Dissertations / Theses on the topic 'Work related symptoms'

Este estudo objetivou a adaptação transcultural do questionário Cultural Study of Musculo-Skeletal and Other Symptoms and Associated Disability - CUPID Questionnaire, para a língua portuguesa falada no Brasil e a validação do seu conteúdo. O estudo é do tipo metodológico e foi realizado obedecendo aos procedimentos internacionais recomendados e aos procedimentos específicos indicados pelo autor do Questionário, uma vez que será aplicado em estudo multicêntrico por ele coordenado. A adaptação transcultural foi realizada seguindo as etapas de tradução, retrotradução, avaliação destas versões por um comitê de juízes e pré-teste da versão pré-final. O pré-teste foi realizado no Departamento de Enfermagem do Hospital Universitário da Universidade de São Paulo com 40 trabalhadores de enfermagem. Ajustes foram feitos após a análise das traduções pelo comitê de juízes quando o Índice de Validade de Conteúdo foi inferior a 80%. A versão resultante do questionário foi então pré-testada para verificar a capacidade compreensão e preenchimento pelos sujeitos e a possibilidade de ajustes, considerando o indicativo de ajustes quando 15% destes apresentassem dificuldades em relação ao preenchimento. Os resultados do pré-teste apontam um número significativo de trabalhadores de enfermagem com dores em região lombar, ombro, cotovelo, punho e/ou mão e joelho, associados a sintomas psicossociais e demais incapacidades. A análise das respostas dos sujeitos aos itens do Questionário não evidenciou dificuldades de compreensão e entendimento na totalidade dos itens, indicando a validade de seu conteúdo para a língua portuguesa falada no Brasil. Conclui-se que a versão Brasileira do CUPID Questionnaire é um instrumento adequado para identificar os sintomas musculoesqueléticos, indicados pelos trabalhadores de enfermagem, relacionados às atividades ocupacionais, aspectos psicossociais e outras incapacidades associadas
The objective of this study was to adapt the Transcultural Questionnaire Cultural Study of Muscular-Skeletal and Other Symptoms and Associated Disability CUPID Questionnaire, to the Portuguese language spoken in Brazil and to validate its contents. This methodological study was performed in accordance with internationally recommended procedures and the specific procedures indicated by the Questionnaires author since it will be applied in a multicenter study coordinated by the author. The transcultural adaptation was performed following the steps of translation, back-translation, evaluation of these versions by a committee of judges and pre-test version of the pre-final. The pre-test was performed in the Nursing Department of University Hospital at the University of Sao Paulo with 40 nursing workers. Adjustments were made after an analysis of the translations by a committee of judges when an index of content validation was less than 80%. The resulting version of the questionnaire was then pre-tested to verify the capacity of comprehension and form completion by the subjects and the possibility of adjustments considering an adjustment indicator when 15% of them presented difficulty related to form completion. The results of this pre-test showed that a significant number of Nursing workers complained of pain in the regions of lumbar, shoulder, elbow, wrist and or hand and knee, symptoms associated with psychosocial and other disabilities. Analysis of the subjects responses to items of the questionnaire revealed no difficulty in the comprehension and total understanding of the items indicating a validity of its contents for the Portuguese language spoken in Brazil. It can be concluded that the Brazilian Version of the CUPID Questionnaire is an adequate instrument for the identification of musculoskeletal symptoms indicated by nursing workers related to occupational activities, psychosocial aspects and other associated incapacities

ABSTRACT Occupational exposure to wood dust and biohazards associated with wood dust (endotoxins, (1->3)-b-D-glucans, Gram (-)ve bacteria and fungi), their correlation to respiratory function, and symptoms among woodworkers have been investigated in the present study. Wood dust, endotoxins, and allergenic fungi are the main hazards found in woodworking environments. Relatively very few studies have been done on wood dust exposure. The present study was designed to comprehensively investigate the health effects of wood dust exposure, and in particular provide new information regarding: Exposure to (1->3)-b-D-glucans in an occupational environment; Levels of exposure to wood dust and biohazards associated with wood dust in different woodworking environments; Correlations among personal exposures, especially correlations between (1->3)-b-D-glucans and fungi exposures, and endotoxins and Gram (-)ve bacteria exposures; Effects of personal exposure to biohazards on lung function; Effects of personal exposure to biohazards on work-related symptoms; and Determinants of inhalable exposures (provide which factors in the environment influence the personal inhalable exposures). Workers at four different woodworking processes; two logging sites, four sawmills, one major woodchipping operation and five joineries situated in the state of New South Wales in Australia were studied for personal exposure to inhalable dust (n=182) and respirable dust (n=81), fungi (n=120), Gram (-)ve bacteria (n=120), inhalable endotoxin (n=160), respirable endotoxin (n=79), inhalable (1->3)-b-D-glucan (n=105), and respirable (1->3)-b-D-glucan (n=62). The workers (n=168) were also tested for lung function. A questionnaire study (n=195) was carried out to determine the prevalence of work-related symptoms. The geometric mean inhalable exposure at logging sites was 0.56 mg/m3 (n=7), sawmills 1.59 mg/m3 (n=93), the woodchipping mill 1.86 mg/m3 (n=9) and joineries 3.68 mg/m3 (n=66). Overall, sixty two percent of the exposures exceeded the current standards. Among joineries, 95% of the hardwood exposures and 35% of the softwood exposures were above the relevant standards. Compared with green mills, the percentage of samples, which exceeded the hardwood standard was high for dry mills (70% in dry mills, 50% in green mills). The respirable dust exposures were high at the joineries compared with the other worksites. Exposure levels to fungi at logging sites and sawmills were in the range 103-104 cfu/m3, woodchipping 103-105 cfu/m3 and joineries 102-104 cfu/m3. The predominant fungi found at sawmills were Penicillium spp. High exposure levels of Aureobasidium pullulans were also found at two sawmills. At the woodchipping mill the predominant species were Aspergillus fumigatus, Penicillium spp., and Paecilomyces spp. The sawmills, which employed kiln drying processes, had lower exposure levels of fungi compared with the green mills. Those workplaces which had efficient dust control systems showed less exposure to fungi and bacteria. Although mean endotoxin levels were lower than the suggested threshold value of 20 ng/m3, some personal exposures at sawmills and joineries exceeded the threshold limit value. The mean inhalable (1->3)-b-D-glucan level at the woodchipping mill was 2.32 ng/m3, at sawmills 1.37 ng/m3, at logging sites 2.02 ng/m3, and at joineries 0.43 ng/m3. For the respirable size fraction, mean endotoxin and mean (1->3)-b-D-glucan concentrations were much lower, being similar to observed dust concentrations. Significant correlations were found between mean inhalable endotoxin and Gram (-)ve bacteria levels (p<0.0001), and mean airborne inhalable (1->3)-b-D-glucan and fungi levels (p=0.0003). The correlations between mean respirable endotoxin levels vs Gram (-)ve bacteria exposure levels (p=0.005), and respirable (1->3)-b-D-glucan exposure levels vs total fungi levels (p=0.005) were also significant. Significant correlations were found between lung function and personal exposures. Multivariate analyses showed that the effect of all the personal exposures on cross-shift decrements in lung function was more prominent among sawmill and chip mill workers compared with joinery workers. Woodworkers had markedly high prevalence of cough, phlegm, chronic bronchitis, frequent headaches, throat and eye irritations, and nasal symptoms compared with controls. Among the woodworkers, smokers had a high prevalence of chronic bronchitis (20%) compared with non-smokers (10%). Some workers also reported a variety of allergy problems due to exposure to various types of wood dust. Both joinery workers and sawmill and chip mill workers revealed significant correlations between work-related symptoms and personal exposures. Chronic bronchitis was significantly correlated with personal exposure to wood dust, endotoxin, (1->3)-b-D-glucan, fungi, and Gram (-)ve bacteria among joinery workers. Whereas among sawmill workers chronic bronchitis was significantly correlated with personal exposure to endotoxin, (1->3)-b-D-glucan, and fungi. Woodworkers showed significant positive correlations between percentage cross-shift change (decrease) in lung function and respiratory symptoms. Significant inverse correlations were also found among percentage predicted lung function and respiratory symptoms. The elevated inhalable dust exposures observed in this study can be explained by a combination of factors, including: lack of awareness of potential health effects of wood dust exposure among both management and workers, aging equipment, inadequate and ineffective dust extraction systems or usually none especially for hand held tools, poor maintenance of the ventilation system in some, non-segregation of dusty processes, dry sweeping, and the use of compressed air jets. The determinant-of-exposure analysis confirmed the field observations. The significant determinants of personal inhalable dust exposures (n=163) were found to be: local exhaust ventilation, job title, use of hand-held tools, cleaning method used, use of compressed air, and green or dry wood processed. Type of wood processed was not found to be statistically significant. A majority of workers (~90%) did not wear appropriate respirators approved for wood dust, while the workers who did wear them, used them on average less than 50% of the time. Workers should be protected by controlling dust at its source. When exposure to wood dust cannot be avoided, engineering controls should be supplemented with the use of appropriate personal protective equipment.

ABSTRACT Occupational exposure to wood dust and biohazards associated with wood dust (endotoxins, (1->3)-b-D-glucans, Gram (-)ve bacteria and fungi), their correlation to respiratory function, and symptoms among woodworkers have been investigated in the present study. Wood dust, endotoxins, and allergenic fungi are the main hazards found in woodworking environments. Relatively very few studies have been done on wood dust exposure. The present study was designed to comprehensively investigate the health effects of wood dust exposure, and in particular provide new information regarding: Exposure to (1->3)-b-D-glucans in an occupational environment; Levels of exposure to wood dust and biohazards associated with wood dust in different woodworking environments; Correlations among personal exposures, especially correlations between (1->3)-b-D-glucans and fungi exposures, and endotoxins and Gram (-)ve bacteria exposures; Effects of personal exposure to biohazards on lung function; Effects of personal exposure to biohazards on work-related symptoms; and Determinants of inhalable exposures (provide which factors in the environment influence the personal inhalable exposures). Workers at four different woodworking processes; two logging sites, four sawmills, one major woodchipping operation and five joineries situated in the state of New South Wales in Australia were studied for personal exposure to inhalable dust (n=182) and respirable dust (n=81), fungi (n=120), Gram (-)ve bacteria (n=120), inhalable endotoxin (n=160), respirable endotoxin (n=79), inhalable (1->3)-b-D-glucan (n=105), and respirable (1->3)-b-D-glucan (n=62). The workers (n=168) were also tested for lung function. A questionnaire study (n=195) was carried out to determine the prevalence of work-related symptoms. The geometric mean inhalable exposure at logging sites was 0.56 mg/m3 (n=7), sawmills 1.59 mg/m3 (n=93), the woodchipping mill 1.86 mg/m3 (n=9) and joineries 3.68 mg/m3 (n=66). Overall, sixty two percent of the exposures exceeded the current standards. Among joineries, 95% of the hardwood exposures and 35% of the softwood exposures were above the relevant standards. Compared with green mills, the percentage of samples, which exceeded the hardwood standard was high for dry mills (70% in dry mills, 50% in green mills). The respirable dust exposures were high at the joineries compared with the other worksites. Exposure levels to fungi at logging sites and sawmills were in the range 103-104 cfu/m3, woodchipping 103-105 cfu/m3 and joineries 102-104 cfu/m3. The predominant fungi found at sawmills were Penicillium spp. High exposure levels of Aureobasidium pullulans were also found at two sawmills. At the woodchipping mill the predominant species were Aspergillus fumigatus, Penicillium spp., and Paecilomyces spp. The sawmills, which employed kiln drying processes, had lower exposure levels of fungi compared with the green mills. Those workplaces which had efficient dust control systems showed less exposure to fungi and bacteria. Although mean endotoxin levels were lower than the suggested threshold value of 20 ng/m3, some personal exposures at sawmills and joineries exceeded the threshold limit value. The mean inhalable (1->3)-b-D-glucan level at the woodchipping mill was 2.32 ng/m3, at sawmills 1.37 ng/m3, at logging sites 2.02 ng/m3, and at joineries 0.43 ng/m3. For the respirable size fraction, mean endotoxin and mean (1->3)-b-D-glucan concentrations were much lower, being similar to observed dust concentrations. Significant correlations were found between mean inhalable endotoxin and Gram (-)ve bacteria levels (p<0.0001), and mean airborne inhalable (1->3)-b-D-glucan and fungi levels (p=0.0003). The correlations between mean respirable endotoxin levels vs Gram (-)ve bacteria exposure levels (p=0.005), and respirable (1->3)-b-D-glucan exposure levels vs total fungi levels (p=0.005) were also significant. Significant correlations were found between lung function and personal exposures. Multivariate analyses showed that the effect of all the personal exposures on cross-shift decrements in lung function was more prominent among sawmill and chip mill workers compared with joinery workers. Woodworkers had markedly high prevalence of cough, phlegm, chronic bronchitis, frequent headaches, throat and eye irritations, and nasal symptoms compared with controls. Among the woodworkers, smokers had a high prevalence of chronic bronchitis (20%) compared with non-smokers (10%). Some workers also reported a variety of allergy problems due to exposure to various types of wood dust. Both joinery workers and sawmill and chip mill workers revealed significant correlations between work-related symptoms and personal exposures. Chronic bronchitis was significantly correlated with personal exposure to wood dust, endotoxin, (1->3)-b-D-glucan, fungi, and Gram (-)ve bacteria among joinery workers. Whereas among sawmill workers chronic bronchitis was significantly correlated with personal exposure to endotoxin, (1->3)-b-D-glucan, and fungi. Woodworkers showed significant positive correlations between percentage cross-shift change (decrease) in lung function and respiratory symptoms. Significant inverse correlations were also found among percentage predicted lung function and respiratory symptoms. The elevated inhalable dust exposures observed in this study can be explained by a combination of factors, including: lack of awareness of potential health effects of wood dust exposure among both management and workers, aging equipment, inadequate and ineffective dust extraction systems or usually none especially for hand held tools, poor maintenance of the ventilation system in some, non-segregation of dusty processes, dry sweeping, and the use of compressed air jets. The determinant-of-exposure analysis confirmed the field observations. The significant determinants of personal inhalable dust exposures (n=163) were found to be: local exhaust ventilation, job title, use of hand-held tools, cleaning method used, use of compressed air, and green or dry wood processed. Type of wood processed was not found to be statistically significant. A majority of workers (~90%) did not wear appropriate respirators approved for wood dust, while the workers who did wear them, used them on average less than 50% of the time. Workers should be protected by controlling dust at its source. When exposure to wood dust cannot be avoided, engineering controls should be supplemented with the use of appropriate personal protective equipment.

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OBJETIVO: Avaliar a capacidade funcional de trabalhadores e sua associação com características individuais e ocupacionais. MÉTODO: Estudo epidemiológico transversal com 360 trabalhadores do setor técnico e produção de uma indústria de materiais elétricos. Utilizaram-se 3 questionários auto-aplicáveis: um com variáveis demográficas, socioeconômicas, ocupacionais e de estilo de vida, o Índice de Capacidade para o Trabalho (ICT) e o Questionário Nórdico de Sintomas Osteomusculares. Modelos de regressão de Poisson foram utilizados para obtenção das Razões de Prevalência (RP) brutas e ajustadas e seus respectivos Intervalos de Confiança 95% (IC95%) RESULTADOS: Participaram do estudo 337 trabalhadores, 51,6% do sexo feminino, 42,1% entre 20 e 29 anos, estando 66,2% nas linhas de produção. A prevalência de baixa/moderada capacidade para o trabalho foi de 19% (IC95% 15%-23%) e a de sintomas osteomusculares relacionados ao trabalho de 47,5% (IC95% 42%-53%). A análise multivariada revelou que a capacidade para o traba
OBJECTIVE: To assess the functional capacity of workers in an electric materials plant and its association with individual and occupational characteristics.METHOD: This is a cross-sectional survey with 360 workers from the technical and production sector of a industry of electric materials. Three self-completed questionnaires were used to collect information on demographic, social-economic, occupational, and life style variables, the Work Ability Index (WAI), and the Nordic Questionnaire of Musculoskeletal Symptoms. Poisson regression models were used to estimate the crude and adjusted Prevalence Ratios (PR) and their respective 95% confidence intervals (CI95%).RESULTS: 337 workers took part in the survey. Of these, 51.6% were women, 42.1% were 20 and 29 years old, and 66.2% were from the production lines. The prevalence of reduced work ability was of 19% (CI95% 15%-23%) and the musculoskeletal symptoms related to work was of 47.5% (CI95% 42%-53%). Multivariate analyses showed that the reduced work ability ca

Background: Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly focused on chronic and common diseases in patient and older populations. The prevalence of multimorbidity in workers and its effect on occupationally relevant outcomes is poorly known. Methods: We computed baseline multimorbidity scores using severity-weighted chronic conditions based on: 1) the relationship between chronic conditions, health-related behaviors and symptoms, and 2) their individual influence on poor health status. Next, we assessed the longitudinal effect of multimorbidity on the incidence and duration of overall and diagnosis-specific sickness absence, as well as on work functioning after return to work from a sickness absence episode. Results: Among men, higher baseline multimorbidity was a risk factor for overall incident sickness absence and episodes due to musculoskeletal and cardiovascular diseases. In women, the trend was less evident, although mental disorders had the strongest association. Associations with sickness absence duration were less consistent. Higher multimorbidity negatively impacted work functioning over time. Conclusion: Multimorbidity affects occupational outcomes, such as sickness absence, and its measurement may allow the early detection of workers coping with unbalanced health-related limitations and work demands.
Antecedents: La recerca sobre multimorbiditat, la coexistència de dues o meés condicions relacionades amb la salut, s’ha enfocat principalment a poblacions de pacients i de major edat. La prevalença de multimorbilitat entre treballadors, i el seu efectes sobre indicadors rellevants per a la salut ocupacional, no està gaire estudiada. Mètodes: Partint de dades de dues poblacions treballadores, vam calcular puntuacions de multimorbilitat ponderades per la seva severitat considerant: 1) la interrelació entre condicions cròniques, hàbits relacionats amb la salut i símptomes, 2) l’efecte de cada condició crònica sobre el mal estat de salut general. Seguidament, vam avaluar l’efecte longitudinal de la multimobilitat basal en la incidència i durada del total d’episodis d’incapacitat temporal, d’episodis per diagnòstics específics, així com en la capacitat d’assolir les demandes laborals un cop retornat d’una incapacitat temporal. Resultats: Pels homes, la multimorbiditat alta va ser un factor de risc tant pel total d’episodis d’incapacitat temporal com per aquells deguts a trastorns musculoesquelètics i malalties cardiovasculars. Per a les dones aquesta tendència va ser menys clara, malgrat que els episodis deguts a trastorns mentals van mostrar l’associació més evident. L’associació amb la durada dels episodis va ser menys consistent. La multimorbilitat alta es va associar negativament a la capacitat per assolir les demandes laborals, al llarg del temps, i un cop tornat al treball desprès d’una incapacitat temporal. Conclusió: La multimorbiditat té efectes sobre indicadors de salut laboral. Mesurar-la permetria la detecció precoç de treballadors que s’enfronten a un desequilibri entre les limitacions relacionades amb la salut i les demandes laborals, i que estan a risc d’un episodi d’incapacitat temporal.

A identificação da prevalência de sintomatologia de LMELT, assim como a consequente necessidade de intervenção preventiva, foram estudadas numa indústria em 2010. Realizou-se uma análise do trabalho para identificar a exposição aos factores de risco de LMELT. Utilizou-se adaptação do QNM para identificar a prevalência de sintomas de LMELT. Efectuou-se formação sobre LMELT. A amostra (n=59) foi maioritariamente feminina (94,9%). A prevalência mais elevada de sintomatologia nos últimos 12 meses situou-se na região lombar (52,5%), e nos últimos 7 dias na coluna dorsal (33,9%). Os resultados identificam associações significativas entre a repetitividade gestual (1) dos braços e cotovelos com as queixas a nível do pescoço (p=0,013) e ombro direito (p=0,004); e das mãos e dedos com (2) punho e mão esquerda (p=0,024) e punho e mão direita (p=0,000). Relativamente à intervenção sócio-organizacional, efectuada com recurso à formação em LMELT, observou-se um impacto positivo com 81,30% de boa e excelente apreciação; ABSTRACT: The identification of prevalence of symptoms of WRMSDs as well as the consequent need for preventive intervention was studied in a Lisbon industry in 2010. It was conducted a job analysis to identify the exposure to risk factors for WRMSDs. It was used adaptation of NMQ to identify the prevalence of symptoms of WRMSDs. It was carried out training on WRMSDs. The sample (n = 59) was mostly female (94.9%). The higher prevalence of symptoms in the last 12 months was located in the lumbar region (52.5%), and in the last 7 days in the spine (33.9%). The results indicate significant associations between the gestural repetition (1) of the arms and elbows with complaints at the neck region (p = 0.013) and right shoulder (p = 0.004), and hands and fingers (2) wrist and left hand (p = 0.024) and wrist and hand (p = 0.000). Relatively to the socio-organizational intervention, made using the WRMSDs training, it was observed a positive impact with 81.30% of good and excellent evaluations.

The current study investigated a model explaining sexual assault victims’ severity of trauma symptoms that incorporated multiple stigma constructs. Integrating the sexual assault literature with the stigma literature, this study sought to better understand trauma-related outcomes of sexual assault by examining three levels of stigma—cultural, social, and self. Results showed self-stigma was significantly and positively related to trauma symptom severity. Thus, results revealed that the internalized aspect of stigma served as a mechanism in the relation between sexual assault severity and increased levels of trauma symptom severity, highlighting the importance of assessing self-stigma in women reporting sexual assault experiences.

Depression is a serious public health concern and leading cause of global disability; in the U.S., it is estimated that over 35 million individuals suffer from depression. Health-related dysfunction, including impairment and poor quality of life, are often associated with depressive symptoms; however, little research has examined the interrelationships between these factors. Functional impairment, or the experience of difficulty conducting necessary activities of daily living, may contribute to emotional distress directly but may also impact perceived quality of life. Health-related quality of life (HRQL), which is conceptualized as a holistic and subjective perception of one’s physical and mental quality of life, is a wellestablished indicator of overall general health. Given the dearth of research examining the linkages between these variables, we hypothesized that greater levels of functional impairment would be positively related to depressive symptoms and that physical and mental HRQL would mediate this association, such that greater functional impairment would be associated with poorer mental and physical HRQL and, in turn, to greater depressive symptoms. Our sample (N=100; 70.3% female (N=71); 93% Caucasian (N=94); Mean Age = 42.18, SD = 12.83) was recruited from a rural, Southern Appalachian primary care clinic serving working and uninsured patients. Participants completed self-report measures: Instrumental Activities of Daily Living Scale, World Health Organization Quality of Life Scale - Brief, and the Center for Epidemiological Studies Depression Scale. Simple mediation analyses, consistent with Preacher and Hayes, were conducted covarying age, sex and ethnicity. In support of our hypothesis, the direct effect of functional impairment on depressive symptoms decreased but remained significant (DE=-1.39, SE=.66, p=.03) when mental HRQL was included as a mediator (IE lower 95% CI=-3.27, upper 95% CI=-.877), indicating partial mediation. In addition, the direct effect of functional impairment on depressive symptoms fell out of significance (DE=-1.18, SE=.33, p=.15) when physical HRQL was included as a mediator (IE lower 95% CI=-3.79, upper 95% CI=-.83), indicating full mediation. Our findings suggest that individuals experiencing functional limitations are less likely to report good mental and physical HRQL and, in turn, endorse higher levels of depressive symptoms. Our findings may have clinical implications; therapeutic enhancement of coping skills and problem-solving strategies may reduce psychological distress, whereas engagement with social and instrumental support networks may provide assistance with physical limits, thereby reducing risk for depressive symptoms in individuals experiencing functional impairment.

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Work-related musculoskeletal disorders (WRMDs) are diseases that result in persistent pain, loss of functional capacity and associated work disability. This diagnostic is important because it is used to guide clinical and legal decisions. Their initial diagnosis is difficult because such diagnoses are based on complaints of pain and they often involve conflicting social and economic interests. Because of the complexity of such diagnoses, further studies are needed in order to analyze the association between subjective descriptions and objective findings. Therefore was made two research. The objective of the first research was to evaluate the impact of personal, clinical and occupational aspects on work ability of workers with and without WRMDs using an approved version of the Work Ability Index (WAI) and pain scale. This evaluated 127 workers of industrial production lines. A descriptive analysis was carried out using the Chi-square test and it was also performed a logistic regression analysis. A significant association was identified between the WAI and all personal, clinical and occupational aspects. Regression analysis showed that pain and sick leave together accounted for 59% of poor work ability. The objective of the second research was to evaluate the clinical and functional aspects of WRMDs, in relation to physical evaluation, perception of pain, self-reporting of symptoms and functional ability, among active workers at a single company with and without symptoms or evidence of this disorders. 134 female workers were physically evaluated by two trained physiotherapists. They filled out a questionnaire on discomfort due to pain, a pain scale, the Oswestry Disability Questionnaire (ODQ) and the Work Ability Index (WAI). The results were correlated and logistic regressions were run. According to the results symptom reports were explained by the results from the pain scale and the clinical findings and clinical findings by symptom reports and WAI. In two research the relationship between pain, symptom reports and clinical findings demonstrates that the patient s current state can be assessed not only by means of objective examinations, but also by means of instruments that take into account the patient s perception of his or her state.
Os distúrbios ostemusculares relacionados ao trabalho (DORT) podem resultar em dor crônica, diminuição da capacidade funcional e associada incapacidade para o trabalho.Seu diagnóstico é importante pois direciona as decisões clínicas e legais. No entanto, essas lesões apresentam desafios para seu diagnóstico e prognóstico, uma vez que envolvem indicadores subjetivos, porque há fatores de interesses sociais e econômicos envolvidos. Em função desta complexidade, mais estudos são necessários para analisar a associação entre relatos subjetivos e achados objetivos. Desta forma foram realizados dois estudos. O objetivo do primeiro foi avaliar o impacto de fatores pessoais, do trabalho e da lesão na capacidade funcional dos trabalhadores com e sem história de acometimento de lesões músculo-esqueléticas relacionadas ao trabalho, utilizando a aplicação autorizada do Índice de Capacidade para o Trabalho (WAI) e escala de dor. Este avaliou 127 trabalhadores de linhas de produção industrial. Os resultados foram analisados descritivamente, por meio do teste Qui-quadrado e pela análise de regressão logística. Todos os fatores pessoais, ocupacionais e clínicos analisados apresentaram relação significativa com a capacidade para o trabalho. A análise de regressão mostrou que dor e afastamento do trabalho explicaram juntas 59% da baixa capacidade para o trabalho. O objetivo do segundo estudo foi avaliar os aspectos clínicos e funcionais dos DORT, em relação a avaliação clínica, percepção da dor, auto-relato de sintomas e capacidade funcional através da avaliação de trabalhadores de uma mesma empresa, com sem sintomas de DORT. 134 mulheres foram fisicamente avaliadas por dois fisioterapeutas treinados e responderam a um questionário relacionado a sensação de dor ou desconforto, escala de dor, questionário de incapacidade de Oswestry (ODQ) e índice de capacidade para o trabalho (WAI). Os resultados foram correlacionados e a análise de logística foi aplicada. Os resultados indicaram que relatos de sintomas foram explicados pela escala de dor e exame clínico e o exame clínico foi explicado pelos relatos de sintomas e WAI. As associações entre dor, relatos de sintomas e exame clínico, demonstraram que o estado atual do paciente pode ser avaliado não somente por exames objetivos mas também por meio de instrumentos que levem em conta a percepção do próprio paciente sobre seu estado.

Work-related musculoskeletal disorders (WMDs) are a major public health problem in terms of the considerable amount of disability, impairment, and associated economic cost. Among these disorders, the occurrence of WMD symptoms of the neck is prevalent and has been associated with significant disability, long periods of sick leave and loss of productivity in occupational settings. Risk factors for WMDs are multifactorial, and studies have typically focused on ergonomic factors. Psychosocial factors in the work environment have been recently considered; however, findings across these studies have not been consistent. Despite the evidence associated with ergonomic factors on the occurrence of WMDs, widespread prevention and treatment efforts have not been successfully implemented. Psychosocial factors such as high psychological demands, low decision latitude and low social support may play a role in WMD occurrence. The demand-control-support model has been widely used to predict job strain. Particularly for disorders of the neck, job strain seems to play a strong role in their occurrence. The psychosocial work environment and WMDs are listed as research priorities of the National Occupational Research Agenda developed by the National Institute for Occupational Safety and Health. This cross-sectional study looked at job strain and neck symptoms, while controlling for confounders. This project was carried out on a group of semiconductor manufacturing workers. The prevalence of neck symptoms was measured by a self-administered questionnaire. A Chinese version of the Job Content Questionnaire was included to assess psychosocial factors and to test the demand-control-support model. An observational checklist was developed and used to assess ergonomic exposures on individual workers' jobs. The participation rate was 86.5%. The final sample of semiconductor workers consisted of 373 female participants. Their mean age was 28.4 years ranging from 18 to 41 years. The mean length of employment was 4.3 years. The prevalence of symptoms of neck disorders in the semiconductor manufacturing population was 23.9%. It was concluded that the prevalence rates of neck symptoms of WMDs in this study were high, especially given the very conservative outcome definition that was used. The study findings partially supported the job strain model, showing an increase in prevalence of neck symptoms with psychological and physical job demands; however, association with decision latitude and social support were not supported. Further studies with more comprehensive measurements of work-related psychosocial factors are implicated and effective prevention strategies for neck symptoms of WMDs are suggested.

Occupational skin and respiratory symptoms, and disease, are common problems. Workers can develop new disease or aggravate existing disease as a result of exposures at work. Many workers are exposed to chemicals that can cause both respiratory and skin responses and there is evidence that some workers experience symptoms in both systems. There is also evidence that skin exposure may lead to sensitization and the development of respiratory disease. There is very little research that has examined both airborne and skin exposures together with lung and skin outcomes. The purpose of this thesis was to further investigate the relationships between occupational exposures, skin symptoms and disease, and respiratory symptoms and disease. Four studies were undertaken to improve our understanding of these complex relationships. Results from a study of clinical patch test data determined that seven of the ten most common occupational contact allergens are also capable of causing occupational asthma and that these common occupational exposures may not be recognized as sensitizers in common reference materials. Exposure-response relationships for skin symptoms were modeled in bakery workers and auto body shop workers using historical data; significant exposure-response relationships were found for auto body workers. In two separate studies of concurrent skin and respiratory symptoms, workers did report concurrent skin and respiratory symptoms. In predictive models, subjects reporting a history of eczema were more likely to report concurrent skin and respiratory symptoms. Overall, the results from this thesis provide more evidence that the skin and respiratory systems are associated. This body of work suggests that: (1) several common occupational exposures can cause disease in both the skin and respiratory system; (2) a portion of workers report both skin and respiratory symptoms; and (3) exposure-response relationships do exist for skin symptoms, both work-related and non-work-related. Future studies need to gather detailed information about exposure and response in both systems in order to better determine the role of exposure(s) in the development of skin and respiratory symptoms. Improved understanding of these relationships will allow for more targeted and effective exposure prevention strategies and will ultimately reduce the burden of occupational disease.

碩士
國立臺北護理健康大學
中西醫結合護理研究所
101
Musculoskeletal pain and musculoskeletal disorders (MSDs) have been described as one of the main occupational problems among the nursing profession. Several epidemiological studies have investigated MSD risk factors or focused on the prevalence of MSD. The amount of research has been limited on intervention programs that are designed to improve nurses’ musculoskeletal symptoms. Qigong is a mind-body exercise with a rhythmic breathing and forms of slow movement that affects the autonomic nervous system. This paper aims to examine the effect of implementation of Baduanjin qigong for nurse with work-related musculoskeletal symptoms, general health status and stress after six weeks and twelve weeks of Qigong training. The quasi-experimental pilot study was conducted at medical centre in Taipei. 29 Experimental group（36.83±6.81yrs）and 30 normal controls（37.03±9.09 yrs）were include this study. Experimental group practiced home-based 20 min Baduanjinq Qigong training three times per week for 12 weeks, control group were instructed to maintain their usual lifestyle. Both groups were evaluated at the baseline and after six and twelve weeks of Baduanjinq Qigong training. MSD assessment by SF-36 health questionnaire, musculoskeletal questionnaire (NMQ) and heart rate variability analysis. The outcome measure was analyzed by SPSS.20 version statistical software with Generalized estimating equation. The result revealed that physical functioning (PF), bodily pain (BP), physical composite score (PCS) subscale of the SF-36, the experimental group demonstrated greater improvement compared to controls. The HRV in experimental group reduced the heart rate and increased HRV as indicated by a SDNN significantly. Among each parts of NMQ, symptom outcomes demonstrated relief significant for experimental group. These findings suggest that low intensity Baduanjin qigong stabilizes the cardiac autonomic nervous system and it is convenient and practical way to relieve the symptoms of musculoskeletal discomfort.

Individual distress in the work-place has been cited as the cause of enormous loss of productivity and income, and has therefore attracted much attention from researchers and therapists alike. However, an extensive literature study reveals that in the field of work-related distress and its management, there appears to be discontinuity, a diversity of opinion and even confusion with regard to definitions, causes and possible remedies for the problem. It is suggested that this situation has been brought about and is being perpetuated by the Newtonian/Cartesian epistemological foundation on which most thinking in the field is based. It is further suggested that an epistemology informed by ecosystemic, constructivist principles could facilitate a way of thinking which would be more useful in this context. A case study was done in accordance with the above-mentioned ideas, which served as an investigation of their usefulness in a situation of reported work-related stress. On the basis of the information which emerged from the study, it is concluded that an ecosystemic approach can indeed provide a useful basis for understanding such situations. Furthermore, it is suggested that there are certain commonalities between such situations which are primarily founded in contexts in which the individual finds himself faced with contradictory demands which are not acknowledged as such. Finally, the point is made that if, in accordance with a constructivist viewpoint, "stress" is understood to be a social construction rather than an absolute condition, then the traditional way of thinking provides us with descriptions of man, society and the relationship between them, which are negative and may also be reflexively destructive. However, since constructivism allows for a different construction to be brought forth, we may utilise ecosystemic thinking to provide a more optimistic view.
Psychology
D. Litt. et Phil. (Psychology)

This study examines the effects of TYSABRI on the health-related quality of life (HrQoL) outcomes, disease status and symptomatology, treatment satisfaction, productivity outcomes and healthcare utilization for patients with Crohn’s Disease (CD). A total of 241 patients consented to participate in the study, out of which 61 patients qualified for the baseline survey. After three-months of TYSABRI therapy, the follow-up survey was completed by 24 patients. Changes in outcome scores from baseline to the three-month follow-up were evaluated. The 24 patients with the three-month follow-up were, on average 41 years old and 62.5% percent were female. For those with follow-up, a significantly lower proportion of patients (41.7 percent) identified their CD severity as moderate to severe compared to 83.3 percent at baseline (p=0.001). The patients also reported experiencing a significantly lower mean number of CD relapses at follow-up (4.0) compared to baseline (6.8) (p=0.004). Improved median well-being scores (2.0 vs. 1.0; p<0.001) and improved median abdominal pain scores (2.0 vs. 1.0; p=0.001) were also reported at follow-up. The patient global assessment of HrQoL over the last 2 weeks was significantly improved at follow-up (2.0 vs. 3.0; p=0.006). Similar improved results were observed regarding their assessment of the impact of CD on HrQoL (7.0 vs. 5.0; p<0.001). A significant change of 32.0 points on the total Inflammatory Bowel Disease Questionnaire (IBDQ) scale (p<0.001) and significant improvements in each of the four component scales were also seen at follow-up (p≤0.05). Significant improvement was noted on the SF-36 PCS scale (mean change 7.0; p=0.001) and MCS scale (mean change 6.0; p=0.05). Significant improvements were observed in the scores for each of the four scales of the treatment satisfaction questionnaire at follow-up: effectiveness scale (28.6 vs. 63.0; p<0.001); side-effects scale (61.6 vs. 82.2; p=0.01); convenience scale (63.8 vs. 70.8; p=0.05); and global satisfaction scale (41.3 vs. 67.0; p<0.001). A significant decrease in the number of CD-related emergency room (ER) visits was observed between baseline and follow-up (1.3 vs. 0.7; p=0.03). For the productivity outcomes, the percent of planned household work lost due to absenteeism was significantly reduced (73.1 percent vs. 43.9 percent; p=0.02) and the total percent of planned hours lost was also reduced (87.3 percent vs. 64.4 percent; p=0.037). These results indicate that TYSABRI is associated with significant improvement in HrQoL outcomes, CD disease severity, treatment satisfaction, ER visits and productivity outcomes.
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Introduction: L’asthme relié au travail (ART) est induit ou aggravé par le milieu du travail. L’asthme professionnel (AP) et l’asthme exacerbé au travail (AET) sont difficiles à distinguer en pratique clinique puisque dans les deux conditions les travailleurs se plaignent d’une détérioration de leur asthme au travail. De plus, les médecins sont souvent confrontés à des patients ayant des symptômes respiratoires reliés au travail (SRT) sans être asthmatiques. Ces patients sont souvent exclus des études qui visent à mieux caractériser l’ART. Objectifs : 1. Comparer la variabilité quotidienne des débits expiratoires de pointe (DEP) durant les périodes au et hors travail chez des sujets atteints d’AP et d’AET. 2. Évaluer la prévalence des patients ayant des SRT parmi les sujets référés pour possibilité d’ART, et comparer leurs caractéristiques et leur environnement professionnel avec ceux ayant l’ART. Résultats : L’exposition professionnelle induit une variabilité accrue des DEP chez les sujets avec AP et AET mais celle-ci est plus prononcée dans l’AP. Les sujets ayant des SRT sans être asthmatiques représentent une grande proportion des sujets référés pour possibilité d’ART. Conclusions : L’ART devrait être considéré chez tous les individus qui présentent un asthme de novo, ou une aggravation de leur asthme. La similitude des symptômes entre les sujets ayant des SRT et l’ART rend nécessaire d’effectuer une évaluation extensive. Cette évaluation devrait se faire selon une approche par étapes dans laquelle des tests objectifs améliorent la certitude du diagnostic et aident à différencier entre l’AP et l’AET.
Background: Work related asthma (WRA) refers to asthma that is induced or exacerbated by the workplace. Occupational asthma (OA) and work-exacerbated asthma (WEA) are difficult to distinguish in clinical practice since in both conditions workers complain of deterioration of their asthma while at work. In addition, physicians are often faced with subjects with work related respiratory symptoms (WRS) without being asthmatics. These subjects are often excluded from studies whose aim is to better characterize WRA. Objectives: 1. To compare the diurnal variability of peak expiratory flow (PEF) during periods at and away from work between subjects with OA and WEA. 2. To assess the prevalence of subjects with work related respiratory symptoms but without asthma among subjects referred for possible WRA, and to compare their characteristics and work environment to subjects with WRA. Results: Work exposures induce a significant PEF variability in both OA and WEA. However, the magnitude of variability is higher in OA than in WEA during work exposures. Subjects with WRS without asthma represent a large proportion of the subjects referred for possible WRA. Conclusions: WRA should be considered in all individuals who present with new-onset or worsening asthma. The similarity of the symptoms between subjects with WRA and WRS emphasizes the need to perform an extensive investigation. This investigation should be based on a stepwise approach in which multiple objective testing improves the certainty of diagnosis and help to differentiate between OA and WEA.

Dissertação de mestrado em Engenharia Humana
O problema das lesões músculo-esqueléticas ligadas ao trabalho é cada vez mais uma preocupação para as empresas. Assim, a ginástica laboral (GL) surge como uma possível solução pois leva a alterações do estilo de vida e promove uma vida ativa. Neste sentido, foi realizado um estudo com o principal objetivo de contribuir para a análise do impacto da implementação de um programa de GL em contexto real. Pretendeu-se elaborar, implementar e avaliar o impacto de um programa de GL na prevalência de sintomatologia ligada ao trabalho, na qualidade de vida e na flexibilidade do trabalhador nos segmentos da coluna cervical e ombro. Com base na revisão bibliográfica, foi desenhado um projeto de implementação do programa de GL que se dividiu nas fases estruturação, avaliação diagnóstica, planeamento, execução e avaliação do programa. Na avaliação diagnóstica realizou-se a avaliação dos postos de trabalho, onde se aplicou o método ROSA (Rapid Office Strain Assessment), e a avaliação inicial do trabalhador onde se aplicaram os instrumentos Questionário Nórdico para Sintomas Músculo- Esqueléticas, para a análise da sintomatologia ligada ao trabalho, o Short Form Health Survey 36, para a análise da qualidade de vida, e ainda se utilizou um goniómetro universal, para a análise dos níveis de flexibilidade. Estes mesmos instrumentos foram aplicados no final do programa, assim como um instrumento de avaliação do programa de GL, onde se pretendeu obter a opinião dos colaboradores. O programa ocorreu durante três meses, com sessões duas vezes por semana e com duração de quinze minutos. A amostra foi constituída por um grupo de intervenção formado por 30 elementos e por um grupo de controlo formado por 8 elementos. Os resultados obtidos sugerem melhorias na sintomatologia, na qualidade de vida e na flexibilidade ao nível da coluna cervical e ombro. Em relação à sintomatologia, os trabalhadores referiam menos dor músculo-esquelética entre os dois momentos de avaliação e uma diminuição da intensidade dos mesmos. Em relação à qualidade de vida, as melhorias não foram tão evidentes devido ao tempo reduzido do programa. Quanto à flexibilidade, o aumento registado entre os dois momentos de avaliação no grupo de intervenção foi significativo, ao contrário do verificado no grupo de controlo, apesar do registo de ligeiras melhorias. Genericamente, os trabalhadores consideraram o programa muito positivo e importante para a melhoria generalizada da sua condição física e psíquica.
The problem of work-related musculoskeletal disorders is a rising concern in the companies. Thus, occupational gym has emerged as a possible solution to this problem because it leads to changes in the lifestyle by promoting health and physical activity. In this regard, a study was conducted with the main objective to analyse the impact of the implementation of an occupational gym program in a real context. The purposes were elaborate, implement and evaluate the impact of an occupational gym program in the prevalence of work-related symptoms, quality of life and flexibility of the worker in cervical spine and shoulder segments. Based on literature review, a project was designed to implement the occupational gym program. It was divided into several phases as structuring, diagnostic assessment, planning, implementation and final evaluation of the program. In the diagnostic assessment was held the job review, where the Rapid Office Strain Assessment was applied, and the initial assessment of the worker, where was applied instruments like the Nordic Questionnaire for Musculoskeletal Symptoms for the analysis of work-related symptoms, the Short Form Health Survey 36 for the analysis of quality of life, and the universal goniometer for analysing levels of flexibility. These same instruments were applied at the end of the program and an additional tool for assessment of the occupational gym program, which it was required to obtain the opinion of the workers. The program had extent over three months, with sessions twice a week and lasting 15 minutes. The sample consisted in an intervention group comprised of 30 elements and a control group composed of 8 elements. The results suggest that there were improvements in symptoms, quality of life and flexibility at the cervical spine and shoulder segments. Regarding symptoms, the workers had less musculoskeletal pain between the two time points of the evaluation and a decrease in intensity. Regarding quality of life, the improvements were not as evident due to the reduced program time. Regarding flexibility, the increase between the two time points in the intervention group was significant, unlike the control group although slight improvements. Workers considered the program positive and important for the improvement of their condition.

O objetivo principal deste estudo manifestou-se no intuito de avaliar a exposição ocupacional e o risco de ocorrência de lesões músculo-esqueléticas na atividade de retalho. É sabido que tal atividade laboral possui como uma de suas principais etapas a manipulação manual de cargas (MMC), de diferentes volumes e pesos, e esta por sua vez constitui um determinante fator de risco para o desenvolvimento de Lesões MúsculoEsqueléticas ligadas com o Trabalho (LMELT). Este risco pode ser minimizado através de uma intervenção ergonómica baseada na identificação e na avaliação dos fatores de risco associados a esse tipo de tarefas. Para tal, existem diversos métodos que permitem identificar e avaliar o risco de lesões músculo-esqueléticas na manipulação manual de cargas. Foram realizadas avaliações em cinco lojas de vendas de retalho e um armazém logístico de distribuição, com uma amostra total de 134 colaboradores de idades variadas. As ferramentas utilizadas basearam-se na avaliação das condições de trabalho, da sintomatologia músculo-esquelética, da capacidade funcional e da exposição mecânica das tarefas de manipulação de carga. Os resultados demonstraram que o peso da carga movimentada, a sua localização (acima da linha dos ombros ou abaixo da linha da cintura) e a repetição de movimentos são fatores essenciais para a associação de queixas relacionadas a saúde músculoesquelética, pois estes muitas vezes levam a adoção de posturas penosas, como rotações e flexões de tronco. Não foram observados sinais significativos em relação a perda de capacidade funcional da população avaliada. A identificação dos pontos críticos para a atividade de movimentação manual de carga permitiu a proposta de sugestões de transformações organizacionais e de engenharia, com o intuito de minimizar os impactos futuros, no entanto, há a necessidade da continuação do estudo uma vez que os locais avaliados não abrangem todos os tipos de estabelecimentos voltados para o comércio de retalho.
The main objective of this study was expressed in order to assess occupational exposure and the risk of occurrence of musculoskeletal injuries in the flap activity. It is known that such work activity has as one of its main stages the manual handling of loads (MMC), of different volumes and weights, and this in turn constitutes a determinant risk factor for the development of musculoskeletal disorders linked with the work. This risk can be minimized through an ergonomic intervention based on the identification and assessment of risk factors associated with this type of tasks. To this end, there are several methods that allow the identification and assessment of the risk of musculoskeletal injuries in manual handling of loads. Evaluations were carried out in five retail sales stores and a logistics distribution warehouse, with a total sample of 134 employees of different ages. The tools used were based on the assessment of working conditions, musculoskeletal symptoms, functional capacity and mechanical exposure of load handling tasks. The results showed that the weight of the cargo moved, its location (above the shoulder line or below the waist line) and the repetition of movements are essential factors for the association of complaints related to musculoskeletal health, as these often lead to the adoption of painful postures, such as rotations and trunk flexions. No significant signs were observed in relation to the loss of functional capacity of the assessed population. The identification of critical points for the activity of material manual handling, allowed the proposal of suggestions for organizational and engineering changes, with the intuition to minimize future impacts, however, there is a need to continue the study once the locations evaluated do not cover all types of establishments aimed at the retail trade.