Hasil untuk "Industrial hygiene. Industrial welfare"

Pamela Talero Cabrejo, Clara Duarte Cuervo

Este número de la Revista Ocupación Humana rinde homenaje a la profesora Martha Lucía Torres Carvajal (1951–2025), presidenta de la Asociación Colombiana de Terapia Ocupacional entre 1994 y 1996 y referente fundamental de la Terapia Ocupacional en Colombia y América Latina. A través de una narrativa biográfica, política y afectiva, este editorial hace un recorrido somero por su trayectoria como lideresa institucional y gremial, educadora, investigadora y agente de transformación social en contextos atravesados por desigualdades de género, jerarquías disciplinares y exclusión profesional. El texto articula su pensamiento ético y su comprensión relacional de la realidad con su apuesta por una Terapia Ocupacional comprometida con la inclusión, el trabajo digno y la ciudadanía. Se analizan sus aportes profesionales, académicos y gremiales al fortalecimiento y posicionamiento de la profesión, situando su liderazgo en las luchas históricas de las mujeres por el acceso al poder y la voz pública. Asimismo, se subraya cómo su práctica convierte lo cotidiano en un territorio político. Este homenaje reconoce su legado como una invitación permanente a “ocupar el mundo” desde la ética, la acción colectiva y la imaginación social.

Nienke Ruijter, Ilaria Zanoni, Daniel Persson et al.

Abstract Background The Safe and Sustainable by Design (SSbD) concept facilitates the design of safer and more sustainable chemicals and materials and is a crucial approach towards reaching the goals set out in the European Green Deal. It is critical that suitable guidance is provided on how to use new approach methodologies (NAMs) to fill hazard data gaps for nanomaterials (NMs) to facilitate SSbD decisions. Here, we showcase a nano-specific in vitro SSbD case study. The five colloidal silica nanoforms (SiO2-NFs) under investigation in this study are surface modified with varying amounts of glycerolpropyl-organosilane groups. In this study, we use a simple yet comprehensive in vitro test battery along with thorough particle characterization to investigate the effect of surface silanization on in vitro toxicity to inform SSbD decisions. Results Cytotoxic, pro-inflammatory and oxidative stress responses in A549, dTHP-1, and BEAS-2B cells after exposure to SiO2-NFs submerged and at the air-liquid interface (ALI) decreased with increasing silane surface modification. None of the SiO2-NFs showed surface reactivity or haemolytic potential. Deposition assessment using inductively coupled plasma – optical emission spectrometry (ICP-OES) revealed that increasing silane surface modification decreased particle settling. The two SiO2-NFs with the highest amount of surface silanization did not reach the cells in a submerged exposure setting, and they were therefore only tested at the ALI. Identical dose-response curves were observed for both the submerged testing and testing at the ALI for the SiO2-NFs without and with low/intermediate surface functionalization, again showing a decrease in effects with increasing surface functionalization. Conclusion We show that in vitro toxicity assays provide valuable information for SSbD decision making. In vitro cytotoxic, pro-inflammatory and oxidative stress responses can be reduced with increasing surface silane functionalization. The reduced deposition efficiency with increasing silane functionalization, however, highlights that thorough characterization of particle behaviour in cell culture medium should always be performed for SSbD hazard testing. The amount of silane required to reduce toxicity is important information for the future production of safer SiO2-NFs and nano-enabled products. Exposure, functionality, and sustainability remain to be investigated to draw full SSbD conclusions.

Antonija Tadin, Marija Badrov, Branimira Mikelic Vitasovic et al.

Orthodontic therapy is associated with a more significant accumulation of dentobacterial plaque and impaired oral hygiene, which increase the risk of developing dental caries and periodontal disease. Therefore, it is crucial to educate orthodontic patients about proper oral hygiene maintenance and oral health before and during treatment. The aim of this pilot study was to implement evidence-based best practices related to oral hygiene in adult orthodontic patients and improve compliance. In addition to evaluating oral hygiene practices, another goal of the project was to assess the knowledge of orthodontic patients regarding oral health. Questionnaires with seven pre- (before) and post-test criteria (90 day after implementation) were developed based on the best evidence available. This project was conducted in a private dental clinic in Split, Croatia, and included 45 patients. The baseline audit showed a gap between clinical practice and the best evidence. Three criteria achieved a high compliance baseline, while after implementation, there were substantial improvements in compliance for all. The everyday use of mouthwash improved from 17.8% at baseline to 66.7% at follow-up, as did the use of interdental aids, which increased from 55.6% to 91.1%. Statistically significant differences were found in the total score for oral health knowledge between the baseline (6.67 ± 1.74) and the follow-up audit (7.78 ± 0.56, <i>p</i> ≤ 0.001). The strategies developed in this project were effective in providing essential information to adult orthodontic patients and improving compliance with evidence. Guidelines on this topic should be designed to assist orthodontists and patients in maintaining oral health and oral hygiene.

Tianyi Zhang, Sheng Yang, Yiling Ge et al.

Abstract Background Nanoplastics (NPs) could be released into environment through the degradation of plastic products, and their content in the air cannot be ignored. To date, no studies have focused on the cardiac injury effects and underlying mechanisms induced by respiratory exposure to NPs. Results Here, we systematically investigated the cardiotoxicity of 40 nm polystyrene nanoplastics (PS-NPs) in mice exposed via inhalation. Four exposure concentrations (0 µg/day, 16 µg/day, 40 µg/day and 100 µg/day) and three exposure durations (1 week, 4 weeks, 12 weeks) were set for more comprehensive information and RNA-seq was performed to reveal the potential mechanisms of cardiotoxicity after acute, subacute and subchronic exposure. PS-NPs induced cardiac injury in a dose-dependent and time-dependent manner. Acute, subacute and subchronic exposure increased the levels of injury biomarkers and inflammation and disturbed the equilibrium between oxidase and antioxidase activity. Subacute and subchronic exposure dampened the cardiac systolic function and contributed to structural and ultrastructural damage in heart. Mechanistically, violent inflammatory and immune responses were evoked after acute exposure. Moreover, disturbed energy metabolism, especially the TCA cycle, in the myocardium caused by mitochondria damage may be the latent mechanism of PS-NPs-induced cardiac injury after subacute and subchronic exposure. Conclusion The present study evaluated the cardiotoxicity induced by respiratory exposure to PS-NPs from multiple dimensions, including the accumulation of PS-NPs, cardiac functional assessment, histology observation, biomarkers detection and transcriptomic study. PS-NPs resulted in cardiac injury structurally and functionally in a dose-dependent and time-dependent manner, and mitochondria damage of myocardium induced by PS-NPs may be the potential mechanism for its cardiotoxicity. Graphical abstract

Ainayya Rizky Savitri, Noeroel Widajati

Introduction: Work stress is the inability of a worker to face job demands, leading to discomfort while working. Work stress can be caused by many factors, among them work monotony, excessive workload, and individual characteristics. This study's aim was to analyze the strength of the relationship among individual characteristics, work monotony, and mental workload with work stress on the crane operators of Jamrud Terminal. Methods: This study used cross-sectional design. The population in this study was all crane operators in Jamrud Terminal as many as 28 people. Total sampling was applied as sampling technique. The independent variables in this study include individual characteristics (age and tenure), work monotony obtained from the questionnaire, mental workload which was appraised using NASA-TLX questionnaire, while the dependent variable was work stress assessed with DASS 42 questionnaire. Coefficient contingency and Spearman correlation test were applied to analyze collected data. Results: This study revealed 13 operators (46.4%) felt normal work stress and the other operators (53.6%) felt work stress ranging from light until very heavy. Contingency coefficient correlation test resulted in weak relationship among age and work stress and strong relationship among work monotony and work stress. Spearman correlation test revealed weak relationship among tenure and work stress and moderate relationship among mental workload and work stress. Conclusion: There were relationships among work monotony and mental workload with work stress on crane operators. The company is advised to give work music, variation on work, and arrange proper break time for crane operator.

Sjahrul Meizar Nasri, Asduki D. Athari, Laksita Ri Hastiti et al.

Introduction: Mold may affect the Indoor Air Quality (IAQ) in workplace dormitories. This study aims to investigate indoor air factors that affect molds growth in a dormitory of an LNG Company in Indonesia. Several indoor air determinant factors, including relative humidity, general temperature, wet temperature, dry temperature, air velocity, illumination, particulate matter, and carbon dioxide concentration were assessed against the growth of microorganism colonies. Methods: This study was a cross-sectional study using a 2 (two)-stage Andersen sampler based on NIOSH 0800 Bioaerosol Sampling Method for Indoor Air Quality for viable bioaerosol sampling. Bioaerosol samples were collected from 50 indoor, corridor, and outdoor sampling points. The total colony count for bioaerosols (TCC) was then determined (CFU/m3). Ten indoor air quality parameters, i.e., relative humidity, general temperature, wet temperature, dry temperature, air velocity, illumination, particulate matter, and carbon dioxide concentration, were measured. Results: The average mold colony concentration in the dormitory rooms was higher (703.1 CFU/m3) than the maximum standard issued by the Ministry of Health of the Republic of Indonesia (< 700 CFU/m3) while the relative humidity was very high (84.4% RH on average), with a direct relation between the humidity and the mold colony concentration. A significant correlation was also identified between mold colony concentration, wet temperature, and CO2 concentration. Conclusion: Significant correlations between bioaerosols, relative humidity, wet temperature, and indoor CO2 concentration indicate insufficient ventilation and poor indoor air quality in the dormitory.

J. Duarte, Jacqueline Castelo Branco, J. Santos Baptista

Occupational noise-induced hearing loss (ONIHL) is one of the most recognised occupational diseases globally. Mining and earthworks are among those with the greatest impact in this matter. A systematic review addressing the noise exposure characterisation, in order to develop a preventive design, is being proposed in this protocol. The Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were used to draw the research outline, where the study and report characteristics are provided. All of the selected keywords and databases/journals were priorly identified and are now presented. The search methodology is clarified, and an example for Scopus is provided. A methodology to deal with bias within studies is proposed, and all the systematic review narrative processes of the systematic review are discussed in the protocol, including information that will be extracted from the selected records. The Preferred Reporting Items for Systematic Review and Meta-analysis guidelines will be used to help develop the review.

Bárbara Lázara Hernández González, Violeta González González, Kely Rivero Domínguez et al.

Introduction: The lifelong learning of nursing workers develops their acting in function of the continuous improvement of the attention quality that they offer. Objective: To characterize the performance of the lifelong learning activities of nursing workers at health institutionsin Arroyo Naranjo, 2013-2019. Materials and Methods: Descriptive study through documental review to dictated documents and final reports of the activities taught for nurses in educational stages in Arroyo Naranjo, 2013-2019; it was applied Descriptive Statistic techniques to calculate frequencies distributions and to make statistical tables and graphics. Results: 110 courses, 12 educational shops, 7 diploma projects and 6 trainingswere performed, for a total of 135 activities with 3219 graduates. At Julio Trigo Hospital were done 48 activities followed by Julio Trigo School Medicine with 40. It was implemented 18 editions of the intensive therapy course with 320 graduates, 14 of endoscopia with 338 graduates and 8 of techniques for the handling of the childbirth, newborns and postpartum women with 95 graduates, to replace the learning necessities identified by Municipal Collaboration Department and 60 Anniversary Contingent. Conclusions: The lifelong learning activities of nursing workers were characterized by the sustained increment of activities performed in the period 2013-2019 with prevalence of courses; intensive therapy and endoscopia contributed the biggest numbers of imparted editions and graduates in answer to the knowledge demands of collaborators and 60 Anniversary Contingent members, followed by the Childlike Maternal Attention Program, the ethic of taking care, communication topics and the occupational nursing

Sabina Halappanavar, Sybille van den Brule, Penny Nymark et al.

Abstract Toxicity testing and regulation of advanced materials at the nanoscale, i.e. nanosafety, is challenged by the growing number of nanomaterials and their property variants requiring assessment for potential human health impacts. The existing animal-reliant toxicity testing tools are onerous in terms of time and resources and are less and less in line with the international effort to reduce animal experiments. Thus, there is a need for faster, cheaper, sensitive and effective animal alternatives that are supported by mechanistic evidence. More importantly, there is an urgency for developing alternative testing strategies that help justify the strategic prioritization of testing or targeting the most apparent adverse outcomes, selection of specific endpoints and assays and identifying nanomaterials of high concern. The Adverse Outcome Pathway (AOP) framework is a systematic process that uses the available mechanistic information concerning a toxicological response and describes causal or mechanistic linkages between a molecular initiating event, a series of intermediate key events and the adverse outcome. The AOP framework provides pragmatic insights to promote the development of alternative testing strategies. This review will detail a brief overview of the AOP framework and its application to nanotoxicology, tools for developing AOPs and the role of toxicogenomics, and summarize various AOPs of relevance to inhalation toxicity of nanomaterials that are currently under various stages of development. The review also presents a network of AOPs derived from connecting all AOPs, which shows that several adverse outcomes induced by nanomaterials originate from a molecular initiating event that describes the interaction of nanomaterials with lung cells and involve similar intermediate key events. Finally, using the example of an established AOP for lung fibrosis, the review will discuss various in vitro tests available for assessing lung fibrosis and how the information can be used to support a tiered testing strategy for lung fibrosis. The AOPs and AOP network enable deeper understanding of mechanisms involved in inhalation toxicity of nanomaterials and provide a strategy for the development of alternative test methods for hazard and risk assessment of nanomaterials.

Débora Ester Grandón Valenzuela

De forma tácita, la interrogante que guía el presente trabajo reflexivo es la pregunta por las ausencias dentro de la producción del conocimiento en Terapia Ocupacional. Particularmente, el cuestionamiento por la ausencia de las perspectivas de género y feministas en la comprensión de la discapacidad conduce hacia un análisis desde la interseccionalidad, tensionando al Modelo Social de Discapacidad como último modelo teórico, de manera que nos permita una mayor complejidad para comprender dicho fenómeno social. El examen que aquí se realiza busca apelar al permanente ejercicio reflexivo del gremio, considerando que lo que seguimos transmitiendo académicamente representa hegemonías del saber que debemos cuestionar, para así dar paso a nuevos saberes, a la emergencia de reflexiones que surjan desde la vida cotidiana y, de esta manera, constituirnos en actores políticos con un posicionamiento que vaya de la reflexión a la acción, y hacia la reflexión otra vez.

Marissa Romano da Silva, Rita de Cássia Ietto Montilha, Maria Inês Rubo de Souza Nobre

Se busca describir el abordaje grupal como acción terapéutica con familiares de niños con discapacidad sensorial desde la perspectiva de Terapia Ocupacional. Para ello se realizó un estudio cualitativo descriptivo entre marzo y diciembre de 2012, con grupos de familiares en un centro de habilitación y rehabilitación sensorial. Los datos fueron obtenidos a partir de la observación y los relatos de las participantes, registrados en diarios de campo. Los registros fueron analizados de manera exhaustiva y crítica para describir las percepciones, creencias y actitudes de las participantes ante la discapacidad de sus hijos, las dificultades y nuevas formas de enfrentamiento, los sentimientos y posibles cambios en la vida cotidiana. Mediante la realización de actividades terapéuticas, se observaron aspectos positivos en la acción y expresión de las participantes. Fue posible identificar que los grupos terapéuticos, a partir de la apertura de un espacio de amparo y escucha, favorecieron la recepción e intercambio de información acerca de la discapacidad, experiencias, ampliación de conocimientos, expresión de sentimientos, ofrecieron estrategias para superar barreras actuales y futuras y construir nuevas formas de manejar el cuidado y las dificultades cotidianas, promoviendo principalmente la calidad de vida de la familia y de los niños involucrados en el proceso de habilitación y rehabilitación sensorial.

Lucía González, Natalia Rivas-Quarneti, Lissette Farías

Introdução: O uso problemático de drogas representa um dos problemas de saúde mais significativos em todo o mundo. A terapia ocupacional é um dos atores sociais que promove a participação na comunidade, através da ocupação, contribuindo para a justiça ocupacional. No entanto, não se sabe quais perspectivas e prioridades estão sendo utilizadas na pesquisa em terapia ocupacional, o que é fundamental para o desenvolvimento de uma prática reflexiva e crítica. Objetivo: Atualizar, identificar e sintetizar as prioridades e perspectivas da produção científica existente relacionada ao consumo de drogas e terapia ocupacional. Método: Uma revisão da literatura foi realizada seguindo o referencial de 'Scoping Review', desenvolvido por Arksey e O'Malley. As seguintes bases de dados eletrônicas foram pesquisadas: CINAHL, Biblioteca Cochrane Plus, Dialnet, EMBASE, ISI Web of Science, OTseeker e Scopus. O método descritivo-analítico e a triangulação dos pesquisadores foram utilizados para realizar a análise dos dados. Resultados: A análise da literatura surgiram três categorias: 'contextualização', Relation 'Prioridades de Pesquisa' entre desempenho e qualidade de ferramentas de avaliação de vida e intervenções terapia Occupational- e 'Olhares de pesquisa teórica' ​​ocupacional ( uma visão positivista: a neurociência como suporte para a intervenção, uma visão fortalecedora: construindo o caminho para a inclusão e uma visão sistêmica: centrada na família como base da intervenção). Conclusão: É necessário continuar investigando o problema do uso de drogas a partir da terapia ocupacional, utilizando uma perspectiva crítica baseada na ciência da ocupação.

Jean Gajardo J.

La demencia y los trastornos cognitivos son condiciones que aumentan de forma importante su prevalencia en el mundo y en nuestro país, con un impacto a nivel individual y social, estableciéndose hoy como una prioridad para la sa- lud pública. La investigación en Terapia Ocupacional y Ciencia de la Ocupación se ha orientado a comprender las experiencias de vivir con demencia, desde la vida diaria y visualizando espacios y estrategias de apoyo para las personas y sus entornos familiares. La investigación que involucra personas con trastornos cognitivos o demencia puede ser objeto de diversas discusiones y dilemas éticos, usualmente relacionados con la noción de autonomía, capacidad de consentir, métodos, calidad y validez de los hallazgos...

Silvia Gómez Lillo, Laura Rueda Castro

Experimental and descriptive study which analyses the occupational patterns of specifc persons, in cross-section, from a quantitative and qualitative look. It means examining the organization of time and orchestation of the participants and the meaning that people attributed to their occupations.Idiosyncratic Pattern is applied, proposed by S. Cynkin, modifed by the authors in which is observed time, frequency and diversity.The qualitative analysis is done through a self analysis of the pattern describing the most important occupations, the sense of performed activities, evaluation of the above according to life expectancy, reformulation of the purpose and meditation in so far as they are living their lives.The importance attributed to this study relates to the possibility that people in the sample have an instance of refection on their situation in the world and professional occupational therapist of deepen their knowledge in a relevant subject. All that is backed by the premise that the relative occupation balance leads to increase well-being in the live people.

Samet James M, Hofer Thomas PJ, Bromberg Philip A et al.

<p>Abstract</p> <p>Background</p> <p>Concerns over the health effects of nanomaterials in the environment have created a need for microscopy methods capable of examining the biological interactions of nanoparticles (NP). Unfortunately, NP are beyond the diffraction limit of resolution for conventional light microscopy (~200 nm). Fluorescence and electron microscopy techniques commonly used to examine NP interactions with biological substrates have drawbacks that limit their usefulness in toxicological investigation of NP. EM is labor intensive and slow, while fluorescence carries the risk of photobleaching the sample and has size resolution limits. In addition, many relevant particles lack intrinsic fluorescence and therefore can not be detected in this manner. To surmount these limitations, we evaluated the potential of a novel combination of darkfield and confocal laser scanning microscopy (DF-CLSM) for the efficient 3D detection of NP in human lung cells. The DF-CLSM approach utilizes the contrast enhancements of darkfield microscopy to detect objects below the diffraction limit of 200 nm based on their light scattering properties and interfaces it with the power of confocal microscopy to resolve objects in the z-plane.</p> <p>Results</p> <p>Validation of the DF-CLSM method using fluorescent polystyrene beads demonstrated spatial colocalization of particle fluorescence (Confocal) and scattered transmitted light (Darkfield) along the X, Y, and Z axes. DF-CLSM imaging was able to detect and provide reasonable spatial locations of 27 nm TiO₂particles in relation to the stained nuclei of exposed BEAS 2B cells. Statistical analysis of particle proximity to cellular nuclei determined a significant difference between 5 min and 2 hr particle exposures suggesting a time-dependant internalization process.</p> <p>Conclusions</p> <p>DF-CLSM microscopy is an alternative to current conventional light and electron microscopy methods that does not rely on particle fluorescence or contrast in electron density. DF-CLSM is especially well suited to the task of establishing the spatial localization of nanoparticles within cells, a critical topic in nanotoxicology. This technique has advantages to 2D darkfield microscopy as it visualizes nanoparticles in 3D using confocal microscopy. Use of this technique should aid toxicological studies related to observation of NP interactions with biological endpoints at cellular and subcellular levels.</p>

Hillegass Jedd M, Shukla Arti, MacPherson Maximilian B et al.

<p>Abstract</p> <p>Background</p> <p>Exposures to an amphibole fiber in Libby, Montana cause increases in malignant mesothelioma (MM), a tumor of the pleural and peritoneal cavities with a poor prognosis. Affymetrix microarray/GeneSifter analysis was used to determine alterations in gene expression of a human mesothelial cell line (LP9/TERT-1) by a non-toxic concentration (15×10⁶μm²/cm²) of unprocessed Libby six-mix and negative (glass beads) and positive (crocidolite asbestos) controls. Because manganese superoxide dismutase (MnSOD; SOD2) was the only gene upregulated significantly (p < 0.05) at both 8 and 24 h, we measured SOD protein and activity, oxidative stress and glutathione (GSH) levels to better understand oxidative events after exposure to non-toxic (15×10⁶μm²/cm²) and toxic concentrations (75×10⁶μm²/cm²) of Libby six-mix.</p> <p>Results</p> <p>Exposure to 15×10⁶μm²/cm²Libby six-mix elicited significant (p < 0.05) upregulation of one gene (<it>SOD2</it>; 4-fold) at 8 h and 111 gene changes at 24 h, including a 5-fold increase in <it>SOD2</it>. Increased levels of SOD2 mRNA at 24 h were also confirmed in HKNM-2 normal human pleural mesothelial cells by qRT-PCR. SOD2 protein levels were increased at toxic concentrations (75×10⁶μm²/cm²) of Libby six-mix at 24 h. In addition, levels of copper-zinc superoxide dismutase (Cu/ZnSOD; SOD1) protein were increased at 24 h in all mineral groups. A dose-related increase in SOD2 activity was observed, although total SOD activity remained unchanged. Dichlorodihydrofluorescein diacetate (DCFDA) fluorescence staining and flow cytometry revealed a dose- and time-dependent increase in reactive oxygen species (ROS) production by LP9/TERT-1 cells exposed to Libby six-mix. Both Libby six-mix and crocidolite asbestos at 75×10⁶μm²/cm²caused transient decreases (p < 0.05) in GSH for up to 24 h and increases in gene expression of heme oxygenase 1 (<it>HO-1</it>) in LP9/TERT-1 and HKNM-2 cells.</p> <p>Conclusions</p> <p>Libby six-mix causes multiple gene expression changes in LP9/TERT-1 human mesothelial cells, as well as increases in SOD2, increased production of oxidants, and transient decreases in intracellular GSH. These events are not observed at equal surface area concentrations of nontoxic glass beads. Results support a mechanistic basis for the importance of SOD2 in proliferation and apoptosis of mesothelial cells and its potential use as a biomarker of early responses to mesotheliomagenic minerals.</p>

Rogerieux Françoise, Delalain Patrice, Gamez Christelle et al.

<p>Abstract</p> <p>Background</p> <p>Constituted only by carbon atoms, CNT are hydrophobic and hardly detectable in biological tissues. These properties make biokinetics and toxicology studies more complex.</p> <p>Methods</p> <p>We propose here a method to investigate the biopersistence of CNT in organism, based on detection of nickel, a metal present in the MWCNT we investigated.</p> <p>Results and conclusion</p> <p>Our results in rats that received MWCNT by intratracheal instillation, reveal that MWCNT can be eliminated and do not significantly cross the pulmonary barrier but are still present in lungs 6 months after a unique instillation. MWCNT structure was also showed to be chemically modified and cleaved in the lung. These results provide the first data of CNT biopersistence and clearance at 6 months after respiratory administration.</p>

Claudia Marcela Rozo Reyes, Nancy Gárces Robayo

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Claudia Viviana Suárez Lara

María Victoria Urrea U.

Estudios demográficos en el país y en el exterior reportan aumento progresivo del número de personas viejas. El aumento de edad en los ancianos conduce al aumento de la incidencia de los problemas de salud afectando en algunos casos su capacidad de independencia, o desempeño diario. La existencia de este número de ancianos incapacitados origina múltiples problemas de orden económico, social, salud y moral en cuya adecuada solución deben intervenir y cooperar muchas personas, entre las cuales está el terapeuta ocupacional.