Magister Public Health - MPH / Introduction: Despite ongoing training provided to healthcare workers (HCWs) on tuberculosis infection prevention and control (TB IPC), at the health institution and implementation of TB IPC precautions, nosocomial TB infection within the hospital persist. The facility’s 2017 Occupational Infection & Needle Prick Report showed the proportions of new nosocomial TB infection cases among HCWs rose steadily from (5.6%) n=2 in 2013/14, (7.8%) n= 4 2015/16 and (9%) n=7, to (11%) n=11 cases in 2017/18. Study findings confirmed high new nosocomial TB infections among HCWs and a likelihood that these cases were usually under- reported meaning the problem of nosocomial TB infection among HCWs was actually bigger than understood at the hospital. In fact during the period of the mini-thesis study (July 2018) alone, three (3) cases of nosocomial TB infections were reported among HCWs (a porter and 2 nurses). Aim: The aim of this study was to explore the factors which are perceived to be contributing to nosocomial TB infection amongst doctors and nurses in a Level 2 referral hospital in the Free State Province of South Africa.

Introduction The problems associated with poor indoor air quality and the possible subsequent effects thereof on workers, as experienced by the Department of Health in the Regional office situated in the Karel Schoeman building (KSB) in Pretoria, were investigated and are discussed. The possible association between the physical indoor environmental conditions and the sick building syndrome (SBS) like symptoms as well as the seemingly low productivity and the above average rate of absenteeism are included in these discussions. To find a possible association between these poor physical environmental indoor conditions and the potential adverse affects on the health and motivation of workers, a cross sectional survey was conducted to assess the physical, biological and chemical quality of indoor air (Refer to as IAQ – Indoor Air Quality) as well as the chemical and biological quality of the drinking water. Objectives This research report documents a project to measure the environmental conditions which include CO(Carbon Monoxide), CO2(Carbon Dioxide), relative humidity( RH), temperature, air velocity, the microbial and chemical composition of the drinking water and culturable micro organisms in specific work environments within the KSB and to compare the outcome to standards for acceptable indoor working environments. The specific objectives of this study are:  To describe the environmental conditions CO, CO2, RH, temperature and air velocity exposures in specific work environments during the period 2003-2004;  To describe the microbial exposures to Legionellae (which is actually one of a group of similar diseases collectively known as Legionellosis.)  To compare measured environmental exposures to the Environmental Regulations for workplaces promulgated in terms of the Occupational Health and Safety Act 1993 (Act 85 of 1993) (OHSA), the National Institute for Occupational Safety and Health (NIOSH) standards and other national and internationally recognised standards and  To compare the microbial monitoring results including the evaluation results of the drinking water for culturable micro organisms and E.coli, to the NIOSH and other national and international recognized standards. Methods To control for confounding, samples of the drinking water as well as from a stagnant pool in the basement were taken and analysed for bacteriological and chemical compliance as well as identification of any microbes and chemicals that can contribute to SBS Environmental conditions which include CO, CO2, RH, temperature, air velocity, the microbial and chemical composition of the drinking water and culturable micro organisms including E.coli, in specific work environments were measured. Measurements were conducted in accordance with the procedures prescribed in the ASHRAE 41.6 of 1994, ACGIH (Handbook for industrial ventilation, EPA building Air quality guidelines, US Department of Labour –OHSA Technical manual),the respective manufacturers recommendations and the SABS Code 0400 of 1990 and sampling of the water in terms of the procedures prescribed by NIOH in the case of sampling for Legionellae and the Microbiological laboratory of the Rietvlei accredited water research laboratory with reference to sampling for identification of micro organisms including E.coli and the chemical composition. Appropriate recognized analytical methods were used to analyse and interpret the data generated from both the chemical and biological sampling results. Results Based on the outcome of the project results, it is clear that the air conditioning system does meet the mentioned minimum prescribed physical environmental national and international norms and standards for indoor air quality. The findings from the study indicate compliance of the physical environmental conditions to universally accepted standards and no association between those poor physical indoor environmental conditions and the sick building syndrome (SBS) like symptoms as well as the seemingly low productivity and the above average rate of absenteeism could therefore be made. The presence of coliform organisms above the norm in the air samples is however a concern. Discussion The OHSA requires employees to access the health and safety risks that hazards pose to their employees in their respective working environments and to take reasonably practicable steps towards eliminating or controlling these hazards. Like any other risks in a workplace environmental conditions need to be identified and controlled based on the principles of risk management. Conclusion The above high rate of absenteeism, as perceived by management, could not be associated with the environmental conditions covered in this project. It could however be ascribed, directly or indirectly to the following variables and assumptions which could be categorised under environmental conditions and the management thereof as well as the management of employees/workers located within the building. Environmental conditions such as substandard quality water supply, the management processes during the decommissioning of the old HVAC system and the commissioning of the replacement system, poor general housekeeping and unacceptable management principles of good quality clean working environments location of the building in the mid city centre of Pretoria and the possible contamination of indoor air by external sources bio quality could be variables contributing to the high rate of absenteeism. The seasonal occurrences of influenza and colds as well as home and external exposures could also possibly be considered as contributing factors in this regard. In addition poor general workers or people‟s management which could have resulted in low staff morale and personal motivation linked to poor supervision during a period of a very serious organizational restructuring which affected many workers could have also being considered as contributing factors to high absenteeism. Substandard ergonomics could have also played a role during this process.

The primary purpose of this investigation was to determine the relationship between high school athletic administrators' job satisfaction and job-related stress. In addition, differences in the levels of administrators' job satisfaction and job-related stress according to gender, years of experience, and school size were examined. / Data were obtained from 371 high school athletic administrators employed in public schools from North Florida and South Georgia. Specifically, the subjects were head coaches who coached sports such as football, basketball, volleyball, softball, and baseball. / Three instruments were used in the investigation. They included a Personal Data Sheet, the Job Satisfaction Scale, and the Job-Related Stress Scale. The Pearson-Product Moment Correlation was used to test hypothesis one and a one-way Analysis of Variance was used to test hypotheses two through seven. The.05 alpha level was used as the criterion for the rejection of the hypotheses. / The following conclusions were made: (a) There is a positive correlation between satisfaction and job-related stress; (b) Gender appears to have an affect on job stress; (c) Gender does not appear to be a factor in the perception of job satisfaction; (d) Years of experience appears to have an affect on job satisfaction and job stress; and (e) School size appears to have an affect on job satisfaction and job stress. / The following recommendations were made: (a) Similar studies should be conducted using a national sample of head coaches and athletic administrators to examine the relationship between job satisfaction and job stress; (b) Future research should identify specific coping mechanisms used by head coaches to control and decrease the negative aspects of job stress. Also, measures should be taken to determine whether female head coaches use different stress-reducing mechanisms than male head coaches; (c) Future research should compare head coaches from larger schools to coaches from smaller schools to determine whether perceptions related to effectiveness and job satisfaction are different; (d) Future research should include interviews with former administrators and coaches to determine reasons why they quit coaching; and (e) Future research should include an analysis of the various sports to determine which sports activity may create the greatest potential for stress. / Source: Dissertation Abstracts International, Volume: 53-11, Section: A, page: 3841. / Major Professor: Dewayne J. Johnson. / Thesis (Ph.D.)--The Florida State University, 1992.

Humans are exposed daily to the deleterious effects of acute environmental stressors. Experimental research can provide solutions to the problems of protecting human life in adverse environments. However, it is not always possible or practical to employ human subjects when exploring acute or extreme conditions. Consequently, an applied nonhuman model may provide the best substitute for human subjects to assess the environmental impact. The model must be able to be evaluated and respond validly and reliably to the stressor. / In this study, a primate model was assessed during cold stress that conceivably may be encountered by civilian or military workers. Specifically, two of the hormones responsible for fluid shifts in the body during acute cold exposure and their relationships to urine output and body temperatures were studied in five male adult rhesus monkeys (Macaca mulatta). Plasma concentrations of vasopressin and norepinephrine were measured before, during (every 30 minutes), and after 2 hours at 6 and 26$\sp\circ$C. Urine volume and sodium and potassium concentrations were also determined. The monkeys did not exhibit diuresis or natriuresis during the exposure. Plasma vasopressin and norepinephrine increased significantly (p $<$ 0.05) during cold exposure. These data suggest that both vasopressin and norepinephrine are important in the body fluid response of the rhesus monkey during acute cold stress. It appeared that vasopressin may be the dominant hormone because of the antidiuretic effect observed. Norepinephrine did not induce a diuretic effect. This response is contradictory to previous works with other animals and humans. Despite these results, the rhesus monkey appeared to be suitable for examining the effects of cold at rest under controlled environmental conditions. However, data from cold research with this primate model may not extrapolate to humans or other animals. / Source: Dissertation Abstracts International, Volume: 57-03, Section: B, page: 1549. / Major Professor: Emily Haymes. / Thesis (Ph.D.)--The Florida State University, 1996.

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.

Introdução: A informalidade no mercado de trabalho assola muitas economias em desenvolvimento e é uma característica notável da produção de joias e bijuterias em Limeira, São Paulo, um dos maiores polos de produção de joias e bijuterias do Brasil. A produção de joias e bijuterias envolve o manuseio de produtos que podem ter em sua composição elementos com potencial tóxico à saúde humana. Em Limeira, a atividade de produção ocorre dentro dos domicílios, o que significa que o trabalhador e seus familiares podem estar expostos a elementos potencialmente tóxicos (EPT) oriundos da atividade ocupacional. Objetivos: Este estudo investigou a exposição ocupacional aos EPTs Cromo (Cr), Manganês (Mn), Níquel (Ni), Cobre (Cu), Zinco (Zn), Arsênio (As) Cádmio (Cd), Antimônio (Sb), Estanho (Sn), Mercúrio (Hg) e Chumbo (Pb), dos trabalhadores domiciliares e de seus familiares inseridos no arranjo produtivo de joias e bijuterias na cidade de Limeira - SP e discutiu os riscos identificados no ambiente de trabalho domiciliar versus a legislação ocupacional vigente. Métodos: Este estudo incluiu 52 famílias (n=165 indivíduos), divididas em grupo Exposto (n=112) e grupo Controle (n=53). Foram coletadas amostras de sangue (n=165) dos trabalhadores e seus familiares, e amostras de ar da zona de respiração de soldadores (n=9). As concentrações de EPTs foram determinadas por espectrometria de massas com plasma indutivamente acoplado (ICP-MS). Questionários foram aplicados para obter informações sociodemográficas, detalhes das condições do local de trabalho e dos materiais utilizados. As informações relevantes para compor a avaliação do ambiente de trabalho frente aos requisitos legais vigentes foram obtidas a partir destes questionários. Além disso, a análise de componentes principais (PCA), formação de clusters e regressão logística foram realizadas. Resultados: Os elementos Cd, Ni e Cu apresentaram concentração no ar maiores do que as diretrizes ocupacionais americanas. Foi encontrada diferença estatisticamente significativa para a concentração de Pb entre os grupos Exposto e Controle e entre os sexos (p <0,05), já para o Cu e Sb foram encontradas diferenças apenas entre os sexos (p <0,05). Conclusões: As concentrações de EPTs encontradas no ar são preocupantes, uma vez que os familiares dos trabalhadores, incluindo as crianças, estão no mesmo cenário de exposição. Condições inadequadas de trabalho foram observadas nas residências, revelando a necessidade de implementar ações públicas urgentes para proteger essas famílias de trabalhadores. A avaliação do cenário de exposição revelou que os trabalhadores e familiares estão sob os mesmos riscos de exposição, uma vez que a produção de joias é realizada sem nenhuma proteção do trabalhador e em ambiente geralmente compartilhado dentro das casas. Ações públicas e remodelagem do fluxo produtivo são necessárias para proteção social e de saúde destes trabalhadores e seus familiares com foco em melhoria das condições de trabalho e regularização profissional. / Introduction: Informality in the occupational segment devastated many developing economies and is a notable feature of the production of jewelry and fashion jewelry in Limeira city, São Paulo, one of the largest poles of jewelry and fashion jewelry production in Brazil. The production of jewelry and fashion jewelry involves the manipulation of chemical products that may have in their composition potentially toxic elements (PTE) to human health. In Limeira, the production activity occurs inside the households, which means that worker and family members could be exposed to PTE from the occupational activity. Objective: This study investigated occupational exposure to PTE Chromium (Cr), Manganese (Mn), Nickel (Ni), Copper (Cu), and Zinc (Zn), Arsenic (As), Cadmium (Cd), Antimony (Sb), Tin (Sn), Mercury (Hg), and Lead (Pb), household workers and their families included in the production of jewelry and fashion jewelry in Limeira, and discussed the risks identified in the households\' occupational environment assessment versus the current occupational legislation. Methods: This study included 52 families (n = 165 individuals), divided into Exposed group (n = 112) and Control group (n = 53). Blood samples (n = 165) were collected from the workers and their relatives, and air samples from the breathing zone of welders (n = 9). Concentrations of EPTs were determined by ICP-MS. Questionnaires were applied to collect sociodemographic information, details of the workplace conditions and the materials used. The relevant information to compose the occupational environment assessment against the current legal requirements were obtained from these questionnaires. In addition, the principal component analysis (PCA), clusters formation and logistic regression were performed. Results: Cd, Ni, and Cu elements presented higher air concentration than the American occupational guidelines limits. A statistically significant difference was found for the Pb concentration between the exposed and control groups and between the sexes (p <0.05), whereas for Cu and Sb only differences between the sexes were found (p <0.05). Conclusions: Concentrations of EPT found in the air raise concern, since workers\' relatives, including children, are in the same exposure scenario. Inadequate working conditions were observed in the houses, revealing the need to implement urgent public actions to protect these families and the workers. The exposure assessment revealed that workers and family members are at the same risk of exposure as the production of jewelry is carried out without any individual protection and, generally, is performed in the shared environment inside the houses. Public actions and remodeling the productive flow are necessary for the social and health protection of these workers and the families with a focus on improving working conditions and professional regularization.

O estudo teve como objetivo evidenciar os problemas de saúde apresentados pelos 4307 trabalhadores de enfermagem lotados nas 23 unidades de saúde da Fundação Hospitalar Estadual de Minas Gerais, comparar os problemas identificados às doenças relacionadas ao trabalho contidas na lista de doenças ocupacionais do Ministério da Saúde e analisar os problemas de saúde no contexto das mudanças processadas no mundo do trabalho na década de 1990. Trata-se de um estudo descritivo e retrospectivo cujos dados foram coletados por meio do levantamento dos atendimentos realizados pela Divisão de Assistência à Saúde do Trabalhador no ano de 2002 e pela análise dos diagnósticos médicos registrados nos prontuários dos trabalhadores e nos relatórios dos exames efetuados. Os diagnósticos obtidos dos 6070 atendimentos realizados foram categorizados com base na CID-10 em vinte grupos de diagnósticos. Os dados foram tratados por meio de estatística descritiva. Os resultados evidenciaram que os problemas de saúde dos trabalhadores se distribuíram nos seguintes grupos: fatores que influenciam o estado de saúde (20,15%), doenças do sistema osteomuscular (11,83%), transtornos mentais e comportamentais (11,40%), doenças respiratórias (10,69%), doenças do aparelho circulatório (8,62%) e lesões, envenenamento e causas externas (8,25%). Quando comparados os diagnósticos encontrados às doenças relacionadas ao trabalho da lista do Ministério da Saúde foi constatado que a força de trabalho da enfermagem estudada está sendo consumida por danos que afetam o corpo e a mente em decorrência de enfermidades causadas por violência oculta no trabalho, conhecidas também como doenças da modernidade tais como: LER/DORT, depressão, angústia, estresse, alcoolismo, hipertensão arterial e infarto agudo do miocárdio. Constatou-se que a instituição acompanha as mudanças processadas no mundo do trabalho adquirindo novas tecnologias e equipamentos, promovendo mudanças organizacionais com novas modalidades de assistência e modelos gerenciais. Destaca-se que 55,7% dos trabalhadores de enfermagem possuíam vínculo de trabalho temporário, ou seja relações precárias de trabalho, sem direitos e garantias trabalhistas e assistenciais. Os trabalhadores estavam expostos não apenas às “doenças da modernidade" mas também às mais antigas como a dengue e a tuberculose, ocasionando licenças para tratamento de saúde e as outras formas de adoecimento pelo trabalho devido a exposição ocupacional a riscos: biológicos, químicos, físicos, ergonômicos e psicossociais. / The aim of the study was to show the health problems presented by the 4307 nursing workers in the 23 health units of the Minas Gerais State Hospital Foundation, compare the problems identified to the illnesses related to work contained in the list of occupational illnesses of the Ministry of Health and analyze the health problems in the context of the changes operated in the world of work in the 1990’s. It is about a descriptive and retrospective study whose data was gathered by means of the survey of the cases attended to carried out by the Worker’s Health Assistance Division in the year 2002 and by the analysis of the medical diagnoses recorded in the workers’ files and in the reports on tests carried out. The diagnoses obtained from the 6070 cases attended to were categorized based on CID-10 in twenty groups of diagnoses. The data was dealt with by means of descriptive statistics. The results showed that the workers’ health problems were distributed among the following groups: factors that affect the state of health (20.15%), illnesses of the osteomuscular system (11.83%), mental and behavioral upsets (11.40%), illnesses of the respiratory system (10.69%), illnesses of the circulatory apparatus (8.62%) and lesions, poisoning and external causes (8.25%). When the diagnoses found were compared with the illnesses related to work from the list of the Ministry of Health, it was found that the nursing labor force under study is being consumed by damages that affect the body and mind as a result of illnesses caused by hidden violence in the workplace, also known as illnesses of modernity such as: LER/DORT, depression, anguish, stress, alcoholism, high arterial blood pressure and acute heart attack. It was found that the institution follows the changes undergone in the world of work by acquiring new technology and equipment, promoting organizational changes with new kinds of welfare and management models. It has to be pointed out that 55.7% of the nursing workers were temporary employees, meaning precarious working relations, with no labor and welfare rights and guarantees. The workers were exposed not just to the “illnesses of modernity" but also to the older ones such as dengue and tuberculosis which led to people taking leave for health treatment, and to the other forms of falling ill because of work due to occupational exposure to risks: biological, chemical, physical, ergonomic and psychosocial.

Estudos dos fatores que geram incapacidade para o trabalho são prioritários para a adoção de medidas preventivas, na melhoria das condições de trabalho e valorização dos recursos humanos da área da saúde, segundo as recomendações da Organização Panamericana de Saúde para o período 2006-2015. Dentre os fatores de incapacidade para o trabalho de profissionais que atuam em hospitais estão as lesões ostemusculares, que podem estar relacionadas à sobrecarga na manipulação de cargas, adoção de más posturas e a movimentos repetitivos. As lesões osteomusculares por vezes, se associam aos fatores ergonômicos que requerem o estabelecimento de programas preventivos. Nesse contexto foi proposta esta investigação, cujo objetivo foi analisar a ocorrência de lesões osteomusculares e de absenteísmo-doença entre trabalhadores de um hospital mexicano e as condições ergonômicas do ambiente de trabalho. Trata-se de um estudo descritivo com abordagem quantitativa dos dados executado por meio de investigação epidemiológica censitária com análise retrospectiva dos afastamentos no trabalho por licença-saúde no hospital de Morélia, México e de um survey para identificação de indicadores de morbidade por lesões osteomusculares e das opiniões dos trabalhadores sobre o ambiente de trabalho. O estudo foi realizado com as licenças - saúde, emitidas em 2005 e 2006 e com a amostra de 226 trabalhadores atuantes no hospital em 2007. Os procedimentos de execução foram: identificação do absenteísmo-doença, validação da versão em espanhol do Questionário Nórdico de Sintomas Osteomusculares, aplicação do instrumento de coleta de dados composto pela identificação de aspectos pessoais e ocupacionais dos trabalhadores, do Questionário Nórdico de Sintomas Osteomusculares e de informações sobre o ambiente de trabalho. Para apresentação dos resultados foi utilizado o método estatístico de análise percentual, com distribuição de freqüências simples em tabelas e figuras. O projeto de pesquisa foi aprovado pelo comitê de ética em pesquisa do hospital estudado. Em 2005 foram registradas 107 licenças-saúde, 1.177 dias de faltas, índice de porcentagem de Tempo Perdido (TP) acumulado de 0,56%, as licenças-saúde ocasionadas por problemas osteomusculares foram responsáveis 232 dias perdidos de trabalho, correspondente a 19,71% de faltas no ano. Em 2006 foram registradas 118 licenças-saúde, 1201 dias de faltas, TP acumulado = 0,57%, as licenças-saúde ocasionadas por problemas MONTOYA-DÍAZ, M. C. osteomusculares foram responsáveis 303 dias perdidos de trabalho, correspondente a 25,22% das faltas no ano. Dentre os motivos de adoecimento dos trabalhadores, 59,68% dos sujeitos atribuem a causa aos problemas osteomusculares. Os sintomas ostemusculares mais freqüentes foram na região lombar (31,86% e 23,89%) e cervical (24,78% e 15,04%) respectivamente nos 12 meses e sete dias precedentes a coleta de dados. Houve concordância entre o relato dos sintomas na região lombar com a distribuição da freqüência de afastamentos no trabalho nos 12 meses precedentes. Grande parte dos profissionais não percebe os riscos ocupacionais. Os fatores ergonômicos percebidos por 39,82% dos sujeitos foram: sobrecarga física, mobiliários e equipamentos inadequados, danificados e obsoletos, movimentos repetitivos, espaços reduzidos, iluminação inadequada. Conclusões: as lesões osteomusculares causam absenteísmo, existe um grande número de trabalhadores com indicadores de morbidade osteomuscular que podem vir a faltar do trabalho. Aspectos ergonômicos do ambiente precisam ser corrigidos visando a prevenção do adoecimento dos trabalhadores e de prejuízos para o hospital. / Studies of factors which cause work disability are priority for the adoption of preventive measures, improvement of work conditions and valorization of health human resource, according to the Pan American Health Organization recommendations for the period 2006- 2015. Among the factors of disablement for work of professionals working in hospitals are the osteomuscular injuries, which can be related to overburden in handling loads, poor posture and repetitive movements. Many times osteomuscular injuries are associated to ergonomic factors which require the establishment of preventive programs. In this context, this research was proposed aiming to analyze the occurrence of osteomuscular injuries and absenteeism-illness among workers from a Mexican hospital and ergonomic conditions at work. It is a descriptive study using quantitative data approach, carried out through census epidemiological investigation, with retrospective analysis of work absences because of sick leave at a hospital in Morélia, Mexico. A survey was done to identify indicators of osteomuscular injuries morbidity and workers opinion about the working environment. The study was carried out with sick leaves issued in 2005 and 2006, and with a sample of 226 workers of the hospital in 2007. The execution procedures were: absenteeism-illness identification, validation of the Spanish version of the Nordic Musculoskeletal Questionnaire, application of the data collection instrument consisting of the workers\' personal and occupational aspects identification, the Nordic Musculoskeletal Questionnaire and information on working environment. For the results display, percentage analysis statistical method was used, with simple frequency distribution in tables and figures. The research project was approved by the hospital\'s ethics committee. In 2005 there were registers of 107 sick leaves, 1.177 absence days, percentage index of accumulated wasted time (TP) of 0,56%, sick leaves caused by osteomuscular problems were responsible for 232 wasted work days, corresponding to 19,71% of the year\'s absences. In 2006, there were registers of 118 sick leaves, 1201 absence days, accumulated TP = 0,57%, sick leaves caused by osteomuscular problems were responsible for 303 wasted work days, corresponding to 25,22% of the year\'s absences. Regarding the reasons for workers sickness, 59,68% of the subjects believed the cause is osteomuscular problems. The most frequent ostemusculares symptoms were in the lumbar (31,86% and 23,89%) and cervical (24,78% e 15,04%) regions, respectively, in the 12 months and seven days preceding data collection. There was concordance between the reported symptoms in lumbar region and the work absence frequency distribution in the 12 preceding months. Great part of the professionals is not aware of the occupational risks. The ergonomic factors perceived by 39,82% of the subjects were; physical overburden, inappropriate furniture, damaged and obsolete equipments, repetitive movements, reduced spaces and inappropriate illumination. Conclusion: osteomuscular injuries cause absenteeism, there is a large number of workers with osteomuscular morbidity indicators who may have to be absent at work. Ergonomic aspects of the environment must be improved aiming prevention of workers illness and losses for the hospital.

Nesta dissertação analisa-se, através da metodologia de pesquisa-ação, a implantação, entre os anos de 2007 e 2010, de um comitê de melhorias das condições de trabalho e saúde dos trabalhadores, ancorado na ergonomia da atividade e que tinha por objetivo modificar políticas e processos de um hospital escola público do Estado de São Paulo. Os objetivos deste estudo são de identificar que fatores facilitam e quais dificultam a implementação de um comitê permanente de melhorias das condições de trabalho ancorado na abordagem da ergonomia da atividade em uma instituição pública de saúde e quais elementos são necessários para sua permanência. Para alcançar estes objetivos, o presente estudo foi desenvolvido com base no referencial teórico da ergonomia da atividade, da vigilância epidemiológica e de pesquisas realizadas sobre a implantação de comitês de ergonomia. Os resultados obtidos são então comparados com os encontrados por outros estudos descritos na literatura e demonstra-se a importância de previamente definir claramente os objetivos e o papel do comitê e também suas relações com outras instâncias da instituição. Mostra-se ainda, a necessidade de que o comitê disponha de autoridade para tomar decisões e que seja composto por executivos de níveis hierárquicos elevados e também por funcionários do nível operacional para o desenvolvimento de novos processos e políticas que leve em consideração as atividades reais de trabalho. Neste sentido, foi evidenciado, a necessidade da real apropriação da abordagem ergonômica pelos níveis de decisão de forma a inserir critérios ergonômicos nas linhas estratégicas da instituição. Foi também demonstrado, a necessidade de incentivar os funcionários através da informação constante das atividades já realizadas pelo comitê e da demonstração do apoio por parte da superintendência. Apresentam-se igualmente nesta dissertação, uma análise da condição política e pública da instituição e sua influência na implementação do comitê, os limites da presente pesquisa e perguntas que acreditamos serem relevantes para futuros desenvolvimentos. / In this study, using the methodology of action-research we analyze the implementation between 2007 and 2010 of a committee based on the approach of activity-oriented ergonomics. The objective of this committee was to improve workers health and working conditions, through the modification of policies and processes in a public teaching hospital of São Paulo state. This study aimed at identifying what factors facilitate and which ones hinder the implementation of a permanent committee for improvement of working conditions based on the activity-oriented ergonomics approach in a public health institution. In addition, it aimed at identifying what elements are necessary to ensure its permanence. To achieve these objectives, the present study was developed based on the theoretical background of activity-oriented ergonomics, epidemiological surveillance, and on researches performed on the implementation of ergonomics committees. The results demonstrate the importance of clearly defining the objectives and the role of the committee and its relations with other sectors of the institution. They also show the need for the committee to have decision making authority, to include the presence of senior executives but also of employees from the operational level in order to develop new processes and policies that take into account the real work activities. In this sense, it was highlighted the need for real ownership of the ergonomics approach from the highest levels of the institutions hierarchy in order to insert ergonomics criteria in the strategic lines of the institution. It was also shown the need to encourage employees through continuous feedback from activities already undertaken by the committee and the need for a clear and visible support from management. In this study, we also present an analysis of the institutions public and political nature and its influence on the implementation of the committee, the limits of this research and questions that we believe are relevant for future developments.

O trabalho de enfermagem em unidades básicas de saúde é caracterizado por situações geradoras de riscos à saúde, muitas vezes desconhecidas. Esta investigação teve como objetivo analisar as condições do trabalho de enfermagem em uma unidade básica de saúde, utilizando-se o método ergonômico proposto por IIDA (1990). Os dados foram coletados no período de fevereiro a maio de 2005,utilizando-se formulários, aplicados às trabalhadoras de enfermagem, contendo variáveis relativas aos dados dos profissionais, do ambiente e postos de trabalho e à atividade do trabalho e a técnica de observação. Os resultados evidenciaram que 50% das trabalhadoras é portadora de hipertensão arterial, 75% está com peso acima do ideal, a maioria identifica a excessiva de tarefas demandada pela população em relação ao insuficiente número de trabalhadoras como fator predisponente de estresse e violência ocupacional que interferem na qualidade de vida no trabalho. O ambiente apresenta inadequação de mobiliários nos postos de trabalho, ruído e temperaturas em níveis elevados. A situação de trabalho é geradora de violência do tipo estrutural e psicológica portanto, a situação de trabalho analisada não oferece adequadas condições de trabalho as trabalhadores de enfermagem. Pode-se inferir que a situação de trabalho vivida pela enfermagem na UBS interfere na organização e qualidade de vida no trabalho em saúde coletiva, culminando na influência sobre sua saúde, desempenho e bem-estar. / The work of nursing in basic units of health is characterized by generating situations of risks to the health, many unknown times. This inquiry had as objective to analyze the conditions of the work of nursing in a basic unit of health, using the ergonomic method considered by IIDA (1990).Os data they had been collected in the period of February the May of 2005, using forms, applied to the nursing workers, I contend changeable relative to the data of the professionals, the environment and ranks of work and to the activity of the work and the technique of comment. The diligent results had evidenced that 50% are carrying of arterial hipertension, 75% are with do above ideal weight, the majority identifies the extreme one of tasks demanded population in relation the insufficient number of workers as predisponent factor of stress and occupational violence that intervenes na quality of life no work. The environment presents inadequacion of movable in the work ranks, noise and temperatures in high levels. The work situation is generating of violence of the structural type and psychological therefore, the analyzed situation of work does not offer to adequate conditions of work the nursing workers. It can be inferred that the situation of work lived for the nursing in the UBS interfe in the organization and quality of life in the work in collective health, culminating in the influence on its health, performance and well-being.