Collective & Public Health: Understanding Determinants

• Professionals need to comprehend Collective Health and Public Health
• Aims to broaden the determination within society and move beyond simplistic cause-and-effect views
• ST challenges reductionist perspectives and focuses on collective health
• Understanding health-disease processes involves social, environmental, cultural, and productive aspects
• It facilitates combining scientific and technological instruments to understand the factors determining population health
• It's purposed with protecting and preventing health problems through implementing health profiles

Work's Role in Health

• Ethical, technical, and legal implications exist in acknowledging work's role in shaping workers' health-disease progression
• These implications influence organizing and providing health services for this population segment
• Establishing a causal link between health events (damage or disease) and work conditions is essential for implementing Worker's Health initiatives
• This involves identifying and controlling health risk factors in work environments based on diagnosis, treatment, and prevention efforts

List of Work-Related Diseases

• Categorizes health conditions based on etiological agents, occupational risk factors, and diseases
• Includes neoplasms, mental disorders, and infectious diseases
• Also includes parasitic diseases, blood disorders, and diseases of the nervous system
• Encompasses diseases of the eye, ear, circulatory, respiratory, digestive, musculoskeletal, and endocrine systems

Public Health and Disease

• All cases of worker illness are significant during evaluation
• Any work-related illness is a sentinel event, and one case is sufficient to trigger workplace modifications to prevent recurrence
• Sentinel events indicate a failure in existing safety measures or unknown individual/collective susceptibilities, prompting new control measures

Bernardino Ramazzini and Gravedigger Diseases

• Reflect on Bernardino Ramazzini's case study from the 1700s on gravedigger diseases
• Gravediggers faced arduous tasks, carefully preparing bodies through washing, anointing, cremating, and storing ashes in urns
• Workers from the lowest social class were recruited for embalming, carrying, and cremating corpses
• Currently, bodies are taken to temples or cemeteries where gravediggers bury them
• Families had tombs in noble churches or commoners piled bodies promiscuously in large sepulchers, posing dangers when gravediggers descended

Factors of Risk

• Exposure to hazardous substances leads to various illnesses, resulting in a cadaverous, jaundiced appearance
• To mitigate risks, precautions such as washing the mouth and throat with vinegar, carrying vinegar-soaked cloths, and ensuring tomb ventilation were advised
• After work, changing clothes and maintaining cleanliness was recommended
• Treatment with caution and mild bloodletting was suggested for illnesses
• Bernardino Ramazzini observed a group of musculoskeletal conditions in notaries and scribes due to repetitive hand motions while writing in 1713

Workplace Risk Factors in Brazil

• Classified into five main groups: chemical, biological, ergonomic/psychosocial, and mechanical/accident-related
• Chemical: agents and substances in liquid, gaseous, or particulate form common in work processes
• Biological: includes viruses, bacteria, and parasites commonly found in hospitals, labs, agriculture, and livestock operations
• Ergonomic/Psychosocial: stemming from the organization and management of work (inadequate equipment, poor conditions, shift work, excessive workload, authoritarian relationships, insufficient training)
• Mechanical/Accident-Related: Linked to machine protection, physical layout, signage, and product labeling can lead to workplace accidents

Risk Management Process

• Professionals prioritize worker protection by evaluating the severity of situations
• The process involves establishing risk excess based on the steps in Regulatory Standard No. 3 (NR 3)
• Assess current risk levels, considering existing control measures
• Establish the desired risk level after implementing necessary preventive measures
• Determine risk excess by comparing current and target risk levels

Assessing Workplace Risk

• Use the method adopted by NR 3, which characterizes tasks with high risk
• Must consider the consequence (expected outcome of an event) and probability (chance of that outcome occurring)
• Consider both consequence and probability to express risk
• Refer to risk descriptions in Tables 2 and 3 and Table 1

Analyzing narratives of health and labor

• Consider the narratives of health and labor conditions of painters
• Painters commonly suffer from afflictions such as tremors, cachexia, discolored teeth, fatigue, melancholy, and loss of smell
• Attributed to sedentary lifestyles and melancholic nature, but the colored matter they handle is a significant factor
• The odors emanating from the paint mixture are hazardous, and the components used contribute to severe health problems

Multidisciplinary teams evaluate workplaces

• Multidisciplinary teams assess workplaces and observe activities
• They listen to the difficulties of the workers
• Risk Evaluations are integrated with safety and health plans, programs, and documents
• Must highlights PPRA, PCMSO, Machine Inventory, Ergonomic Analysis
• It all constitutes a Risk Management Plan (PGR)

Repetitive Strain Injuries (RSI) and Work-Related Musculoskeletal Disorders (WMSDs)

• Considered syndromes can cause lasting health consequences
• This includes permanent disability, physical and psychological changes
• Pain and weakness in limbs/spine have the potential to become chronic
• Can prevent a worker from completing daily tasks at work and socially

RSI and WMSDs Early Concepts

• Associated with repetitive manual tasks
• Ramazzini first identified musculoskeletal disorders, especially among scribes in 1713
• Believed overuse of hands from writing leads to cramping

Ramazzini's Three Main Causes of RSI

• Sedentary lifestyle
• Repetitive hand motions
• Mental focus to avoid errors
• Associated symptoms: paresthesia, heaviness, fatigue, neck/lower back pain

Ramazzini on Scribes and Notaries

• Describes health concerns of scribes/notaries around 1700
• Higher number of scribes/notaries in the past than today after printing invention
• Scribes/notaries sustained livelihood by writing
• Occupations included freed slaves/servants
• Notaries are known for fast, small-note writing

Ramazzini and Scribes health today

• Health issues result from sitting, repetitive hand movements, and mental focus
• Consequences include obstructed viscera, indigestion, leg weakness, poor circulation, overall illness
• Limited benefits from exercise hinder health
• Hand position for writing strains harmfully. It causes muscle and tendon tension
• Over time, it diminishes hand strength.
• Ramazzini encountered a notary with life-long writing leading to overall health decline
• Writing with either hand leads to same issues

Modern-day Impact of Repetitive writing

• Powerful/tenacious labor requires brain concentration, nerve/fiber compression
• Over time, leads to headaches, nasal discharge, hoarseness, vision problems with concentration
• Mental anguish stems from heavy writing load, deciphering intentions leading to job aversion
• Scribes' occupation is scorned by the upper position

Fighting RSI/WMSDs

• In Brazil during the 1980s, tenosynovitis cases among data entry personnel caused unions to pursue recognition as occupational illnesses
• Ministry of Social Security identified the correlation and through ordinance 4.602, the category of inclusion of tenosynovitis of the data entry person into the index of occupational illnesses
• In 1993 a technical standard name Lesões Por Esforços Repetitivos (LER) was issued
• It broadened the concept and application of workers' rights suffering from those conditions to employment

Prevention field is still developing

• In 1998, changes to the norms brought the term Distúrbios Osteomusculares Relacionados ao Trabalho (DORT)
• These changes reduced workers compensation substantially

Norms that exist, but do not cover various responsibility factors

• Regulatory Standard (NR-17) is the guiding authority for businesses in work areas requiring repetitive effort, fast speed, poor posture, etc
• LER is the label for musculoskeletal ailments, not an illness or sickness. There are many illnesses with distinct symptoms
• LER is not a condition itself but an inflammatory syndrome, triggering pain and diminished performance
• Diagnostic evaluation includes tendinitis, rheumatism, bursitis, traumatic sclerosis, etc; all due to exertion

Stages of LER/DORT

• Stage 1: pain is vague and may improve with rest
• Stage 2: more objective signs of pain with rest helping
• Stage 3: pain is severe and doesn't improve with rest

Stages, Grades of LER with details

• Stage 1 has fatigue during work day, normal performance
• Stage 2 persistent pain and fatigue remain after work, restless sleep, repetitive issues
• Stage 3 constant pain fatigue, restful, can't sleep, has lesions
• Stage 4 Limitation Inflammation Weak Force, limited strength
• Grade 1 pain occurs during specific activity, affected area feels heavy
• The pain grade and intensity fluctuates, occasionally interfering with work without significantly disrupting it

Grades

• Grade 2: pain extends to numerous body parts when performing a specific activity; it is constant, intense, and bears down on working positions with little-to-no effect
• Tolerance may accompany local tingling or warmth
• Grade 3: The pain and strength are increased, especially when resting
• It often results in the loss of the designable task, and Edema often develops

Grade 4 levels

• Grade 4 levels include, heightened sensitivity, less energy for labor, and increased stress and depression
• Since 2000, the 28th of February has been the International Day Against Repetitive Injury with narratives of challenges and relationships existing

Preventing LER/DORT: Profession Vision

• Prioritize the relationship between tasks that directly or indirectly affect manifest symptoms. Examples
• Identify potential overloads that could overburden the worker
• Determine whether workers face pressure from supervisors or colleagues
• Visualize workers, ability, lack of control over daily activities or the company
• Mandate maintenance from a constant rhythm of manufacturing or product output

Factors that impact job success

• Fragmented work where employees executes specific repetitive operations
• Recognize less professionals for specific functions/roles
• A long work week, poor equipment and adequate protection

Ergonomics

• Incorporate an amplified vision for the professional that works with the office. These include
• Intrinsic (posture, inadequate design)

Extrinsic Factors

• A few environmental factors that lead to organization problems include
• Biomechanical factors (excessive forces during lab activities)

Risks during activities

• Disorganizations during breaks (bathroom use), not stretching their bodies, drinking fluids and other
• Lack of a controlled climate. Temperature.
• Common issues of stress are brought upon by the worker and could alter their quality of life drastically

Health Professional Actions

• Based on the occupation assessment and examinations. Also with data and epidemology that focus on LER
• A person with the knowledge can have a better standard of life and occupation to assist those lacking/suffering

Professional role in multidisciplinary team

• Can range from a team that includes nursing assistants, dentists, and professionals

Workspaces

• With three levels of preventive attention, we can create improvement and understanding
• This can eliminate or reduce the harm

Prevention strategies

• Prevention strategies involve reducing work strain
• This can heal injuries and muscle disorders that have occurred
• Aid can be given by those with experience in occupational roles

Avoid injuries that workers can have

• The team will attempt to eliminate or reduce as much as it can

Positives and effects of team efforts

• Better work quality, decrease errors, job satisfaction, reduces sickness, etc
• It will be necessary to have mutual understanding in the workplace that values the job

Investigating and Assessing the Workplace

• Involve the following steps when investigating the environment
• History that is explained through details
• Investigate the systems involved and habits with health

Process continued

• Gather an environment and have a discussion with each other
• A final exam is required if you are asked to

Anamnesis

• Creates an investigation that allows a professional to become relevant as they treat people. It is a must to create a process
• Professionals must analyze workplace conditions and find injuries
• Ministry of Health supports the worker and their work environment to assist with the health process

Investigation for Legal Aspects

• In the area and acknowledgement for a condition the following must occur
• Specialists are needed for assessment

Ministry of Health Support

• Ministry of Health supports the worker and their work environment to assist with the health process (2001, page 27). Factors include
• Ethical, technical, and legal in process
• Reflected by the association and provisions provided for safety

Professionals

• The association is used to prevent a injury to one or all people
• There must exist a dangerous environment for workers

Disease Relation

• There should exist points that connect to the workers. These include
• Diseases that create issues that may become permanent
• Some aspects that might lead to injuries

Accidents and Disease Data

• Injury and occupational accident details gathered with proper analytics
• Clinical history combined with the occupation
• Study both physical locations
• Data should also follow technical guidance

Preventative Actions

• Health is an essential process. It is important to
• Promote a healthy working environment
• Have constant checkups

Prevention levels

• Pre-Pathogenesis
• Health Improvement
• Specific Care is also important

Prevention of workplace events

• Is common for health clinics to prioritize health
• This means that it will be more beneficial
• Action also requires
• MACRO
• MESO
• MICRO

Micro

• Health care provided is examined

Meso

• Expert teams are involved that assist in a correct manner

ILO Help and Solutions

• To provide assistance, there are solutions with practical means

Macro

• All the actions that take place are for the betterment of the clinic

PNSST

• Goals include improvement of workers and to prevent situations