O atual Curr(culo M(nimo do Curso de Especialização para Enfermeiros do Trabalho - CEET, está em vigor desde 1978, sendo seu conteúdo estabelecido pela Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho - FUNDACENTRO. Desde essa época o currículo não foi alterado e se acumulam nos CEETs as insatisfações e preocupações quanto a real adequação da formação às necessidades da prática profissional e da assistência à saúde dos trabalhadores. Diante disso, decidiu-se desenvolver uma pesquisa com a finalidade de avaliar o currículo vigente e de propor alterações curriculares. Esta pesquisa foi realizada entre as categorias diretamente envolvidas no ensino e na assistência de enfermagem do trabalho, a saber: coordenadores, professores e alunos de tris CEETs do Brasil, e enfermeiros do trabalho do Estado de São Paulo no ano de 1984. Os objetivos desta pesquisa foram: - verificar o ajuizamento e sugestões das categorias supra referidas, sobre o CEET, tomando por base o Currículo Mínimo estabelecido pela FUNDACENTRO para esse Curso, avaliando-o nos aspectos relativos a: filosofia e objetivos, organização curricular, processo ensino-aprendizagem e organização administrativa; - elaborar uma proposta de reestruturação curricular para o CEET, com base na análise crítica dos dados coletados. A coleta de dados se desenvolveu por meio de questionários, onde os participantes expressaram o ajuizamento e sugestões de modificações do currículo em questão. A análise crítica desses dados foi fundamentada em experiências curriculares que estão sendo desenvolvidas em outros países, e na experiência pessoal da autora no desenvolvimento de currículos para diferentes níveis de ensino de enfermagem. Os resultados obtidos demonstraram que inexistem no currículo do CEET, a adoção explícita de uma linha filosófica norteadora, e a definição de objetivos para o Curso, sendo tais aspectos considerados necessários por todas as categorias pesquisadas. No que diz respeito a organizaçio curricular, ficou evidenciada a inadequaçio do elenco de disciplinas que compõem o currículo. A carga horária foi considerada insuficiente, e mal distribuída em termos teórico-práticos. O conteúdo curricular foi considerado repetitivo em algumas disciplinas e com falhas em outras; o estágio prático previsto, apresentou-se qualitativa e quantitativamente insuficiente. Foram propostas pelos participantes, diversas alterações nessa organizaçio curricular. Com relação ao processo ensino-aprendizagem, ficou demonstrado que: não existe qualquer definição do modo de condução desse processo nos cursos pesquisados: os métodos de ensino e avaliação adotados nem sempre facilitaram ou avaliaram totalmente a aprendizagem dos alunos; os enfermeiros de campo julgaram que os cursos frequentados supriram parcialmente as necessidades requeridas na prática profissional, sendo que muitos consideraram insuficiente o ensino prático que tiveram em seus cursos. Quanto à organização administrativa dos CEETs, sentiu-se necessidade de se estabelecer requisitos prévios para matrícula dos alunos; a maioria dos pesquisados aponta o profissional enfermeiro do trabalho como aquele que deve assumir a coordenação do CEET, devendo ele ter experiência na área de administração de ensino e prática de campo na área de enfermagem do trabalho. Frente a estes resultados, sentiu-se então necessidade de uma ampla e profunda reestruturação curricular, sendo elaborada uma nova proposta curricular para o CEET. Essa proposta foi sub-dividida em: marco conceitual, onde foram definidas as linhas norteadoras do currículo; marco metodológico, em que se assentaram as diretrizes condutoras do processo ensino-aprendizagem; marco estrutural, onde foram estabelecidas as áreas de ensino, bem como o elenco e o conteúdo das disciplinas e a distribuição horária teórico-prática. Antes da implantação desta proposta curricular, ela deverá ser validada pelas categorias diretamente envolvidas no ensino e na assistência de enfermagem do trabalho, e ao mesmo tempo, os professores e coordenadores dos CEETs deverão ter acesso a cursos específicos que os capacitem a conduzir o trabalho dentro da nova filosofia curricular. / In 1978 a curriculum for the Specialization Course on Occupational Health for Nurses was established by FUNDACENTRO - Fundaço Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho and has not been changed since then. Throughout the years, it became clear that the present curriculum does not cover adequately all aspects of protection of worker\'s health and, therefore, it was thought advisable to carry out a research aimimg the evaluation of the present curriculuru and its eventual changes. To carry out such research, a questionnaire was answered by all categories of people directly involved with the ministration of such courses: coordinators, teachers and students of three Brazil ian CEET; besides, occupational health nurses of the state of São Paulo also answered a questionnaire. The main objectives of this studw were to verify how the present curriculum was judged by the people involved from the point of view of its: philosophy and objectives; curricular organization; teaching-learning process and administrative organization. The final objective was to propose a curricular restructuration of the courses based on the critical analysis of the points above outlined. Data collection was dane through the use of special questionnaires, different for each group of people, who expressed their opinion on the present curriculum and presented suggestions as to its modification. On the basis of similar courses existing in developed countries, and also on the basis of the author´s experience, an analysis was carried out and it was possible to demonstrated that presently inexists either a philosophic guideline or a definition of objectives, these two points being considerer as essential by all categories of people who participated of this study. Concerning the curricular organization, it became evident the inadequacy of the curricular contents of each discipline which composes the whole curriculum. The number of hours of teaching was considered as insufficient and not well distributed among theoretical and practical teaching. The curricular content was considered repetitive in some disciplines and insufficient in others. In the whole, it was considered that the curriculum is not adequate both in quantity and in quality and several changes were proposed. As to the teaching-learning process, it was evident that there is no definition regarding the way of conducting it. The adopted teaching techniques and methods of evaluation of the students\' learning results, were not considered as satisfactory. The already practicing occupational health nurses informed that the courses attended have only partially supplied the needed knowledge needed for professional practice and many others considered as insufficient the practical learning they had in their courses. Concerning the administrative organization of the courses, it was considered as very important to establish previous requirements for the selection of students. The majority of the people consulted considered that the courses\' coordinators must be occupational health nurses having a good experience in the field of teaching administration and also a very good practice in the occupational health nursing field. Due to these results, it was felt that there is an urgent need of a wide and deep curricular re-structuration and, a new curriculum for the courses is proposed. The proposed curriculum was sub-divided in conceptual framework, in which the curriculum guidelines were defined; methodological framework, in which were founded the directives te conduct the teaching-learning process; structural framework, where were established the areas of teaching, as well as the set and content of disciplines, and the theoretical-practical classes distribution. Before this curricular proposal is implemented, it shall be validated by the categories directly involved with occupational health nursing teaching and assistance, and, at the same time, the teachers and coordinators of the CEET\'s shall have access to specific courses with capacitale them to conduct the work within the new curricular philosophy.

Student Number : 0110574V - MPh research report - School of Public Health - Faculty of Health Sciences / Pesticide poisoning poses a health risk to individuals throughout the world although the reported global and local risk are not consistent in the literature. Mpumalanga Province has areas of epidemic malaria. Spray teams, applying local insecticides to indoor surfaces operate just prior to the rainy season (October to May) to control malaria. The purpose of this cross sectional study was to compare prescribed safe handling and application practices of Mpumalanga malaria spray operators mixing and applying insecticides versus actual practices in the field. All members of the spray operating teams were included in the study. A tick list and questionnaire was utilized to observe field practices and enquire about reasons for non-compliance. Only 28% of all operators complied with prescribed safety practices and differences in compliance between mixing (38%) and application (36%) were marginal. Gloves, face shields and dust masks were not utilized as recommended and contributed to the highest levels of non-compliance. Compliance was found to be dependent on gender, age, years of experience, education level and employment status. The low compliance rate necessitates further investigation of the malaria programme occupational safety management system. All stakeholders need to be aware of the consequences of pesticide poisoning and collaborate in efforts to work towards prevention rather than cure.

Low back problems are among the most common nonfatal occupational injuries reported in the United States, and account for substantial healthcare expenditures (e.g., medical care costs) and losses to worker productivity. A strong association has been well-documented between occupational exposure to repetitive trunk motion and low back problems, particularly among workers performing manual material handling (i.e., lifting) activities. A feature of repetitive motion believed important to the development of work-related musculoskeletal disorders (MSDs), including low back problems, is a lack of within-individual, between-cycle variation of physical exposure summary measures, e.g., when observed visually, the cycle-to-cycle motion pattern appears consistent. An active literature has emerged using concepts of motor control to improve ergonomists’ understanding of physical exposure variation (i.e., motor variability) arising from individual-level mechanisms during repetitive work. Fundamentally, for any particular individual, the onset of exposure to a repetitive physical activity (i.e., task training) involves a learning process during which motor control strategies are developed to accomplish the task effectively. The cycle-to-cycle variability of motor learning metrics, such as postural and task performance summary measures, has been observed to exponentially decay during task training. From an ergonomics perspective, a temporal reduction in postural variability may lead to greater cumulative loading and physiological fatiguing of the underlying muscle tissues (due to more consistent cycle-to-cycle movements), thus increasing MSD risk over time. However, it is not known if, or to what extent, physical task characteristics (e.g., work pace) modify the temporal behavior of motor variability during training of a repetitive occupational activity. Moreover, the relationships between motor variability, task performance, and muscle fatigue during occupational task training are not well understood. The goal of this dissertation was to present new information concerning occupationally relevant metrics of motor learning during training of a laboratory-simulated, repetitive lifting activity. In this study, participants performed 100 repetitions (i.e., cycles) of the lifting task in each of four experimental sessions (i.e., visits) at different combinations of box load (low or high) and work pace (slow or fast). Three main observations were discussed in this dissertation: (i) participants exhibited a greater temporal reduction in the cycle-to-cycle variability of trunk postural summary measures during training of a heavier-weighted and faster-paced lifting activity (Chapter 3), which may have facilitated increases in the efficiency and repeatability of box movements (Chapter 4), (ii) the cycle-to-cycle variability of the erector spinae (back) muscle activity summary measures increased, but the variability of the multifidus muscle activity summary measures decreased, over time during faster-paced lifting (Chapter 3), and (iii) a greater temporal increase in trunk postural variability (i.e., a more “flexible” trunk movement strategy) was generally associated with lesser electromyographic back muscle fatigue during training of the lifting task (Chapter 5). Collectively, these research findings may open pathways to the development of new task design criteria and ergonomic guidelines to promote motor variability in the workplace and, ultimately, improve workers’ musculoskeletal health.

Occupational asthma affects a variety of industry sectors, including agricultural and manufacturing. Currently, asthma pharmaceuticals are delivered via an inhaler and deposited in the respiratory system. The effectiveness of the medication depends partially on where the particle deposits in the lung. The specific aims of this research were to (1) develop a system to measure hygroscopic particle growth under different environmental conditions; (2) determine the accuracy of a hygroscopic growth model during the growth phase of salt particles; and (3) determine whether the large-diameter particles of an aerosol, those that will most likely deposit in the upper airways, can be separated from the smaller particles. Aim 1: A system was developed that satisfied the design criteria to measure particle growth within fractions of a second. The particles growth was measured every 0.03 seconds and had a relative humidity that only varied by a maximum of 1.3% over a 30 second trial. Aim 2: The next step in the research was to determine how well the model compares to reality in the initial growth phase. The model that included the initial growth rate as a saturated solution had a lower root mean square of error (RMSE) than the model that did not include a maximum saturation value. The maximum reduction in RMSE was 0.254. Aim 3: The analysis of a virtual impactor was conducted to see if aerosolized particles can be size separated at a cut point of 2.5 μm. The virtual impactor was designed to have small particles exit the device in one airflow and the large particles exit in a different airflow. Multiple trials were conducted however, there were only two trials that had any size separation between the two exiting flows. From these results, it was determined that large-diameter particles cannot be separated from smaller particles while remaining aerosolized. The cut-point was 2.3 μm, the small particles were split at 50% through both flows, and the flow that was supposed to contain 100% of all of the large particles only contained a maximum of 70%.

Tractors and other self-propelled farm equipment, such as combines, sprayers, and towed grain carts, are often used on public roadways as the primary means for traveling from homestead to homestead or from homestead to a distributer. Increased roadway exposure has led to a growing concern for crashes involving farm equipment on the public roadway. A handful of studies exist examining public roadway crashes involving farm equipment using crash data, but none thus far have evaluated road segment data to identify road-specific risk factors. The objective of this study is to identify if roadway characteristics (traffic density, speed limit, road type, surface type, road width, and shoulder width) affect the risk of a crash involving farm equipment on Iowa public roadways. A retrospective cohort study of Iowa roads was conducted to identify the types of roads that are at an increased risk of having a farm-equipment crash on them. Crash data from the Iowa Department of Transportation (to identify crashes) were spatial linked to Iowa roadway data using Geographic Information Systems (GIS). Logistic regression was used to calculate ORs and 95% CL. Out of 319,705 road segments in Iowa, 0.4% segments (n=1,337) had a farm equipment crash from 2005-2011. The odds of having a farm equipment crash were significantly higher for road segments with increased traffic density and speed limit. Roads with an average daily traffic volume of at least 1,251 vehicles were at a 5.53 times greater odds of having a crash than roads with a daily traffic volume between 0-30 vehicles. (CI: 3.90-7.83). Roads with a posted speed limit between 50mph and 60mph were at a 4.88 times greater odds of having a crash than roads with a posted speed limit of 30mph or less. (CI: 3.85-6.20). Specific roadway characteristics such as roadway and shoulder width were also associated with the risk of a crash. For every 5 foot increase in road width, the odds for a crash decreased by 6 percent (CI: 0.89-0.99) and for every 5 foot increase in shoulder width, the odds of a crash decreased by 8 percent. (CI: 0.86-0.98). Although not statically significant, unpaved roads increased the odds of a crash by 17 percent. (CI: 0.91-1.50) Lastly, it was found that Farm to Market routes increased the odds of a crash by two fold compared to local roads (which make up roughly 67 percent of Iowa public roads). (CI: 1.72-2.43) When the same model was stratified by rurality (urban/rural), it was found that high traffic density leads to a higher risk of a crash in rural areas. Iowa routes and Farm to Market routes had a greater odds of a crash in urban than rural areas, and road and shoulder width were more protective in rural than urban areas. When only using roads with a crash involving an injury versus all other roads as the outcome, Iowa routes and roads with increased speed limits had higher odds for an injury-involved crash, while increased road width were more protective against crashes involving injuries. Findings from the study suggest that several roadway characteristics were associated with farm-equipment crashes. Through administrative and engineering controls, the six static explanatory variables used in this study may be modified to decrease the risk of a farm equipment crash. Speed limit can be modified through administrative controls while traffic density, road and shoulder width, road type, and surface type can be modified through engineering controls. Results from this study provide information that will aid policy-makers in developing safer roads for farm equipment.

Although the production of polychlorinated biphenyl (PCB) technical mixtures has been banned in the U.S. since the 70’s, they remain ubiquitous in the environment, particularly in indoor and ambient air. Due to the presence of PCB’s in air, inhalation is a significant route of exposure. PCBs released from various building materials have been shown to contaminate the indoor air in homes and schools. In the AESOP Study, an epidemiologic study of PCB exposures among school children and their mothers, PCB28 was found in the serum of over 20% of participants. Data are lacking on the absorption, distribution, metabolism, and excretion (ADME) of inhaled PCBs and on the biological fate and dose-specific toxicological endpoints. In order to inform toxicokinetic modeling for risk-assessment, we are conducting ADME toxicological studies with lung exposure to a representative trichlorobiphenyl, and evaluating the uptake from the lung and the distribution, metabolism, and excretion. Male Sprague-Dawley rats were exposed to [14C]PCB28 via intratracheal instillation at two different doses (42 µg/rat and 4.2 µg/rat). Digestive matter from five separate compartments of the gastrointestinal tract and thirty-six tissue types were excised and measured by scintillation counting. Exhaled air and excreta were also collected and analyzed. Measurements for the high dose were made at 12, 25, 50, 100, 200, 400, 720, and 1440 min, and for the low dose at 2, 12, 50, 200, and 720 min post-exposure. Data show that pulmonary uptake exceeded 99% in both doses. [14C]PCB28 entered the blood stream and distributed quickly to all tissues within minutes of dosing. In the high dose, the majority of radioactivity initially went to the muscle and liver, while in the low dose [14C]PCB28 initially distributed to the muscle, esophagus, and trachea, before being redistributed to the skin and adipose tissue, where it accumulated in both doses. In most tissues, elimination was biphasic, consisting of an initial fast phase with a half-life (t1/2) of 7-93 min (high dose) and t1/2 of 6-60 min (low dose), followed by a slower phase with t1/2 of 5-18 hours (high dose) and t1/2 of 3-18 hours (low dose). The metabolism of PCB28 was not extensive, with the parent compound as the major component in liver, kidney, serum, and adipose tissue. Excretion via urine and feces was limited, with 92% (high dose) and 88% (low dose) of radioactivity remaining in the tissues by the end of the time course, primarily in skin and adipose tissue. Low urinary concentration relative to serum, suggested that parent PCB28 in serum would serve as an accurate biomarker for assessment of exposure to inhaled trichlorobiphenyls. The time course and tissue distribution is comparable to [14C]PCB11, while metabolism and excretion of [14C]PCB28 is much less extensive.

This study looked at the effect relative humidity had on respirator performance.

Con el objetivo de examinar la frecuencia de obesidad abdominal y el ausentismo laboral por causa médica, se realizó un estudio transversal en 185 varones pertenecientes a una industria metalmecánica. En ellos, además de datos sociodemográficos, se recogió datos antropométricos y se midió la circunferencia de cintura (CC) en centímetros como indicador de obesidad abdominal. Se encontró, además de una alta frecuencia de obesidad abdominal (28,7%), que los trabajadores con obesidad abdominal presentaron mayor frecuencia, mayor tiempo y mayores costos por las incapacidades médicas. Se concluye que la obesidad abdominal en esta muestra fue altamente frecuente; no obstante, al tratarse de un riesgo reversible, las empresas podrían beneficiarse, en términos de ausentismo laboral, de programas preventivo promocionales destinados a controlar este problema. / The aim of this study was examined the abdominal obesity prevalence and association with medical-related absenteeism. A cross-sectional study in 185 men from the metal-mechanical industry was conducted. Sociodemografic and antropometrics data of was gathered, waist circumference was measured as an indicator of abdominal obesity. The prevalence of central obesity was 28.7 %. Subjects with higher values of central obesity showed higher frequency, higher duration and higher costs of medical-related absenteeism, however, this relationship was not significant. We conclude that abdominal obesity is highly frequent in this sample; however, since it’s a reversible risk, enterprises could get benefits from preventive and promotional programs destiny to control this problem. / Revisión por pares.

Pesticides are toxic by nature and they pose a serious threat to populations in agricultural communities, particularly to children, and farmers in low-income countries. Children living in agricultural communities may face a higher risk from pesticide exposure in the home environment than children in the general population. Farmers in low-income countries may also have higher risks from increased pesticide exposure due to the use of highly toxic pesticides that are banned in other countries and to unsafe practices and behaviors while handling pesticides. There is a growing body of literature that suggests pesticides, specifically organophosphorus pesticides (OPs), cause neurobehavioral impairment in children and adults. In a fruit orchard community in the U.S. Pacific Northwest, dust was collected from households and analyzed for four types of OPs. Various factors such as housing characteristics and resident behaviors were evaluated to examine their relationships with the OP concentrations in the home dust. School-aged children completed a battery of neurobehavioral tests at two time points, one year apart. The relationship between pesticide exposure, measured with parents’ occupations and a summary OP concentration, and neurobehavioral performance was examined. A cross-sectional study was carried out in The Gambia to identify rural residents’ knowledge about pesticide hazards and practices while handling pesticides. Relationships between participants’ knowledge, characteristics, and practices were examined. Occupational exposure scores were developed to quantify participants’ chronic pesticide exposures using the study’s questionnaire. In addition, participants provided information on neurological symptoms associated with pesticide use and a neurobehavioral test battery was administered to assess cognitive function. The relationships between occupational exposure scores and neurological symptoms and neurobehavioral performance were examined. In the orchard community, OP detection frequencies and concentrations were higher in agricultural households compared to non-agricultural households. Significant associations were found between higher OP concentrations in dust and the following: (1) homes with a parent working in an agricultural field and/or orchard, (2) homes with ≥ 2 agricultural workers living in the home, and (3) homes located in close proximity to an agricultural field or orchard. Having air conditioning in the home had a protective effect on OP concentrations. Results suggested that deficits in learning, or less improvement, on the neurobehavioral tests from the first visit to the second visit were found in agricultural children compared to non-agricultural children. In The Gambia, the majority of participants reported risky practices while handling pesticides such as: not wearing any protective clothing or equipment; mixing with bare hands; applying with their bare hands, plastic bags, or leaves; storing pesticides in the home; inadequately disposing of empty pesticide containers; and wearing shoes into the home after working with pesticides. They also reported having concerns about the adverse effects of pesticides on their health. Participants having had farm or pesticide safety training reported having less risky pesticide handling practices and behaviors. Participants with high occupational exposure scores experienced more symptoms and had worse performance on several of the neurobehavioral tests, including tests of motor function and dexterity, compared to participants with low exposure scores. Results from these studies suggest neurobehavioral impairments were found in participants with higher pesticide exposures compared to participants with lower exposures in the two populations. Further research is needed to identify successful strategies for reducing pesticide exposure in the home environment and while handling pesticides.

Pesticide use has steadily increased in the United States and throughout the world since the development of more highly effective agrichemicals dating back to World War II. While many of these compounds are considered to have little to no detrimental environmental impact with relatively low toxicity and potential for causing adverse health effects in humans, many recent studies examining the toxicological properties and health outcomes associated with exposure to a variety of pesticides suggest otherwise. In heavily agricultural-based regions, particularly where row crops predominate, large amounts of herbicides and insecticides are used in activities involving pest management annually. The high volume of chemical applications to agricultural fields is cause for concern due their potential for leaching into soil following application events and subsequent transport to water systems. Pesticide-contaminated ground and surface water systems may pose a threat to public health by the presence and persistent elevated concentrations of chemicals found in both public and private drinking water. The herbicides atrazine and glyphosate are and have been the two most heavily applied pesticides in the U.S. Many studies have examined occupational exposures to these compounds and related health outcomes, yet very few have evaluated low-level exposures to more susceptible rural populations. This thesis will examine state-of-the- science behind atrazine and glyphosate, evaluate drinking water quality measurements in relation to herbicide usage estimates in Iowa, and finally, make recommendations for future atrazine and glyphosate exposure assessment studies in rural Iowa populations.