1. Ana Claudia Fiorini, PhD Catholic University of São Paulo PUC-SP Brazil

2. 26 states and Brasília (DC) 170 million habitants Occupational Activities: mining, manufacturing, industrial services, construction, trade, service, public administration and farming. 2008: 40 million formal employees BRAZIL

3. Repetitive Strain Injury (RSI) Occupational Hearing Loss BRAZIL Major Occupational Disease

4. Health Benefits Work OSH Work OSH Departments BRAZILIAN POLICIES  2002: The National Network of Total Worker´s Health Care  2004: Ordinance to regulate compulsory notification of work related accidents and diseases

5. NR-15: exposure limits Brazilian Occupational Safety and Health Organization NR-6: individual protectors NR-9: safety program NR-7: health program Portaria 19: audiometric test

6. Brazilian Occupational Safety and Health Organization Ordinance 19: audiometric test  Rules to perform and follow-up audiometric test (PTA from 500- 8kHz, air and bone conduction)  Pre-employment, after six months and, after that, Annual PTA  Baseline audiogram  STS follow-up

7. Maximum Level: continuous or intermittent noise Lav 85 dB(A) ------ 8 h 86 dB(A) ------ 7 h 87 dB(A) ------ 6 h 88 dB(A) ------ 5 h 89 dB(A) ------ 4 h 30 min 90 dB(A) ------ 4 h 91 dB(A) ------ 3 h 30 min 92 dB(A) ------ 3 h 93 dB(A) ------ 2 h 30 min 94 dB(A) ------ 2 h 15 min 95 dB(A) ------ 2 h 96 dB(A) ------ 1 h 45 min 98 dB(A) ------ 1 h 15 min 100 dB(A) ------ 1 h 102 dB(A) ------ 45 min 104 dB(A) ------ 35 min 105 dB(A) ------ 30 min 106 dB(A) ------ 25 min 108 dB(A) ------ 20 min 110 dB(A) ------ 15 min 115 dB(A) ------ 7 min NR - 15 5 dB: Impact noise: 130 dB (linear).

8. NHO 01 Fundacentro (2001)

9. PREVALENCE OF HL Until 1990  Textile: 37%  Metallurgy: 40%  Cellulose: 36%  Glass: 39%  Stones/mining: 32%  Plastic: 42%  Farmer drivers: 56% Andrade e Schochat, 1988; Costa et al., 1989

10. PREVALENCE OF HL Now  Hearing Loss in Industry: 18-40%  Cross-sectional household survey was conducted with 2427 persons in Southern Brazil, using WHO Ear and Hearing Disorders Survey: moderate (5.4%), severe (1.2%) and profound (0.2%) HL= 6,8% Béria et al., 2007 – Pan Am J Public Health. 2007;21(6):381-7

11. Hearing Loss Prevention Program – Textiles General guidelines Implemented in 1997 5 plants in Brazil (manufacture denim) Main occupational hazards: cotton dust, noise and vibration (2000 workers) Associated to the company´s environmental manegment There is a safety engineer, a safety technician, na occupational phisician and na audiologist

12. Hearing Loss Prevention Program – Textiles General guidelines Non-occupational activities Non-occupational activities

13. Workplace *Specific program for selection, recommendation, fitting and follow-up of hearing protectors

14. Hearing Protection Program's stages * It determines the HP that may be used in the workplace, taking scientific research and new technologies (NIOSH´s rules and field survey)

15. Hearing Protector Approval Ear muffs (three types, NRRsf > 18 dB) Sample: 20 subjects (normal hearing) Noise measurement: 3 dose/3 days (average bellow 80 dBA to be accepted) Questionnaire (protector's use, comfort and attenuation): after one month (score above 80%) Three types are always approved

16. HP DOSE DOSE DOSE Right WP Left 1 78.4 93.3 78.7 2 79.6 92.7 81.1 3 78.0 93.7 75.7 HP TEST (dBA)

17. Evaluation of Hearing Protector  Individual training  Group training  Guide  User satisfaction survey (questionnaire)  Maintenance program  Regular replacement of HP

18. Guide on how to protect your ears

20. Before exposure Example: OAE test

21. After exposure

22. Hearing Loss Prevention Program Non-occupational Activities: identifying workers´leasure (personal music players, shows and others) Epidemiological Surveillance: the performance and analysis of audiometric testing is standardized (longitudinal studies to check onset and worsening of HL)

23. Results Normal group remains around 80% Maximum STS: 0.27%

25. Thank you!! acfiorini@pucsp.br