RESUMO
The aim of this study was to assess the long-term asymptomatic effects of low-dose radiation on microvascular structure among interventional physicians, whose hands are exposed to ionizing radiation during daily practice. The study, approved by the national ethics committee, included 186 radiation-exposed (surgeons, cardiologists, radiologists) and 35 unexposed physicians, all of whom had provided written consent. The subjects completed a questionnaire describing their current and past daily practice, from which tentative estimates of current and cumulative radiation exposure estimates were computed. Subject dermal microcirculation state was assessed by capillaroscopy of the nail fold of eight fingers (thumbs excluded) based on photographs. Two quantitative scores characterizing extravasation and morphological abnormalities based on seven semiquantitative indices were obtained from post hoc coding of the photographs by five capillaroscopists. These evaluations were randomized and blind to the exposure. The effect of the radiation exposure on both abnormality scores was modelled using multilevel proportional odds regression adjusted for potential confounders. The proportion of physicians for which the most frequent act is close to the radiation source was highest among surgeons, but with fewer weekly acts. The median duration of exposure was highest among radiologists and cardiologists. No exposure effect could be detected on the extravasation score. The morphological anomaly score increased significantly with duration of exposure and estimated cumulative exposure among surgeons and interventional radiologists, unlike cardiologists among whom no effect could be detected. It is concluded that the shown effects of chronic low-dose exposure to ionizing radiation on physician microvascular structure reveal the importance of increased exposure monitoring and prevention.
Assuntos
Angioscopia Microscópica , Microvasos/efeitos da radiação , Exposição Ocupacional/análise , Médicos , Adulto , Doenças Assintomáticas , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
The establishment of causal relationship between a previous exposure and a disease is based on medical and scientific data. In France, three procedures operate for the recognition and the compensation of the diseases related to occupational exposure, to asbestos and to nuclear weapons tests. A suspicion of link is enough for the victim to initiate proceedings. The physician of each patient had to identify the exposure that could further the occurrence of their disease, to advise and to make the social allocations easier, and to certify the disease but not the link or exposure.
Assuntos
Doenças Profissionais/epidemiologia , Exposição Ocupacional , Aconselhamento Diretivo , Humanos , Formulário de Reclamação de Seguro , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Papel do MédicoAssuntos
Seguro Saúde/economia , Doenças Profissionais/economia , Previdência Social , França/epidemiologia , Humanos , Revisão da Utilização de Seguros , Doenças Profissionais/epidemiologia , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricosRESUMO
We analyze the effect of occupational exposure to asbestos on the occurrence of lung cancer based on a recent French case-control (CC) study. We build a large collection of threshold regression models, data-adaptively select a better model by CC-weighted likelihood-based cross-validation and then fit this better model by CC-weighted maximum likelihood. The CC-weighting allows us to draw valid inferences from CC data without relying on a logistic regression. This is possible because the joint distribution of the indicator of being a case and matching variable is available beforehand owing to two studies independent from our data set. The implications of the fitted model in terms of years of life free of lung cancer lost due to the exposure to asbestos are discussed.
Assuntos
Amianto/efeitos adversos , Interpretação Estatística de Dados , Neoplasias Pulmonares/induzido quimicamente , Modelos Estatísticos , Exposição Ocupacional/efeitos adversos , Análise de Regressão , Estudos de Casos e Controles , Feminino , Humanos , Funções Verossimilhança , MasculinoRESUMO
Hand is frequently the site of work accidents or occupational diseases. The musculoskeletal upper limb is the first recognized occupational disease and carpal tunnel syndrome is the most common of them. The most common location of occupational dermatoses is the hand. Their causes are often multifactorial, involving chemical irritants, physical, allergens and endogenous factors (mainly atopic dermatitis). Occupational exposure to microtrauma and iterative use of vibrating tools may also be the cause of hypothenar hammer syndrome and acrosyndromes. The frequent chronicity and functional impairment induced by these attacks can cause lasting disabilities, an inability to source workstation. Occupational physician is a focal point for helping to maintain the position and the prevention of socioprofessional disinsertion. Many pathologies of the hand related to professional activity may benefit from a statement in occupational disease and thus allow the patient to obtain compensation and employment protection. Prevention of occupational hand diseases should be made by all health actors, especially in occupations and industries at risk.
Assuntos
Dermatoses da Mão/diagnóstico , Mãos , Doenças Profissionais/diagnóstico , Emprego , Mãos/fisiopatologia , Dermatoses da Mão/etiologia , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/etiologia , Doenças Profissionais/complicações , Doenças Profissionais/fisiopatologia , Vibração/efeitos adversos , Avaliação da Capacidade de TrabalhoRESUMO
INTRODUCTION: sick-leave in the course of pregnancy play a role under estimated according to several studies.They bring to light the existence of risk factors concerning the physical load for contractions, sick-leave, hospitalizations and prematurity.The data obtained on the totality of the wage earners of the AP-HP allow to avoid all the possible bias and to determine the potential impact of a policy of reduction of the physical load METHOD: The data of four years could be analyzed.The used database is PILOT RH, intranet application restoring information extracted from GIPSIE who was until 2008 the institutional software of management of the careers of all the workers of the AP-HP. RESULTS: In 2008,3 937 women having had a maternity leave (ML) accumulated 132 360 days of ordinary sick-leave (OL) (that is 33,6 days on average) without inclusion of the 15 days accepted for "pathological pregnancy" (PP) and "post pregnancy leave". Ordinary sick-leave of all the 53 132 women amounts to 11.5 days by agent. But, the set apart of the women having had a ML reduces the number of days of sick-leave to 9,7 days This difference weighs for 15.6 % of the total of the absenteeism OL. The results are similar on the four years. The analysis by occupational catégory, for 2008, shows that the average number of days of sick-leave, after exclusion of women having had a ML, decreases with the physical load of the posts estimated by the study PRESST-NEXT :ancillary staff 19.9 days, nursing aids 13.7 days, registered nurses 8.2 days, specialized nurses 7.7 days, medico - technical workers 5.7 days and head nurses 5.1 days. For the women having had a ML, the average number of days of ordinary sick-leave, is the most raised for nursing aids (41.9 days) followed by the ancillary staff (36 days) and the registered nurses (36 days) and slightly less for the specialized nurses (28.3 days). On the other hand, in the professions having least physical load the women have less than 25 days of ordinary sick-leave the year of their pregnancy :medico-technical workers 21.3 days, head nurses 23.1 days and administration staff 23.7 days.The results are similar on the four years. For the nurses, it is 25.5% of total ordinary sick-leave that are attributable to the women having had a pregnancy, and 34.4 % if we add OL and 15 days of official "pathological pregnancy". DISCUSSION: An intervention to reduce the physical load in test hospitals could be led.The reduction of sick-leave in the course of pregnancy can be a fast indicator of evaluation of the efficiency of the investments. The improvements will benefit to all the agents, in the medium term, with a reduction of the risks of musculoskeletal disorders. Such an action also allows to maintain the employability of the older employees and to integrate) persons into situation of handicap in a work which has for them a strong sense and which they do not want to give up.
Assuntos
Recursos Humanos de Enfermagem Hospitalar , Licença Médica , Carga de Trabalho , Adulto , Feminino , França , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto JovemRESUMO
OBJECTIVE: Cleaning products may cause work-related asthma, but information regarding the specific exposures involved is scarce. We aimed to determine the associations between asthma and occupational exposure to cleaning agents in hospital workers. METHODS: Analyses were conducted in 179 (136 women) hospital workers and a reference population of 545 subjects (18-79 years) from the French case-control and familial Epidemiological study on the Genetics and Environment of Asthma (2003-2007). Exposures to cleaning agents were estimated using three methods: self-report, expert assessment and an asthma-specific job-exposure matrix (JEM). Associations between cleaning products and current asthma were evaluated by logistic regressions, stratified by sex and adjusted for age and smoking status. RESULTS: According to expert assessment, 55% of male and 81% of female hospital workers were exposed to cleaning/disinfecting tasks weekly (p<0.001). No association was observed between cleaning/disinfecting tasks and current asthma in men or in women whatever the assessment method used. In women, exposure to decalcifiers (expert assessment) was associated with current asthma (OR (95% CI):2.38 (1.06 to 5.33)). In hospital workers classified as exposed according to both the expert assessment and the JEM, additional associations were observed for exposure to ammonia (3.05 (1.19 to 7.82)) and to sprays with moderate/high intensity (2.87 (1.02 to 8.11)). CONCLUSIONS: Female hospital workers are often exposed to numerous cleaning products, some of which were markedly associated with current asthma. Low numbers prevented a meaningful analysis in men. Objective and more accurate estimates of occupational exposure to cleaning products are needed to better understand the adverse effects of cleaning products.
Assuntos
Amônia/efeitos adversos , Asma/etiologia , Desinfetantes/efeitos adversos , Hospitais , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Ocupações , Adolescente , Adulto , Idoso , Cálcio , Estudos de Casos e Controles , Desinfecção , Feminino , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fatores Sexuais , Local de Trabalho , Adulto JovemRESUMO
Among the wheat prolamins, D-type glutenins display a highly repetitive sequence similar to ω-gliadins, but they contain a cysteine, that allows them to be included in the gluten macropolymers. An ω-gliadin-like D-type glutenin, an α-gliadin, and an ω5-gliadin-like D-type glutenin were obtained as recombinant proteins and compared using synchrotron radiation circular dichroism. This technique evidenced the strong thermostability of the ω5-gliadin-like protein. The IgE reactivity of recombinant proteins was evaluated using 45 sera from wheat-allergic patients. The sera from patients diagnosed with cutaneous hypersensitivity to hydrolyzed wheat proteins often reacted with the ω-gliadin-like D-type glutenin and α-gliadin, whereas the IgE reaction was less frequent after dietary sensitization. So, these two proteins could be useful to diagnose these diseases. The sera from patients with exercise-induced anaphylaxis recognized the ω5-gliadin-like protein as a positive control and, less frequently, the other proteins tested. Only some sera from patients with baker's asthma reacted with the proteins tested.
Assuntos
Gliadina/química , Glutens/química , Imunoglobulina E/metabolismo , Triticum/química , Hipersensibilidade a Trigo/diagnóstico , Sequência de Aminoácidos , Proteínas de Transporte/química , Proteínas de Transporte/metabolismo , Gliadina/imunologia , Glutens/imunologia , Humanos , Imunoglobulina E/sangue , Dados de Sequência Molecular , Proteínas Recombinantes , Hipersensibilidade a Trigo/imunologiaRESUMO
The IgE reactivity of the recombinant glutenin subunits P73 and B16, and of their repetitive N-terminal and nonrepetitive C-terminal halves, was analyzed using dot-blot with sera from patients diagnosed with baker's asthma, wheat-dependent exercise-induced anaphylaxis, or allergy to hydrolyzed wheat proteins. The linear epitopes of B16 were identified using the Pepscan method. Except for one common epitope, the IgE binding domains of glutenins differ from those of ω5-gliadins. Secondary structure content of the proteins was determined using synchrotron radiation circular dichroism (SRCD): while α structures were predominant in all glutenin subunits, fragments, or chimeras, a high IgE reactivity was associated with proteins rich in ß structures. Mixing B16 halves induced conformational interaction, as evidenced by dynamic light scattering and SRCD. IgE reactivity was correlatively increased, as when the halves were associated in the B16-P73 chimera. These results suggest that structural interaction between N- and C-terminal halves may promote epitope presentation.
Assuntos
Glutens/química , Glutens/imunologia , Imunoglobulina E/imunologia , Triticum/química , Sequência de Aminoácidos , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Quimera , Dicroísmo Circular , Epitopos , Gliadina/química , Gliadina/imunologia , Glutens/genética , Humanos , Immunoblotting , Imunoglobulina E/sangue , Dados de Sequência Molecular , Peso Molecular , Proteínas Recombinantes/metabolismo , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/imunologiaRESUMO
OBJECTIVE: Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001-2009. METHOD: Data were collected from the French national network of occupational health surveillance and prevention (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. RESULTS: Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p = 0.007), aldehydes (p = 0.01) and latex (p = 0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p = 0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. CONCLUSIONS: WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.
Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Asma Ocupacional/epidemiologia , Exposição Ocupacional/efeitos adversos , Adulto , Asma Ocupacional/etiologia , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Humanos , Incidência , Indústrias , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Razão de Chances , Vigilância da PopulaçãoRESUMO
BACKGROUND: As a result of prolonged survival, more patients with cystic fibrosis (CF) participate in the labour force. The aim of this study was to evaluate their education, occupation levels and risk factors for work disability. METHOD: 207 patients answered a self-administered questionnaire about their educational level and work status. Independently, medical records were reviewed for illness severity indicators. RESULTS: 39 patients (19%) were students, 117 (57%) were in the labour force, 13 (6%) were seeking employment and 38 (18%) were inactive. CF patients had a higher educational level and were more likely to hold skilled jobs and to work part time than the general population. FEV1 and educational level were the strongest predictive factors of disability. CONCLUSION: Many CF patients have access to professional life. Their higher educational levels improve the chances of attaining employment, which highlights the need for career counselling. Working part time helps to maintain employment despite declining health.
Assuntos
Fibrose Cística , Pessoas com Deficiência/estatística & dados numéricos , Emprego/estatística & dados numéricos , Adulto , Criança , Estudos Transversais , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Escolaridade , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Qualidade de Vida , Fatores de Risco , Inquéritos e Questionários , Adulto JovemAssuntos
Dermatite Alérgica de Contato/etiologia , Óculos/efeitos adversos , Dermatoses Faciais/etiologia , Hipopigmentação/etiologia , Adulto , Catecóis/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Eczema , Dermatoses Faciais/diagnóstico , Feminino , Humanos , Hipopigmentação/diagnóstico , Pintura/efeitos adversos , Testes do Emplastro , Resinas Sintéticas/efeitos adversosRESUMO
BACKGROUND: Light is a powerful synchronizer of the biological clock and of the sleep/wake cycle. Blind people have more sleep disturbances than people without eyesight problems. However, whether visually able people who are underexposed to bright natural light suffer from sleep wake disorders has never been examined. This study tried to assess the prevalence of sleep and wake disorders in subjects working in environments that are not exposed to natural light. METHODOLOGY: A setting-controlled cross-sectional epidemiological study was carried out. A representative sample of 13,296 French employees of a single transportation company participated in the study. During working hours, 4635 subjects (34.9%) experienced no light exposure (NLE) and 8661 were partially or completely exposed (LE) to natural light. Sleep disorders, sleep quality, and sleepiness were assessed using subjective tools: the Sleep Disorders Questionnaire-French version (SDQFV) and the Epworth Sleepiness Scale (ESS). Light exposure was estimated on workers' schedules and by objective measurements of light intensity (lux meter). PRINCIPAL FINDINGS: On a univariate analysis, complaints of poor sleep and sleepiness were significantly higher in NLE workers compared to LE: nonrestorative sleep (36.8% vs. 29.5%; P<.0001), insomnia (28.8% vs. 24.8%; P<.0001), severe insomnia (14.1% vs. 10.9%; P<.0001), and daytime somnolence (6.8% vs. 4.3%; P<.0001). After multivariate analysis, NLE has shown more insomnia (OR=1.8, 95% CI 1.3-2.3, P<.01) and hypersomnia (OR=1.9, 95% CI=1.3-2.4, P<.01) than LE. SIGNIFICANCE: These data suggest that underexposure to natural light at work may significantly impair sleep and wake disorders in non-light-exposed workers.
Assuntos
Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Luz , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Ritmo Circadiano , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Fases do Sono , Inquéritos e QuestionáriosRESUMO
A new case of occupational asthma caused by Chrysonilia sitophila (asexual state of Neurospora sitophila) was diagnosed by molecular identification of the mold and confirmed by skin prick test, peak expiratory flow rate measurements, and experimental immunoglobulin E analysis.
Assuntos
Asma/diagnóstico , Neurospora/imunologia , Doenças Profissionais/diagnóstico , Adulto , Agricultura , Café , DNA Fúngico/química , DNA Fúngico/genética , Humanos , Masculino , Dados de Sequência Molecular , Ventilação Pulmonar , Análise de Sequência de DNA , Testes CutâneosRESUMO
OBJECTIVE: To assess employment status and socio-economic burden in SSc patients. METHODS: Eighty-seven SSc patients (72 females), fulfilling the ACR or the Leroy and Medsger criteria, or both, were evaluated for employment status, socio-economic burden and handicap. Statistical analysis involved Mann-Whitney U-test and Fisher's exact test and backward stepwise regression analysis. RESULTS: In total, 60.9% of the SSc patients were on full-time sick leave and 35.6% were receiving a disability pension. On univariate analysis, myalgia was the only clinical manifestation more frequently encountered in sick-leave patients than others (73.6 vs 47.1%; P = 0.012). Karnofsky performance status (KPS) was lower in SSc patients who were on sick leave or were receiving a disability pension than others [78.5 (10.6) vs 85.8 (9.0); P = 0.004 and 78.1 (8.7) vs 83.1 (11.2); P = 0.016, respectively]. In addition, greater global, hand and mouth handicaps and depression were observed in patients on sick leave [HAQ 0.9 (0.7) vs 0.6 (0.5); P = 0.021; Cochin Hand Function Scale 21.7 (18.9) vs 10.7 (12.1); P = 0.003; mouth handicap scale 20.2 (10.8) vs 14.6 (10.0); P = 0.014; and depression dimension of the hospital anxiety and depression scale 7.1 (3.9) vs 4.8 (3.4); P = 0.003]. On multivariate analysis, factors associated with sick leave were KPS [odds ratio (OR) 0.92; 95%CI 0.88, 0.98] and myalgias (OR 3.19; 95% CI 1.19, 8.58), and the factor associated with receiving a disability pension was decreased income (OR 8.19; 95% CI 2.67, 25.12). CONCLUSIONS: SSc patients commonly have to take full-time sick leave from work. Despite such patients receiving disability pensions, the socio-economic burden is considerable.