Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2002. / Bibliography: leaves102-106.

453f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-11T19:17:54Z No. of bitstreams: 1 LuizOliveiraseg.pdf: 2721778 bytes, checksum: 874bf73b421146a26fce2873c25ef8eb (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-26T11:01:03Z (GMT) No. of bitstreams: 1 LuizOliveiraseg.pdf: 2721778 bytes, checksum: 874bf73b421146a26fce2873c25ef8eb (MD5) / Made available in DSpace on 2013-05-26T11:01:03Z (GMT). No. of bitstreams: 1 LuizOliveiraseg.pdf: 2721778 bytes, checksum: 874bf73b421146a26fce2873c25ef8eb (MD5) Previous issue date: 2006 / A LER/DORT (Lesões por Esforços Repetitivos/Distúrbios Ósteo Articulares Relacionados ao Trabalho) é uma doença que cursa com dor crônica e incapacidade para o trabalho e que afeta em graus variados a saúde e a vida dos doentes. A subjetividade dos sintomas e a inexistência de um diagnóstico morfofuncional conflitam o manejo clínico dos casos e a relação médico-paciente. Os conceitos narrativa e experiência, sob uma perspectiva hermenêutica e fenomenológica, são utilizados para investigar duas dimensões do adoecimento que estão presentes nesse conflito: 1) a historicidade do conceito – a dificuldade da medicina em “objetivar” esse sofrimento, que não impede a doença instituir-se na presença de certos elementos e situações sociais e políticas; 2) a natureza hermenêutica da clínica - com suas aberturas, “incompletudes” e o caráter posicional do médico, para mostrar que a doença institui-se na rede de atenção à saúde do trabalhador a partir de espaços sociais e políticos, cujas interseções são marcadas por interesses, conflitos e alianças transitórias. Confluências e impasses práticos, científicos, teóricos, políticos, éticos, morais envolvidos na compreensão do fenômeno são evidenciados, de modo a subsidiar políticas de melhorias do exercício profissional do médico e da qualidade assistencial fornecida aos enfermos. / Salvador

Einleitung: Die arbeitsmedizinische Tätigkeit bewegt sich heute im Spannungsfeld zwischen medizinischer Heilkunst und kundenorientierter Dienstleistung. Sie hat sich mit Fragen der Regulierung und Deregulierung und des betriebswirtschaftlichen Kalküls auseinanderzusetzen. An den Naht- und Schnittstellen eines integrierten und abgestimmten Managementsystems werden Qualität, Wirksamkeit und Effektivität des betrieblichen Arbeits- und Gesundheitsschutzes bestimmt. Gesundheitscontrolling ist eine Spezialisierung des allgemeinen Controllings mit einer funktions- oder objektspezifischen Ausprägung zur Unterstützung und Beratung des Managements. Der Begriff Gesundheitscontrolling ist nicht abschließend definiert und bezieht sich je nach Autor auf Aspekte des betrieblichen Gesundheitsmanagements (BGM), Qualitätsmanagements, Risikomanagements, Gesundheitsmonitorings sowie der Personalentwicklung und Kostenrechnung. Fragestellung: „Was verbindet der Arbeitsmediziner als Gesundheitsexperte im betrieblichen Handlungsfeld mit dem Begriff des Gesundheitscontrollings und ist oder könnte Gesundheitscontrolling für den Arbeitsmediziner ein effektives Instrument der Zielerreichung von Maßnahmen des betrieblichen Arbeits- und Gesundheitsschutzes sein?“ Die als heuristische Ausgangsüberlegung formulierte Gegenhypothese besagt, dass Arbeitsmediziner mit dem Thema Gesundheitscontrolling wenig verbindet. Zielsetzung: Befragung im Hinblick auf Begriffsverständnis, Motivation, Erfahrung und Kenntnisstand von Gesundheitscontrolling zur Widerlegung der getroffenen Annahme. Methode: Online-Befragung unter Arbeitsmedizinern plus Vertiefung durch vier teilstrukturierte persönliche Interviews. Die quantifizierten Ergebnisse wurden vor dem Hintergrund der Forschungsliteratur zum Thema interpretiert. Ergebnisse: Teilnehmerzahl von 115 mit insgesamt 2770 Antworten als (nicht repräsentative) zufällige Stichprobe aus der Grundgesamtheit der deutschen Arbeitsmediziner. Erkennbare Trends und differenzierte Aussagen lassen den Schluss zu, dass eine relevante Anzahl von Arbeitsmedizinern in Deutschland sich differenziert, praktisch und kritisch mit dem Thema Gesundheitscontrolling und den Reflektionen auf ihre eigene Tätigkeit auseinandersetzen.

Le rôle de la protection sociale dans un pays, au-delà de son importance pour l’équilibre des rapports sociaux, doit nécessairement tendre vers l’inclusion sociale et le respect de la dignité humaine. Ce travail sur la protection sociale en Mauritanie dénonce et critique toutes formes d’injustice sociale par rapport à l’accès non égalitaire à l’assurance maladie et à la sécurité sociale. En effet, une partie infime de la population mauritanienne bénéficie de ce système, il s’agit des fonctionnaires, agents de l’état, parlementaires, les forces armés en position d’activité.et certains salariés du secteur privé. Le régime de protection sociale en Mauritanie incarne l’exclusion pour une grande majorité de la population mauritanienne. La protection sociale en Mauritanie comme en France a pour objectif de garantir l’individu, la famille contre tous les risques sociaux, d’origine professionnelle ou non professionnelle, susceptibles de diminuer leur revenu en portant atteinte à la capacité de travail (la maladie, l’accident, la vieillesse, le chômage, la maladie à la naissance). Divers systèmes de couverture du risque maladie et de protection sociale sont pratiqués en Mauritanie. Il serait approprié d’engager une vaste réflexion pour assurer l’harmonie et la cohérence du régime mauritanien de protection sociale afin que ce dernier puisse suivre le sillage de la politique française en la matière pour parvenir à un système de protection sociale digne de ce nom, c'est-à-dire universelle. / The role of social protection in a country, beyond its importance for the balance of social relations, must necessarily get to word social inclusion and respect of human dignity. This work on social protection in Mauritania denounces and criticizes all forms of social injustice as non equal access to health insurance and social security is concerned. In fact a very small part of the Mauritanian population benefits of this system, such as official works, state agents, parliamentarians, armed forces in position of activity and some private sector employees. The system of the social protection in Mauritania incarnates the exclusion of a large majority of the population. The social protection in Mauritania as in France is for guarantee the individual, the family against all social risks litters professional or non professional, nature likely to reduce their income by infirming the capacity for work ( illness, accident, old age, joblessness, illness at birth). Various systems of health and social protection converge are applied in Mauritania. It would be appropriate to put in place a wide reflection in order sure the harmony coherence of the Mauritanian social protection system so as it on follow the wake of French policy in this field to achieve a social protection system as result worthy of this name, that means universal.

Medical certification of workers for respirator use is an important activity of occupational medicine health professionals. Spirometry is a diagnostic tool to evaluate respiratory distress/insufficiency that may affect respirator use. In this study, we analyzed the pulmonary function data of 337 workers from different occupations which required medical evaluation to wear a respirator. The American Thoracic Society and National Fire Protection Association criteria were used to evaluate employees. Of 337 workers who were cleared for respiratory use on the basis of medical questionnaires for respirator compliance, 14 (4.15%) failed to pass respirator compliance on the basis of NFPA criteria and 5 (1.48%) failed to pass respirator compliance criteria on the basis of ATS criteria. We compared the use of different Spirometric equations to evaluate these criteria and we found the Crapo equation cleared more workers for respirator use as compared to the Knudson and NHANES III equations. We also measured repeated Forced Expiratory Volume in 1st Second (FEV1) and Forced Vital Capacity (FVC) and compared the results longitudinally over time. Age was the only significant factor affecting the reduction in the lung function in longitudinal analysis. Longitudinal spirometry results suggested that workers were protected while using a respirator in the workplace, but age is the significant factor in reducing their lung function. As some workers were able to qualify for respirator use based on questionnaire alone but failed respirator clearance subsequent to pulmonary function testing, it is recommended that spirometry be used to evaluate clearance for all workers who will use a respirator in the workplace. As well, using different Spirometric equations can affect the outcome on passing or failing clearance for respirator use, and this should be considered in a respiratory medical certification program.

This thesis seeks to examine the ethical basis for occupational medicine, as it is practised in the United Kingdom (UK). There is empirical evidence of occupational physicians being confused with regard to confidentiality and consent, and variations in their practice. It is argued that the ethical guidance from the General Medical Council and the Faculty of Occupational Medicine on these matters, contributes significantly to such confusion. The doctor-patient relationship, consent for disclosure of a medical report, and medical confidentiality, all in the context of occupational medicine practice, are explored. These issues are addressed in the core part of this thesis in the form of the three published papers. In the first paper, the doctor-patient relationship in occupational medical practice is reviewed, and it becomes apparent that in the UK, the occupational physician carries out different roles and functions, ranging from duties that mirror those of a therapeutic encounter, to those that require the occupational physician to be completely independent for the purposes of a particular type of assessment (for ill-health retirement). The former is compatible with the assumption of a fiduciary relationship between doctor and patient, whereas in the latter situation, it would be incongruous to expect the doctor to be independent and owe the patient a “duty of undivided loyalty” simultaneously. In the second paper, consent for disclosure of information, in particular a medical report, is distinguished from the “informed consent” for treatment or interventional research, and the phrase “permission to disclose” is proposed for the disclosure situations. Although this distinction may not have much significance in therapeutic practice, the output of virtually all occupational physician activities results in the writing of a report, so this difference between the two “consents” has greater relevance. The third paper reviews the ethical, and in particular, legal basis for medical confidentiality with reference to an independently commissioned report. In such a situation, UK courts have been consistent in stating that disclosure of such a report to the commissioning party does not breach confidentiality, and no further consent for such disclosure is required. This conflicts with ethical guidance to occupational physicians on this matter. Such conflict between the law and ethical guidance are a further, and important, source of ethical confusion for occupational physicians. Indeed, a common theme through the three papers is that ethical guidance to occupational physicians is in parts either incongruent, incoherent, or conceptually flawed. This may not be surprising, as current ethical guidance is predicated on a doctor-patient relationship that exists in the usual setting for most doctor-patient encounters, that is, the therapeutic setting. It seems unreasonable to expect that simply transposing such an ethical paradigm into a different setting, with dissimilar roles and obligations, could work in a seamless manner. The occupational physicians’ ethical confusion thus reflects the confusion in their ethical guidance.

Coronary heart disease takes a large toll of middle-aged males thereby reducing the overall occupational fitness and potential of the workforce. Most of the risk factors for CHD (and other diseases) are self-determined and/or the result of preventable behaviour or alterable environment. The Multiple Risk Factor Hypothesis and the CHD risk factors are reviewed in detail in Chapter 2. It is more the interaction among risk factors within supposedly "normal" limits, rather than abnormally high levels of one or a few factors which results in the development of CHD, a phenomenon which obscures the issue of causation. It is hypothesized that the imbalance between the collective pathogenic effects of risk factors and the ability of the body to resist and/or repair such effects cause CHD. States such as sedentariness and obesity in which most of the risk factors tend to be clustered are important risk indicators. Moreover, since the overall risk profile is improved with reversal of these two states through regular aerobic activity and weight loss, the latter two are key interventions in CHD prevention. Risk factor screening to identify those at risk and subsequent modification of the risk status are useful manoeuvers for the prevention of CHD. As well as being secondary to the ravages of such diseases as CHD, occupational productivity is also reduced by poor levels of employee physical fitness. The recognition by employers of the potential success of CHD prevention programs and the increased productivity of the fit employee has led to the emergence of employer-sponsored occupational fitness programs. Such programs are based on a wholistic health-enhancement approach with regular aerobic physical activity as the core. The operative principles, contents (including the what and how of the all important assessment component) and benefits of such programs are reviewed in Chapter 3. A review of the state of health and fitness in the Canadian Forces and the experimental portion of the thesis make up Chapter 4. In spite of policies, orders and programs to ensure the health and fitness of Canadian Forces' personnel, the CF remains a fairly high-risk population. The cross-sectional study on the health and fitness of 2 83 CF personnel at National Defence Headquarters shows that Other Ranks constitute a higher-risk rank grouping than Officers, as do lower ranks in both of these two major rank groupings. Volunteers appear to be a self-selected sub-population which is healthier and fitter than average. Aerobic fitness (VO₂ max), obesity and resting heart rate emerge as the three key indicators of health and CHD risk status. Chapter 5 summarizes the thesis and contains conclusions and recommendations to the CF for future actions which are also applicable to most occupational settings. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

Thesis (MMed)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction: The morbidity and mortality associated with tuberculosis (TB) disease is of grave consequences for the health and employment of afflicted individuals. Healthcare workers are identified amongst high risk groups in communities. The prevalence/incidence of TB is dependent on the presence of associated risk factors which varies in diversity and intensity in different communities and workplaces. Understanding the risk factors operating in any given environment is indispensable to any tuberculosis control programme. Objective: The objective of this study was to describe the occurrence and trends of TB disease as well as to determine the risk factors associated with the disease among Tygerberg hospital employees. Method: A cross-sectional descriptive study design with a nested case-control component was used to determine the occurrence (and trends) and risk factors of TB disease respectively. Occurrence and trends of tuberculosis: The frequencies, distribution and trends of TB disease from 2008 to 2011 were obtained by calculating and comparing the annual incidence rates for each variable. Cases were identified from the occupational health clinic TB register, while the various denominator data were obtained from the Human Resource database. Determination of risk factors: Cases were recruited from the occupational health clinic TB register and controls were randomly selected from unaffected workers during the study period. Self-administered risk factor questionnaires were completed by both cases and controls. Multivariate logistic regression analysis was used to determine the association between known and suspected risk factors and the occurrence of TB disease amongst employees. Results: Sixty six cases of TB disease occurred in the workforce during the study period resulting in an annual average incidence rate of 397/100,000 population (95% CI: 307/100,000-505/100,000). Twenty three (34.8%) of the 66 cases occurred in Housekeeping staff, making them the most affected sub-group [1181/100,000 population (95% CI: 747/100,000-1768/100,000)]. The rate of TB disease in nurses was 1.7 times (95%CI: 1.4-2.0) that of doctors. Workers in the 40-49 years age-group experienced the highest incidence [490/100,000 population (95%CI: 329.6/100,000-706.8/100,000)] of TB disease compared to the other age-groups. There was no obvious difference in gender occurrences. Disease rates varied among different racial groups, with the highest rate in black employees [1473/100,000 population, (95%CI: 924/100,000-1981/100,000)]. Distribution of TB disease in the institution was widespread, with security department being the most affected [2500/100,000 population (95%CI: 311/100,000- 9262/100,000)]. There was a downward but statistically insignificant (annual range 9-23; p=0.28) trend in the rate of disease occurrence over the study period. No previous training on TB prevention (OR: 2.97, 95% CI: 1.15 - 7.71), HIV (OR: 67.08, 95% CI: 7.54 – 596.64) and working without knowledge of TB risk profile of the workplace (OR: 8.66, 95% CI: 1.10 – 67.96) were associated with TB disease occurrence. Conclusion: Occurrence of TB disease among Tygerberg hospital employees was low compared to that of the general population of its drainage areas. Disease occurrence in the facility was wide and varied with respect to occupational groups, workplaces and time. Well-established risk factors for TB infection (and disease) were found to be determinants of disease occurrence in the facility.