Magister Public Health - MPH / The Essential Drugs Programme (EDP) is one of the tools developed to achieve the objectives of the South African National Drug Policy. Occupational health (OH) services are largely in the private sector and usually provide an element of Primary Health Care in addition to Occupational Hygiene, Medicine and Nursing. The aim of this study was to determine the challenges of implementing the Essential Drugs Programme into Occupatinal Health settings in the Port Elizabeth and East London areas. A descriptive cross-sectional study was carried out. Respondents cited the evidence-based approach to management of clients as a motivating factor for adopting the EDP in Occupational Health clinics. / South Africa

Background: Heart Rate Variability (HRV) as a research outcome has the potential for misclassification due to its inability to account for changes in the heart rate. HRV can be parsed into Acceleration Capacity (AC) and Deceleration Capacity (DC) which address these limitations. Objectives: To investigate the associations between AC and DC with short-term and long-term metal PM2.5 exposures; and examine if these associations are mediated by inflammation. Methods: A panel of 45-50 male welders, mean age 39-40 years, had continuous PM2.5 exposure during typical welding work shifts for 4-6 hours repeated 2-5 times over sampling periods in 2010-2012. We also obtained continuous recordings of digital electrocardiograms (ECG) over their work shift using Holter monitors during the same time; and analyzed blood samples before and after each welding shift for potential mediators of inflammation. In our first analysis, we used linear mixed models to assess the association between hourly PM2.5 exposure and each of simultaneously measured hourly AC and DC, controlling for covariates. Then, mediation analysis was done using linear mixed models to assess the associations between shift PM2.5 exposure, potential mediator levels, and AC and DC, controlling for relevant covariates in order to deduce the direct and indirect effects (via the mediator) of PM2.5 on AC and DC. In our final analysis, we used linear regression to assess the association between CEI PM2.5 exposure and each of current AC and DC, controlling for confounders. Results: Negative exposure-response associations were found for AC and DC with increased PM2.5 both in the short-term and long-term exposure after adjusting for covariates. In our mediation models, the proportion of the total effect of PM2.5 on AC or DC (indirect effect) mediated through IL-6 on AC was at best 4%. Conclusions: There are sustained acute and chronic effects of metal particulates on AC and DC even after exposure has ceased. These findings suggest that there may be more pathways that sustain response following exposure other than a direct effect of metal particulates on AC and DC. Furthermore, there may be complex mediating pathways involving interleukin 6. / Environmental Health

Statement of Problem: Despite significant advancements in occupational health and safety in recent decades, injury rates in commercial construction remain high. New programs that address the complexity of the construction work environment are needed to keep workers healthy and safe. Methods: The first step of this dissertation was to explore associations between organizational programs and policies, as measured by a Contractor Safety Assessment Program (CSAP) score, and worker safety climate scores. Next, a safety communication and recognition program was developed and piloted. It was evaluated through a mixed methods approach in a randomized controlled trial. Primary outcome measures included safety climate, awareness, communication, and teambuilding. Additionally, the dynamic nature of the construction site was quantified through an analysis of the determinants of length of stay of construction workers on the worksite. Results: Correlations between CSAP scores and safety climate scores were weak at best, thus highlighting a gap in communication between management and workers. The B-SAFE program, a safety communication and recognition program was developed to meet this gap. It used data from safety inspection scores to provide feedback to workers on hazards and controls, and provided a reward when the site met a pre-determined safety inspection threshold (a measure that was fair, consistent, attainable and fair). In the final program design, the whole site was treated as the unit of analysis. B-SAFE led to many positive changes, including a statistically significant increase in safety climate scores of 2.29 points (p-value=0.012), when adjusting for time-varying parameters and worker characteristics. Workers at the B-SAFE sites noted increased levels of safety awareness, communication, and teamwork, when compared to control sites. The composition of workers on-site at any given month changed by approximately 50%, and the length of stay on-site was associated with race/ethnicity, union status, title, trade, and musculoskeletal pain (p-values<0.05). Conclusions: The construction work environment is dynamic, with over half of the population on-site changing each month. This makes applying and evaluating traditional worksite based interventions challenging. Interventions like B-SAFE that are developed to address the complexities can have a positive impact on site safety measures. / Environmental Health

Background: welders are often exposed to various types of metals from the welding fumes and they also have high risks of cardiac autonomic dysfunction. Knowing the hazardous components within metals mixture as well as understanding the potential underlying mechanisms is essential for environmental and occupational regulations. Objective: to identify metal components which are associated with cardiac autonomic responses, as measured by two novel markers -acceleration capacity (AC) and deceleration capacity (DC); to examine whether inflammation mediates effects of metals exposure on AC/DC changes; to identify epigenetic variants which are associated with AC/DC changes. Methods: we collected urine, blood and electrocardiogram (ECG) samples from 75 welders over six sampling occasions between June 2003 and June 2012. Urinary concentrations of 16 types of metals were determined. Blood serum samples were analyzed for inflammatory cytokines levels including CRP, IL-2, IL4, IL6 and IL8. AC and DC values were quantified from ECG recordings. Firstly, we used linear mixed-effects models with Lasso to identify hazardous metals that were significantly associated with AC or DC changes. We fitted the co-pollutants model with “selected” metals in the linear mixed model to estimate the exposure-response relationship. Then, we conducted a mediation analysis to examine whether inflammatory cytokines mediated the effects of metals exposure on AC or DC changes. We report both direct and indirect effects in single pollutant model as well as co-pollutants models. Finally, we conducted the epigenome-wide association study (EWAS) to identify epigenetic variants that were associated with AC or DC changes. Results: we observed negative associations between urinary mercury and chromium concentrations with both DC and AC changes. Indirect effects of metals exposure on AC or DC through inflammation pathway were not significant. We identified GPR133 gene at which methylation level changes were associated with DC values. Conclusion: metals exposures are associated with impaired cardiac autonomic functions. Our study did not provide evidence that these effects were mediated through inflammation pathway. However, DNA methylation of specific genes may be a potential pathway linking environmental and occupational pollutants exposure and alterations in cardiac autonomic responses.

Purpose. Exposures to paper dust, classified as Particulates Not Otherwise Regulated (PNOR), in an industrial setting can cause irritation to the eyes, skin, throat and upper respiratory tract. An exposure assessment was conducted to evaluate the paper dust exposures in the coupon manufacturing facility during a normal production working period. Methods. Total and respirable personal dust sampling was performed according to NIOSH 0500 and 0600 methods. Six total dust samples and seven respirable dust samples were taken within the sampling areas where airborne paper dust was produced to evaluate the Time Weighted Average (TWA) of the exposed employees. Results. Results showed that the TWAs for total dust within the three sampling areas ranged from 0.4% to 4.7% of the Occupational Safety and Health Administration (OSHA) Permissible Exposure Limit (PEL) and 0.5% to 7.1% of the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV), except sample RD-4 in the Baler Room. TWAs for respirable dust within the Press Room and Collation Area ranged from 0.8% to 0.9% of the OSHA PEL for all samples and 1.4% to 1.5% of the ACGIH TLV. Descriptive statistics showed the sample standard deviation for both total and respirable dust to be below 1.0. The coefficient of variation for TWAs of total dust in the Press Room was 32.7% while all other total dust and respirable dust coefficient of variations for TWA ranged from 1.3% to 3.4%. Conclusion. Exposures to paper dust ranged from 0.4% to 7.1% of either the OSHA PEL or ACGIH TLV with an exception of sample RD-4 in the Baler Room which was 34% of the OSHA PEL and 56.7% of the ACGIH TLV. Identical respirable dust data and variable total dust data in the Press Room and Collation Area suggest that the dust being generated is of a larger particle size and therefore affects the nose, throat, and upper lungs. The engineering and administrative controls present appeared to be adequate based on the sampling data. Respiratory Personal Protective Equipment (PPE) was not considered a requirement but should be permitted if requested. Present workplace practices also appeared adequate based on the sampling data.

Noise is a major aggressor in the workplace. It is widely acknowledged that noise may be hazardous to health and may interfere with speech communication. Researchers have found that noise and noise-induced hearing loss can also compromise the audibility of warning signals. A computerized tool called "Detectsound" has been developed for predicting the capability of workers to detect auditory warning signals in noise and for providing an optimal adjustment of signal levels according to the functional limits of the target worker(s). This work represents a comprehensive revision and improvement over an earlier version of the "Detectsound" model [Laroche et al. (1991), Applied Acoustics, 32, 193--214]. The main enhanced features are: (1) taking into account the hearing status for individuals, (2) incorporating the normative data describing the effect of noise exposure and age on hearing thresholds (ISO 1999, ISO 7029), (3) integrating more recent and accurate data on frequency selectivity, and (4) improving the user interface for the implemented software program. (Abstract shortened by UMI.)

The main objective of this thesis was to develop and empirically test a novel analytical framework for occupational mental health: the Healthy Learning Organizations model. One of the central premises of this model is that the organization is an important analytical component to the explanation of the ecology of occupational mental health. More specifically, the nature of the organizational learning process underwent by organizations constitutes a determining source of organizational variability in the distribution of psychosocial risk factors and mental health outcomes. The predictive power of the model was evaluated through the examination of the organizational reality of senior executives from the federal public service of Canada using a mixed methods approach. The thesis is organized around four scientific articles. The first article provides a critical synthesis of organizational learning literature and draws on the sociological theory on agency and structure to formulate a set of theoretical propositions tackling current challenges on the dimensionality of organizational learning. The second article operationalizes these propositions with a psychometric evaluation of the Organizational Learning Dimensions Inventory. Findings supported the validity and fidelity of the instrument, as well as the relevance of its utilization as a subjective (i.e., individual scores) and collective measure (i.e., scores aggregated at the organizational unit) of organizational learning. The Healthy Learning Organizations model bridges this definition of organizational learning to dominant conceptualizations on occupational stress. In the third article, multilevel analysis demonstrates that the subjective measure of organizational learning is a protective factor in association to mental health outcomes, independent of the relative contribution of psychosocial work factors and the sociodemographic profile of senior executives. Semi-structured interviews offer additional insights for such a protective association. Lastly, latent class analysis in the fourth article shows that the Healthy Learning Organizations model supports a typology of organizational contexts associated to differential risk exposures for occupational mental health. Overall, the Healthy Learning Organizations model emphasizes the need to increase current understanding about organizations and their internal dynamics as social contexts for population health among workers.

As nanotecnologias são um conjunto multidisciplinar de técnicas que manipulam a matéria em escala nanométrica, mais precisamente partículas abaixo de 100 nanômetros, cujas características por conta do tamanho diminuto são essencialmente diferentes daquelas encontradas no material em sua forma macro. Em função destas novas propriedades dos materiais, existem lacunas de conhecimento relativas aos efeitos destas partículas sobre o organismo humano e sobre o meio ambiente. Embora ainda sejam consideradas tecnologias emergentes, seu crescimento é cada vez mais acelerado e o número de produtos que fazem uso de nanotecnologia em alguma fase de sua produção continua crescendo, bem como o número de pesquisadores envolvidos com o tema. Considerando este cenário e a literatura pertinente, este trabalho objetivou desenvolver uma sistemática de ações de segurança e saúde no trabalho (SST) para laboratórios de pesquisa com atividades de nanotecnologia. Esta sistemática é fundamentada na estrutura das diretrizes para um sistema de gestão de segurança e saúde no trabalho proposto pela Organização Internacional do Trabalho (OIT). A esta base foram agregadas diversas recomendações nanoespecíficas, sendo desta maneira consolidada a Sistemática de SST para Laboratórios com Nanotecnologia (S-SST/LabNano). Além da comparação desta sistemática com outras apresentadas por outros autores, uma pesquisa survey foi realizada, com o propósito de obter um retrato da SST em laboratórios com atividades de nanotecnologia no Brasil. De forma complementar, objetivando a adequação prática, a S-SST/LabNano foi avaliada em relação a realidade de SST encontrada em laboratório. O resultado final da tese, além da sistemática em si (S-SST/LabNano), almeja oferecer elementos de reflexão que possam auxiliar a gestão e o controle de riscos ocupacionais associados às nanotecnologias. / Nanotechnology is a multidisciplinary set of techniques that manipulates material at nanoscale, precisely particles below 100 nanometers whose characteristics, due to the small size, are essentially different from those found in material while in macro format. In the light of these new properties of materials, there are knowledge gaps regarding the effects of these particles on the human body and the environment. Although still considered emerging technologies, their growth is increasingly accelerated and the number of products that use nanotechnology in some stage of its production continues to grow, as well as the number of researchers involved with the topic. Given this scenario and its relevant literature, this study aimed to develop a proposed methodology of actions in occupational safety and health (OSH) to research laboratories with nanotechnology activities. This methodology is based on the structure of the International Labour Organization (ILO) guidelines for a management system in safety and health at work. Several specific recommendations were added, named Participatory Nano Safety Lab (PNSL). Besides the confrontation of this proposal with other authors, a research survey was conducted with the purpose to obtain a general picture of the OSH in laboratories with nanotechnology activities in Brazil. In a complementary way, aiming a practical suitability, the PNSL was confronted with the reality of OSH found in laboratory. The final result of this thesis, besides the methodology itself (PNSL), aims to provide elements of reflection that may assist management and occupational risk control associated to nanotechnology.

Orientador: Lúcia Figueiredo Mourão / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T12:55:06Z (GMT). No. of bitstreams: 1 Nascimento_CamilaLima_M.pdf: 1273438 bytes, checksum: 0b89e644865e6d7951705fdb4f26d3e5 (MD5) Previous issue date: 2014 / Resumo: Os militares constituem uma categoria profissional pouco estudada em relação à saúde vocal. A formação do Oficial do Exército Brasileiro envolve atividades específicas que podem levar a danos vocais. Um exemplo é o Programa de Treinamento Militar (PTM), que consiste em exercício de 48 horas de duração que envolve alta demanda vocal, para a produção de brados e canções, associada a intensa atividade física. Durante o exercício, a hidratação e o tempo de sono são controlados. Após abuso vocal é necessário um tempo para uma recuperação funcional e celular. O objetivo do estudo é avaliar o impacto vocal imediato após o PTM e a recuperação vocal de estudantes militares duas semanas após o PTM. Para tanto, amostras vocais de jovens adultos (entre 18 e 22 anos) foram coletadas em três momentos distintos: antes, imediatamente após e duas semanas após o PTM. Medidas fonatórias foram realizadas com produções da vogal /a/, das consoantes fricativas /s/ e /z/. Paralelamente, alguns parâmetros acústicos foram analisados com amostras de fala e da vogal /a/: frequência fundamental, jitter, shimmer, intensidade média, proporção harmônico-ruído, H1-H2, modulação de frequência, modulação de intensidade e ênfase espectral. Os parâmetros acústicos foram extraídos ou calculados a partir de dados obtidos pelo software de análise acústica Praat. Na análise estatística, o Teste T pareado foi utilizado para a comparação das diferenças entre dois momentos de coleta de dados (antes e imediatamente após PTM) e para a comparação das diferenças entre os três momentos de coleta de dados foi utilizado o teste One Way ANOVA. Para a comparação entre os dados encontrados no primeiro momento de coleta de dados e os valores normativos da literatura foi utilizado o Teste T para amostras independentes, todos com nível de significância de 0,05. Ao compararmos os dois primeiros momentos de coleta de dados, os resultados apresentaram diferenças estatisticamente significativas nas medidas fonatórias e nos valores de intensidade média e de ênfase espectral para as amostras da vogal isolada. Na comparação dos três momentos de coleta de dados, os resultados mostraram que não houve diferença significativa entre os dados do primeiro e do terceiro momento de coleta, com exceção da medida fonatória da vogal /a/, o que sugere a ocorrência de recuperação vocal após duas semanas. Há diferenças nos resultados no primeiro momento de coleta de dados (pré PTM) comparados com medidas normativas da literatura recente, sugerindo mais estudos sobre a presença de um padrão vocal característico para esse grupo / Abstract: The military are an understudied occupational category in relation to vocal health. The Brazilian Army Officer formation involves specific activities that could lead to vocal injury. One example is the Military Training Program which consists of a 48-hour exercise that involves high vocal demand to produce military command shouts with intense physical training. During the training, students are submitted to controlled hydration and sleep deprivation. After vocal abuse at least 18 hours of complete vocal rest are necessary for functional recovery. However, the cell recovery demands more time until inflammatory process ends (at least 14 days after the injury). The goal of this study is to evaluate the immediate vocal impact and the vocal recovery of military students two weeks after completion of the Military Training Program. Vocal samples from young adult males (18 to 22 years old) were collected in three moments: before, immediately after and two weeks after Military Training Program. Phonatory measures were collect using vocalization of vowel /a/ and fricative consonants /s/ and /z/. Besides, some acoustic parameters were analyzed using speech samples: fundamental frequency, jitter, shimmer, mean of intensity, harmonic-to-noise ratio, H1-H2, spectral emphasis, range of frequency and intensity. The acoustic parameters were extracted or calculated from software Praat. Paired samples t-test was used to statistical analysis to compare differences among the parameters between two moments (before and immediately after Military Training Program) and One way ANOVA was used to statistical analysis to compare differences among the parameters in the three moments. Independent samples t-test was used compare the data found in the first moment of data collection and normative values from the literature, all with significance level of 0.05.The results of comparison of two first moments showed significant differences in maximum phonation times, mean of intensity and spectral emphasis for sustained vowel samples. Results of comparison of three moments showed no significant differences between first and third moment, except for maximum phonation time of vowel /a/, what suggest a vocal recovery after two weeks. There were differences between first moment data (before MTP) and normative values that suggest more researches about a vocal pattern different for this group / Mestrado / Interdisciplinaridade e Reabilitação / Mestre em Saúde, Interdisciplinaridade e Reabilitação

Orientador: Sérgio Roberto de Lucca / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:24:20Z (GMT). No. of bitstreams: 1 Silva_BeatrizMachadodeCamposCorrea_M.pdf: 1307099 bytes, checksum: bf245e0e10eac40c07c5a70348d7b27f (MD5) Previous issue date: 2015 / Resumo: Comparecer ao trabalho doente é um comportamento frequentemente adotado pelos trabalhadores. Esse comportamento, denominado de presenteísmo, é um problema emergente que devido as suas repercussões sociais e econômicas tem despertado a atenção de pesquisadores em diversas áreas e preocupação de gestores por ser difícil de ser percebido. Objetivo: Determinar a prevalência de presenteísmo entre os trabalhadores em uma indústria do setor alimentício. Método: Estudo epidemiológico, de corte transversal, com população de 1.224 trabalhadores, utilizando o Stanford Presenteeism Scale ¿ SPS-6 como método de investigação do presenteísmo. Resultados e Discussão: a avaliação do presenteísmo por meio do SPS-6 revelou que 50,9% dos trabalhadores são presenteístas. Foi possível observar que a prevalência do presenteísmo tende a ser a mais elevada nas seguintes condições de saúde: diabetes (83,3%), doença de pele (62,5%), doenças respiratórias (59,1%), doença renal (53,7). As informações obtidas revelaram que entre os trabalhadores presenteístas a prevalência dos sintomas neuropsíquicos (51,5%) é mais elevada, seguido pelos sintomas gastrointestinais (49,3%), sintomas cardiovasculares (46,2%) e sintomas osteomusculares (45,3%). Também foi possível observar maior frequência de presenteísmo entre trabalhadores que não praticam atividade física e com sobrepeso e obesos (52%). Conclusão: Os resultados encontrados por meio do SPS-6 evidenciam elevada prevalência de presenteísmo entre os trabalhadores da indústria pesquisada. Entre os presenteístas observou-se associação significativa entre obesidade e sedentarismo afetando o desempenho no trabalho. A introdução de programas de educação em saúde, relacionado com alimentação adequada e prática de exercícios poderá contribuir para a redução do presenteísmo nesta empresa / Abstract: to work ill has been a common behavior for workers. This behavior named presenteeism is a rising problem which by its economical and social repercussions has awaked the researches attention in diverse areas and the managers worry. Objective: to determine the presenteeism prevalence at a food industry. Method: Epidemiological, cross-cut study with 1224 workers applying the Stanford Presenteeism Scale - SPS-6 as research method of presenteeism. Results and discussion: the presenteeism evaluation by SPS-6 showed that 50,9% of workers are presenteeist. It has been possible to observe that the presenteeism prevalence is higher on the following health conditions; skins problems 59,6% renal disease 55,6% psychiatric conditions 53,1% headache and heart disease 51,6%. The obtained information showed among the presenteeist workers the prevalence of neuropsychiatric symptoms 51,5% is higher, followed by the gastrointestinal problems 49,3% cardiovascular symptoms 46,2% and osteomuscular symptoms 45,3%. Also was possible to observe more frequency of presenteeism among workers with overweight and obese 52%. Conclusion: The results found by SPS-6 showed high prevalence of presenteeism by disease among works of the researched industry. Among the presenteeísts there was a significant association between obesity and sedentary lifestyle affect job performance. The introduction of health education programs related to proper nutrition and physical exercises can help to reduce presenteeism this company / Mestrado / Epidemiologia / Mestra em Saúde Coletiva