kostnader för olika typer avolycksfall, undersöks hur många sjukdagar de fem vanligaste orsakerna bidrar med. Detvisar sig att den sjukskrivningskategori som kostar arbetsgivaren mest är fall från höjdoch att de åtgärder som enligt många studier förebygger detta är att ha en städadarbetsplats.Slutligen kan det konstateras att det finns kopplingar mellan arbetsplatsolyckor,sjukskrivningar och kostnader för företag inom byggsektorn. Det finns även åtgärdersom kan ge effekt på minskade sjukskrivningar, exempelvis städning och information.Utöver detta pekas även projektering ut som en punkt där anpassningar förarbetsmiljön kan göras och på så vis minska sjukskrivningar och öka lönsamheten hosföretagen. / The construction industry is one of our most injurious industries in Sweden today. Theaccident frequency currently lies around 11 per 1000 employees per year. Statistics showthat the construction industry has more sick leave due to accidents than other business,which of course leads to larger cost in relation to others industrial branches in this area.One way to increase the interest in safety and work environment issues in theconstruction industry can be to examine the economical aspects. It is clear that sickleave is a big cost for construction companies, but is there really any contradictionbetween profitability and safety?The purpose of this study is to investigate the connection between work environmentand profitability for companies in the construction sector. The study is carried out inorder to give an independent recommendation on which measures within workenvironment and safety that could be used to reduce the number of sick leave occasionsdue to work accidents. The idea is to investigate which accidents contribute to the mostsick days, and to see which root causes that could be associated with these accidents.The study only addresses sick leave where the underlying cause is workplace accidents.This means that occupational diseases caused by industrial hygiene conditions will notbe taken into account, this is to limit the study to the section which contributes themost to sick leave in the construction industry .The study has been conducted as an analysis of the surrounding world with theintention of gathering information and mapping out the subject. Information andstatistics in this research have, as far as possible, been based on scientifically securedliterature and government information. The report is largely based on the complieddescription of the current situation presented in chapter 4. This chapter describes thebackground and current situation for the construction industry in regards to legislation,work environment, accident statistics as well as causes and costs for sick leave in theevent of work accidents.In this report, various research has been combined to obtain a result on how much sickleave, caused by occupational accidents, costs. The costs are based on the SwedishWork Environment Authority and the Swedish Social Insurance Agency’s accidentstatistics as well as the Swedish Social Insurance Agency’s calculation basis for sickleave. In order to estimate the costs for different types of accidents, the number of sickdays for the five most common causes of injuries were picked out. It turns out that thecause of accidents that contributes to the highest costs for the employer is fall fromhight. It was also detected that according to many studies, the most efficient way toprevent fall from hight was to have a tidy workplace.Finally, it’s concluded that there are connections between work environment accidents,sick leave and costs for companies within the construction sector. There are alsomeasures that can affect sick leave, for example cleaning and information. Beyondthese, construction design is pointed out as an area where adjustments for the workenvironment can be made and though that reduce sick leave and increase profits for thecompanies.

The purpose of this study is to make a survey of the liability of municipal corporations in Texas for the construction, repair, and maintenance of their streets and sidewalks, and for injuries sustained by the traveling public through defects in same.