Orientador: Satoshi Kitamura / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T03:38:28Z (GMT). No. of bitstreams: 1 Reis_FelipeRovereDiniz_D.pdf: 865251 bytes, checksum: 7c06c5faa9dbc34f45c77a4e9418b226 (MD5) Previous issue date: 2015 / Resumo: Para diminuir os custos sociais decorrentes dos riscos relacionados ao trabalho, os Estados criam normas que obrigam o empregador a controlar a saúde ocupacional dos trabalhadores. No Brasil, estas ações devem estar dispostas no Programa de Controle Médico de Saúde Ocupacional, segundo obriga a Norma Regulamentadora nº 07. Para garantir o cumprimento desta norma, tanto o Estado quanto o empregador podem auditar o PCMSO; no entanto, não existem critérios para realizar esta auditoria. O objetivo deste estudo foi verificar a aplicabilidade desta auditoria dentro do modelo brasileiro de controle estatal em saúde ocupacional e propor critérios para sua realização. Para isso, foi feita uma revisão narrativa da literatura, para reconhecer o controle estatal no Brasil, tanto no que se refere às normas referentes à fiscalização em saúde e segurança no trabalho e ao seguro acidente de trabalho quanto às propostas para sua melhoria. Os resultados indicaram que o Estado ao se basear em normas punitivas e reparadoras, através de uma fiscalização pontual e repressora falha tanto em reduzir os gastos com doenças relacionadas ao trabalho quanto em estimular o cumprimento voluntário da lei. Indicaram também que as propostas de melhoria do controle estatal (aumento do número de fiscais, flexibilização da alíquota do seguro acidente de trabalho e a fiscalização programática) seguem o modelo de controle adotado por diversos países desenvolvidos. No entanto, ao contrário destes países, o Brasil ainda não possui incentivos à adoção de Sistemas de Gestão em Saúde e Segurança no Trabalho, os quais no Brasil deveriam contemplar uma auditoria do PCMSO. Desta forma, foram sugeridos 20 critérios para auditoria do PCMSO. Tais critérios podem ser usados para avaliar o cumprimento da NR-07, tanto pela empresa para melhorar seu sistema de gestão da saúde ocupacional e fundamentar um pedido de redução da alíquota do Seguro Acidente de Trabalho, quanto pelo Estado para aumentar a capacidade da fiscalização, fundamentar a redução da alíquota do Seguro Acidente de Trabalho e incentivar a adoção dos Sistemas de Gestão em Saúde e Segurança no Trabalho / Abstract: To reduce the social consequences of the risks related to the work, the States shall establish rules, which require the employer to control the occupational health of workers. In Brazil, these actions are to be arranged in the Medical Control Program of Occupational Health in accord to which requires Regulatory Standard 07. To ensure compliance with this standard, both State and the employer can audit the PCMSO; however, there are no criteria to perform this. The objective of this study was to verify the applicability of this audit within the Brazilian model of state control in occupational health and propose criteria for its realization. For this it was made a narrative review of the literature to recognize state control in Brazil both in regard to relating to supervisory standards in health and safety at work and occupational accident insurance on the proposals for improvement. The results indicated that the State to be based on rules punitive and remedial and through supervision timely and repressive fail both in reduce spending on work-related diseases as well as to encourage voluntary compliance. They also indicated that the state control improvement proposals (increase in tax, easing of workers' compensation insurance rate and programmatic oversight) follow the control model adopted by many developed countries. However, unlike these countries, Brazil yet does not have incentives for adoption of Management Systems Health and Safety at Work. When they are adopted by companies in Brazil, it should include an audit of PCMSO. Thus, were suggested 20 criteria for audit PCMSO. They may be used to assess compliance with NR-07, both the company to improve their occupational health management system and support an application for reduction of social security tax rate, and the State to increase the surveillance capacity, support the reduction of social security tax rate and encouraging the adoption of Occupational Health and Security Management Systems / Doutorado / Epidemiologia / Doutor em Saude Coletiva

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.

The repair of automobiles is a critical aspect in vehicle ownership and is potential source of volatile toxic compounds being brought into a home when repairs are conducted in an attached garage. The goal of this study was to assess the impact of the repair of automobiles in an attached garage on the exposure of the home mechanic and degradation of indoor air. Five common automotive tasks were performed in two garages with the garage door either opened 30.5 centimeters (n=5) or closed (n=4). The exposure to the home mechanic, the behavior of contaminants within the garage, and infiltration of contaminants in the home were the determinants of interest. Integrative sampling incorporating charcoal sorbent sampling tubes analyzed by gas chromatography and directs reading photo ionization detectors were used to assess exposure. The tasks with the greatest contributions to the home mechanic’s exposure were found to be brake pad replacement and oil change; these generated 95th percentile concentrations of 51.2 ppm and 12.8 ppm, respectively, with the garage door closed. In contrast, the tasks of refueling and shock replacement had 95th percentile contributions of 0.85 ppm and 2.99 ppm, respectively, in the closed garage. Equations were fitted to the aggregated concentrations during decay to estimate general ventilation (Q/V) in a closed garage. The contaminants within the garage were not found to infiltrate into the home as the average concentrations within the home never exceeded 1 ppm. It was found that automotive repair work in a closed garage may constitute up to 18% of threshold limit value of toluene over a 105 minute exposure at home. Automotive repair inside an attached garage has the potential to make a significant contribution to a mechanic’s daily exposure and should be incorporated into occupational exposure assessments of volatile organic compounds.

Toxic exposure to hydrogen sulfide (H2S) is a well-recognized hazard in agriculture, particularly in livestock operations that manage large amounts of manure. Numerous fatalities have been observed, often multiple fatalities in a single incident, due to toxic exposure to H2S from manure pits at concentrations higher than 500 ppm. Direct-reading instruments that alarm workers in the areas when H2S concentrations are high may prevent these fatalities. However, monitors that are commonly found in industries with robust safety programs are impractical for agricultural use as they are often prohibitively expensive and require regular maintenance and calibration that may be above the expertise level of agricultural workers. In more recent years, manufacturers marketed simpler models of direct-reading H2S monitors as “low-maintenance” or “maintenance-free” at a much lower cost than traditional monitors, which may cost $500 for basic models or more than $1000 for more complex models. The objective of this study was to test several models of low-cost, low-maintenance monitors in order to examine the features of each for comparison, as well as to test the performance of these monitors with no maintenance over time while under constant exposure to low levels of H2S. Two types of monitors were examined: qualitative monitors that were lowest-cost (around $100) and provided only alarm settings with no concentration displayed (Honeywell BW Clip and MSA Altair), and quantitative monitors that cost slightly more (around $200) but displayed concentration readings (Dräger Pac 3500 and Industrial Scientific T40 Rattler). All models were exposed to H2S for a test period of 4 months, at concentrations slightly higher than typical background concentrations to simulate expected monitor exposure for a year in a barn. The performance of qualitative (‘alarm-only’) monitors declined faster than over the course of the simulated barn year than the quantitative monitors, with both models of qualitative meters failing to alarm at the high setting before the test period was complete. The quantitative (‘concentration-display’) models showed fewer effects from long-term exposure over the duration of testing, but both models exhibited inaccuracies in the concentration readings when compared to calibration gas concentrations. The T40 Rattler provided consistently higher readings (+2.3 ppm) than the calibration gas concentration, while the Pac 3500 showed consistently lower readings (-3.4 ppm) than the calibration gas concentration. Serious acute health effects for H2S are not typically observed until exposure to concentrations above 500 ppm, so inaccuracies of this small magnitude are relatively insignificant. Though each of the test monitors is advertised to be maintenance-free for two years, this study found that failures occurred within one simulated year in a barn. Bump checks should be performed regularly to ensure the monitor reacts to the presence of H2S appropriately, even when the manufacturer’s literature may say otherwise. Most importantly, agricultural workers should always inspect and bump check these monitors prior to any potentially high-risk activity such as manure agitation or pumping to ensure that the monitor is still providing the protection needed from a potentially toxic release of H2S. This study tested each of these models within a clean chamber at room temperature to isolate the effects of long-term exposure to H2S. In an actual barn, these monitors may be exposed to variations in temperature and humidity, as well as other barn contaminants such as ammonia, dust, and chemicals. Each of these other exposures could also affect the performance of these monitors over time, and should be considered when storing and using these monitors. Furthermore, the potential interactions from other exposures is an opportunity for future study to better understand how these interactions may affect sensor performance in an agricultural environment.

Agriculture is one of the most hazardous industries in the United States, with a fatality rate that consistently surpasses other industries. Livestock handling activities are often found to be the second or third leading cause of on-farm injuries, with machinery and falls being cited as other leading causes. Among all livestock, cattle are responsible for the most injuries and fatalities on farms, and cattle-related nonfatal injuries have been shown to be some of the most costly, and result in more time off work than other injuries. Despite the fact that research has improved our understanding of cattle behavior and sensory functions, developed low-stress handling practices, and determined how facilities can be safer for workers and livestock, injury rates remain high. This project identified the types of equipment commonly used on beef farms, evaluated relationships between injuries and farm characteristics (such as herd size and equipment used), and assessed farmer perceptions of safety and obstacles to implementing changes. Most farms cited that they utilized equipment like alleyways (82.69%), a manual headgate (75.51%), a sorting/diverter gate (53.06%), and a manual squeeze chute (51.02%). However, it was found that having certain types of equipment had no influence on the likelihood of injuries. Herd size, on the other hand, was shown to be influential in that farms with larger than average herd size were shown to have a higher rate of injury. A final finding of this study was that farmers cited the cost of equipment, lack of necessity (their setup worked well already), and lack of time as being the main reasons they have not implemented changes on their operations. This study supports the idea that safe equipment and facilities are being implemented and used on most farms already, which suggests that the focus of future research should shift towards evaluating the influence that factors such as human behavior, handling practices, degree of training received, and training methods used have on the risk of worker injury.

This study looked at 19 years of Bureau of Labor Statistics Census of Fatality data for the purpose of describing occupational homicide and suicide for farmers and agriculture workers. The study found homicide rates for farmers and agriculture workers were lower than rates for total occupations for 14 years, while suicide rates for farmers and agriculture workers were consistently higher than total occupations. Significant regional variations in homicide and suicide patterns were identified. Finally, this study confirmed prior research in that males were most commonly victims of both occupational homicide and suicide when compared to females, while both male and female farmers and agriculture workers were most likely victims of homicide by firearms.

BACKGROUND: Work-related musculoskeletal disorders (WMSD) are the leading cause of work disability. Healthcare workers (HCW) have a particularly high risk of developing these disorders. OBJECTIVE: To review the current knowledge, from an occupational therapy (OT) perspective, on interventions for upper body WMSD among HCW in close contact with clients through manual handling. METHODS: This systematic review attempted to gather experimental and observational studies published between 2008 and 2019, that discussed interventions within OT practice to prevent or treat WMSD of the upper body among HCW. The searches were conducted on CINAHL, Cochrane Library, PsycINFO, PubMed, OTSeeker, AMED and Emerald. RESULTS: Nine articles were included in the final analysis. Overall, the methodological quality of the articles was moderate. The main preventive measures used were classified according to the components of the Person-Environment-Occupation-Performance model. The identified interventions were training in ergonomics and safe patient-handling, the use of assistive devices and equipment, physical exercise, and workplace modifications. CONCLUSIONS: Findings suggest that these interventions are effective in the prevention and treatment of upper body WMSD in HCW. Furthermore, these interventions appear to be more beneficial when combined together. Researchers could also investigate the effectiveness of interventions targeting psychological factors in the prevention of WMSD.

Philosophiae Doctor - PhD / Occupational health (OH) in physiotherapy is well known for addressing workrelated musculoskeletal disorders (WRMDs), which are high in number according to the available statistics (Fingerhut, Concha, Punnet, Steenland, & Driscoll, 2014). The introduction of the Bachelor of Science in Physiotherapy degree in Kenya in 2010 created a good platform for the development and review of occupational health content in the curriculum

Thesis advisor: Erika L. Sabbath / The care industry is encountering a critical demand for care workers in the formal and informal sectors. As a result, the healthcare industry is strained from the increasing shortage of workers and capacity in facilities. Moreover, there is a desire among the aged to age in place, thus, care provided in the home and community is also on the rise. The requisite for care workers in the U.S. suggests that this population is vulnerable to job and personal demands in the workplace that are associated with negative health outcomes such as poor sleep and burnout. The purpose of this three-paper dissertation is to evaluate the moderating effects of job and personal resources on the health and well-being of nurses and patient care associates (PCAs) in the formal sector and Filipina care workers in the informal sector. The first two papers used the Boston Hospital Health Workers Study, a longitudinal study that was established in 2006 to examine the working organization and condition, behaviors, and health outcomes among healthcare workers from two large hospitals in the same health system in Boston. The first paper (N=845) used a mixed methods approach and used logistic regression analysis to examine the association of discrimination and short sleep and interaction terms to assess the buffering effect of people-oriented culture between discrimination and short sleep. The qualitative section used a combination of grounded theory and thematic analysis of interviews of unit nurse directors (N=16) to gain an in-depth understanding of how discrimination transpires in the workplace and the resources available to address discrimination and poor sleep among care workers. The second paper (N=874) evaluated the association of job and personal demands and burnout using logistic regression. Interaction terms were implemented to assess the buffering effect of workplace flexibility between job and personal demands and burnout. The third paper used semi-structured interviews of Filipina care workers in New England (N=14). A combination of grounded theory and thematic analysis were used to analyze the qualitative data. In Paper 1, findings showed that people-oriented culture did not buffer the relationship of discrimination and short sleep. However, people-oriented culture slightly attenuated the association of discrimination and odds of short sleep. Qualitative findings illuminated that discrimination transpired among co-workers in relation to their job titles and while numerous job resources are available, these resources do not necessarily address discrimination and promotion of inclusivity. In the second paper, workplace flexibility moderated the relationship between married healthcare workers without children and odds of burnout. Moreover, there are significant associations between active (high demand, high control) and high strained (high demand, low control) workers with perceived low workplace flexibility and odds of burnout. In the third paper, qualitative findings highlighted that Filipina care workers are tasked with multiple job responsibilities that are associated with abuse and injuries and personal demands of providing financial care to their family and saving face from divulging difficult experiences. While job resources like job contracts are helpful in lowering the likelihood of abuse, lack of government oversight facilitated violence in the workplace. Filipina care workers found support through community organizations and advocating for themselves and other fellow care workers. Findings from this study suggest that organizational policies and practices play a role in attenuating poor health outcomes among care workers but not all experience these policies and practices equally. Barriers such as not acknowledging discrimination directly and providing specific resources to discrimination, differing control in the workplace because of job title and racial and gender identities, and reporting abuse and violence in the workplace outweighing the cost of the demand to provide the needs for family members prevent care workers from being able to fully benefit from these policies and practices. Nevertheless, while structural changes take time, unit managers in formal settings and employers in informal settings can address these inequities in their specific settings to improve the health and well-being of care workers. This dissertation will assist the field of social work to advocate for federal, state-level, local, and organizational policies to be implemented in the workplace that will adjust to the needs of healthcare and domestic workers. Furthermore, the study can also inform future interventions to integrate effective organizational policies that reduce poor sleep quality and burnout among care workers. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The purpose of this study was to explore Zohar’s Multi-Climate Framework for Occupational Safety to determine the effects of staff nurse perceptions of safety priorities in their organization (safety climate) and their work ownership climate (Magnet Hospital designation) on safety citizenship behaviors viewed as in role or extra role. Safety citizenship behaviors are described as behaviors that go beyond the job description to ensure safety. Participants from a convenience sample of three Magnet designated community hospitals in New England completed three scales (Zohar’s Safety Climate Questionnaire, Essentials of Magnetism II and the Safety Citizenship Role Definitions Scale) representing the study variables via an online survey platform. Multivariate analysis of covariance informed the results. Findings include a positive unadjusted relationship between safety climate and work ownership climate (rs=.492, pF (1, 86) = 8.4, p=.005, N=92), controlling for work ownership climate and hospital. Implications include support for a continued focus on better understanding the importance of a positive nursing work environment, a characteristic shared by Magnet designated hospitals, on the presence of safety citizenship behaviors in the acute care environment. A professional work environment should be considered as an important factor in reducing errors in the acute care setting.