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EN
Due to WHO – health is a physical, psychical and social welfare. The collapse of health is serious threats of safety. Only healthy man may be liable to education, will participate in organizational processes, actively and creatively incorporate processes aimed at improving safety culture and defense, which serves harmonious development of certain entities and achieving safety in its broad sense. Meanwhile fatigue, caused by unhealthy lifestyle or physico-somatic changes, reduces feeling of welfare which is equivalent of safety. Taking adequate measures to minimize subjective feeling of lack of welfare might contribute to increasing our effectiveness and creativity and, at the same time, to improve conditions to our safety.
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EN
Chronic fatigue is a common symptom but a small investigated. Scientific interests of this problem increased significantly during the last two decades. The same a large number of instruments have been developed to measure chronic fatigue. The aim of this article is to present a review of fatigue measures. These are divided in three groups: scales for healthy people, scales for people with chronic fatigue syndrome, scales for patients with other chronic diseases. Each scale is described in followed aspects: structure, way of answering, interpretation, utility, modification and psychometric properties.
EN
The maritime system operates non-stop, by the workers who operate, sleep, eat and live 24/7 in noisy, dynamic and stressful environment. Irregular and extended shifts are not unusual for the workers aboard. The final result of the extended shifts is fatigue, represented by the symptoms such as drowsiness, irritability, reduced alertness, lack of concentration and memory, depression and headaches. Lack of sleep or rest can impair the cognitive skills, slows down the reaction times and makes it difficult to concentrate. Proving fatigue as the cause of the maritime accident can be a challenging task. So, the method of investigation the fatigue in the terms of maritime transport has to be used. This paper provides a recommendation for the process of investigation and assessing of the causal factors, such as human factor, especially the fatigue. The preventive measures how to avoid the fatigue aboard the vessel are also given.
EN
This paper attempts to analyze modern urban space in the context of intercepting the effects of biopolitical production by means of a conceptual apparatus taken from urban landscape studies. Among the discussed sections of urban space, which illustrate the issue undertaken in this text, there are first and foremost places that focalize and intertwine practices of urban design, landscape architecture, design and media initiated by local governments, institutions, and private investors. All of these practices strive to create a new type of urban landscapes, characterized by their simultaneous functioning as sights and as “urban stages.” Following from the above findings, this paper aims to describe the listed forms of land use in terms derived from cultural concepts of landscape, considering the latter to be a useful tool for explaining the relations between modern urban subjects and the environment they exist in.
EN
Introduction The purpose of this study was to develop and initially validate an objective, yet quick, method for assessment of human fatigue. This aim can be achieved by the use of an optical, non-contact method of analysis of pupil activity. The study involved 2 phenomena typical for the behavior of the human pupil: pupillary reflex and pupillary movements. The 1st phenomenon is related to the pupillary light reflex (PLR), which presents the results of physiological adaptation mechanisms of the human eye. The pupillary unrest index (PUI) is an additional parameter referring to the tendency for instability of the pupil. Material and methods Indicators of these 2 mechanisms were assessed under the same experimental laboratory conditions. Assessment was conducted on a group of volunteers (N = 10) during 4 controlled series of measurements performed at night. Pupillary reflex parameters associated with PLR and pupillary unrest index (PUI) were recorded using F²D Fit-For-Duty, a commercially available system made by AMTech Pupilknowlogy GmbH. Baseline pupil diameter, oscillations, reflex latency, maximum reaction time, pupil constriction time, pupil dilation time, and constriction amplitude were recorded. Results As a result of the study, we were able to demonstrate correlation and confirm the usefulness of PLR and PST methods in the assessment of sleep deprivation. Parameters of PLR that may indicate human fatigue were identified. The effect of light impulse sequences on the dynamics of pupillary reflex and the relationship between PUI (pupillary unrest index) measurement duration and sleepiness assessment validity, were assessed. Conclusions The results of the pilot studies were sufficient to develop minimum requirements for a PLR sensor that would be capable of estimating the level of fatigue with accuracy of a PUI method, but at a 5 times faster rate.
EN
It is estimated that sleep-related traffic accidents represent 20 % of all crashes and 25 % of all those with fatal consequences (Engleman & Douglas, 2005; Jackson et al., 2011). There are several risk factors increasing the likelihood of fatigue driving such as driving under monotonous conditions (especially after night shift), lack of sleep or poor sleep, or driving under the influence of certain addictive substances, such as alcohol or drugs. An important factor in determining driver sleepiness is a circadian rhythm, which affects changes in mental and physical performance throughout the day. Therefore, the connection between performance level in a particular time of the day and traffic accident frequency becomes the subject of research. For purpose of this study, the curve of expected human performance (by Kohoutek & Štěpaník, 2000) was used to compare the levels of alertness and the number of traffic accidents in particular times of the day. The aim of this study was to analyse vulnerable times of the day related to traffic accident frequency, based on results from In-depth Accident Analysis in South Moravian Region. Another objective was to determine the extent of correspondence between identified vulnerable times of the day related to traffic accident frequency and the performance curve, describing the expected levels in human performance during the day. Different groups of drivers in terms of sociodemographic factors (gender, age) and driving experience were compared. Data were collected over the project Czech In-depth Accident Study via interviewing road traffic accident participants directly after the accident by a psychologist. The research sample consisted of 213 drivers (149 males and 64 females) who have caused the accident due to their inattention and were assumed to have an average level of vigilance at the time of accident. The data were processed by the statistical software SPSS. A traffic accident frequency curve showed a similar trend as the curve of expected human performance level in the time between 9:00–18:00, where a negative correlation was found (9.00 to 12.00, rp = - 0.76, 12.00 to 15.00, rp = - 0.85, 15.00 - 18.00, rp = - 0.91). For all ages, the most vulnerable time of the day, where traffic accidents happen in a connection with a lower level of expected performance capacity, proved to be time between 15:00–16:00. The least amount of traffic accidents occurred between 10:00–11:00, which represents the time with a higher expected performance level. The increased accident frequency in the early morning hours may be explained by the decrease in drivers´ alertness after waking up. The conclusions of this study partially support results of previous research and the reliability of expected performance level curve during the day (by Kohoutek & Štěpaník, 2000) in a relation to driving. It opens new areas in the field of driver education, how to lead drivers to be more sensitive to their mental and bodily limits, particularly in a connection to their attention level.
EN
Objectives: A high percentage of professional drivers (PDs) often report feeling fatigue during their work, and falling asleep at the wheel (FAW) is a major contributing factor to the occurrence of near-miss or actual accidents. The aim of this study is to evaluate the prevalence of FAW among Italian PDs and the effect of fatigue on this occurrence (corrected for the main predictive factors already known). Material and Methods: We performed a cross-sectional questionnaire survey. Data from PDs (N = 497) were used for analyses. Logistic regression analyses were performed to assess the association of reported sudden-onset sleep at the wheel with working conditions and general lifestyle factors. Results: Forty-one percent of the interviewees experienced at least 1 episode per month of sudden-onset sleep at the wheel (4.7% per week). Predictive factors of self-reported FAW were: age > 55 years old (odds ratio (OR) = 4.91, confidence interval (CI): 1.79–13.50, p < 0.01), traveling more than 40 thousand miles per year (OR = 1.86, 95% CI: 1.08–3.22, p < 0.05), body mass index ≥ 30 (OR = 2.16, 95% CI: 1.01–4.64, p < 0.05) and Chalder Fatigue Questionnaire score > 22 (OR = 3.93, 95% CI: 1.90–8.14, p < 0.01). Conclusions: There are different work and human factors underlying FAW among PDs. The Chalder Fatigue Questionnaire might be useful in measuring fatigue in this group and in detecting PDs at high risk of experiencing FAW.
EN
Objectives The aim of this study was to investigate the prevalence of obesity, alcoholic beverage consumption, unhealthy alcohol use and sudden sleep onset at the wheel among Italian truck drivers. In addition to prevalence rates, this study also aimed at investigating potential predictors for sudden-onset sleepiness and obesity. Material and Methods A sample of truck drivers was extracted from the database of the High Risk Professional Driver Study. Data concerning demographics, anthropometry, medical information and working conditions were collected using anonymous questionnaires. Logistic regression analyses were performed to assess the association of the reported body mass index (BMI), alcohol consumption and sudden sleep onset with working conditions and general lifestyle factors. Results Three hundred and thirty-five questionnaires were collected. According to their BMI, 45% of the participants were overweight and 21.4% of them were obese. Twenty-four point two percent declared they drank alcoholic beverages during working hours or work breaks and 21.3% of the drivers had an Alcohol Use Disorders Identyfication Test Consumption (AUDIT C) score ≥ 5 (the threshold value for unhealthy alcohol use). Forty-one point six percent of the interviewees experienced one episode of sudden sleep onset at the wheel per month (5.5% per week and 0.9% daily). Predictive factors for obesity were: length of service (odds ratio (OR) = 1.09, confidence interval (95% CI): 1.04–1.15, p < 0.001) and the AUDIT C total score (OR = 1.34, 95% CI: 1.08–1.66, p = 0.008). Predictive factors for sudden-onset sleepiness at the wheel were: age > 55 years old (OR = 5.22, 95% CI: 1.29–21.1, p = 0.020), driving more than 50 000 km per year (OR = 2.89, 95% CI: 1.37–6.11, p = 0.006) and the Chalder Fatigue Questionnaire (CFQ) score > 11 (adjusted OR = 2.97, 95% CI: 1.22–7.21, p = 0.016). Conclusions This study strongly emphasizes the need for intervention in order to reduce and prevent important risk factors for the sake of road safety and truck drivers’ health.
EN
Objectives Transient exposure with acute effect has been shown to affect the risk of occupational injuries in various industrial settings and at the healthcare workplace. The objective of this study has been to identify transient exposures related to occupational injury risk in an Italian teaching hospital. Material and Methods A case-crossover study was conducted among the employees of the University Hospital of Udine who reported an occupational injury, commuting accident, or incident involving biological risk in a 15-month period in the years 2013 and 2014. The matched-pair interval approach was used to assess the role of acute sleep deprivation whereas the usual frequency approach was used for other 13 transient exposures. Results Sleep hours were not associated with the risk of injuries whereas a significant risk increase was associated with fatigue, rush, distraction, emergency situations, teaching to or being taught by someone, non-compliant patients, bloody operative/work field, excess noise, complex procedures, and anger. Conclusions We identified transient exposures that increased the risk of occupational injuries in an Italian teaching hospital, providing indications for interventions to increase workers’ safety at the healthcare workplace. Int J Occup Med Environ Health 2016;29(6):1001–1009
EN
Objectives: The aim of this study was to identify factors that contribute to the development of burnout among physiotherapists with different length of service in physiotherapy. Material and Methods: The following research tools were used to study burnout: the Life Satisfaction Questionnaire (LSQ), based on FLZ (Fragebogen zur Lebenszufriedenheit) by Frahrenberg, Myrtek, Schumacher, and Brähler; the Burnout Scale Inventory (BSI) by Steuden and Okła; and an ad hoc questionnaire to collect socio-demographic data. The survey was anonymous and voluntary and involved a group of 200 active physiotherapists working in Poland. Results: A statistical analysis revealed significant differences in overall life satisfaction between length-of-service groups (p = 0.03). Physiotherapists with more than 15 years of service reported greater satisfaction than those with less than 5 years and between 5 and 15 years of service. The results suggest that burnout in those with 5-15 years of service is higher in physiotherapists working in health care centers and increases with age and greater financial satisfaction, while it decreases with greater satisfaction with friend and family relations and greater satisfaction with one's work and profession. In those with more than 15 years of service, burnout increases in the case of working in a setting other than a health care or educational center and decreases with greater satisfaction with one's work and profession. Conclusions: Job satisfaction and a satisfying family life prevent burnout among physiotherapists with 5-15 years of service in the profession. Financial satisfaction, age and being employed in health care may cause burnout among physiotherapists with 5-15 years of service. Physiotherapists with more than 15 years of service experience more burnout if they work in a setting other than a health care or educational center and less burnout if they are satisfied with their profession.
EN
Objectives To explore the relationship between depressive symptoms, fatigue and psychological flexibility, as well as their interactions on depression in Chinese nurses. Material and Methods Using convenience sampling, a cross-sectional survey of 796 nurses in municipal hospitals of Zhengzhou, Henan Province, China, was conducted. The questionnaires of Work-related Acceptance and Action Questionnaire, Center for Epidemiological Studies Depression Scale and Fatigue Assessment Instrument were used. Hierarchical regression and bootstrap methods were used to examine the mediating effect of psychological flexibility between fatigue and depression. Results More than 51.8% of the nurses were at risk of depression and 62.3% were at risk of fatigue. There was a significantly positive and moderate correlation between depression and fatigue severity, situation specificity, and consequences (r = 0.43, r = 0.24 and r = 0.31, respectively, p < 0.01). Depression was negatively correlated with psychological flexibility (r = –0.28, p < 0.01). Psychological flexibility had a negative impact on depression with the explained variance increased by 4.2% (β = –0.211, p < 0.001). The bootstrap method showed that the mediating effect of psychological flexibility accounting for 8.5% and 12.3% on fatigue and depressive symptoms, respectively. Conclusions Psychological flexibility plays a partial mediating role between the fatigue severity, consequences of fatigue and depressive symptoms of nurses. Hospital managers should improve medical staff work acceptance to alleviate their depressive symptoms.
EN
Objectives: The present study examined the relationship between medical student fatigue with psychological variables: emotional intelligence (EI), sense of coherence (SoC) (comprehensibility, manageability, and meaningfulness), quality of life (QoL), stress, and satisfaction with studying medicine. Material and Methods: The sample consisted of 566 medical students from the Medical University of Gdańsk, Poland. The instruments used were the Chalder Fatigue Scale, Schutte Self Report Emotional Intelligence Test, Sense of Coherence Questionnaire, and a questionnaire designed by the authors, comprised questions relating to the quality of life, stress levels, and satisfaction with studying medicine. Results: The results show that fatigue was negatively related to the ability to use emotions effectively in the management of one’s activities (EI), 1 aspect of SoC – a level of comprehensibility, QoL, and satisfaction with studying medicine. Fatigue is positively related to the ability to recognize, understand, and control emotions (EI) and stress connected with studying medicine. Conclusions: The outcomes of the study afford a better understanding of the relationship between selected variables in the field of individual differences in the context of fatigue in the medical student population. It may help medical educators and authorities to have a better understanding of the phenomenon of building resilience and increasing abilities to cope with the negative effects of chronic stress such as fatigue in the population of medical students. Early recognition of specific psychological features in medical students, such as misunderstanding emotions and their perception of environments as unstructured, would make it possible to prepare early support and development programmes.
EN
Objectives The aim of the study was to analyze the long-term burnout levels of healthcare professionals (HCPs) working in Slovenian nursing homes during the fifth wave of the pandemic; to compare the results of similar facilities in 2020 and 2013; and to examine the correlation between demographics and burnout and fatigue among HCPs. Material and methods The study used a descriptive, correlational cross-sectional method. Results In the fifth wave, HCPs suffered more from emotional exhaustion, depersonalization and lack of personal accomplishment than in the first wave of the pandemic and in the spring of 2013. The HCPs caring for COVID-19 patients and younger women had higher rates of burnout and fatigue than other occupational groups. There is a strong positive correlation between burnout and fatigue. Conclusions There is an urgent need to address the problem of fatigue and burnout with administrative measures.
EN
ObjectivesThe Chalder Fatigue Questionnaire (CFQ) was developed to measure fatigue in 2 dimensions: physical and mental. The aim of the study was to translate, adapt and evaluate the psychometric properties of the Polish version of the CFQ (CFQ-PL).Material and MethodsThe process of translation was conducted using a forward and backward translation procedure. After cultural adaptation, the psychometric properties of the CFQ-PL were evaluated. Participants of the study were healthy individuals: medical students (N = 304) and pregnant women (pregnancy without complications, N = 925). The reliability and validity were estimated using fatigue numerical rating scales, the Beck Depression Inventory and the State-Trait Anxiety Inventory. To examine the factor structure of the CFQ-PL, a confirmatory factor analysis was conducted.ResultsThe internal consistency of the CFQ-PL was similar to the original version (Cronbach’s α 0.85–0.91). Statistically significant correlations between the CFQ-PL and the current fatigue level, average fatigue and the sleepiness level (measured using numerical rating scales), as well as the intensity of depression and anxiety symptoms, all confirming the validity of the adapted scale. Using a confirmatory factor analysis, it was determined that a 1-factor model did not fit the data well. A 2-factor model with a correlation between mental and physical factors fitted better than the 1-factor model, yet fit indices revealed a poor fit. Using a 2-factor model with added covariance between items – 1 (problems with fatigue), 2 (resting more), 9 (slips of the tongue), 10 (finding the correct word) – resulted in acceptable fit indices in both groups of participants.ConclusionsAfter the process of translation, adaptation and validation of the CFQ-PL, it is now available for use under Polish conditions. This study provided evidence for structural validity of the 2-factor model of the 11-item version.
EN
Background The COVID-19 disease has a negative impact on the psychophysiological health of populations worldwide, including a decrease in overall physical performance and an increase in fatigue. Fatigue was one of the main symptoms reported by patients and persisted for several weeks after infection with COVID-19. Although the phenomenon of fatigue is still poorly understood, physical activity can be a supportive factor in combating feelings of fatigue and lack of energy. The purpose of this research was to assess the physical activity (PA) and fatigue levels of teachers in Poland and the United Kingdom in the first year after the COVID-19 pandemic. Material and Methods The online research was carried out among 410 teachers from Poland and the United Kingdom. The PA level was assessed using the International Physical Activity Questionnaire (IPAQ). The level of fatigue was measured using the Modified Fatigue Impact Scale (MFIS). Results Polish teachers, regardless of sex, are more physically active (the differences relate mainly to walking and moderate activity). When assessing the level of fatigue, there is a significant difference between men and women – the former indicate a higher degree of fatigue, with the difference between the sexes being particularly large in the Polish community. Quite clearly, there is an association between less activity (except walking) and more fatigue. All models show a statistically significant effect of total fatigue on total effort. Physical activity is not very strongly correlated with age but the level of fatigue increases with age. Conclusions The problem of teacher fatigue is unfortunately widespread. They should be encouraged to engage in as much PA as possible during the day. When planning and targeting fatigue reduction campaigns, PA should be encouraged and variables such as age, sex should be taken into account.
EN
Background Workers who do monotonous and repetitive work in a static position often complain about fatigue and decreased work efficiency. Some studies indicate that to improve muscle fatigue, resistance strength training can be used. Material and Methods To investigate the effect of 4-week inertial training on shoulder muscles’ strength and muscles’ fatigue resistance 44 female workers with disabilities were examined. The participants were randomized into the training group (T) (N = 32) and the control group (C) (N = 12). Before the training and after that shoulder muscles’ strength were tested at the start and at the end of the workday (Monday and Friday). The participants were asked to complete questionnaire concerning their fatigue at work (T and C), inertial training and work efficiency (T). Results The work performed during the last day of the workweek, i.e., Friday (before training) resulted in a significant decrease in shoulder muscles’ strength in T and C. Muscle strength achieved at the end of the workweek (Friday afternoon) was significantly lower than achieved at the start of the workweek (Monday morning) in both tested groups (before training). Moreover, inertial training resulted in a significant increase in shoulder muscles’ strength in T; 34–74% for different muscles. No changes in muscles’ strength were noted in C. Increased muscle strength in T following inertial training effectively prevented muscle fatigue. After training the differences in shoulder muscles’ strength noted in T during different times of the workday and workweek were insignificant. Moreover, 4-week inertial training increased significantly the work efficiency of women from T by 4%; no changes were noted in C. Inertial training was well tolerated by the participants. Conclusions Using inertial training in women with disabilities to prevent shoulder muscles’ fatigue during the workday and workweek is recommended.
PL
Utrata pracy i jej poszukiwanie należą do sytuacji trudnych, których skutki odczuwane są przez osobę bezrobotną w postaci zwiększonego doświadczania stresu, negatywnych emocji, niepokoju i zmęczenia. W dotychczasowej literaturze przedmiotu niewiele miejsca zajmuje problematyka wypalenia oraz zmęczenia osób bezrobotnych, dlatego celem przeprowadzonych badań była analiza zjawiska zmęczenia u osób poszukujących pracy.
EN
Loss of job and searching for it belong to difficult situations, the effects of which are felt by an unemployed person in the form of increased stress, negative emotions, anxiety and fatigue. In the literature to date, the issue of burnout and fatigue of the unemployed is of little importance, therefore the aim of the research was to analyze the phenomenon of fatigue in jobseekers.
PL
Zmęczenie jest zjawiskiem stale towarzyszącym współczesnemu człowiekowi w codziennej aktywności. Wysiłek, zarówno fizyczny, jak i umysłowy, który przekracza możliwości adaptacyjne organizmu, powoduje po pewnym czasie trwałe zmiany w postaci objawów przewlekłego zmęczenia. Dotyczy to coraz częściej dzieci i młodzieży w wieku szkolnym i wymaga zaawansowanych analiz, a w konsekwencji różnorodnych działań zapobiegawczych. Celem artykułu jest charakterystyka zjawiska przewlekłego zmęczenia w populacji młodzieży. Zastosowaną metodą badań jest analiza wybranego piśmiennictwa, którego tematyka oscyluje wokół psychospołecznego funkcjonowania młodzieży doświadczającej przewlekłego zmęczenia.
EN
Fatigue is a phenomenon nowadays constantly accompanying modern man in everyday activ-ities. Effort, both physical and mental, which exceeds the adaptive capacity of the body causes after some time permanent changes in the form of symptoms of chronic fatigue. This phenomenon nowadays increasingly affects children and adolescents in school age and requires advanced analysis and consequently various preventive measures. The aim of this article is to characterize the phenomenon of chronic fatigue in the youth population. The research method used is an analysis of the selected literature, whose subjects oscillate around the psychosocial functioning of adolescents experiencing chronic fatigue.
European Polygraph
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2023
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vol. 17
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issue 2(58)
151-155
EN
A simple question for many, idle for others, but necessary to answer for everyone, is why the comparison question occupies a first position based on the relevant question when it comes to format sequences corresponding to deception polygraph techniques. This questioning is transcendent when it occurs in the context of the scientific, legal debate, or due to the scrutiny of polygraph consumers who make administrative decisions based on the diagnostic results. However, within the polygraphy union it seems that the answer has been dealt with in informal settings, in hallway talks or as a classroom topic, but the truth is that its documentary formality seems to be scarce, for this reason, this discussion has the intention of providing basic knowledge to field examiners about this procedural unknown, of which, we are convinced that they are the ones who must be prepared to answer this and other procedural questions in order to maintain the scientific reputation of our profession.
PL
Stanowiska pracy monotypowej spotyka się w wielu zakładach przemysłowych oraz w innych miejscach pracy. Zarówno wykonywanie samych czynności monotypowych, jak i czynniki występujące w środowisku pracy są źródłami obciążającymi organizm pracownika, co może skutkować stresem, spadkiem wydajności pracy oraz pojawieniem się zmęczenia, a także wielu dolegliwości, w tym schorzeń układu mięśniowo-szkieletowego (tzw. MSDs). W artykule przedstawiono istniejące definicje pracy monotypowej, skutki zdrowotne, które może ona wywoływać, istniejące metody oceny stopnia obciążenia wynikającego z monotypowości ruchów roboczych, a także możliwe sposoby oddziaływania fizycznych czynników środowiska pracy na pracownika wykonującego pracę monotypową. Dokonano również analizy czterech wybranych stanowisk pracy monotypowej, na których oprócz charakterystyki procesu pracy przeprowadzono badania ankietowe pozwalające poznać subiektywną ocenę pracowników na temat warunków pracy. W podsumowaniu podkreślono zagadnienie istotności, a zarazem złożoności kompleksowej oceny ryzyka zawodowego (głównie wystąpienia MSDs) na stanowiskach pracy monotypowej, uwzględniającej m.in. udział fizycznych czynników środowiska pracy w generowaniu obciążeń, ponieważ od prawidłowo rozpoznanych źródeł obciążeń zależy skuteczny dobór działań profilaktycznych.
EN
The workstations of monotype work are commonly met in industrial plants and other work places. Both repetitive work itself and the working environment factors make human body overloaded, which may affect in stress, a decrease of work efficiency, fatigue and the numerous ailments including musculoskeletal disorders (MSDs). In this article, the definition of repetitive work has been given. Health disorders due to this kind of work, the existing methods for evaluating the degree of nuisance resulting from repetitiveness of movements at work as well as well as the possible impact the physical factors of the work environment may have on the employee performing a monotype job have been discussed. Four repetitive work stations have been characterized and analyzed. Workers’ subjective opinions about their working conditions have been collected by the means of survey study. In the summary, the significance and the complexity of the proper evaluation of occupational risk at repetitive workstations (mainly MSDs risk) have been mentioned. The working environment factors that generate the workload have been taken into consideration as it is crucial to identify those factors properly in order to take the effective health prevention actions.
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