Semiparametric modeling of the spatial distribution of occupational accident risk in the casual labor market, Piracicaba, southeast Brazil

The objective of this study was to estimate the spatial distribution of work accident risk in the informal work market in the urban zone of an industrialized city in southeast Brazil and to examine concomitant effects of age, gender, and type of occupation after controlling for spatial risk variation. The basic methodology adopted was that of a population-based case-control study with particular interest focused on the spatial location of work. Cases were all casual workers in the city suffering work accidents during a one-year period; controls were selected from the source population of casual laborers by systematic random sampling of urban homes. The spatial distribution of work accidents was estimated via a semiparametric generalized additive model with a nonparametric bidimensional spline of the geographical coordinates of cases and controls as the nonlinear spatial component, and including age, gender, and occupation as linear predictive variables in the parametric component. We analyzed 1,918 cases and 2,245 controls between 1/11/2003 and 31/10/2004 in Piracicaba, Brazil. Areas of significantly high and low accident risk were identified in relation to mean risk in the study region (p < 0.01). Work accident risk for informal workers varied significantly in the study area. Significant age, gender, and occupational group effects on accident risk were identified after correcting for this spatial variation. A good understanding of high-risk groups and high-risk regions underpins the formulation of hypotheses concerning accident causality and the development of effective public accident prevention policies.

Circuit board accident - organizational dimension hidden by prescribed safety

This study analyzes an accident in which two maintenance workers suffered severe burns while replacing a circuit breaker panel in a steel mill, following model of analysis and prevention of accidents (MAPA) developed with the objective of enlarging the perimeter of interventions and contributing to deconstruction of blame attribution practices. The study was based on materials produced by a health service team in an in-depth analysis of the accident. The analysis shows that decisions related to system modernization were taken without considering their implications in maintenance scheduling and creating conflicts of priorities and of interests between production and safety; and also reveals that the lack of a systemic perspective in safety management was its principal failure. To explain the accident as merely non-fulfillment of idealized formal safety rules feeds practices of blame attribution supported by alibi norms and inhibits possible prevention. In contrast, accident analyses undertaken in worker health surveillance services show potential to reveal origins of these events incubated in the history of the system ignored in practices guided by the traditional paradigm.

Safety illusion and error trap in a collectively-operated machine accident

Workplace accidents involving machines are relevant for their magnitude and their impacts on worker health. Despite consolidated critical statements, explanation centered on errors of operators remains predominant with industry professionals, hampering preventive measures and the improvement of production-system reliability. Several initiatives were adopted by enforcement agencies in partnership with universities to stimulate production and diffusion of analysis methodologies with a systemic approach. Starting from one accident case that occurred with a worker who operated a brake-clutch type mechanical press, the article explores cognitive aspects and the existence of traps in the operation of this machine. It deals with a large-sized press that, despite being endowed with a light curtain in areas of access to the pressing zone, did not meet legal requirements. The safety devices gave rise to an illusion of safety, permitting activation of the machine when a worker was still found within the operational zone. Preventive interventions must stimulate the tailoring of systems to the characteristics of workers, minimizing the creation of traps and encouraging safety policies and practices that replace judgments of behaviors that participate in accidents by analyses of reasons that lead workers to act in that manner.

Forum: social network for the surveillance and prevention of workplace accidents

In 2008, academic researchers and public service officials created a university extension studies platform based on online and on-site meetings denominated "Work-Related Accidents Forum: Analysis, Prevention, and Other Relevant Aspects. Its aim was to help public agents and social partners to propagate a systemic approach that would be helpful in the surveillance and prevention of work-related accidents. This article describes and analyses such a platform. Online access is free and structured to: support dissemination of updated concepts; support on-site meetings and capacity to build educational activities; and keep a permanent space for debate among the registered participants. The desired result is the propagation of a social-technical-systemic view of work-related accidents that replaces the current traditional view that emphasizes human error and results in blaming the victims. The Forum uses an educational approach known as permanent health education, which is based on the experience and needs of workers and encourages debate among participants. The forum adopts a problematizing pedagogy that starts from the requirements and experiences of the social actors and stimulates support and discussions among them in line with an ongoing health educational approach. The current challenge is to turn the platform into a social networking website in order to broaden its links with society.

Prevention of dental trauma during childhood: An overview

The aim of the present study was to evaluate the prevention of dental trauma in children aged 0 to 3 years, as it is studied in the literature. Since these traumatic injuries can cause damage and complications to the deciduous teeth, and even to the permanent teeth, the development of actions to reduce their occurrence is necessary because these injuries represent a considerable problem in dentistry. Although prevention is difficult in this age group, efforts should be directed at education, especially the development of educational programs involving qualified professional directly engaged in the routine of traumatic dental injuries. The actions to be adopted should be based on the understanding of etiological factors, on the different patterns of the mechanism of injury, and on the characteristics of each community. © 2009 Bentham Science Publishers Ltd.

Os acidentes humanos e suas implicações fonoaudiológicas: opiniões de docentes e discentes sobre a formação superior

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Estudo de caso de dois acidentes do trabalho investigados com o método de árvore de causas

São apresentados dois acidentes do trabalho típicos, ocorridos em empresa de grande porte, investigados com o Método de Árvore de Causas ­ ADC, método que permite identificar o papel desempenhado por fatores gerenciais e de organização do trabalho no desencadeamento desses fenômenos. Os casos apresentados revelam a participação, na gênese dos acidentes, de fatores como designação temporária e improvisada de trabalhadores para funções e postos de trabalho, execução de tarefas deixadas à iniciativa e ao arbítrio dos trabalhadores, falta de ferramentas e de materiais apropriados à execução de tarefas e falhas na circulação de informações, entre outros. São também analisadas as indicações para o uso do método, suas potencialidades em termos de prevenção, bem como as implicações decorrentes de dificuldades de aplicação, de necessidades de treinamento e reciclagens e do dispêndio elevado de tempo para investigação de cada acidente.

Análise de barreiras e o modelo de ressonância funcional de acidentes de Erik Hollnagel

Partindo de apresentação da proposta de análise de acidentes baseada no modelo sistêmico e não linear de acidentes, dito de ressonância funcional, desenvolvido por Erik Hollnagel, este texto discute críticas às concepções deterministas de acidente e aos modelos lineares de representação desses eventos. Aspectos do modelo de ressonância funcional são usados como eixo definidor de proposta de agenda de discussões a ser desenvolvida pelos interessados no tema da análise de acidentes, destacando-se: a) a defesa do abandono da idéia de causas de acidentes e sua substituição pela de explicação desses eventos; b) apresentação dos conceitos de variabilidade de desempenhos e adaptações locais e a proposta de sua utilização como bases para a identificação de perfis ou aspectos típicos de acidentes. Por fim, discute-se a necessidade de incorporação dos conceitos apresentados no debate sobre novos caminhos para as práticas de análises e de prevenção de acidentes em nosso país.

Armadilhas cognitivas: o caso das omissões na gênese dos acidentes de trabalho

Neste artigo discute-se o tema das omissões na gênese de acidentes do trabalho, tendo como referência contribuições de James Reason. Os autores descrevem três acidentes de trabalho ocorridos em atividades de manutenção, e nos quais a omissão de passos na execução da atividade foi apontada como causa nas análises efetuadas pelas empresas, acarretando atribuição de culpa aos acidentados. Nos três casos, a análise efetuada pelos autores revelou que, na seqüência de passos da atividade havia presença simultânea de pelo menos quatro das características apontadas por Reason como geradoras de omissões, caracterizando as denominadas armadilhas cognitivas.

Trajetória da análise de acidentes: o paradigma tradicional e os primórdios da ampliação da análise

A abordagem tradicional de acidentes pressupõe que a obediência a procedimentos e normas protege o sistema contra acidentes e que esses eventos decorrem de comportamentos faltosos dos trabalhadores, originados, em parte, de aspectos de suas personalidades. A identificação desses comportamentos baseia-se em comparação com o padrão que toma por base o jeito seguro de fazer, conhecido por antecipação pelos especialistas em segurança. Nas últimas décadas, surgem visões alternativas à abordagem tradicional, ampliando o perímetro das análises de acidentes e abrindo caminho para questionamentos de seus pressupostos relativos às concepções de ser humano e de trabalho. Os novos enfoques ajudam a evidenciar os resultados estéreis das práticas tradicionais: culpar e punir as vítimas, recomendar treinamentos e normas mantendo inalterados os sistemas em que ocorreram os acidentes. As novas abordagens sugerem o esgotamento do enfoque tradicional e ressaltam a importância da contribuição dos operadores para a segurança dos sistemas.

Diagnostic de securite d'une entreprise bresilienne a partir de l'analyse des accidents du travail par la methode de l'arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (man of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to 'dangerous' or 'unsafe' behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to 'material' (78%) and 'environment' (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were 'organizational', a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is, thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.

Diagnostic de sécurité d’une entreprise brésilienne à partir de l’analyse des accidents du travail par la méthode de l’arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (mean of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to dangerous or unsafe behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to material (78%) and environment (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were organizational, a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.

Mortalidade por causas externas no Município de São José do Rio Preto, no período de 1996-1998

Introduction: An epidemiological study of the mortality rates by injuries in São José do Rio Preto, State of São Paulo, Brazil, has been carried out. The period considered is 1996-1998. Objectives: To show injuries mortality rates in São José do Rio Preto-SP in 1996-98. Methods: The study was based on official data from the Mortality Information Service of the Brazilian Ministry of Health, and in a survey based on data from medical forensic examiners (IML). Software Epinfo6.0 and Tabwin was utilized for data analises. Results: The results were compared to values obtained in the literature for the other cities of São Paulo and Brazil. In the case of São José do Rio Preto, was observed a decrease in the number of deaths associated with external causes in the period, but particularly in deaths due to traffic accidents with motor vehicles an increase in cases of pedestrians killed by hit-and-run drivers, that is much larger than the corresponding values for Brazil and for the State of São Paulo. The study showed increase in rates of homicides, mainly in the 15 to 39 years age group. Conclusion: This result suggests that is important to start programs to reduce the number of deaths by injuries, as well as the necessity of monitoring locally all these data.

Mau Funcionamento do Sistema de Circulação Extracorpórea: Relato de Caso

Background and objectives: The introduction of extracorporeal circulation in clinical practice was decisive for the development of modern cardiovascular surgery. Addition of new procedures and equipment, however, brings inherent risks and complications. The objective of this report is to describe a malfunction of the oxygenation system and emphasize the importance of the interaction among the medical team members to prevent errors and complications. Case Report: During valve replacement and IVC correction surgery, we observed a darker shade of red in the blood on the exit of the oxygenator. Laboratory tests demonstrated severe acidosis and hypoxemia. The entire system was evaluated, but the cause of the malfunction was not found. Measures to reduce damage were successfully instituted. After the surgery, the whole system underwent technical evaluation. Conclusions: Interaction among the medical team members, early diagnosis, and immediate intervention were fundamental for a favorable outcome. © 2011 Elsevier Editora Ltda.

Influence of a preventive training program on lower limb kinematics and vertical jump height of male volleyball athletes

Objective: To examine the influence of a preventative training program (PTP) on sagittal plane kinematics during different landing tasks and vertical jump height (VJH) in males. Design: Six weeks prospective exercise intervention. Participants: Fifteen male volleyball athletes (13 ± 0.7 years, 1.70 ± 0.12 m, 60 ± 12 kg). Interventions: PTP consisting of plyometric, balance and core stability exercises three times per week for six weeks. Bilateral vertical jumps with double leg (DL) and single leg (SL) landings were performed to measure the effects of training. Main outcome measurements: Kinematics of the knee and hip before and after training and VJH attained during both tasks after training. The hypothesis was that the PTP would produce improvements in VJH, but would not generate great changes in biomechanical behavior. Results: The only change identified for the SL was the longest duration of landing, which represents the time spent from initial ground contact to maximum knee flexion, after training, while increased angular displacement of the knee was observed during DL. The training did not significantly alter the VJH in either the SL (difference: 2.7 cm) or the DL conditions (difference: 3.5 cm). Conclusions: Despite the PTP's effectiveness in inducing some changes in kinematics, the changes were specific for each task, which highlights the importance of the specificity and individuality in selecting prevention injury exercises. Despite the absence of significant increases in the VJH, the absolute differences after training showed increases corroborating with the findings of statistically powerful studies that compared the results with control groups. The results suggest that short-term PTPs in low risk young male volleyball athletes may enhance performance and induce changes in some kinematic parameters. © 2012 Elsevier Ltd.