Dissertations / Theses on the topic '200507 Occupational health'

Considerable scientific evidence showing climate change will amplify disasters and cause adverse health impacts. If not mitigated, climate change will push health systems beyond their limits and capacity. The projected trend of increasing climaterelated disasters will intensify existing health risks arising from more frequent and severe extreme weather events like floods, bushfires, poor air and water quality, and emerging and re-emerging infectious diseases. This incidents place enormous demands on the future of the healthcare sector, especially on hospitals. To prepare for and deal with the immense challenges ahead, hospitals need to incorporate climate change adaptation (CCA)1 strategies into planning for disaster risk reduction (DRR)2. It is, thus, timely to investigate the feasibility of and pathways to future-poof hospitals against disasters in a changing climate. Hospitals are no stranger to climate change as an issue. They are at the forefront of addressing the health impacts of disasters, treating the illnesses and injuries caused by them, and upholding critical response roles during and after disasters. This role will continue to expand as hospitals struggle to cope with the additional demands of climate change-related disasters. Many hospitals have in place their own emergency response procedures, but little information is available in terms of the extent of how they have incorporated CCA measures into their risk management plans. While hospitals are affected by climate change there is also the reality that they are in part responsible for accelerating climate change. Studies estimate that the healthcare sector is responsible for approximately 4.4% of anthropogenic greenhouse gas emissions. Therefore, it is important therefore for healthcare to start shifting to renewable and reliable energy sources and adopt environmentally responsible waste management practices. The problem remains to facilitate this; it would require leadership commitment, and full participation of other healthcare sector stakeholders. The organisation Health Promoting Hospitals Network (HPH), with members worldwide, promotes an integrative, eco-friendly partnership approach to improving hospital practices. The HPH is well-suited to leading the way to integrate DRR and CCA to future-proof hospitals, making it an ideal partner for this research. Among its network members, Taiwan, with its extensive HPH network and supportive government policies, was chosen for this study. Therefore, this study aims to examine opportunities and strategies for developing HPH’s work in Taiwan ensuring that hospitals are geared towards being future-proof against disasters brought about by climate change. The research began with an extensive critical literature review and then applied quantitative and qualitative methods to conduct a case study on Taiwan’s Health Promoting Hospitals. The study adopted the participatory action research (AR) approach, commonly used in health promoting settings, because it enables participants to develop strategies and actions for change and improve knowledge, strategies, and actions in the process. Overall, the study found that the AR process enabled HPH participants to lead the climate movement in the healthcare sector in Taiwan. This has led Taiwan’s health promoting hospitals to transform towards a sustainable future. Using the AR process, key challenges to effectively implement DRR and CCA efforts were identified, and it was determined that these issues could be addressed through standards that regulate hospitals. Therefore, the researchers and partners created and advocated for a new climate action standard under Taiwan’s Healthy Hospitals 2.0 Accreditation Program. As the study was being conducted, the whole world was affected by the COVID-19 and soon after a pandemic was announced. This led to the AR to modify its priorities in response to emergency needs. The result is the co-design of eco-friendly measures that could ensure healthcare workers’ protection and safety and to make healthcare reduce hazardous waste given that the pandemic has produced many unintentional health care wastes in the process of battling the virus. The research and its findings first synthesise the literature on the rationale for linking CCA and DRR in the hospital sector to inform health authorities and hospital decisionmakers on the need to incorporate these into future action plans. Second, it identifies useful indicators and strategies to guide climate action for building future-proof hospitals, especially in Taiwan. Third, it addresses organisational changes and ways HPH networks could advocate for and facilitate these changes, including strategies to leverage that hospital accreditation scheme to enhance adherence. Finally, the research adds to the evidence that HPHs can use participatory AR to deal with complex issues to better prepare for the future. This is not only timely but has practical implications for other settings-based health promotion movements such as Healthy Cities, Workplaces, and Health-Promoting Schools to help them integrate CCA and DRR into their future action plans in the pursuit of sustainable development.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medicine & Dentistry
Griffith Health
Full Text

Heat stress due to ambient outdoor temperatures is a workplace hazard that has not been well studied or characterized. The incidence of occupational heat-related illness is unknown. Heat-related morbidity and mortality have been well-studied at the population level, however it cannot be determined if these findings extend systematically to workers exposed to high heat conditions. Remarkably, there is no U.S. federal standard to protect workers from the peril of elevated environmental temperatures and few states have protective regulations. This dissertation research will add to the limited knowledge base of occupational heat-related illnesses, by characterizing worker fatalities due to environmental heat stress. Three independent, but related, research strategies were designed, executed, and completed to evaluate the current research, as well as knowledge gaps, and to thoroughly describe these fatalities based on available information.

This work was initiated with a thorough literature review to summarize research findings that characterize U.S. occupational heat-related morbidity and mortality and identify gaps in the existing research literature. This review of science, health, and medical databases found that few studies examine ambient heat stress or characterize the incidence of occupational heat-related illnesses and outcomes. Significantly more research examining the heterogeneity of worker and environmental risk factors to heat exposure is needed to identify unsafe working conditions and implement practical, evidence-based heat-stress policies and interventions. The subsequent study describes the epidemiological characteristics of heat-related deaths among workers in the U.S. from 2000 to 2010. Fatality data were obtained at the Bureau of Labor Statistics from the confidential on-site Census of Fatal Occupational Injuries database. Fatality rates and risk ratios with 95% confidence intervals were calculated by year, sex, age group, ethnicity, race, state, and industry. Between 2000 and 2010, 359 occupational heat-related deaths were identified in the U.S., for a yearly average fatality rate of 0.22 per 1 million workers. Highest rates were found among Hispanics, men, the agriculture and construction industries, the states of Mississippi and Arkansas, and very small establishments. This study provides the first comprehensive national profile of heat-related deaths in the U.S. workplace. Prevention efforts should be directed at small businesses, states, industries and individuals who may be at increased risk of heat stress.

Lastly, to further characterize these fatalities, research was performed to: 1) determine the ranges of heat index and temperature at which workers fatally succumb to environmental heat; 2) identify risk factors that may influence heat-related deaths; and 3) translate these findings to policy recommendations. The Census of Fatal Occupational Injuries and the National Climate Data Center were used to identify worker heat-related deaths in the U.S., 2000- 2010, and to assign a maximum daily temperature and heat index to each case. Demographic, meteorological, and geographical variables were analyzed to evaluate any differences in fatal heat exposure. The National Weather Service temperature alert tools, the Excessive Heat Event warning and the heat index category chart, were utilized to assess community threshold suitability for workers subjected to exertional heat stress. Of the 327 cases that qualified for the analysis, there were no differences found in mean temperatures and heat indexes between the sexes, races, age groups, ethnic groups, and industries. Southern workers died at significantly higher temperatures than workers in the North. This study supports the use of heat index and temperature as a guide when evaluating environmental conditions for workers.

Population-level heat index threshold alerts are unsuitable for preventing exertional heat stress and new warning systems should be developed. Since heat-related health hazards at work can be anticipated before they manifest, preventive measures can be implemented before illness occurs. With no federal regulatory standards to protect workers from environmental heat exposure, and with climate change as a driver for adaptation and prevention of heat disorders, it is increasing sensible and imperative for the Occupational Safety and Health Administration to take action. National leadership is needed to promulgate regulations, develop new heat alert tools using the heat index as a metric, and promote state-specific occupational heat stress prevention policies.

Įvadas. Žmonės didelę laiko dalį leidžia dirbdami, daugelis jų yra veikiami profesinių rizikos veiksnių, lemiančių profesinės ligos atsiradimą. Pastaruoju metu profesinės ligos bei jų keliama našta tapo ypač aktualia problema įvairiose šalyse. Siekiant nustatyti veiksnius, kurie sukelia ginčus, būtina analizuoti ginčytinus profesinių ligų atvejus. Profilaktiniai sveikatos tikrinimai padeda nustatyti profesines ligas ankstyvose stadijose, darbo medicinos gydytojams suteikia svarbią, papildomą informaciją apie pacientą, profesinės ligos nustatymo metu. Todėl nagrinėjant ginčytinus profesinių ligų atvejus svarbu įvertinti profilaktinių sveikatos tikrinimų įtaką. Darbo tikslas. Išanalizuoti Lietuvos ginčytinų profesinių ligų atvejų (GPLA) 2005–2009 m. charakteristikas bei jų sąsajas su profilaktiniais sveikatos tikrinimais. Uždaviniai. Įvertinti ginčytinų profesinių ligų atvejų pasiskirstymą pagal charakteristikas (diagnozę (pirminę, galutinę), priežastis, profesiją, ekonominę veiklos rūšį, kenksmingus darbo aplinkos veiksnius, amžių, darbo stažą, lytį, gyvenamąją vietą). Įvertinti ginčytinų profesinių ligų atvejų pasiskirstymą pagal pirminės ir galutinės diagnozės sutapimą. Įvertinti ginčytinų profesinių ligų atvejų pasiskirstymą pagal profilaktinių sveikatos tikrinimų rezultatus. Įvertinti profilaktinių sveikatos tikrinimų ir ginčytinų profesinių ligų atvejų charakteristikų sąsajas. Tyrimo metodika. Darbe naudoti aprašomosios statistikos ir kiekybiniai tyrimo metodai. Duomenys... [toliau žr. visą tekstą]
Intoduction. A lot of people spend their days at work; high proportion is influenced different risk factors causing occupational diseases. Nowadays the burden occupational diseases is discussed very often all around the world. To identify problems causing disputes about occupational disease diagnosis it is necessary to analyze the controversial cases of occupational diseases. Annual health check ups provide important additional information for occupational doctors, who are determining the diagnosis of occupational disease, also helps to identify diseases in early stages. Since the efectivness of annual health check ups is discussed it is necessary to evaluate how annaul health check ups influence changes in the controversial cases of occupational diseases (CCOD). Aim. To analyze the controversial cases of occupational diseases in Lithuania during years 2005-2009, characteristics of cases and their relation to health annual (mandatory) health check ups. Tasks. To evaluate the distribution of CCOD by characteristics (age, gender, place of residence, seniority, cause of dispute, occupation, economic activity, employment, harmful environmental factors, diagnosis (primary and final). To evaluate distribution of CCOD by congruence of primary and final diagnosis. To evaluate distribution of CCOD by the results of annual health check ups. To evaluate associations with characteristics of contraversial cases of occupational diseases. Methodology. The CCOD registered and analysed by... [to full text]

O Estado do Paraná destaca-se por ser responsável por mais de 20% da produção nacional de grãos. Prevalecem em sua estrutura agrária, pequenas e médias propriedades onde predomina a mão-de-obra familiar. Buscando manter e aumentar as produtividades atuais, a agricultura paranaense utiliza intensivamente os insumos disponíveis no comércio, como é o caso nos agrotóxicos, onde o Paraná é tido como segundo maior consumidor nacional. A venda maciça deste insumo, o baixo grau de escolaridade dos usuários, aliado a falta de cuidados quando da sua utilização resultam no surgimento de intoxicações. Baseado nesta realidade, o presente estudo objetivou identificar e caracterizar o perfil das populações intoxicadas por agrotóxicos no Estado do Paraná, durante o período de 1993 a 2000 e propor medidas que visem diminuir os prejuízos às populações expostas. Para tanto, foram analisadas as intoxicações agudas notificadas durante o período de 1993 a 2000, referentes ao banco de dados fornecido pela Secretaria Estadual da Saúde. As intoxicações foram analisadas segundo as seguintes variáveis: sexo, idade, local de ocorrência, via de contaminação, ocupação, evolução final (cura ou óbito), classe e grupo químico dos agrotóxicos. Após a tabulação dos dados, as variáveis foram relacionadas aos Núcleos Regionais que compõe a Secretaria de Estado da Agricultura do Paraná e as intoxicações foram correlacionadas às áreas de seis grupos de cultivos (frutas, culturas de inverno e verão, olerícolas, olerícolas grandes e outros cultivos). Os resultados do estudo apontaram que a maior parte das intoxicações ocorreu em atividades relacionadas à causa profissional (53,1%), tendo sido os inseticidas os agentes causadores da maioria das intoxicações (37,9%) e óbitos (42%). A maioria dos intoxicados foram indivíduos do sexo masculino (79,8%), sendo a faixa de idade compreendida entre os 18 e 23 anos, onde ocorreram o maior número de intoxicações (21,2%) e óbitos (15,8%). O maior percentual de óbitos ocorreu mediante a tentativa de suicídio (86%), principalmente na faixa de idade entre 18 e 23 anos (16,1%). Foi na zona rural onde se deu o maior número de ocorrências (65%), em indivíduos ligados a ocupação agrícola (63%). As principais vias de contaminação, para a causa profissional foram a via respiratória com 58,3% dos casos e suas combinações com as demais vias (82,2%). Para a causa suicídio a via prioritária foi a digestiva, tendo atingido 95,7% dos casos notificados. A região norte (composta pelos núcleos regionais de Apucarana, Cornélio Procópio, Ivaiporã, Jacarezinho, Londrina e Maringá) deteve o maior número de ocorrências de intoxicações (43,1%) e óbitos (37%), sendo os organofosforados os maiores responsáveis por ambas. A análise de Correlação concluiu ser positiva a relação existente entre as intoxicações notificadas e as áreas de cultivos de culturas de inverno e verão, frutíferas e olerícolas. O acesso fácil, associado ao armazenamento inadequado dos agrotóxicos, assim como a participação prematura em atividades agrícolas resultou na ocorrência de intoxicações e óbitos em indivíduos menores de idade. O uso do Receituário agronômico e Guia de aplicação para agrotóxicos de venda aplicada não impediram a ocorrência de intoxicações e óbitos causados por herbicidas bipiridílios.
The state of Paraná is responsible for more than 20% of the national grain production. Its agricultural structure is organized in small and mediumsized properties where the labor force comes mainly from families. In order to mantain and also increase productivity, the agriculture system in Paraná makes intensive use of the available products in the market, such as pesticides, where Paraná is considered to be the second largest consumer in Brazil. The massive sale of these products, the user’s low schooling level and the careless use of the products result in intoxications. Based on all that, the present study aimed at identifying and characterizing the profile of populations informedly intoxicated by pesticides in the state of Paraná during the period from 1993 to 2000, as well as proposing preventive measures in order to help such exposed populations. Therefore, the acute intoxications informed during the period from 1993 a 2000 refering to the State of Paraná Health Department databank were analyzed. The intoxications were analyzed according to the following variables: sex, age, location of occurrence, contamination method, occupation, final evolution (cure or death), and pesticides class and chemical group. After the data tabulation, the variables were related to the Regional Centers which compose the State of Paraná Agriculture Department and the intoxications were correlated to the áreas of six different crops (fruits, winter and summer crops, vegetable crops, large vegetable crops and other crops). The results show that most of the intoxications took place during professional activities (53.1%), and insecticides were the agents causing most of the intoxications (37.9%) and deaths (42%). Most of the intoxicated people were males (79.8%) between 18 and 23 years old, with the largest number of intoxications (21.2%) and deaths (15.8%). The largest death rate occurred due to suicide attempts (86%), mainly between the ages of 18 and 23 (16.1%). The rural area accounted for most of the occurrences (65%), in individuals somehow connected to agricultural jobs (63%). The main contamination methods for a professional reason were the respiratory tract with 58.3% of the cases and its combinations with the other tracts (82.2%). For the cause of suicide the digestive tract was the most relevant, with 95.7% of the informed cases. The north region (composed by the regional centers of Apucarana, Cornélio Procópio, Ivaiporã, Jacarezinho, Londrina and Maringá) had the highest number of intoxications (43.1%) and deaths (37%), mainly caused by organophosphates. The Correlation analysis showed the relationship between informed notifications and the winter and summer crop areas, as well as fruit and vegetable crops, was positive. Easy access, together with inadequate storage of pesticides and premature participation in agricultural activities resulted in the occurrence of intoxications and deaths in underaged individuals. The dipyridylium herbicides, even being sold strictly under agronomic prescription associated to the aplication guide, did not imped the occurrence of intoxications and deaths of pesticides’s users.

The current research was a cross sectional research and was designed to assess the performance of the selected wind power company on compliance with health and management system OHSAS 1800:2007. One wind power company in Pakistan was selected for the research purpose. To collect quantitative data survey was conducted based on Questionnaire. For finding gaps within the existing practices and also for effectiveness of the research check list was designed. Questionnaires were distributed to the employees and one check list was given to the top management. The questionnaires were distributed randomly to the employees and out of fifteen questionnaires twelve were received back. After analyzing the data from the eleven questionnaires, the results shows that overall employees are 61 % strongly agree, 30 % agree, 2% disagree and 1% strongly disagree that the requirements of the system OHSAS 18001:2007 are met. 6% did not decide about it. The check list was received from top management after analyzing data from the check list results shows that top management of the subjected wind power organization is 74% strongly agree, 23% agree and 3 % undecided about the implementation of the system OHSAS 1800: 2007. From the results it can be concluded that both employees and top management of the subjected organization are agree with the fact that the H&S system OHSAS18001:2007 is being implemented well within the organization.

p. 1-58
Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-07T19:15:14Z No. of bitstreams: 1 44444444444.pdf: 506130 bytes, checksum: b69f86ea11c66bef05bd0c64e5817675 (MD5)
Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-13T13:44:27Z (GMT) No. of bitstreams: 1 44444444444.pdf: 506130 bytes, checksum: b69f86ea11c66bef05bd0c64e5817675 (MD5)
Made available in DSpace on 2013-05-13T13:44:28Z (GMT). No. of bitstreams: 1 44444444444.pdf: 506130 bytes, checksum: b69f86ea11c66bef05bd0c64e5817675 (MD5) Previous issue date: 2010
Introdução: O Traumatismo Crânio Encefálico (TCE) é um agravo evitável que tem contribuído nas estimativas de morbi-mortalidade hospitalar. Acometem principalmente os homens e os jovens. As principais causas são os acidentes de trânsito, as quedas, os acidentes de motocicletas e as agressões. A população masculina, os mais velhos e as agressões estão associados à maior letalidade destas hospitalizações. Objetivo: Descrever as estimativas de morbi-mortalidade hospitalar por Traumatismo Crânio Encefálico (TCE), suas circunstâncias e os fatores associados aos acidentes de trabalho e a letalidade por TCE. Métodos: Trata-se de um estudo transversal seriado e descritivo das internações da população do Brasil, entre 14 a 69 anos de idade registradas no Sistema Único de Saúde, no período de Janeiro de 2001 a Dezembro de 2007. Utilizaram-se dados secundários provenientes do Sistema de Informações Hospitalar (SIH-SUS) e selecionou-se o total das internações por TCE e as internações por Causas Externas (CE), Neoplasia do Aparelho Respiratório (NAR), Diabetes Mellitus (DM), Doenças Cérebro Vasculares (DCV) e Doenças Crônicas do Aparelho Respiratório Inferior (DCARI) no mesmo período e idade, para comparação. Foram estimados os coeficientes de prevalência, mortalidade e letalidade hospitalar por TCE e por cada um dos agravos selecionados, além disso, estimou-se a proporção das circunstâncias (quedas, acidentes de trânsito, acidentes de motocicletas e agressões) no total de internações por TCE, para cada ano. Medidas de associação foram utilizadas para se identificar os fatores associados aos acidentes de trabalho e para letalidade hospitalar por TCE, assim como para as causas externas. Resultados: As hospitalizações por TCE concentraram entre os homens (81,50%) na faixa etária entre 14-34 anos de idade (53,00%) e na região Sudeste (43,00%). O Coeficiente de Prevalência de Hospitalização por TCE foi de 3,90/10.000 hab. (2001) e de 5,50/10.000 hab. (2007), ficando em quinto lugar. O Coeficiente de Mortalidade Hospitalar foi de 4,50/100.000 hab (2001) e aumentou para 6,70/100.000 hab. (2007), mantendo-se sempre à frente dos outros agravos, exceto das DCV. O Coeficiente de Letalidade Hospitalar foi de 11,40% (2001) e de 12,20% (2007), mantendo-se na terceira posição em todo o período do estudo. As quedas (35,20%) e os acidentes de trânsito (22,87%) foram as circunstâncias que mais contribuíram para o TCE, todavia os acidentes por motocicletas apresentaram o maior crescimento no período (75,00%). Embora existam subregistros de acidentes de trabalho nas hospitalizações, verificou-se três vezes mais acidentes de trabalho por TCE na região Nordeste do que nas demais regiões. Ser homem, ter de 35-69 anos, residir no Centro Oeste, sofrer agressão foram fatores que contribuíram significativamente para a maior letalidade por TCE. Conclusões: O TCE, no presente estudo ocasionou mais óbitos do que as NAR, o DM e as DCARI juntas. A maioria destas mortes ocorreu em indivíduos entre 14-34 anos. É preciso que os poderes públicos tomem medidas efetivas no sentido de diminuir as estimativas de morbi-mortalidade hospitalar do TCE atuando nas causas e entre as populações com maior potencial de risco deste agravo.
Salvador

Orientador: Angelo Zanaga Trape
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-12T22:14:31Z (GMT). No. of bitstreams: 1 Figueiredo_GiselaMariade_M.pdf: 1185159 bytes, checksum: 43feacd69c1f4e78d3b2b203d66dd196 (MD5) Previous issue date: 2009
Resumo: A utilização dos agrotóxicos tem determinado impactos sérios do ponto de vista ambiental e principalmente de saúde pública, com relatos de contaminação dos vários meios (ar, água e solo), e casos de intoxicações agudas e morte, porém com poucos relatos reais dos efeitos crônicos da exposição a longo prazo a essas substâncias. Este estudo tem como objetivo avaliar os efeitos na saúde de trabalhadores que tiveram exposição a agrotóxicos, a longo prazo, e que foram atendidos no Ambulatório de Toxicologia do Hospital de Clínicas da Unicamp, nos anos de 2006 e 2007. Trata-se de um Estudo Observacional Transversal Descritivo que relata e analisa os efeitos encontrados na saúde de 370 trabalhadores expostos ocupacionalmente a agrotóxicos a longo prazo. As variáveis estudadas nestes pacientes foram: a idade, o sexo, a relação de trabalho, o tipo de contato com os agrotóxicos, o uso dos equipamentos de proteção individual, a forma como foram encaminhados ao ambulatório, o tempo de exposição aos agrotóxicos, o tipo de exposição ao agrotóxico, as alterações encontradas no exame físico e no laboratorial e o diagnóstico. Essas variáveis acima descritas foram colhidas dos prontuários destes pacientes. Foi utilizado o Programa Excel para montar a base de dados e criação de variáveis e o Programa SPSS versão 15 para a análise estatística destes dados. Desta forma, tentou-se relacionar se trabalhadores expostos a longo prazo a agrotóxicos, dentro da realidade regional estudada de utilização de agrotóxicos, desenvolveram danos crônicos a sua saúde
Abstract: The utilization of pesticides has determined serious impacts under environmental point of view and mainly public health, with reports of contamination of several means (air, water and soil), and cases of severe intoxication and death, but with few real reports of chronic effects of exposition to these substances for long time. The goal of this study is to evaluate the effects in workers health that stayed exposed to pesticides for long time, and the ones those were attended on the Clinical Hospital of Toxicology of Unicamp (Campinas State University), during the years of 2006 and 2007. It is Descriptive Transversal Observational Study, that reports and analyses the effects found on the health of 370 workers occupationally exposed to pesticides for long time. The variations studied in this patients were: age, sex, work relationship, kind of contact with agro-toxics, the use of individual protection equipments, the way they were taken to the ambulatory, time of exposition to the pesticides, type of exposition to the pesticides, alterations found on the physical examination, on the laboratory and the diagnosis. These variations described above were taken on the medical register of these patients, and it was used Excel Program to design the database and variations creation and SPSS Program version 15 for the statistical analyses of these data. This way, we try to relate if workers exposed for long time to the pesticides, in our regional reality of agro-toxics utilization, is able to develop chronic damages to their health
Mestrado
Epidemiologia
Mestre em Saude Coletiva

This qualitative modified participatory study underpinned by social critical theory explored the experiences of immigrant medical practitioners seeking registration in New Zealand. The occupational science notions of occupation, occupational deprivation and occupational apartheid were used to understand the experiences of the participants. The objective of the study was to understand the experiences of the participants and facilitate their self-empowerment through facilitated dialogue, affording them opportunities for collective action. Data was obtained through in-depth interviews and focus group discussions with eighteen immigrant medical practitioners who were doctors and dentists as well as two physiotherapists. The two physiotherapists were sampled out of necessity to explore diversity in findings. Transcripts were analysed using thematic analysis. This method included the processes of coding data into themes and then collapsing themes into major themes which were organised under categories. Four categories were created in the findings describing the experiences of immigrant practitioners and suggesting solutions. Firstly; findings revealed that immigrant medical practitioners had a potential worth being utilised in New Zealand. Secondly; it was found that these participants faced negative and disabling experiences in the process of being registered. Thirdly; the emotional consequences of the negative experiences were described in the study. Fourthly; there were collectively suggested solutions where the participants felt that their problems could be alleviated by support systems modelled in other Western English speaking countries that have hosted high numbers of immigrant medical practitioners from non-English speaking countries. This collective action was consistent with the emancipatory intent of participatory research informed by social critical theory. This study resulted in drawing conclusions about the implications of the participants’ experiences to well-being, occupational satisfaction as well as diverse workforce development initiatives. This study is also significant in policy making as it spelt out the specific problems faced by participants and made recommendations on what can be done to effectively utilise and benefit from the skills of immigrant medical practitioners. A multi-agency approach involving key stakeholders from the government departments, regulatory authorities, medical schools and immigrant practitioners themselves is suggested as a possible approach to solving the problems faced by these practitioners.

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Segurança e Higiene no Trabalho
A importância dos Sistemas de Gestão da SST nas organizações é reconhecida por todos os trabalhadores e partes interessadas, tendo como vantagem para a segurança e saúde dos trabalhadores a redução dos riscos de acidentes e das doenças profissionais. Para a gestão global das organizações podem-se salientar, entre outras, a redução de perdas por paragem de produção, a eliminação de sanções por incumprimento legal, melhoria da produtividade e melhoria da imagem da empresa (Nunes, 2010). O trabalho elaborado tem como objetivos contribuir para compreensão da OHSAS 18001 e dos seus requisitos, no âmbito da implementação de Sistemas de Gestão da SST numa organização, identificar as etapas para a sua implementação, e conhecer as vantagens e as limitações da sua aplicação. O método utilizado consistiu na pesquisa bibliográfica, em documentação sobre o normativo OHSAS 18001, entre outros documentos, que permitiram a interpretação da norma e das ações necessárias ao cumprimento dos requisitos. A implementação de um sistema de gestão da segurança e saúde do trabalho permite que as organizações controlem os seus riscos para a SST, dos colaboradores e das partes interessadas, alcançando a melhoria no seu desempenho e assegurando a conformidade com a política de SST.
Abstract: The importance of OSH management systems in organizations is recognized by all workers and stakeholders, with the advantage for the safety and health of workers at risk reduction of occupational accidents and diseases. For the overall management of organizations can be noted, among others, the reduction of losses by stopping production, the elimination of the legal sanctions for non-compliance, improved productivity and improved company image1 (Nunes, 2010). The elaborate work aims to contribute to understanding of OHSAS 18001 and its requirements in the implementation of OSH management systems in an organization, identify the steps to implement it, and know the advantages and limitations of its application. The method used was the literature research on documentation of OHSAS 18001 standards, among other documents, which allowed the interpretation of the rule and the actions necessary to meet the requirements. The implementation of a management system for safety and health at work enables organizations to control their risks for SST, employees and stakeholders, achieving improvements in their performance and ensuring compliance with the OSH policy.

Research report in partial fulfillment for the degree of MMed (Occupational Medicine)
Background Occupational asthma is one of the most commonly reported occupational respiratory diseases in industrialized countries. Literature suggests that about 15% of all adult-onset asthma is caused by workplace exposures. It is potentially preventable and the prognosis is good with early diagnosis and adequate treatment. However, occupational asthma is under-diagnosed and under-reported. Identification of common causative agents and employment of preventative measures are necessary for proper management and control. Objectives 1. To characterize occupational asthma cases assessed at NIOH Occupational Medicine Clinic from 1st January 1997 to 31st December 2007 in terms of: • types of industries, occupations and agents • duration of exposure prior to onset of occupational asthma • time from onset of symptoms to diagnosis • nature of exposure e.g. intermittent, daily, etc. 2. To investigate factors influencing latency period in cases of sensitizer-induced asthma 3. To investigate factors influencing lag time to diagnosis in cases of sensitizer-induced asthma Methods A record review of a series of cases of occupational asthma was done. All cases of occupational asthma diagnosed from 1st January 1997 to 31st December 2007 by NIOH doctors were identified from the Clinic’s electronic database. All the records of patients who had a final diagnosis of occupational asthma were assessed using a standard data capture sheet. Doubtful cases were presented at the NIOH Occupational Medicine clinical discussion meeting for a consensus decision as to whether they qualified to be included in the study or not. Ethical approval was granted by the University of the Witwatersrand Human Research Ethics Committee (Medical). vi Results One hundred and forty two cases of occupational asthma were identified. Of these, 131 were sensitizer-induced and 11 were irritant-induced asthma. Low molecular-weight agents were in the majority with isocyanates, welding fumes, vanadium being the most common. Within the high molecular weight category, wheat was the most common. The majority of cases emanated from the Engineering, Chemical, Smelter and Food industries. Latency period from first exposure to development of symptoms was surprisingly long: a mean of 9.8 years and a median of seven years. The time from onset of symptoms to diagnosis was also long (mean of 4.9 years and median of three years). Younger cases had a shorter latency period and a longer delay in diagnosis. Agents and jobs for irritant-induced asthma cases varied widely and some came from unexpected industries. Discussion This review of asthma referrals to the NIOH Occupational Medicine Clinic has highlighted causative industries and identified exposure agents implicated in cases of occupational asthma. The very wide range of industries, occupations and agents associated with these cases is suggestive of a wide-spread occupational asthma problem in the region referring cases to the Clinic. The long latency period and delay in diagnosis are of concern since prompt diagnosis and removal from exposure is associated with a better prognosis. Irritant-induced asthma is infrequently reported in the local literature, but the range of agents and jobs is possibly indicative of under-diagnosis. Conclusion Occupational asthma is potentially preventable. New cases still arise particularly in poorly controlled workplaces which are capable of employing basic measures to control exposures. Medical surveillance, prompt diagnosis, proper medical management and application of workplace preventative measures are essential in decreasing the burden of disease and impairment

Thesis (M.P.H.(Occupational Hygiene)), Faculty of Health Sciences,University of the Witwatersrand, 2009
This study was aimed at describing the nature of Occupational Health and Safety (OHS) inspections and blitzes conducted in the Port Elizabeth Integrated Department of Labour (DoL) in 2005, the nature and number of prohibitions, contraventions, as well as improvement notices issued. The objectives were to determine the number of OHS inspections conducted in the Port Elizabeth Labour Centre (PELC) in 2005; to describe the nature of the inspections and the type of industries inspected in the PELC in 2005; and to determine the frequency and nature of prohibitions, contraventions and improvement notices issued. The data was obtained from the PELC. The results of the study revealed that the inspectorate conducted a total of 1258 and this exceeded the target of 800 OHS inspections for the PELC. However, it is questionable how this target was developed. The target is not representative and does not give an overall picture of conditions in the workplace. The results indicated that inspectors were not competent in conducting boiler inspections as well on Major Hazardous Installation (MHI) since none of these inspections were conducted. On the inception of the OHS task team, there was a sudden increase in inspections conducted in the construction industry in October 2005 as well as the rate of finalisation of incidents in November 2005 and this was attributed to the fact that they were not conducting inspections on other labour laws and were only focusing on OHS. An assessment of the inspectors’ inspection checklists revealed that the inspections were being reduced to just a yes or no tick exercise, with no recommendation on appropriate action to be taken by the employer. It became evident that the inception of a special team in September 2005 contributed to an increased number of OHS inspections, since they were only focusing on OHS issues. This team ensured that in November 2005 there were 43 incidents finalised as compared to the 101 finalised over 11 months. They also ensured that a total of 258 OHS inspections were conducted from September 2005 to December 2005. Although these inspectors were not fully competent in addressing health and s afety issues their momentary focus on OHS activities ensured that they made a difference in the rate of finalisation of incidents. However, when some of the cases were taken to court no successful prosecution could be obtained because there are no OHS focused prosecutors, which have a clear understanding of Act. Discussions with the inspectors revealed that there was a lack of morale and loss of interest in their work, thus causing them not to put in much effort. These discussions revealed that this lack of morale was caused by the frustrations they often experienced in the execution of their duties due to lack of training as well as lack of cooperation from the employers. Furthermore, the inspectors revealed that the great number of resignations from inspectors who were leaving for greener pastures left them with a lot of work with no financial incentive. It also became apparent that there was no objective strategy underlying the number of inspections required relative to the purpose of the inspections, taking into account the nature and complexity of the industry that is to be inspected. The failure of the Service Delivery Unit to give a direction on how qualitative inspections should be measured demoralised them because the focus was only on the quantity (240 inspections per annum) of inspections that are to be conducted by each inspector. It is recommended that training, which should include a proper career path be conducted for inspectors to improve the inspectors’ capability and to motivate them. Strong relations with the South African Police Services and the Department of Justice should be promoted to ensure effectiveness of service delivery. These relations will ensure that inspectors are readily assisted by the police when they deal with uncooperative employers. Training of prosecutors will ensure that they understand the OHSA and its implementation and therefore effectively defend cases that are taken to court. The targets set for inspections should be scientifically supported and take into account the nature and complexity of the production processes. Lastly, revision of salary packages should be looked into to ensure retention of competent staff. The above recommendations will only be effective if the Business Unit Manager and the Regional Manager address them through the National Department of Labour since their implementation will affect all inspectors.

碩士
國立中興大學
應用經濟學系所
101
There is close connection between occupation and sickness. Farming needs hard-working and routine operations during the processes. These required works may cause burden to the physical body and the sicknesses hereafter. This study considers the relationship between occupation and diseases with the farmer and non-farmer categories. Also this research is to realize that whether or not people who live in an area with different proportions of farming population may exist significant distinction of named diseases. Taiwan’s National Health Insurance Research Database (NHIRD) with 1,000,000 beneficiaries enrolled in 2005 is used to analyze. Data for outpatient prescriptions data and registry were both been considered. A total 682,310 cases is used to estimate after deleting the duplicate visits of outpatient prescriptions and those aged below 19. And estimated prevalence of the disease is calculated based on age, gender, farming occupation, regions and visits of clinics. Types of disease are identified according to International Classification of Disease 9th edition (ICD9) for outpatients. This study selects high blood pressure, coma, spinal stenosis, strained joints, cataracts, diabetes, acute conjunctivitis, acute gastritis, headaches, joint bacteria to identify outpatient project based on the gap between those the proportion of outpatient project engaged in agriculture and non-agriculture. Statistical results by adopting the binary logistic regression analysis show that male patients have a higher prevalence than female such as high blood pressure and diabetes; farming labors have a higher prevalence than non-farming ones such as spinal stenosis, joints and other diseases. Also the age factor is significantly observed that every clinic elected project have shown increased probability when the age of patient rise. The results by observing the gap between the probability of different ages also show that when a patient at the 40 years old may have rapid increase of probability in hypertension and strain jointm, 45 for diabetes, 50 for cataract, and over 60 for narrow aspects of the spine. The analytical results on different farming regions also support that those high farming regions observe more patients with named diseases above.

Cada vez mais os Sistemas de Gestão da Segurança e Saúde no Trabalho, fazem parte integrante do sistema global de gestão das organizações, dando resposta a um mercado global cada vez mais exigente e competitivo. Consequentemente, os Sistemas de SST assumem um papel estratégico no desenvolvimento das políticas, na prevenção, na produtividade, na reputação e na competitividade das empresas. O objetivo do presente trabalho é assim, através de um estudo de caso, conceber e implementar um modelo de Sistema Gestão Integrado QAS numa empresa de construção civil. Pretende que a implementação efetiva deste projeto contribua para que o Sistema de Gestão Integrado responda ao novo referencial normativo ISO 45001:2018, e que seja passível de ser certificado por entidade certificadora externa, de forma integrada até final do primeiro semestre do próximo ano. O estudo em causa procurou: identificar e caracterizar todas as áreas do Sistema Integrado QAS, que carecem de melhorias, face aos requisitos do novo referencial; sugerir um conjunto de soluções e propor uma estratégia de implementação de modelo de Sistema de Gestão Integrado QAS. Numa perspetiva de futuro foram tidos em consideração todos os requisitos da nova norma ISO 45001, bem como as das normas ISO 9001:2015 e ISO 14001:2015, com a finalidade da certificação integrada do sistema de gestão. No início do presente trabalho é abordada a temática dos sistemas de gestão da segurança e saúde no trabalho, as normas existentes e o novo referencial ISO 45001 que substituirá as atuais normas OHSAS 18001:2007 e a NP 4397:2008, pela qual a empresa é certificada de forma integrada. Seguidamente é efetuado um diagnóstico do sistema atual da empresa objeto de estudo, identificadas as necessidades de elaboração e/ou adaptação da documentação e procedimentos. Na parte final do trabalho e com base em Auditoria diagnóstico ao sistema implementado, é definida uma estratégia e linhas orientadoras, propondo as ações necessárias para a implementação dos novos requisitos que dão cumprimento ao estabelecido na ISO 45001. Foram elaborados alguns dos documentos chave do Sistema e identificados todos os outros que devem ser elaborados e/ou adaptados, com vista à preparação da organização para a certificação externa sob a forma integrada dos seus três sistemas.
Nowadays increasingly Occupational Safety and Health Management Systems are an integral part of the global management system of the organizations, replying to much more demanding and competitive global market. As a result, OSH Systems play a strategic role in policy development, prevention, productivity, reputation and competitiveness of the companies. The objective of the present work is, through a case study, design and implement a Quality, Environment and Safety (QES) Integrated Management System model in a construction company. It intends that the effective implementation of this project will contribute for the Integrated Management System answer to the new normative reference ISO 45001: 2018 and allows it to be certified by an external certifying entity, in an integrated way until the end of the first six months of 2020. The study case focus on identify and characterize all areas of the QAS Integrated System, which need improvement, in view of the requirements of the new framework; suggest a set of solutions and propose a strategy for implementing QES Integrated Management System model. Moring forward, all requirements of the new ISO 45001 standard as well as ISO 9001: 2015 and ISO 14001: 2015 have been taken into account for the purpose of an integrated management system certification.. At the beginning of this project, it is approached the theme of occupational safety and health management systems, the existing standards and the new ISO 45001 standard will replace the current OHSAS 18001: 2007 and NP 4397: 2008, by which the company is certified in an integrated format to prepare de migration. Then a diagnosis of the current system of the company under study is made, identifying the needs of elaboration and/ or adaptation of the documentation and procedures. At the end of this project and based on Gap Analysis to the implemented system, a strategy and guidelines are defined, proposing the necessary actions for the implementation of the new requirements that comply with the established in ISO 45001. Some of the key documents of the System and others that need to be designed and / or adapted to prepare the organization for external certification in the integrated form of its three systems, were elaborated.