The objective of this research is to propose a model of inclusion of people with disabilities (hereby known as PWD) in the labor market of Lima - Peru. Material and Methods: A baseline descriptive, cross-sectional study. Ofthe 10,000 top companies of Peru, 188 companies where chosen aleatory and classified in large 27.1% (51), medium 13.3% (25), Small 48.4% (9) and very small 11% (21). For the quantity information a validated survey was used and for the quality information a narrative matrix was used. Results: Of the universe used, there is only 0.084% of persons with disabilities (PWD) in the payroll of the top companies in Lima. Of the sample, large companies have 0.07%; Medium 0.24%; small 0.21% and 0.69% very small feature in their payroll PWD, whose ages range between 18 and 35 years, although the General Law of Persons with Disabilities says that 3% of the payroll should be PWD. One of the main conclusions is that the companies are not complying with the Law that commands to insert PWD in their payroll, because they are only incorporating an average of 0.084%, far below from the 3% indicated as the standard;however, there is availability to insert PWD according to a profile by company type that requires it. / The objective of this research is to propose a model of inclusion of people with disabilities (hereby known as PWD) in the labor market of Lima - Peru. Material and Methods: A baseline descriptive, cross-sectional study. Ofthe 10,000 top companies of Peru, 188 companies where chosen aleatory and classified in large 27.1% (51), medium 13.3% (25), Small 48.4% (9) and very small 11% (21). For the quantity information a validated survey was used and for the quality information a narrative matrix was used. Results: Of the universe used, there is only 0.084% of persons with disabilities (PWD) in the payroll of the top companies in Lima. Of the sample, large companies have 0.07%; Medium 0.24%; small 0.21% and 0.69% very small feature in their payroll PWD, whose ages range between 18 and 35 years, although the General Law of Persons with Disabilities says that 3% of the payroll should be PWD. One of the main conclusions is that the companies are not complying with the Law that commands to insert PWD in their payroll, because they are only incorporating an average of 0.084%, far below from the 3% indicated as the standard;however, there is availability to insert PWD according to a profile by company type that requires it.

The diploma thesis deals with the issue of employment of people with mild mental disabilities. The theoretical part of the thesis first describes a person with a mild mental disability. It defines this disability, defines the basic etiology and symptomatology. It also describes the specifics of these people in relation to work. It also introduces the employment opportunities of people with mild mental disabilities, defines the basic legislation or job training. Last but not least, it presents specific job opportunities in the region Orlickoústecko. The practically oriented part of the diploma thesis describes the possibilities and specifics of employing several people with mild mental disabilities from a selected region of the Pardubice region. This part of the thesis describes the benefits or obstacles to employment, as well as the level of awareness in the process of obtaining employment and the view of employers on this issue. From a methodological point of view, a qualitative method of interview was used, which was conducted with individual employees, their key employees and their employers. After the interviews, case studies of individual employees were created. Subsequently, a comparison of case studies was performer. The main results of the research can be considered a description of the...

Employee mental health claims have become a costly burden for Canadian workplaces, therefore many organizations are seeking to adopt progressive disability management strategies to support employees with mental health conditions who are either returning to work or trying to remain at work. Developing and implementing effective workplace accommodation practices is one such strategy to support employees. Negotiating workplace accommodations has been recommended in the literature to be an interactive process between the employee and workplace stakeholders. However, there is very limited knowledge regarding the ways in which discussing and negotiating accommodations unfolds, or how employees and stakeholders experience the process of negotiating accommodations. This thesis includes the results of a qualitative study exploring how negotiating accommodations unfolds between employees with mental health conditions and workplace stakeholders, and a sub-analysis of the larger study data exploring how social capital can impact the negotiation process. In order to capture varied perspectives, in depth interviews were conducted with employees in diverse roles who self-identified as having a mental health condition that required accommodation, and stakeholders who were experienced in negotiating accommodations. A qualitative descriptive design was used to iteratively collect and analyze data. Constructive and interpretive strategies including initial and focused coding, memo writing and clustering were used to identify themes about negotiating accommodations. The negotiation process, as reported by participants in this study, was found to be a non-linear, social and political process that unfolded as a combination of micro formal and informal sub-processes, in contrast to the concrete, formal accommodation process mandated by some organizational policies. In addition, there were a number of factors that were experienced as either helpful or challenging in the process of negotiating accommodations. Social capital arose as an important element influencing how employees with mental health conditions accessed accommodations. The findings of a qualitative sub-analysis of the original data set focused on the ways in which workplace social capital impacted the experience of requesting and negotiating accommodations. Some elements of social capital were found to be dynamic, with workers able to accumulate, rebuild and spend social capital in the course of their employment. Employee reputation, employee self-confidence and likeability with coworkers and managerial staff arose as key elements of social capital. Other elements of social capital were external perceptions constructed by coworkers and workplace stakeholders, such as return-on-investment of accommodating and judgements of value to the organization. Overall, workplace social capital appeared to impact how employees experienced the process of requesting and negotiating accommodations, but it was not the determining factor of whether accommodation requests were granted. / Thesis / Master of Science (MSc) / This Master’s thesis focused on the process of discussing and negotiating workplace accommodations between workers with mental health conditions and workplace stakeholders. Six workers with mental health conditions and 6 other workplace stakeholders who had experience negotiating accommodations shared their experiences in interviews. Study findings highlighted that the negotiation process can be complex and non-linear, and is impacted by social and political factors. Workplace social capital had an impact when workers with mental health conditions requested and negotiated accommodations. For example, employee self-confidence, “likeability” (as perceived by coworkers and management), reputation as a good performer and perceived value to the organization appeared to shape how workers experienced the process of negotiating accommodations. Worker status and position also reportedly had an impact on access to supports. It should be noted, however, that social capital was only one of the factors that workers needed to be successfully accommodated, and their social capital could be at risk of being exhausted due to behavior or performance issues. This thesis expands our understanding of the accommodation negotiation process, and the impact of social and political forces on disability management strategies.

The overall aim of this thesis was to gain new knowledge of factors and interventions that improve work ability and return to work (RTW) among women on long-term sick leave from human service organizations (HSOs). The specific aims of the studies were: to evaluate the associations between the self-rated Work Ability Index (WAI) and Work Ability Score (WAS), and the relationship with prospective sick leave, symptoms, and health (Paper I); to investigate whether intervention with myofeedback training or intensive muscular strength training could decrease pain and increase work ability among women with neck pain (Paper II); to examine the associations between workplace rehabilitation and the combination of supportive conditions at work with work ability and RTW over time (Paper III); and to explore experiences, views, and strategies in the rehabilitation process for RTW (Paper IV). This thesis is based on a prospective cohort study (n=324) and a randomized controlled study (RCT) (n=60, participants with neck pain). Both quantitative and qualitative methods were used. The data collection consisted of questionnaires, laboratory-observed data, register-based data, and interviews. The results showed a very strong association between WAI and WAS, and results predicted future sick leave degree, health-related quality of life, vitality, neck pain, self-rated general health, self-rated mental health, behavioral stress, and current stress (Paper I). In the RCT (Paper II), individuals in the myofeedback intervention group increased their vitality and work ability over time and individuals in the intensive musculoskeletal strength training group increased their WAI, WAS, and mental health over time. WAI, WAS, and RTW increased over time among individuals provided with workplace rehabilitation and supportive conditions at work (Paper III) such as a sense of feeling welcome back at work, influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community, and work satisfaction. Women described (Paper IV) how they were striving to work and how they had different views, strategies, and approaches in the rehabilitation process for RTW. They expressed a desire to work, their goals for work, and their wishes for work. In the rehabilitation process for RTW they described their interaction with stakeholders as either controlling the interaction or struggling in the interaction. They described strategies to cope with RTW in terms of yo-yo (fluctuating) working: yo-yo working as a strategy or yo-yo working as a consequence. This thesis identifies factors of importance in improving work ability and RTW among women on long-term sick leave from HSOs. For women with neck pain, the intervention study showed feasibility of the intervention and demonstrated improved work ability and decreased pain (Paper II). The intensive muscular strength training program, which is easy for the individual to learn and perform at home, was associated with increased work ability. The results regarding rehabilitation highlight the importance of integrating workplace rehabilitation with supportive conditions at work to increase work ability and improve RTW (Paper III). Women expressed that they were striving to work and that they wanted to work (Paper IV). These women were “going in and out” of work participation (yo-yo working) as a way to handle the rehabilitation process. For assessing the status and progress of work ability among women on long-term sick leave, the single-question WAS may be used as a compliment to the full WAI as a simple indicator (Paper I). / <p>Akademisk avhandling som för avläggande av medicine doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet, kommer att offentligen försvaras i hörsal Hamberger, Medicinaregatan 16 A, Göteborg, måndagen den 6 oktober 2014, klockan 09.00</p>

Introdução: As restrições para o trabalho nos trabalhadores de enfermagem têm sido alvo de pesquisas nacionais e internacionais, evidenciando a magnitude do adoecimento da categoria bem como suas repercussões no âmbito individual e coletivo em diferentes contextos. Evidências científicas apontam para a fragilidade dos programas de retorno ao trabalho quando o trabalhador é reinserido no ambiente laboral após o adoecimento, traduzida pelo despreparo não somente dos profissionais na avaliação das incapacidades, como por parte das instituições que recebem o trabalhador com restrição física e/ou psíquica. Nesse aspecto, a presente pesquisa propôs compreender a ação social dos trabalhadores de enfermagem diante das restrições para o trabalho, desvelando a interface entre os trabalhadores com incapacidade e supervisores. Método: Trata-se de um estudo qualitativo a partir da fenomenologia social de Alfred Schütz, desenvolvido no Hospital Universitário da Universidade de São Paulo, que envolveu 06 trabalhadores de enfermagem com restrição, bem como 06 enfermeiros responsáveis por supervisionar o processo de trabalho. Após a aprovação do Comitê de Ética em Pesquisa (CEP) da Escola de Enfermagem da USP (EEUSP) e do Hospital Universitário da USP (HUUSP), foram realizadas entrevistas individuais com os trabalhadores de enfermagem, por meio de 02 questões norteadoras para cada grupo. Após a realização das entrevistas, os discursos foram transcritos na íntegra para posterior análise, segundo o referencial da fenomenologia social de Alfred Schütz e outros referenciais da temática em questão. Resultados: A análise resultou na construção de duas categorias expressas pelos enfermeiros que coordenam o trabalho: Vivenciando a incapacidade dos trabalhadores no cotidiano de trabalho (motivos porque) que contemplou o conflito e a discriminação entre os trabalhadores, a preocupação com a produtividade e com a segurança do paciente e o reconhecimento quanto às falhas de estrutura institucional. A categoria Projetando um cenário para o futuro (motivos para) englobou a preocupação do enfermeiro gerente com o aumento do contingente de incapacitados, o reconhecimento da responsabilidade gerencial, a necessidade de implantar programas de retorno ao trabalho e de vigilância, promoção à saúde e prevenção de agravos. Quanto aos trabalhadores com restrição também evidenciou-se duas categorias: Vivenciando a incapacidade laboral (motivos porque) que contemplou a exposição às cargas de trabalho como fator desencadeador da restrição, a vivência de sentimentos ambivalentes na organização do trabalho e a vivência da culpa pela restrição ao trabalho. A categoria Projetando um cenário para o próprio futuro (motivos para) englobou a espera de apoio e compreensão da equipe, as estratégias para reorganização do ambiente de trabalho e a necessidade de acompanhamento desse trabalhador que possui restrição. Considerações Finais: Os resultados evidenciaram a ação dos sujeitos diante da incapacidade, desvelando a interface entre os trabalhadores com restrição para o trabalho e os enfermeiros que coordenam o processo de trabalho, em que questões como a necessidade de implementação de Programas de Retorno ao Trabalho, envolvendo todos os trabalhadores e a capacitação dos gestores para o enfrentamento da problemática emergem na relação face a face. / Introduction: The restrictions for work in nursing workers have been the subject of national and international research, evidencing the magnitude of illness in the category as well as its repercussions in the individual and collective scope in different contexts. Scientific evidences point to the fragility of programs to return to work when the worker is reinserted into the work environment after illness, translated by the lack of preparation not only of the professionals in the evaluation of the incapacities, but also by the institutions that receive the worker with physical restraint and / or psychic. In this aspect, the present research proposed to understand the social action of nursing workers in face of restrictions for work, revealing the interface between workers with disabilities and supervisors. Method: This is a qualitative study based on the social phenomenology of Alfred Schütz, developed at the University Hospital of the University of São Paulo, which involved 06 nursing workers with restriction, as well as 06 nurses responsible for supervising the work process. After the approval of the Research Ethics Committee (CEP) of the USP Nursing School (EEUSP) and the USP University Hospital (HUUSP), individual interviews were conducted with nursing workers, through 02 guiding questions for each group. After the interviews, the speeches were transcribed in full for further analysis, according to Alfred Schütz \'s social phenomenology reference and other references of the subject matter. Results: The analysis resulted in the construction of two categories expressed by the nurses who coordinate the work: Experiencing the incapacity of the workers in the daily work (reasons why) that contemplated the conflict and the discrimination between the workers, the concern with productivity and with the Patient safety and recognition of failures in institutional structure. The category Designing a scenario for own future (reasons for) included the concern of the nurse manager with the increase of the contingent of the disabled, the recognition of managerial responsibility, the need to implement programs of return to work and of surveillance, health promotion and prevention of injuries. Concerning workers with restriction, two categories were also highlighted: Experiencing the work disability (reasons why), which included exposure to workloads as a triggering factor of the restriction, the experience of ambivalent feelings in the organization of work and the experience of guilt by the restriction to work. The category Designing a scenario for own future (reasons for) included the waiting for support and understanding of the team, the strategies for reorganization of the work environment and the necessity to accompany this worker with restriction. Final Considerations: The results evidenced the action of the subjects in face of the incapacity, revealing the interface between the workers with restriction to the work and the nurses who coordinate the work process, in which issues such as the need to implement return to work programs, involving all workers and the training of managers to face the problem emerge in the face-to-face relationship.

Introdução: As restrições para o trabalho nos trabalhadores de enfermagem têm sido alvo de pesquisas nacionais e internacionais, evidenciando a magnitude do adoecimento da categoria bem como suas repercussões no âmbito individual e coletivo em diferentes contextos. Evidências científicas apontam para a fragilidade dos programas de retorno ao trabalho quando o trabalhador é reinserido no ambiente laboral após o adoecimento, traduzida pelo despreparo não somente dos profissionais na avaliação das incapacidades, como por parte das instituições que recebem o trabalhador com restrição física e/ou psíquica. Nesse aspecto, a presente pesquisa propôs compreender a ação social dos trabalhadores de enfermagem diante das restrições para o trabalho, desvelando a interface entre os trabalhadores com incapacidade e supervisores. Método: Trata-se de um estudo qualitativo a partir da fenomenologia social de Alfred Schütz, desenvolvido no Hospital Universitário da Universidade de São Paulo, que envolveu 06 trabalhadores de enfermagem com restrição, bem como 06 enfermeiros responsáveis por supervisionar o processo de trabalho. Após a aprovação do Comitê de Ética em Pesquisa (CEP) da Escola de Enfermagem da USP (EEUSP) e do Hospital Universitário da USP (HUUSP), foram realizadas entrevistas individuais com os trabalhadores de enfermagem, por meio de 02 questões norteadoras para cada grupo. Após a realização das entrevistas, os discursos foram transcritos na íntegra para posterior análise, segundo o referencial da fenomenologia social de Alfred Schütz e outros referenciais da temática em questão. Resultados: A análise resultou na construção de duas categorias expressas pelos enfermeiros que coordenam o trabalho: Vivenciando a incapacidade dos trabalhadores no cotidiano de trabalho (motivos porque) que contemplou o conflito e a discriminação entre os trabalhadores, a preocupação com a produtividade e com a segurança do paciente e o reconhecimento quanto às falhas de estrutura institucional. A categoria Projetando um cenário para o futuro (motivos para) englobou a preocupação do enfermeiro gerente com o aumento do contingente de incapacitados, o reconhecimento da responsabilidade gerencial, a necessidade de implantar programas de retorno ao trabalho e de vigilância, promoção à saúde e prevenção de agravos. Quanto aos trabalhadores com restrição também evidenciou-se duas categorias: Vivenciando a incapacidade laboral (motivos porque) que contemplou a exposição às cargas de trabalho como fator desencadeador da restrição, a vivência de sentimentos ambivalentes na organização do trabalho e a vivência da culpa pela restrição ao trabalho. A categoria Projetando um cenário para o próprio futuro (motivos para) englobou a espera de apoio e compreensão da equipe, as estratégias para reorganização do ambiente de trabalho e a necessidade de acompanhamento desse trabalhador que possui restrição. Considerações Finais: Os resultados evidenciaram a ação dos sujeitos diante da incapacidade, desvelando a interface entre os trabalhadores com restrição para o trabalho e os enfermeiros que coordenam o processo de trabalho, em que questões como a necessidade de implementação de Programas de Retorno ao Trabalho, envolvendo todos os trabalhadores e a capacitação dos gestores para o enfrentamento da problemática emergem na relação face a face. / Introduction: The restrictions for work in nursing workers have been the subject of national and international research, evidencing the magnitude of illness in the category as well as its repercussions in the individual and collective scope in different contexts. Scientific evidences point to the fragility of programs to return to work when the worker is reinserted into the work environment after illness, translated by the lack of preparation not only of the professionals in the evaluation of the incapacities, but also by the institutions that receive the worker with physical restraint and / or psychic. In this aspect, the present research proposed to understand the social action of nursing workers in face of restrictions for work, revealing the interface between workers with disabilities and supervisors. Method: This is a qualitative study based on the social phenomenology of Alfred Schütz, developed at the University Hospital of the University of São Paulo, which involved 06 nursing workers with restriction, as well as 06 nurses responsible for supervising the work process. After the approval of the Research Ethics Committee (CEP) of the USP Nursing School (EEUSP) and the USP University Hospital (HUUSP), individual interviews were conducted with nursing workers, through 02 guiding questions for each group. After the interviews, the speeches were transcribed in full for further analysis, according to Alfred Schütz \'s social phenomenology reference and other references of the subject matter. Results: The analysis resulted in the construction of two categories expressed by the nurses who coordinate the work: Experiencing the incapacity of the workers in the daily work (reasons why) that contemplated the conflict and the discrimination between the workers, the concern with productivity and with the Patient safety and recognition of failures in institutional structure. The category Designing a scenario for own future (reasons for) included the concern of the nurse manager with the increase of the contingent of the disabled, the recognition of managerial responsibility, the need to implement programs of return to work and of surveillance, health promotion and prevention of injuries. Concerning workers with restriction, two categories were also highlighted: Experiencing the work disability (reasons why), which included exposure to workloads as a triggering factor of the restriction, the experience of ambivalent feelings in the organization of work and the experience of guilt by the restriction to work. The category Designing a scenario for own future (reasons for) included the waiting for support and understanding of the team, the strategies for reorganization of the work environment and the necessity to accompany this worker with restriction. Final Considerations: The results evidenced the action of the subjects in face of the incapacity, revealing the interface between the workers with restriction to the work and the nurses who coordinate the work process, in which issues such as the need to implement return to work programs, involving all workers and the training of managers to face the problem emerge in the face-to-face relationship.

This diploma thesis deals with a social policy of Czech Republic and young disabled people. The main aim of this thesis is an evaluation of social policy. If and how social policy reflects needs and issues of disabled persons. The second aim of this thesis is an indentification of biggest issues which disabled people have with a support of interviews with respondents - users of social policy. Next aim is to describe how actual social policy supports to solve issues of disabled people. This thesis analyzes possibilities of current social policy for young disabled people, how these possibilities disabled people use and how it helps them. This diploma thesis also deals with a question, if current social policy support indenpendence of young disabled people and helps them to have their own indenpendent life and household. Also topic of negative gaps in current social policy is subject of this thesis.

Introdução: O Código de Processo Civil determina que nos processos judiciais em que a matéria depender de conhecimento técnico ou científico, o juiz será assistido por perito, que produzirá um laudo. Foram analisados 83 laudos de processos judiciais do Tribunal Regional do Trabalho da 2ª Região (TRT-2), referentes a reclamantes com Lesões por Esforços Repetitivos ou Distúrbios Osteomusculares Relacionados ao Trabalho (LER/Dort), que abrangem afecções crônicas do sistema musculoesquelético de origem ocupacional e são decorrentes, dentre outros motivos, da execução de movimentos repetitivos por tempo prolongado e sobrecarga estática, sem que haja tempo para uma recuperação fisiológica. Deveriam abordar os vários aspectos do adoecimento para auxiliar a decisão judicial quanto à existência de agravo à saúde relacionado ao trabalho, assim como sua extensão e repercussões sobre a vida e capacidade laboral do trabalhador. Objetivos: Identificar e analisar, nos laudos, conceitos sobre adoecimento ocupacional e incapacidade laboral, bem como as principais linhas de argumentação, para a descaracterização do nexo causal nos casos em que havia nexo causal presumido pelo critério epidemiológico. Material e método: O material de estudo (83 laudos) foi buscado dentre os processos arquivados no período de 2012 a 2016 na Coordenadoria de Gestão de Arquivo do TRT-2, que abrange 30 municípios da região metropolitana de São Paulo e Baixada Santista. Atributos associados aos grandes temas da pesquisa foram codificados com o objetivo de melhor sistematização para uma análise de conteúdo. Resultados: Os laudos periciais foram elaborados, na sua quase totalidade por médicos, dentre os quais 56 (67,47%) médicos do trabalho, 13 (15,66%) médicos sem especificação de especialidade, 9 (10,84%) médicos com especialização em perícia ou legistas e 4 ortopedistas (4,82%). Um deles (1,21%) foi elaborado por fisioterapeuta. Do total de laudos, 25 (30,12%) não tinham quaisquer informações sobre o processo de adoecimento e apenas 23 (27,71%) contemplaram uma história clínica abrangente. Em 34 (40,96%) não havia qualquer informação sobre as características da atividade de trabalho e em 30 (36,15%) havia a citação de alguns aspectos biomecânicos. Apenas 19 (22,89%) apresentaram uma análise da atividade de trabalho, incluindo aspectos biomecânicos e organizacionais. Nenhum laudo continha uma análise da incapacidade para o trabalho de forma ampla, sendo que em 50 laudos (60,24%), o perito considerou apenas o diagnóstico para se pronunciar sobre a incapacidade. Do total dos laudos, apenas 13 (15,66%) utilizaram o conceito de multicausalidade e 12 (14,46%) o de concausalidade. Dos 15 laudos com nexo causal presumido pelo critério epidemiológico, descaracterizados no caráter ocupacional na perícia, nenhum continha uma análise da atividade de trabalho, embora 9 deles tenham utilizado argumentos biomecânicos, 8 tenham utilizado o argumento de que se tratava de doença degenerativa e 3 de que o quadro era de fibromialgia não ocupacional. Foram discutidos conceitos de adoecimento ocupacional, nexo causal e incapacidade, além da relação de desigualdade, presenteísmo, individualização do adoecimento e culpabilização. Conclusão: A maioria dos laudos periciais peca pela falta de consistência conceitual, metodológica e argumentos fundamentados, deixando lacunas na área clínica, na análise da atividade de trabalho e na avaliação de incapacidade. / Introduction: The Civil Code Procedure determines that in judicial proceedings in which the matter depends on technical or scientific knowledge, the judge will be assisted by experts, who will produce a forensic report. A total of 83 reports, from the Regional Labor Court of the 2nd Region (TRT-2), were analysed, concerning claimants suffering from Repetitive Strain Injury or Work-Related Musculoskeletal Disorders (RSI/WRMD), which include occupational chronic conditions of the musculoskeletal system, that are due, among other reason to the execution of repetitive movements for a prolonged time and static overload without pause foa a physiological recoevery. They should address the various aspects of illness in order to assist the judge in his decision regarding the existence of as aggravated health related to work, as well as its extent and repercussions on the life and work capacity of the worker. Objectives: To identify and analyse concepts about occupational illness and disability to work, expressed in the reports, as well as the main lines of argument, for the de-characterization of the causal nexus in cases where there was causal nexus presumed by the epidemiological criterion. Material and method: The study material was searched from the archived processes from 2012 to 2016 in the File Management Coordination of TRT-2, which covers 30 municipalities in the metropolitan region of São Paulo and Baixada Santista. Attributes associated with the major themes of the research were codified with the aim of better systematization for a content analysis. Results: The expert reports were elaborated almost entirely by physicians, among them 56 (67.47%) occupational physicians, 13 (15.66%) doctors without a declared specialty, 9 (10.84%), forensic doctors, 4 orthopedists (4,82%). One of the reports (1.21%) was elaborated by a physiotherapist. Of the total reports, 25 (30.12%) did not have information about the illness process and only 23 (27.71%) contemplated a comprehensive medical history. In 34 (40.96%) there was no information about the characteristics of the work activity and in 30 (36.15%) there were citation of some biomechanical aspects. Only 19 (22.89%) presented an analysis of the work activity, including biomechanical and organizational aspects. No report contained an embrancing analysis of disability to work comprehensively, and in 60.24% of them, the expert considered only the diagnosis to pronounce on the disability. Of the total reports, only 13 (15.66%) used the concept of multicausality and 12 (14.46%) the concept of concausality. Of the 15 reports with a presumed causal nexus by the epidemiological criterion, which were not characterized in the occupational character, none contained an analysis of the work activity, although 9 of the 15 reports used biomechanical arguments to de-characterize the occupational character, 8 used the argument that it was degenerative disease and 3 that the condition was non-occupational fibromyalgia. Concepts of occupational illness, causal nexus and disability were discussed, as well as the relationship of inequality, presenteism, individualization of illness and blame. Conclusions: Most of the expert reports are lacking in conceptual, methodological and reasoned arguments, leaving relevant gaps in the clinical area, in the analysis of the work activities and in the assessment of disability.

No description available.

Introdução: O Código de Processo Civil determina que nos processos judiciais em que a matéria depender de conhecimento técnico ou científico, o juiz será assistido por perito, que produzirá um laudo. Foram analisados 83 laudos de processos judiciais do Tribunal Regional do Trabalho da 2ª Região (TRT-2), referentes a reclamantes com Lesões por Esforços Repetitivos ou Distúrbios Osteomusculares Relacionados ao Trabalho (LER/Dort), que abrangem afecções crônicas do sistema musculoesquelético de origem ocupacional e são decorrentes, dentre outros motivos, da execução de movimentos repetitivos por tempo prolongado e sobrecarga estática, sem que haja tempo para uma recuperação fisiológica. Deveriam abordar os vários aspectos do adoecimento para auxiliar a decisão judicial quanto à existência de agravo à saúde relacionado ao trabalho, assim como sua extensão e repercussões sobre a vida e capacidade laboral do trabalhador. Objetivos: Identificar e analisar, nos laudos, conceitos sobre adoecimento ocupacional e incapacidade laboral, bem como as principais linhas de argumentação, para a descaracterização do nexo causal nos casos em que havia nexo causal presumido pelo critério epidemiológico. Material e método: O material de estudo (83 laudos) foi buscado dentre os processos arquivados no período de 2012 a 2016 na Coordenadoria de Gestão de Arquivo do TRT-2, que abrange 30 municípios da região metropolitana de São Paulo e Baixada Santista. Atributos associados aos grandes temas da pesquisa foram codificados com o objetivo de melhor sistematização para uma análise de conteúdo. Resultados: Os laudos periciais foram elaborados, na sua quase totalidade por médicos, dentre os quais 56 (67,47%) médicos do trabalho, 13 (15,66%) médicos sem especificação de especialidade, 9 (10,84%) médicos com especialização em perícia ou legistas e 4 ortopedistas (4,82%). Um deles (1,21%) foi elaborado por fisioterapeuta. Do total de laudos, 25 (30,12%) não tinham quaisquer informações sobre o processo de adoecimento e apenas 23 (27,71%) contemplaram uma história clínica abrangente. Em 34 (40,96%) não havia qualquer informação sobre as características da atividade de trabalho e em 30 (36,15%) havia a citação de alguns aspectos biomecânicos. Apenas 19 (22,89%) apresentaram uma análise da atividade de trabalho, incluindo aspectos biomecânicos e organizacionais. Nenhum laudo continha uma análise da incapacidade para o trabalho de forma ampla, sendo que em 50 laudos (60,24%), o perito considerou apenas o diagnóstico para se pronunciar sobre a incapacidade. Do total dos laudos, apenas 13 (15,66%) utilizaram o conceito de multicausalidade e 12 (14,46%) o de concausalidade. Dos 15 laudos com nexo causal presumido pelo critério epidemiológico, descaracterizados no caráter ocupacional na perícia, nenhum continha uma análise da atividade de trabalho, embora 9 deles tenham utilizado argumentos biomecânicos, 8 tenham utilizado o argumento de que se tratava de doença degenerativa e 3 de que o quadro era de fibromialgia não ocupacional. Foram discutidos conceitos de adoecimento ocupacional, nexo causal e incapacidade, além da relação de desigualdade, presenteísmo, individualização do adoecimento e culpabilização. Conclusão: A maioria dos laudos periciais peca pela falta de consistência conceitual, metodológica e argumentos fundamentados, deixando lacunas na área clínica, na análise da atividade de trabalho e na avaliação de incapacidade. / Introduction: The Civil Code Procedure determines that in judicial proceedings in which the matter depends on technical or scientific knowledge, the judge will be assisted by experts, who will produce a forensic report. A total of 83 reports, from the Regional Labor Court of the 2nd Region (TRT-2), were analysed, concerning claimants suffering from Repetitive Strain Injury or Work-Related Musculoskeletal Disorders (RSI/WRMD), which include occupational chronic conditions of the musculoskeletal system, that are due, among other reason to the execution of repetitive movements for a prolonged time and static overload without pause foa a physiological recoevery. They should address the various aspects of illness in order to assist the judge in his decision regarding the existence of as aggravated health related to work, as well as its extent and repercussions on the life and work capacity of the worker. Objectives: To identify and analyse concepts about occupational illness and disability to work, expressed in the reports, as well as the main lines of argument, for the de-characterization of the causal nexus in cases where there was causal nexus presumed by the epidemiological criterion. Material and method: The study material was searched from the archived processes from 2012 to 2016 in the File Management Coordination of TRT-2, which covers 30 municipalities in the metropolitan region of São Paulo and Baixada Santista. Attributes associated with the major themes of the research were codified with the aim of better systematization for a content analysis. Results: The expert reports were elaborated almost entirely by physicians, among them 56 (67.47%) occupational physicians, 13 (15.66%) doctors without a declared specialty, 9 (10.84%), forensic doctors, 4 orthopedists (4,82%). One of the reports (1.21%) was elaborated by a physiotherapist. Of the total reports, 25 (30.12%) did not have information about the illness process and only 23 (27.71%) contemplated a comprehensive medical history. In 34 (40.96%) there was no information about the characteristics of the work activity and in 30 (36.15%) there were citation of some biomechanical aspects. Only 19 (22.89%) presented an analysis of the work activity, including biomechanical and organizational aspects. No report contained an embrancing analysis of disability to work comprehensively, and in 60.24% of them, the expert considered only the diagnosis to pronounce on the disability. Of the total reports, only 13 (15.66%) used the concept of multicausality and 12 (14.46%) the concept of concausality. Of the 15 reports with a presumed causal nexus by the epidemiological criterion, which were not characterized in the occupational character, none contained an analysis of the work activity, although 9 of the 15 reports used biomechanical arguments to de-characterize the occupational character, 8 used the argument that it was degenerative disease and 3 that the condition was non-occupational fibromyalgia. Concepts of occupational illness, causal nexus and disability were discussed, as well as the relationship of inequality, presenteism, individualization of illness and blame. Conclusions: Most of the expert reports are lacking in conceptual, methodological and reasoned arguments, leaving relevant gaps in the clinical area, in the analysis of the work activities and in the assessment of disability.