A queimadura pode ser considerada como um dos traumatismos mais destrutivos que o ser humano pode sofrer. Sua relevância decorre não só da frequência com que acontece, mas também, pelas sequelas funcionais, estéticas e emocionais que a queimadura provoca. A autoagressão é um dos motivos preocupantes e de difícil manejo tanto para a equipe de saúde como para toda a sociedade, visto que é uma situação que relaciona tanto aspectos subjetivos e culturais, como também religiosos e de saúde pública. Os objetivos desta pesquisa são: caracterizar os pacientes que sofreram queimadura térmica por líquido inflamável na tentativa de suicídio, após a alta hospitalar de uma Unidade de Queimados de um Hospital Universitário entre os anos de 2006 e 2009; investigar a vida ocupacional do paciente em suas atividades de vida diária e prática, atividades produtivas e de trabalho e as atividades de lazer após a alta hospitalar e identificar quais são os recursos que contam para prosseguir sua vida. Trata-se de um estudo qualitativo, em que a história oral foi utilizada como método de investigação na modalidade história oral temática. Para a análise dos dados, seguiram-se os passos da técnica de Análise Indutiva de Conteúdo. A coleta de dados foi realizada no período de agosto a outubro de 2010. As entrevistas foram realizadas com oito pacientes queimados por autoagressão que forneceram subsídios para a construção de três núcleos de sentidos: \"Morrer ou viver: a busca pelo atendimento de urgência/emergência\"; \"Os desafios enfrentados pelo paciente no retorno para casa\" e \" Recursos e projetos futuros após a sobrevivência\". A partir da análise e discussão destas categorias, fica evidente a importância de conhecer estes pacientes em seu retorno para casa e saber por meio de suas experiências as principais dificuldades, avanços e desafios, bem como os recursos com que contam para enfrentar suas vidas, com um olhar atento para suas queixas relacionadas a ideias ou pensamentos de morte, a fim de atentar-se principalmente a possíveis reincidivas que certamente poderão ser letais; necessitando dos profissionais de saúde de urgência e emergência e dos familiares a capacidade, quando possível, de identificar um pedido de socorro ou ajuda com tomadas de ações mais efetivas e de acompanhamento a esses pacientes, mesmo com a falta de adesão ao tratamento. Para isso, é preciso conhecer a realidade e as necessidades dos serviços a partir das experiências das pessoas que recebem assistência nos mesmos e dos profissionais de saúde que as assistem. / The burn can be considered as one of the most destructive traumas that humans can suffer. Its relevance stems not only on how often it happens, but also by functional sequelae, both aesthetic and emotional cause. Self-harm is one reason for concern and difficult to manage both for the health care team for the whole society, since it is a situation that relates both subjective and cultural aspects, as well as religious and public health. The objectives of this research are: characterizer of patients who suffered thermal burns of flammable liquid in a suicide attempt, after discharge from a burn unit of a university hospital between the years 2006 to 2009; investigate the occupational life of the patient in their activities of daily living and practical, productive activities and work and leisure activities after discharge and identify what resources they have to continue your life. This is a qualitative study in which oral history was used as a method of research in oral history form. For data analysis, followed the steps of the technique of Inductive Content Analysis. Data collection was conducted between August to October 2010. The interviews were conducted with eight patients burned by self-harm which provided subsidies for the construction of three groups of meaning: \"To die or live: the search for urgent care / emergency,\" \"The challenges faced by the patient upon returning home\" and \"Resources and future projects after survival.\" From the analysis and discussion of these categories, it is evident the importance of knowing these patients on their return home and learn from their experiences major difficulties, progress and challenges, as well as the resources that have to face their lives with a look attentive to their complaints related to ideas or thoughts of death, to pay attention mainly to relapsed possible that certainly could be lethal for health professionals needing urgent and emergency capacity and family whenever possible to identify a distress or help with more effective actions taken and follow-up of these patients despite the lack of adherence to treatment. For this, one must know the reality and needs of services from the experiences of people who receive the same assistance and health professionals who care for them.

A queimadura pode ser considerada como um dos traumatismos mais destrutivos que o ser humano pode sofrer. Sua relevância decorre não só da frequência com que acontece, mas também, pelas sequelas funcionais, estéticas e emocionais que a queimadura provoca. A autoagressão é um dos motivos preocupantes e de difícil manejo tanto para a equipe de saúde como para toda a sociedade, visto que é uma situação que relaciona tanto aspectos subjetivos e culturais, como também religiosos e de saúde pública. Os objetivos desta pesquisa são: caracterizar os pacientes que sofreram queimadura térmica por líquido inflamável na tentativa de suicídio, após a alta hospitalar de uma Unidade de Queimados de um Hospital Universitário entre os anos de 2006 e 2009; investigar a vida ocupacional do paciente em suas atividades de vida diária e prática, atividades produtivas e de trabalho e as atividades de lazer após a alta hospitalar e identificar quais são os recursos que contam para prosseguir sua vida. Trata-se de um estudo qualitativo, em que a história oral foi utilizada como método de investigação na modalidade história oral temática. Para a análise dos dados, seguiram-se os passos da técnica de Análise Indutiva de Conteúdo. A coleta de dados foi realizada no período de agosto a outubro de 2010. As entrevistas foram realizadas com oito pacientes queimados por autoagressão que forneceram subsídios para a construção de três núcleos de sentidos: \"Morrer ou viver: a busca pelo atendimento de urgência/emergência\"; \"Os desafios enfrentados pelo paciente no retorno para casa\" e \" Recursos e projetos futuros após a sobrevivência\". A partir da análise e discussão destas categorias, fica evidente a importância de conhecer estes pacientes em seu retorno para casa e saber por meio de suas experiências as principais dificuldades, avanços e desafios, bem como os recursos com que contam para enfrentar suas vidas, com um olhar atento para suas queixas relacionadas a ideias ou pensamentos de morte, a fim de atentar-se principalmente a possíveis reincidivas que certamente poderão ser letais; necessitando dos profissionais de saúde de urgência e emergência e dos familiares a capacidade, quando possível, de identificar um pedido de socorro ou ajuda com tomadas de ações mais efetivas e de acompanhamento a esses pacientes, mesmo com a falta de adesão ao tratamento. Para isso, é preciso conhecer a realidade e as necessidades dos serviços a partir das experiências das pessoas que recebem assistência nos mesmos e dos profissionais de saúde que as assistem. / The burn can be considered as one of the most destructive traumas that humans can suffer. Its relevance stems not only on how often it happens, but also by functional sequelae, both aesthetic and emotional cause. Self-harm is one reason for concern and difficult to manage both for the health care team for the whole society, since it is a situation that relates both subjective and cultural aspects, as well as religious and public health. The objectives of this research are: characterizer of patients who suffered thermal burns of flammable liquid in a suicide attempt, after discharge from a burn unit of a university hospital between the years 2006 to 2009; investigate the occupational life of the patient in their activities of daily living and practical, productive activities and work and leisure activities after discharge and identify what resources they have to continue your life. This is a qualitative study in which oral history was used as a method of research in oral history form. For data analysis, followed the steps of the technique of Inductive Content Analysis. Data collection was conducted between August to October 2010. The interviews were conducted with eight patients burned by self-harm which provided subsidies for the construction of three groups of meaning: \"To die or live: the search for urgent care / emergency,\" \"The challenges faced by the patient upon returning home\" and \"Resources and future projects after survival.\" From the analysis and discussion of these categories, it is evident the importance of knowing these patients on their return home and learn from their experiences major difficulties, progress and challenges, as well as the resources that have to face their lives with a look attentive to their complaints related to ideas or thoughts of death, to pay attention mainly to relapsed possible that certainly could be lethal for health professionals needing urgent and emergency capacity and family whenever possible to identify a distress or help with more effective actions taken and follow-up of these patients despite the lack of adherence to treatment. For this, one must know the reality and needs of services from the experiences of people who receive the same assistance and health professionals who care for them.

L’objectif général était d'étudier les liens entre les conduites addictives et différents aspects de la vie professionnelle dans l’infrastructure de recherche CONSTANCES : (1) Estimer les prévalences d'usage de substances en population générale française en fonction des facteurs sociodémographiques et cliniques, (2) Étudier les associations longitudinales entre stress au travail et usage chronique de benzodiazépines, (3) Étudier les associations transversales entre demande émotionnelle au travail et usages d’alcool, de tabac et de cannabis, (4) Étudier les associations transversales entre demande émotionnelle au travail et usage chronique de benzodiazépines, (5) Étudier les associations longitudinales entre usages d’alcool, de tabac et de cannabis et la perte d’emploi.1. Les prévalences d'usage d'alcool, de tabac et de cannabis en population générale ont été estimées. Concernant l’usage chronique de benzodiazépines, sa prévalence était en 2015 de 2,8 % (IC 95% : 2,3-3,4) chez les hommes et de 3,8% (IC 95 % : 3,3-4,5) chez les femmes(n = 9 535).2. Il existait des relations dose-dépendantes entre l’intensité du stress au travail, mesuré par le déséquilibre effort-récompense, et le risque d’usage chronique de benzodiazépines sur une période de suivi de deux ans (n = 31 077), avec un OR = 2,18 (IC 95 % : 1,50-3,16) pour les sujets les plus stressés comparés aux moins stressés, après ajustement pour les facteurs sociodémographiques, les usages d’alcool et de tabac, la dépression et l’état de santé perçu.3. Il existait des associations significatives entre la demande émotionnelle au travail, mesurée par la fréquence de l’exposition stressante au public, et les usages d’alcool, de tabac et de cannabis, en ajustant pour les facteurs sociodémographiques (n=23 641). Concernant l’usage d’alcool, la demande émotionnelle était associée chez les hommes à une augmentation du risque d’alcoolisations paroxystiques intermittentes plus d’une fois par mois (OR = 1,29 (IC 95 % : 1,10-1,51), et chez les femmes à une augmentation des risques de consommation hebdomadaire élevée ou très élevée (OR = 1,59 (IC 95 % : 1,12-2,25) et de trouble de l’usage d’alcool (OR = 2,30 (IC 95 % : 1,54-3,44).4. Il existait des relations dose-dépendantes entre la demande émotionnelle au travail et l'usage chronique de benzodiazépines, en ajustant pour l’âge, le niveau d’éducation et l’indice de déprivation sociale (n=33 195). Les OR étaient de 2,3 (IC 95 % : 1,5-3,6) chez les hommes et de 2,5 (IC 95 % : 1,8-3,4) chez les femmes pour les individus exposés à la plus forte demande émotionnelle comparée à la plus faible. Ces associations persistaient en l’absence d’autres facteurs de vulnérabilité à l’usage des benzodiazépines.5. Les usages d’alcool, de tabac et de cannabis étaient tous associés, de manière indépendante, et suivant des relations dose-dépendantes, au risque de perte d’emploi à un an, en ajustant pour l’âge, le genre, la dépression et l’état de santé perçu(n=18 879). Le risque de perte d’emploi associé à un usage problématique ou de dépendance probable de l’alcool était de 1,92 (IC 95 % : 1,34-2,75) comparé à un usage à faible risque. Il était de 1,78 (IC 95 % : 1,26-2,54) pour les gros fumeurs comparés aux non-fumeurs et de 2,68 (IC 95 % : 2,10-3,42) pour les consommateurs de cannabis au moins une fois par mois comparés aux non-consommateurs.Ces résultats pourraient permettre aux décideurs en santé publique et en santé au travail d'élaborer des stratégies d'information et de prévention destinées à réduire l'usage de substances, notamment en milieu professionnel. En raison de la complexité des interrelations entre conduites addictives et vie professionnelle, ce champ de recherche en épidémiologie devrait poursuivre son développement afin de répondre aux enjeux majeurs de santé publique posés tant par les conduites addictives que par l'exposition aux risques professionnels. / The overall objective was to explore the links between addictive behaviours (alcohol, tobacco, cannabis, benzodiazepines) and different aspects of occupational life (i.e. job stress, emotional demand, job loss) using data from the CONSTANCES research infrastructure.This general objective has been operationalized into five distinct objectives:(1) Estimate the prevalence of substance use in the general population according to socio-demographic and clinical factors,(2) Examine the longitudinal associations between job stress and benzodiazepine long-term use,(3) Examine the cross-sectional associations between emotional job demand and alcohol, tobacco and cannabis use,(4) Examine the cross-sectional associations between emotional job demand and benzodiazepine long-term use,(5) Examine the longitudinal associations between alcohol, tobacco and cannabis use and job loss.1. The prevalence of alcohol, tobacco and cannabis use in the general population have been estimated. The prevalence of benzodiazepine long-term use in 2015 was of 2.8 % (CI 95 % : 2.3-3.4) in men and 3.8 % (CI 95 % : 3.3-4.5) in women (n=9 535).2. There were dose-dependent relationships between job stress, as measured by the effort-reward imbalance, and the risk of benzodiazepine long-term use over a two-year follow-up (n=31 077), with an OR = 2.18 (CI 95 % : 1.50-3.16) for the most stressed compared to the least stressed subjects, after adjusting for socio-demographic factors, alcohol and tobacco smoking use, depression and self-rated health status.3. There were significant associations between emotional job demand, measured by the stressful exposure to the public in the workplace, and alcohol, tobacco and cannabis use, after adjusting for socio-demographic factors (n=23 641). Regarding alcohol use, emotional job demand was associated in men with an increased risk of heavy episodic drinking more than once a month(OR = 1.29 (CI 95 % : 1.10-1.51), and in women with an increased risk of high or very high weekly consumption (OR = 1.59 (CI 95 % : 1.12-2.25) as well as with alcohol use disorder(OR = 2.30 (CI 95 % : 1.54-3.44).4. There were dose-dependent relationships between emotional job demand and benzodiazepine long-term use, adjusting for age, education level and social deprivation index (n=33 195). ORs were 2.3 (CI 95 % : 1.5-3.6) in men and 2.5 (CI 95 % : 1.8-3.4) in women for individuals exposed to the highest emotional demand compared to the lowest. These associations remained significant even without other factors of vulnerability to benzodiazepine use.5. Alcohol, tobacco and cannabis use were independently and dose-dependently associated with the risk of job loss at one-year, adjusting for age, gender, depression and self-rated health status (n=18 879). The risk of job loss associated with problematic use or alcohol dependence was 1.92 (CI 95 % : 1.34-2.75) compared to low-risk use. This risk was 1.78 (95% CI : 1.26-2.54) for heavy smokers compared to non-smokers and 2.68 (CI 95 % : 2.10-3.42) for cannabis users at least once a month compared to non-users.These findings could help public health and occupational health decision-makers to develop information and prevention strategies aiming at reducing the burden of substance use, particularly in the workplace. Because of the complexity of the interrelationships between addictive behaviours and occupational life, this field of the epidemiologic research should continue to be developed in order to meet the major public health challenges posed by both addictive behaviours and exposure to occupational risks.

Thesis (MOccTher)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Heideveld, a suburb that forms part of the “Cape Flats”, is plagued by high levels of crime, gangsterism, unemployment and relative poverty. I became specifically interested in the occupations of the young men in Heideveld, as I often observed them loitering in the streets, at an age when they should have been in school, studying or starting a career. This led me to wonder about the repertoire of occupations that they had performed over the course of their lives, i.e. their occupational-life-trajectories. I became interested in the influence that the environment and their personal attributes had on the occupations that they performed over time. Guided by the Person-Environment-Occupation model as a conceptual tool I decided to explore the occupational-life-trajectories of men between the ages of 20 and 25 throughout the course of their life, up to their current age. At the organisation where I volunteered during my time in Heideveld, there was a weekly programme for the children and young women (aged 12 to 22), but nothing for young men, which prompted my interest in doing research about this age group. My initial thinking was to form the theoretical basis from which an occupation-based intervention group could be developed. I intended to explore what had motivated occupational participation throughout their lives, how certain occupations developed over time and the influence of the environment on their occupations. Snowball sampling was applied to gain access to the participants. Using a qualitative approach I combined a method called PhotoVoice with individual, narrative interviews, in order to collect data on the occupational-life-trajectories of five young men from Heideveld. PhotoVoice is a participant-based method that allowed the interviewees to take photos of occupations that they have performed throughout their lives. The photographs were used to facilitate the interview process along with two or three guiding questions. Within-case and cross-case analysis were used to find themes that pertained to the aims of the study. I uncovered five themes in my analysis: “Ons gee nie krag weg nie/We don’t give away power”, “Ons het saam geloop/We ‘hang out’ together”, “Ek het baie probleme by die huis gehet/I had many problems at home”, “Die lewe is swaar hier buite/Life is hard out here” and “Ek wil net uit hierdie plek kom/I just want to get away from this place”. I found that the environment played a large role in the occupational-life-trajectories of the participants. I also found that the participants’ sense of masculinity, gender and identity affected their occupational choices and participation. I explain the peer nature and motivational factors influencing gangsterism and drug use as they manifested in the young men’s lives. I concluded that an occupation-based intervention programme might address certain aspects such as occupational choice and exposure, but that wider, more long-lasting intervention was necessary to truly make a difference in the occupational-life-trajectories of young men in Heideveld. After taking the support structures in the physical environment into consideration, recommendations were made in terms of the family unit, the peer group, education, skills training and community empowerment. Furthermore, as the organisation already serves boys between 10 and 14 years and a greater impact may be possible at this life stage, more detailed recommendations were developed regarding a possible occupational therapy intervention programme. / AFRIKAANSE OPSOMMING: Heideveld, ‘n voorstad wat deel vorm van die Kaapse Vlaktes, gaan gebuk onder hoë vlakke van misdaad, bende bedrywighede, werkloosheid en relatiewe armoede. Ek het ‘n spesifieke belangstelling ontwikkel in die “occupations”¹ van die jong mans in Heideveld, omdat ek dikwels waargeneem het dat hulle in the strate drentel, op’n ouderdom wat hulle op skool moes gewees het, besig om te studeer, of om ‘n loopbaan to begin. Dit het my laat wonder oor die verskillende “occupations” waaraan hulle deelneem gedurende hulle lewens, m.a.w. hulle “occupational-life-trajectories²”. Ek was geïnteresseerd oor die invloed wat die omgewing en hulle persoonlike eienskappe gehad het op die “occupations” waarin hulle oor ‘n tydperk deelgeneem het. Gelei deur die “Person-Environment-Occupation” model as ‘n konseptuele instrument, het ek besluit om die “occupational-life-trajectories” van mans tussen die ouderdomme van 20 en 25, gedurende die tydperk van hulle lewens tot en met hul huidige ouderdomme, te bestudeer. By die organisasie waar ek ‘n vrywilliger was gedurende my tyd in Heideveld, was daar ‘n weeklikse program vir kinders en jonger vrouens (vanaf ouderdom 12 tot 22), maar niks vir jong mans nie. Dit het gelei tot my belangstelling om navorsing omtrent hierdie ouderdomsgroep te doen. My aanvanklike gedagtes was om ‘n teoretiese basis te vorm waarvandaan ‘n “occupation”-gebaseerde intervensie-program ontwikkel kon word. Ek wou die motivering agter die jong mans se “occupational”-deelname, hoe sekere “occupations” oor tyd ontiwkkel en die invloed van die omgewing op hul “occupations” verken. Sneeubalsteekproeftrekking is gebruik om toegang tot die deelnemers te kry. Deur ‘n kwalitatiewe benadering te gebruik, het ek ‘n metode genaamd “PhotoVoice” met individuele, narratiewe onderhoude gekombineer, om data te versamel omtrent die “occupational-life-trajectories” van vyf jong mans in Heideveld. “PhotoVoice” is ‘n deelnemer-gebaseerde metode wat die deelnemer toegelaat het om foto’s van die “occupations” waaraan hulle gedurende hulle lewens deelgeneem het, af te neem. Die foto’s is gebruik om die onderhoude te fasiliteer tesame met twee of drie gerigte vrae. Tussen-geval en kruis-geval analise is gebruik om temas te vind wat die doelwitte van die studie aanspreek. Ek het vyf temas ge-identifiseer gedurende my analise: “Ons gee nie krag weg nie/We don’t give away power”, “Ons het saam geloop/We ‘hang out’ together”, “Ek het baie probleme by die huis gehet/I had many problems at home”, “Die lewe is swaar hier buite/Life is hard out here” en “Ek wil net uit hierdie plek kom/I just want to get away from this place”. Ek het gevind dat die omgewing ‘n groot rol speel in die deelnemers se “occupational-life-trajectories”. Ek het ook gevind dat die deelnemers se sin van manlikheid, geslag en identiteit hul “occupational” keuses en deelname geaffekteer het. Ek verduidelik ook die portuur natuur en motiverende faktore wat lei tot bende-aktiwiteite en dwelm gebruik, soos dit in die jong mans se lewens gemanifesteer het. Ek het afgelei dat ‘n “occupation” gebaseerde intervensie program moontlik sekere aspekte soos “occupational” keuses en -blootstelling kan affekteer, maar ‘n breër, langduriger intervensie is nodig om werklik ‘n verskil te maak in die “occupational-life-trajectories” van jong mans in Heideveld. Nadat ek die ondersteunende strukture in die fisiese omgewing inaggeneem het, het ek voorstelle gemaak in terme van die familie-eenheid, die portuur groep, onderrig, vaardigheidsopleiding en bemagtiging van die gemeenskap. Aangesien die organisasie reeds toegang het tot seuns tussen 10 en 14 jaar oud, en ‘n groter impak in hierdie lewenstydperk gemaak kan word, maak ek verdere, meer gedetailleerde voorstelle rondom ‘n arbeidsterapie program vir hierdie ouderdomsgroep.