Made available in DSpace on 2016-06-02T20:18:07Z (GMT). No. of bitstreams: 1 TeseRSP.pdf: 2033512 bytes, checksum: d5ddb9118edecd3afca2376359856f6d (MD5) Previous issue date: 2006-04-25 / Load handling activities impose great overloads on the musculoskeletal system, increasing the risk of injuries. The fact that these handling activities are considered risky had led to several studies regarding load lifting, lowering, pulling and pushing. The results obtained certainly allowed many findings about influence of different variables on risk factors of these activities. However, other studies are needed, especially about risks by load carrying activities, since the literature has not dealt extensively with this topic. Thus, studies have been carried out about load handling, leading to 4 scientific papers. Study one aimed at comparing two groups of workers, with and without musculoskeletal symptoms in the upper limbs when they performed simulated tasks of handling techniques as to trunk movements and load support. Movements analysis was quantified by a flexible electrogoniometer and contact between load and trunk, by load cells. Nine asymptomatic and 10 symptomatic industrial workers were evaluated. An ANOVA was performed to compare results between symptomatic and asymptomatic workers. Most of the symptomatic workers supported the load on their trunk, whilst most of the asymptomatic did not. Higher values of lumbar flexion occurred for the symptomatic workers (p<0,05). The objective of the second study was ti describe trunk movements in sedentary subjects, and in workers with and without musculoskeletal symptoms, when carrying loads in simulated tasks. The 38 subjects who participated in this study were divided into 4 groups, consisting of 9 male students, 10 female students, 10 female symptomatic industrial workers and 9 asymptomatic industrial workers. The trunk movements of all subjects were recorded by biaxial back electrogoniometer when carrying loads between surfaces of different heights. An analysis of variance for repeated measures were performed, which was followed by the Duncan post hoc test for comparison of anthropometrical data between subjects, amplitude of movement, and time spent in each movement per group and per experimental condition. The height of the surfaces to which the loads were carried to or from, significantly influenced the trunk positions during handling (p<0,01), as if subjects were anticipating the target position whilst handling. Also more time was spent in flexion (p<0,01) than in extension. These aspects increase the risks of possible injury in such activities. The objective of the third study was to describe the kinds of grip used during handling activities of 5Kgf and 10 Kgf loads between surfaces of different height and to quantify flexion/extension movements and wrist radial and ulnar deviations quantified by electrogoniometry. Ten male volunteers participated in this study handled a box between surfaces of different heights. The activities was performed to evaluate significant differences between the anthropometry of volunteers´ hands and between movements used for load handling and different heights. The results showed that the surface heights to which the objects were handled significantly influenced (p=0,000) joint amplitudes, nevertheless there wasn t any difference in the movements for different load masses handled (p=0,43). Time over what is considered advisable was spent in radial deviation when handling involved high surfaces. The fourth study aimed at evaluating the anterior-posterior movements of the trunk and the time spent in task performance by experienced and inexperienced subjects during load handling activities to different target surfaces. The 36 subjects who participated in this study were healthy males, divided into groups of 16 and 20, experienced and inexperience respectively, in the performance of load handling activities. The activities consisted of carrying the 7Kg and 15Kg boxes from a surface at a fixed height to another at a variable height. Lumbar thoracic movements were quantified by a flexible electrogoniometer. Significant differences were found in the time spent to perform the handling between the groups (p<0,008) and between the loads (p<0,000). However, there was no significant difference in the trunk movemets between the groups (p>0,005) and the loads (p>0,005). Surfaces heights to which the box was transported significantly influenced trunks movements (p<0,000). / As atividades de manuseio de carga geram grandes sobrecargas ao sistema músculoesquelético, aumentando com isso os riscos de lesões. O fato dessas atividades de manuseio serem consideradas de risco fez com que muitos estudos fossem realizados considerando situações de levantamento, abaixamento, puxar e empurrar cargas. Os resultados obtidos certamente permitiram muitas descobertas sobre as diferentes variáveis envolvidas e os fatores de risco dessas atividades. Contudo, são necessidade outros estudos principalmente sobre os riscos gerados por atividades de carregamento de carga, já que a literatura cientifica aborda muito pouco essa temática. Assim, foram então realizados estudos sobre atividade de carregamento de carga que geraram 4 (quatro) artigos científicos. O objetivo do Estudo I foi comparar dois grupos de trabalhadores com e sem sintomas músculo-esqueléticos em membros superiores quando realizaram tarefas simuladas de manuseio, quanto aos movimentos do tronco e suporte da carga. A análise do movimento foi realizada por meio de um eletrogoniômetro flexível, o contato entre a carga e o tronco foi mensurado por meio de células de carga. Foram avaliados 9 trabalhadores assintomáticos e 10 sintomáticos. Para comparar os resultados entre sintomáticos e assintomáticos utilizou-se uma ANOVA. A maioria dos trabalhadores sintomáticos apoiou a carga no tronco enquanto que a maioria dos assintomáticos não. A amplitude de movimento de flexão lombar que ocorreram no grupo de trabalhadores sintomáticos foram bem maiores do que no grupo de assintomáticos (p<0,05). O objetivo do segundo estudo foi descrever os movimentos do tronco em indivíduos sedentários e em trabalhadores com e sem sintomas músculo-esqueléticos. Participaram do estudo 38 indivíduos sendo divididos em 4 grupos, 9 homens estudantes, 10 mulheres estudantes, 10 trabalhadoras sintomáticas e 9 trabalhadoras assintomáticas. Os movimentos do tronco foram registrados por um eletrogoniômetro biaxial de tronco durante o carregamento de carga para diferentes alturas de superfícies. Uma análise de variância ANOVA para medidas repetidas foi aplicada. Os resultados mostraram que a altura das superfícies para a qual a carga seria levada influenciou significativamente os movimentos do tronco (p<0,01) e que mais tempo foi gasto em movimentos de flexão quando comparados à extensão do tronco (p<0,01). O objetivo do terceiro estudo foi descrever os tipos de preensão empregados durante atividades de manuseio de cargas de 5 e 10Kgf entre superfícies de alturas diferentes e, quantificar os movimentos de flexão/extensão, desvio radial e ulnar do punho registrados por meio da eletrogoniômetria. Participaram 10 voluntários do sexo masculino que manusearam uma caixa entre superfícies de diferentes alturas. A atividade foi filmada para identificar os tipos de preensão empregados durante a tarefa. Uma análise de univariância foi utilizada para avaliar diferenças significativas entre a antropometria das mãos dos voluntários, e entre os movimentos utilizados para o manuseio de cargas para diferentes alturas. Os resultados mostraram que as alturas das superfícies para as quais as cargas eram manuseadas influenciaram significativamente (p=0,000) as amplitudes articulares, contudo não houve diferença significativa nos movimentos para as diferentes massas das cargas manuseadas (p=0,43). O gasto tempo acima das faixas de amplitude consideradas recomendáveis foi expressivo para os movimentos de desvio radial quando os manuseios envolviam superfícies altas. O quarto estudo objetivou avaliar os movimentos antero-posteriores do tronco e o tempo gasto na realização da tarefa, por indivíduos experientes e inexperientes, durante atividade de carregamento de cargas para diferentes superfícies alvo. Participaram do estudo 36 homens saudáveis, sendo 16 experientes e 20 inexperientes na realização da atividade de manuseio de carga. A atividade consistiu no transporte de caixa com massa de 7 e 15kg, partindo de uma superfície com altura fixa e depositavam a caixa em uma outra superfície de altura variável. Os movimentos da coluna tóraco-lombar foram registrados com um eletrogoniômetro flexível. Foram encontradas diferenças significativas no tempo gasto para realizar os manuseios entre grupos (p<0,008) e entre cargas (p<0,000). Contudo não houve diferença significativa (p>0,05). As alturas das superfícies para as quais a caixa era deslocada influenciaram significativamente os movimentos do tronco (p<0,000).

Made available in DSpace on 2016-06-02T20:19:10Z (GMT). No. of bitstreams: 1 2263.pdf: 1056918 bytes, checksum: 74315a2bbe3c4b6607e0af700be2d6d1 (MD5) Previous issue date: 2009-02-19 / Financiadora de Estudos e Projetos / Despite the intense mechanization that has taken place over recent years, manual material handling still takes place in most occupational environments. Gripping loads have been related with musculoskeletal disorders, but few studies evaluating upper-limb movements by means of direct measurements in occupational environments are available in the literature. The aim of the present study was to describe the types of grip adopted during handling boxes at different heights on industrial pallets, and to record the wrist, forearm and elbow movements. Electrogoniometry was used to record the movements of seven experienced workers during a real activity in an occupational environment. Most of the workers positioned their hands on the load asymmetrically, and the box handles were not used. Large elbow movements and extreme amplitudes of wrist extension and radial deviation were observed according to the different types of grip. The Kruskal-Wallis and post-hoc Dunn tests indicated significant differences in the range of motion for the different heights of the handling task. In order to decrease the load on the upper limbs during manual material handling activities, new box designs associated with worker training, need to be investigated in future studies. / Apesar da intensa mecanização ocorrida nos últimos anos, o manuseio de materiais ainda ocorre na maioria dos ambientes ocupacionais. Os movimentos de preensão têm sido relacionados com lesões musculoesqueléticas, no entanto, poucas pesquisas avaliando movimentos dos membros superiores por meio de medidas diretas em ambientes ocupacionais estão disponíveis na literatura. O objetivo do presente estudo foi descrever os tipos de preensão adotados durante o manuseio de caixas em diferentes alturas em paletes industriais, e registrar os movimentos do punho, antebraço e cotovelo. Sete trabalhadores experientes tiveram seus movimentos registrados por meio do eletrogoniômetro durante atividade real em ambiente ocupacional. A maioria dos trabalhadores posicionou as mãos na carga de forma assimétrica, sendo que as alças da caixa não foram utilizadas. Movimentos amplos do cotovelo e amplitudes extremas de extensão e desvio radial do punho foram observados nos diferentes tipos de preensões adotadas. Os testes de Kruskal-Wallis e post hoc de Dunn apontaram diferenças significativas nas amplitudes de movimento para as diferentes alturas de manuseio. Novos designs de caixas associados ao treinamento dos trabalhadores devem merecer atenção de estudos futuros como forma de diminuir a sobrecarga nos membros superiores durante manuseios.

Made available in DSpace on 2016-06-02T20:19:19Z (GMT). No. of bitstreams: 1 4746.pdf: 1426086 bytes, checksum: f41b8c37c91b06ab62579658c926ad62 (MD5) Previous issue date: 2012-11-20 / Universidade Federal de Sao Carlos / With the rapid development of civil aviation in Brazil there was a large number of subjects involved in the aircraft maintenance work. Much of workers develop tasks involving manual material handling (MMH), which already have evidenced musculoskeletal risks. However, workers from the aircraft maintenance industry suffer huge pressure due the safety issues and the quality of the work that is performed. There were no studies in the literature that addressed the risk factors present in this sector. Thus, the aim of Study 1 was to evaluate the psychosocial indicators, as well as reports of musculoskeletal symptoms and disorders among workers iof the aircraft maintenance industry. One hundred and one employees were assessed using the Nordic Musculoskeletal Questionnaire, a standardized physical examination, the Job Content Questionnaire and the Utrecht Work Engagement Scale. The results indicate that the workers are exposed to good psychosocial conditions, which have neither prevented the emergence of musculoskeletal disorders, nor the self reported pain and functional disability, particularly associated with the lower back. As the MMH was the main activity performed by the aircraft maintenance workers assessed, musculoskeletal disorders seem to be associated with the biomechanical characteristics of this activity. Despite the risks already identified, the literature suggests some strategies for reducing the physical load imposed to the musculoskeletal system during MMH. These strategies such as the implementation of handles on boxes, ensuring better coupling object/hands during handling. However, the recommendations of adaptations in boxes are not conclusive regarding handle placement, and their impact on workers' musculoskeletal conditions. Thus, the Study 2 was conducted based on a systematic literature review. The aim was to synthesize evidence regarding the effect of adjustment on boxes, aiming at reduction of musculoskeletal load. A survey was conducted in the following databases: Embase, Pubmed / Medline, Web of Science, and Lilacs Bireme CINAHAL, Sportdiscuss, Cochrane. Two reviewers independently selected the relevant studies, and any disagreements were solved by consensus. Cross-sectional studies were included. The scale proposed by Ariens (2000) was used to assess the quality of the studies included in this review. The electronic search yielded a total of 1170 references published in English. At the end of the selection process, and after manual search of references, the selection included 15 cross-sectional studies. Due to do the great methodological variability, regarding both methods and the proposed adaptations (size and mass of boxes), associated with the low quality of the studies prevented the synthesis of evidence. There is a need of using objective and subjective methods to evaluate standardized boxes with handles, which can also be applied to the assessment of other ergonomic interventions. Furthermore, the handles should be investigated using various positions and inclinations, and the MMH has to be carried out to different heights, in order to provide more conclusive evidence to support the implementation of those adaptations in the occupational practice. Experienced subjects have also to be considered in future studies. / Com o desenvolvimento acelerado da aviação civil no Brasil observou-se um elevado número de sujeitos envolvidos com o trabalho de manutenção de aeronaves. Grande parte dos trabalhadores desenvolvem tarefas que envolvem a realização do manuseio de cargas, o qual já tem grandes evidências de riscos musculoesqueléticos. No entanto, o setor de manutenção de aeronaves sofre grandes pressões com a segurança e com a qualidade do trabalho realizado. Não foram encontrados na literatura estudos que abordassem os fatores de risco presentes neste setor. Dessa forma, o Estudo 1 teve como objetivo avaliar os indicadores psicossociais, assim como os relatos de sintomas musculoesqueléticos entre trabalhadores do setor de manutenção de aeronaves. Cento e um funcionários foram avaliados por meio do Questionário Nórdico de Sintomas Osteomusculares, por uma avaliação física padronizada e pelas Escala de Estresse e Trabalho e a Escala de Bem Estar e Trabalho. Os resultados indicam que trabalhadores da indústria de manutenção de aeronaves envolvidos com tarefas de manuseio de materiais são expostos a boas condições psicossociais, o que não impediu o surgimento de distúrbios musculoesqueléticos, nem o alto índice de relato de dor e incapacidade funcional, particularmente associado com a parte inferior da coluna. Como o manuseio de materiais foi a principal atividade realizada no setor de manutenção de aeronaves avaliado, os distúrbios musculoesqueléticos encontrados foram associados às características biomecânicas desta atividade. Apesar dos riscos já identificados, a literatura aponta algumas estratégias para redução da carga física imposta ao sistema musculoesquelético durante o manuseio de cargas. Tratam-se de estratégias nos instrumentos de trabalho, como a implementação de pegas em caixas, garantindo melhor acoplamento objeto/mãos durante o manuseio. No entanto, as adaptações em caixas não são conclusivas em relação às recomendações de posicionamento e sua repercussão nas condições musculoesqueléticas dos trabalhadores. Desta forma, foi realizado o Estudo 2 desta dissertação a partir de uma revisão sistemática da literatura. O objetivo foi sintetizar evidências em relação ao efeito da adaptação de caixas na redução da carga musculoesquelética. Foi realizada pesquisa nas seguintes bases de dados: dados Embase, Pubmed/Medline, Web of Science, Bireme e Lilacs CINAHAL, Sportdiscuss, Cochrane. Dois revisores independentes selecionaram os estudos pertinentes, e as eventuais discordâncias foram solucionadas por consenso. Foram incluídos estudos tranversais. A escala proposta por Ariens (2000) foi utilizada para avaliação da qualidade dos estudos incluídos nesta revisão. A busca eletrônica resultou em um total de 1170 referências publicadas em inglês. Ao final do processo de seleção e da busca manual das referências dos artigos inicialmente incluídos na revisão, totalizou-se a seleção de 15 estudos transversais. A grande variabilidade metodológica, tanto em termos de avaliação como em relação às formas de adaptação de pegas propostas, tamanho e massa das caixas, associadas à baixa qualidade dos estudos incluídos, inviabilizou o agrupamento dos estudos para síntese de evidência. Observa-se a necessidade da utilização conjunta de metodologias objetivas e subjetivas padronizadas na avaliação de caixas adaptadas com pegas, o que pode ser estendido para outros tipos de intervenções ergonômicas. Além disso, as caixas adaptadas precisam ser investigadas a partir de diferentes posicionamentos e inclinações das pegas, a serem manuseadas em diferentes alturas, para fornecer evidências mais definitivas para a implementação na prática ocupacional. A questão da experiência dos sujeitos avaliados também deve ser considerada em estudos futuros.

INTRODUÇÃO: Os trabalhadores dos Serviços de Nutrição Hospitalar são submetidos às exigências físicas, cognitivas e psíquicas que levam à distúrbios osteomusculares relacionados ao trabalho. O objetivo deste estudo foi implantar ações de melhorias nas situações de trabalho de um serviço de nutrição hospitalar e avaliar a percepção dos trabalhadores e as repercussões sobre os sintomas osteomusculares. MÉTODO: Esta pesquisa foi desenvolvida em um hospital público especializado em cardiologia, localizado em São Paulo, Brasil, após aprovação pelo comitê de ética da instituição. A coleta de dados foi realizada por meio da aplicação de questionários e análise ergonômica do trabalho. Os questionários continham dados sócio-demográficos, história ocupacional, situação de trabalho atual, sintomas osteomusculares e satisfação no trabalho. Do total de 130 trabalhadores, 115 participaram voluntariamente. A análise ergonômica do trabalho foi efetuada de acordo com Guérin et al (2001), sendo realizadas entrevistas, medições do ambiente da cozinha e análises biomecânicas. A partir dos resultados foram implantadas ações de intervenção baseadas na ergonomia participativa durante um ano. Após esta fase, 89 (77%) trabalhadores responderam novamente ao questionário, sendo incluídas perguntas sobre a percepção das modificações. A análise dos dados incluiu testes estatísticos para verificar se houve mudança da prevalência de sintomas antes e após as intervenções, com nível de significância de 5%, por meio dos Programas SPSS 13.0 e Excel 2003. Além disso, foram analisados os dados de percepção dos trabalhadores e dos especialistas em ergonomia sobre o impacto das melhorias na saúde e no processo de trabalho. RESULTADOS: A população constitui-se, em sua maioria, por mulheres, na faixa etária de 25 a 34 anos, com grau médio de escolaridade, casadas, com filhos, e ocupavam o cargo de atendente de nutrição. A maioria trabalhava de 5 a 10 anos no hospital e em jornada de trabalho de 40 horas semanais. Os principais problemas observados foram espaço físico reduzido, equipamentos e materiais de trabalho inadequados, absenteísmo e déficit de pessoal, volume excessivo de trabalho com elevado esforço mental, alta prevalência de sintomas osteomusculares, principalmente nos membros inferiores e ombros. Após as intervenções realizadas, houve melhoria na situação de trabalho com redução nos sintomas osteomusculares e os trabalhadores perceberam as seguintes mudanças nas situações de trabalho: melhoria na iluminação e no controle do ar condicionado, aquisição de batedeira de tamanho médio, conserto de equipamentos, substituição dos pratos de vidro por descartáveis, aquisição de cadeiras, introdução de pausas durante a jornada de trabalho, ginástica laboral e treinamento em liderança para as chefias. Neste período houve ampliação no número de leitos do hospital com conseqüente aumento no volume de trabalho e diminuição da satisfação no trabalho associados à crise financeira da instituição com suspensão de contratações e da compra de materiais e equipamentos. CONCLUSÕES: As intervenções repercutiram em melhorias, principalmente quanto ao ambiente e equipamentos, e na redução dos sintomas osteomusculares nos membros inferiores, ombros, pescoço/região cervical, antebraço e região lombar, apesar desta redução não ter sido estatisticamente significativa. / INTRODUCTION: Hospital food service workers have high level of physical, cognitive and mental demands that are associated with musculoskeletal disorders. The objective of this study was to introduce improvements in the working conditions in a hospital food service and to evaluate the workers perceptions and its effects on musculoskeletal symptoms. METHOD: this study was performed in a public cardiac hospital in São Paulo, Brazil, after its approval by the Ethics Committee. The data were collected by questionnaires and ergonomic analysis of the work. The questionnaire included: socio-demographic, workhistory, work conditions, musculoskeletal symptoms and job satisfaction. A hundred and fifteen questionnaries were applied from 130 workers. The work ergonomic analysis was carried out in accordance with Guérin et al (2001), by means of interviews, observations of kitchen working conditions and biomechanical analyses. Based on the results, interventions have been undertaken by means of a participatory ergonomic approach over one year. After this, another ergonomic analysis was carried out and 89 workers (77%) answered a new questionnaire that also included questions about their perception of the improvements. Data analysis was done by statistical tests to verify symptom prevalences before and after the interventions with a 5% level of significance. SPSS 13.0 and Excel 2003 software was used. RESULTS: The workers were women in the 25-34 age-group, had secondary education, were married, had children and occupied the position of nutrition attendants. They were in this hospital for from 5 to 10 years and on a 40 hour working week schedule. Most of problems observed were reduced space, inadequate equipment and work materials, absenteeism, insufficient number of workers, great volume of work with mental demands, high prevalence of musculoskeletal symptoms mainly in lower members and shoulders. After the improvements in working conditions, the symptoms of musculoskeletal disorders reduced and the workers perceived the following changes in the work process: better lighting and control of air conditioning, acquisition of low capacity mixer, repair of equipment, use of disposable utensils instead of glass plates, acquisition of more chairs, introduction of breaks during working hours, work related gymnastics, workshops for leadership training. In this period the number of hospital beds was increased with a corresponding intensification of the work load and a decline on job satisfaction. The hospital was in a financial crisis with consequences in terms of the hiring of personnel and the acquisition of equipment and materials. CONCLUSION: Interventions brought improvements mainly as regards the work environment and equipment and in the reduction of musculoskeletal symptoms in the lower members, shoulders, neck/cervical region, forearm and lumbar region, though this reduction has not been statistically significant.

Introdução: O Código de Processo Civil determina que nos processos judiciais em que a matéria depender de conhecimento técnico ou científico, o juiz será assistido por perito, que produzirá um laudo. Foram analisados 83 laudos de processos judiciais do Tribunal Regional do Trabalho da 2ª Região (TRT-2), referentes a reclamantes com Lesões por Esforços Repetitivos ou Distúrbios Osteomusculares Relacionados ao Trabalho (LER/Dort), que abrangem afecções crônicas do sistema musculoesquelético de origem ocupacional e são decorrentes, dentre outros motivos, da execução de movimentos repetitivos por tempo prolongado e sobrecarga estática, sem que haja tempo para uma recuperação fisiológica. Deveriam abordar os vários aspectos do adoecimento para auxiliar a decisão judicial quanto à existência de agravo à saúde relacionado ao trabalho, assim como sua extensão e repercussões sobre a vida e capacidade laboral do trabalhador. Objetivos: Identificar e analisar, nos laudos, conceitos sobre adoecimento ocupacional e incapacidade laboral, bem como as principais linhas de argumentação, para a descaracterização do nexo causal nos casos em que havia nexo causal presumido pelo critério epidemiológico. Material e método: O material de estudo (83 laudos) foi buscado dentre os processos arquivados no período de 2012 a 2016 na Coordenadoria de Gestão de Arquivo do TRT-2, que abrange 30 municípios da região metropolitana de São Paulo e Baixada Santista. Atributos associados aos grandes temas da pesquisa foram codificados com o objetivo de melhor sistematização para uma análise de conteúdo. Resultados: Os laudos periciais foram elaborados, na sua quase totalidade por médicos, dentre os quais 56 (67,47%) médicos do trabalho, 13 (15,66%) médicos sem especificação de especialidade, 9 (10,84%) médicos com especialização em perícia ou legistas e 4 ortopedistas (4,82%). Um deles (1,21%) foi elaborado por fisioterapeuta. Do total de laudos, 25 (30,12%) não tinham quaisquer informações sobre o processo de adoecimento e apenas 23 (27,71%) contemplaram uma história clínica abrangente. Em 34 (40,96%) não havia qualquer informação sobre as características da atividade de trabalho e em 30 (36,15%) havia a citação de alguns aspectos biomecânicos. Apenas 19 (22,89%) apresentaram uma análise da atividade de trabalho, incluindo aspectos biomecânicos e organizacionais. Nenhum laudo continha uma análise da incapacidade para o trabalho de forma ampla, sendo que em 50 laudos (60,24%), o perito considerou apenas o diagnóstico para se pronunciar sobre a incapacidade. Do total dos laudos, apenas 13 (15,66%) utilizaram o conceito de multicausalidade e 12 (14,46%) o de concausalidade. Dos 15 laudos com nexo causal presumido pelo critério epidemiológico, descaracterizados no caráter ocupacional na perícia, nenhum continha uma análise da atividade de trabalho, embora 9 deles tenham utilizado argumentos biomecânicos, 8 tenham utilizado o argumento de que se tratava de doença degenerativa e 3 de que o quadro era de fibromialgia não ocupacional. Foram discutidos conceitos de adoecimento ocupacional, nexo causal e incapacidade, além da relação de desigualdade, presenteísmo, individualização do adoecimento e culpabilização. Conclusão: A maioria dos laudos periciais peca pela falta de consistência conceitual, metodológica e argumentos fundamentados, deixando lacunas na área clínica, na análise da atividade de trabalho e na avaliação de incapacidade. / Introduction: The Civil Code Procedure determines that in judicial proceedings in which the matter depends on technical or scientific knowledge, the judge will be assisted by experts, who will produce a forensic report. A total of 83 reports, from the Regional Labor Court of the 2nd Region (TRT-2), were analysed, concerning claimants suffering from Repetitive Strain Injury or Work-Related Musculoskeletal Disorders (RSI/WRMD), which include occupational chronic conditions of the musculoskeletal system, that are due, among other reason to the execution of repetitive movements for a prolonged time and static overload without pause foa a physiological recoevery. They should address the various aspects of illness in order to assist the judge in his decision regarding the existence of as aggravated health related to work, as well as its extent and repercussions on the life and work capacity of the worker. Objectives: To identify and analyse concepts about occupational illness and disability to work, expressed in the reports, as well as the main lines of argument, for the de-characterization of the causal nexus in cases where there was causal nexus presumed by the epidemiological criterion. Material and method: The study material was searched from the archived processes from 2012 to 2016 in the File Management Coordination of TRT-2, which covers 30 municipalities in the metropolitan region of São Paulo and Baixada Santista. Attributes associated with the major themes of the research were codified with the aim of better systematization for a content analysis. Results: The expert reports were elaborated almost entirely by physicians, among them 56 (67.47%) occupational physicians, 13 (15.66%) doctors without a declared specialty, 9 (10.84%), forensic doctors, 4 orthopedists (4,82%). One of the reports (1.21%) was elaborated by a physiotherapist. Of the total reports, 25 (30.12%) did not have information about the illness process and only 23 (27.71%) contemplated a comprehensive medical history. In 34 (40.96%) there was no information about the characteristics of the work activity and in 30 (36.15%) there were citation of some biomechanical aspects. Only 19 (22.89%) presented an analysis of the work activity, including biomechanical and organizational aspects. No report contained an embrancing analysis of disability to work comprehensively, and in 60.24% of them, the expert considered only the diagnosis to pronounce on the disability. Of the total reports, only 13 (15.66%) used the concept of multicausality and 12 (14.46%) the concept of concausality. Of the 15 reports with a presumed causal nexus by the epidemiological criterion, which were not characterized in the occupational character, none contained an analysis of the work activity, although 9 of the 15 reports used biomechanical arguments to de-characterize the occupational character, 8 used the argument that it was degenerative disease and 3 that the condition was non-occupational fibromyalgia. Concepts of occupational illness, causal nexus and disability were discussed, as well as the relationship of inequality, presenteism, individualization of illness and blame. Conclusions: Most of the expert reports are lacking in conceptual, methodological and reasoned arguments, leaving relevant gaps in the clinical area, in the analysis of the work activities and in the assessment of disability.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic and Somatology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa. 2017. / Background The growing popularity and competitive nature of the beauty industry has resulted in beauty therapists performing an extensive range of treatments to meet the demand, often at the jeopardy of their own well-being. Treatments include massage, waxing, pedicures and facials. These techniques involve vigorous and repetitive movements that may lead to overuse and strain on the musculoskeletal system, resulting in injury. Work-related activities together with factors such as socio-demographic, psychosocial, environmental and anthropometric can influence the prevalence of work-related musculoskeletal disorders (WRMDs). There has been little investigation into the WRMDs of beauty therapists both locally and internationally. Aim The aim of this study was to determine the prevalence, selected risk factors and impact of self-reported work related musculoskeletal disorders (WRMDs) in beauty therapists working within the hotel spa industry in the eThekwini municipality. Method A cross sectional epidemiological design was used to survey 254 beauty therapists working in the hotel spa industry in the eThekwini municipality of Durban. A pre-validated questionnaire was hand delivered to beauty therapists working at all hotel spas that agreed to participate. Informed consent was obtained. The survey contained questions related to musculoskeletal pain, socio-demographic, psycho-social, lifestyle and occupational factors. Results A response rate of 70% was obtained (n=178). The majority of the respondents were female (94.3%; n=165), the mean age of the respondents was 27.74 (SD±4.83) years. The respondents had been working as beauty therapists for an average of 5.91 (SD±4.19; n=176) years and performed on average 27.89 (SD±13.33; n=170) treatments per week, working 47.38 (SD±13.36; n=175) hours per week. Those working overtime worked on average 5.43 (SD±2.94; n=59) hours of overtime per week. There was a high rate of reported WRMDs with the lifetime, current and 12 month period prevalence being 86% (n=153), 85% (n=151) and 83% (n=148), respectively. The area most affected were the low back followed by the neck, the hand and wrist. Ninety percent of the respondents indicated that their pain was mild to moderate in nature, with half expressing an inability to cope with the pain, and 78% reporting that it interfered with their ability to work. Mental exhaustion (p=0.032), suffering from a concomitant co-morbidity (p=0.031), years worked as a beauty therapist (p˂0.001) and treating clients after hours (p=0.007) were significantly associated with the presence of musculoskeletal pain. Performing manual massage (p=0.043) and reporting feelings of exhaustion whilst performing specialised massage techniques (p=0.014) and applying makeup/eyelashes (p=0.022) were associated with the presence of WRMDs. Those who reported having co-worker (p=0.006) and managerial support (p˂0.001) were less likely to experience musculoskeletal pain. In contrast, feeling frustrated by work (p=0.007), being under pressure (p=0.005) and over worked (p=0.009) increased the chances of experiencing WRMDs. Working with the back in an awkward position (p˂0.001), standing for prolonged periods (p˂0.001), lifting heavy loads (p=0.019) and working in a hot and humid environment (p<0.001) increased the risk of WRMDs. Conclusion WRMDs have a significant impact on beauty therapists’ ability to work. Effective strategies to prevent and manage WRMDs in hotel spa beauty therapists is required, along with governmental regulation. / M

INTERNET-BASED BEHAVIOR OF IT PROFESSIONALS: IMPLICATIONS FOR ONLINE ERGONOMIC EDUCATION TO PREVENT WORK-RELATED MUSCULOSKELETAL DISORDERS By Priyadarshini Pattath, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2017 Director: Dr. Robin Hurst, Assistant Professor of Adult Learning, Teaching and Learning, School of Education The purpose of this study was to explore the preferences of medium of ergonomic education and views about self-directed online training modules to prevent musculoskeletal disorders in computer professionals and understand their perspectives and experiences about online health information seeking using a self-directed learning framework. To accomplish this, a qualitative research design was used to analyze data from interviews and observation. An exploratory case study research design was employed to examine the experiences of fifteen information technology professionals. The findings revealed that the preference for the mode of delivery of ergonomic education depends on the individual attitude and on the perceived attributes of the particular mode of delivery. The findings highlighted the role of the Internet in making significant lifestyle and contextual modifications. Finally, the findings highlighted the barriers that were faced when seeking health information on the Internet. The findings of this study were limited by the nature of the research and sample size. Additional research is needed to support the findings. Implications for research and practice are discussed.

Cette thèse propose de faire le point sur les indicateurs disponibles pour la surveillance épidémiologique des lombalgies liées au travail, notamment les données de réparation de maladies professionnelles (MP) et les données issues du réseau pilote de surveillance des troubles musculo-squelettiques des Pays de la Loire.La part de hernie discale opérée (utilisée comme traceur de lombalgie) attribuable à l’activité professionnelle était particulièrement élevée pour les ouvriers des deux sexes et les employées femmes. La lombalgie est un phénomène complexe et ne peut être surveillée grâce à un indicateur unique. Les données de MP, malgré leurs limites, donnent des résultats comparables aux autres sources de données et présentent l’avantage de ne nécessiter aucun recueil spécifique. Les données de cohortes, basées sur un questionnaire standardisé, sont nécessaires pour permettre des comparaisons internationales. Enfin, les données chirurgicales issues des bases de données des hôpitaux et cliniques, fournissent l’information la plus fine, si elles sont complétées de données professionnelles. Il s’agit cependant d’un indicateur mixte de morbidité et de soins. Les fortes disparités territoriales qu’il révèle au sein d’une région incitent à la mise en place de programmes de prévention différenciés.En complément de ces trois indicateurs, il serait intéressant d’ajouter un indicateur d’invalidité ou d’incapacité dans le système de surveillance pour mieux cibler les actions de prévention en fonction du risque de désinsertion professionnelle, dimension importante en termes d’impact social pour les individus et de coût pour la société. / This thesis proposes to review the available indicators for the epidemiological surveillance of work-related low back pain, including compensation data of occupational diseases and data from the pilot surveillance system for musculoskeletal disorders in the Pays de la Loire region.The proportion of cases of lumbar disc surgery (used as sentinel event of low back pain) attributable to occupational activity was particularly high among blue-collar workers of both genders and lower-grade female white-collar workers. Low back pain is a complex phenomenon and cannot be monitored using a single indicator. Compensation data, despite their limitations, give results comparable to other data sources and don’t require specific gathering. Cohorts’ data, based on a standardized questionnaire, are necessary for international comparisons. Finally, surgical data from private and public hospitals databases provide the finest information, if they are completed with occupational data. However, this is a mixed indicator of morbidity and care. It shows large local disparities in a region, encouraging the development of differentiated prevention programs.In addition to these three indicators, it would be interesting to add a disability or incapacity indicator in the surveillance system to better target prevention programs according to occupational exclusion which is an important dimension in terms of social impact for people and cost for the society.

Musculoskeletal disorders, specifically low back pain, has been well documented andreported by astronauts throughout the space exploration era. Statistics from astronautmemoirs states that 52-68% of astronauts experience moderate to severe lower backpain after prolonged spaceflights. The main cause is atrophy in the paraspinal musclesof the lumbar region. No sufficient countermeasure exists in-flight currently and therehabilitation programs remain ineffective. This thesis presents the first attempt to designand develop a prototype robotic exoskeleton, actuated by pneumatic artificial muscles, asan active countermeasure in-flight where it will be utilised as an equipment for muscularhypertrophy and a supporting device for rehabilitation programs on Earth. It will bemanufactured by additive manufacturing methods for adaptability while remaining lowin weight.A thorough analysis of the spine and lumbar region as a biomechanical system wasmade. Appropriate assumptions was made to simplify the understanding of the complexsystem that is the human spine. The targeted muscles were: multifidus, erector spinaeiliocostalis and erector spinae longissimus. A force analysis of the human torso bendingin the sagittal plane was made, finding that the torques of the torso reaches 244 Nm.The complete exoskeleton design is presented with the parts that will be 3D-printed andthe working principle of the system. Thereafter an extensive model of the exoskeletonis established using Denavit-Hartenberg representation of manipulators as a serial linksystem. The model provides a fundamental understanding of exoskeleton and enablesthe possibility to simulate it accurately. The evaluation protocol for the validation testsis then presented. Active pressure will be tested at 0, 3 and 6 bar and loads of 5 and 11kg will be lifted.Subsequently the assembly, with all the hardware and software selected for the prototypeis demonstrated. Thereafter the results of the evaluation tests are presented followed bya discussion of the results; anomalies, faults and challenges are subjects discussed. Thediscussion concludes that the exoskeleton shows potential for both supporting the motionin a rehabilitation use and enabling muscular hypertrophy in the lumbar region for theresistive tests. Although an extensive heavy-duty evaluation needs to be performed totruly validate the exoskeleton.

La industria de confección textil tiene gran relevancia, particularmente en los países en desarrollo como Perú, ya que ocupa el segundo lugar con respecto al sector que más aporta al PBI en el ámbito manufacturero. En el 2019 los problemas del sector textil representaron el 19% del sector manufacturero, de los cuales el 25.4 % eran problemas de trastornos musculo esqueléticos (TME), esto debido a las malas prácticas y un inadecuado diseño de estaciones de trabajo. La importancia de trabajar en un adecuado ambiente laboral está relacionada directamente a la prevención de Desórdenes Músculo Esqueléticos (DME) y a las Ausencias Laborales. En varios estudios se señala la importancia de un adecuado diseño, así como el correcto uso de metodologías ergonómicas, para poder evaluarlos y validarlos; sin embargo, estos se enfocan en la validación de la metodología y no del proceso que abarca desde la formulación de propuestas hasta la validación de estas. Es por ello, que el presente estudio está enfocado en un modelo de rediseño de estación de trabajo que abarca desde las propuestas de diseño hasta la validación del mismo; utilizando técnicas ergonómicas observacionales como REBA, RULA, NIOSH y SNOOK Y CIRIELLO, y herramientas de ingeniería como Sistema de Manipulación de Materiales (SMM), Estudio de Métodos, Técnica de Interrogatorio Sistemático (TIS) y Economía de Movimientos. Como resultados se obtuvieron un 51.68 % de reducción de los TME en los puestos de trabajo de Tendido, Remalle y en el proceso de Abastecimiento de Rollo; asimismo, una reducción de 364 horas de ausentismo y un ahorro de 6,000 soles por año aproximadamente. / The textile industry is highly relevant, particularly in developing countries such as Peru, as it ranks second place with respect to the sector that contributes the most to GDP in the manufacturing field. In 2019, textile sector problems represented 19% of the manufacturing sector, of which 25.4% were problems of Musculoskeletal Disorders (MSD), this due to bad practices and an inadequate design of workstations. The importance of working in a suitable work environment is directly related to the prevention of Musculoskeletal Disorders (MSD) and Work Absences. Several studies point out the importance of an adequate design, as well as the correct use of ergonomic methodologies, to be able to evaluate and validate them; however, these focus on the validation of the methodology and not on the process that ranges from formulating proposals to validating it. For this reason, this study focuses on a model of redesign of the workstation that ranges from design proposals to validation of the same; using observational ergonomic techniques such as REBA, RULA, NIOSH and SNOOK AND CIRIELLO, and engineering tools such as Materials Handling System (MHS), Method Study, Systematic Interrogation Technique (SIT) and Movement Economics. As a result, a 51.68% reduction of the MSD was obtained in the jobs of “Tendido”, “Remalle” and in the process of “Abastecimiento de Rollo”; likewise, a reduction of 364 hours of absenteeism and a saving of 6,000 soles per year approximately. / Trabajo de Suficiencia Profesional