Assessing the Utility of Multimodal Large Language Models (GPT-4 Vision and Large Language and Vision Assistant) in Identifying Melanoma Across Different Skin Tones.

The large language models GPT-4 Vision and Large Language and Vision Assistant are capable of understanding and accurately differentiating between benign lesions and melanoma, indicating potential incorporation into dermatologic care, medical research, and education.

Strain-based work-to-family conflict as a predictor of lumbar and cervical pain in Tunisian nursing staff.

Objective. This study aimed to examine the association of the different dimensions and forms of work-family conflict with the occurrence of neck and lower back pain (LBP) in Tunisian nurses. Methods. We conducted a cross-sectional study on nurses assigned to a district hospital in Tunisia. The work-family interface was assessed with the work-family conflict scale of Carlson et al. Psychosocial and organizational constraints at work were assessed through the nursing work index - extended organization in its specific version designed for nurses. Assessment of neck and lumbar pain was carried out with the standardized Nordic musculoskeletal questionnaire. Results. Seventy-two nurses participated in the present study (participation rate = 100%) with a mean age of 42.38 ± 10.85 years. Binary logistic regression analyses retained strain-based work-to-family conflict as a significant determinant of both LBP (p < 10-3; odds ratio [OR] = 5.07; 95% confidence interval [CI] [2.1, 11.7]) and neck pain (p = 0.001; OR = 6.8; 95% CI [2.13, 22]). Conclusions. Strain-based work-to-family conflict was found to predict lumbar and cervical pain more than the other types of conflict in nursing staff. Thus, reducing strain in health-care settings should be a central component of the preventive approach of musculoskeletal disorders in nursing staff.

Influence of socioprofessional determinants on teachers' mental well-being.

SUMMARY: Aims. To assess the influence of socio-professional factors on mental health of teachers at primary and secondary schools. Materials and Methods. It's a cross-sectional study, lasted 3 months of the year 2014. This study involved a representative sample of teachers working in public schools. Data collection was based on a survey sheet prepared beforehand and describing socio-demographic and occupational characteristics of the participants. Mental health was assessed by the GHQ 30 score in its validated version in Arabic. Results. Study population was composed of 255 teachers with a participation rate of 78.43%. This population was characterized by a slight female predominance (57.5%) with a sex ratio of 0.73. The mean age was 43.54 ± 8.9 years. Of the responding teachers, 17% felt that their profession was poorly perceived by the society. More than half of participants were satisfied with their profession (68.8%). Relational constraints with parents were reported by 50.5% of teachers. Seventy-one teachers reported having problem of indiscipline in class. The mean GHQ score was 7.21 ± 6.24. Teachers' psychological health deterioration was significantly correlated with smoking (p = 0.03, OR = 0.2, IC = [0.05-0.9]) , pathological antecedents (p = 0.02, OR = 3.6, IC = [1.1-10]), feeling guilty toward pupils passivity (p = 0.01, OR = 3.8, IC = [1.3-10]), to professional seniority (p = 0.008, OR = 0.2, IC = [0.06-0.6], to the image referred back by the society (p = 0.005, OR = 4.9, IC = [1.6-15]), to emotional exhaustion and personal satisfaction (p = 0.00, OR = 12.7, IC = [3.4-47] ). Conclusion. Acting on these factors through a collective preventive approach headed by the Ministry of Education is necessary to reduce the rate of psychological distress among teachers and therefore improve the quality of teaching.

Influence of Shift Work on Manual Dexterity and Reaction Time in Tunisian Nurses.

BACKGROUND: Major effects of shift schedule are related to sleep alertness and performance, but also to long term health outcomes. For nurses, these negative effects have consequences not only on the individual, but also on the workplace, as decreased alertness and reduced job performance could endanger human lives. OBJECTIVE: The specific aim of our study is to assess the influence of shift schedule on nurses´ cognitive ability and rapidity of execution. METHOD: Our survey is a cross sectional study which had been conducted for 15 months; it involved a sample of 293 participants representative of 1118 nurses working in two Tunisian university hospitals. It included an evaluation of the rapidity of execution performance through the manual dexterity test and the reaction time test. The study was completed by an assessment of the workability Index through a 7- item survey. RESULTS: No association was found between the groups of work schedules and the cognitive ability of execution speed. However, we found a significant decrease in cognitive performance in the nurses exceeding 10 years of job seniority for both schedules. CONCLUSION: We concluded to an impaired cognitive performance speed in the over 10-year seniority groups in both schedules. Recommendations should be focused on implementing periodic assessment of cognitive performance based on O'Connor finger dexterity test and time reaction test and on implementing effective preventive measures in hospitals after ten years of seniority at work.

[Career concerns among occupational physicians serving on the Institutes for Occupational Safety and Health in Tunisia]. / Préoccupations de carrière chez les médecins de travail des groupements de Médecine de travail en Tunisie.

INTRODUCTION: Career dissatisfaction among occupational physicians (OP) may affect their performance and the quality of healthcare services provided. Our study aims to assess the job satisfaction of OP serving on the Institutes for Occupational Safety and Health(IOSH) in Tunisia and to identify the determinant factors. METHODOLOGY: We conducted a national cross-sectional validated SAPHORA JOB survey among all the OP serving on 22 IOSH. RESULTS: 58% of OP serving on the IOSH were dissatisfied with their career. Career satisfaction was statistically influenced by the number of healthcare facilities for which they were responsible (p=0.016), the work organisation (p=0.010), the work impact (p=0.011), the salary (p<10-3) and knowledge on current regulation (p=0.047). CONCLUSION: The standardisation of pay scale and career ladders for OP serving on the IOSH based on a revision of legislative texts is recommended. Improving organization and working conditions may allow success in the workplace and benefit enhancement.

The Quality of Life and Professional Future among Tunisian Workers Suffering from Occupational Asthma.

OBJECTIVE: To identify the factors influencing the quality of life and professional future of patients suffering from occupational asthma. METHOD: A cross-sectional study of patients compensated for occupational asthma in Tunisian center during 2004-2011. The study of quality of life was based on the Asthma Quality of Life Questionnaires (AQLQ). Some related patents were also discussed. RESULTS: One hundred twenty-nine patients were compensated and the mean age was 40.8 ± 7.6 years. The global score of quality of life was 3.65 ± 0.75. The group of employees having a "bad quality of life" included 82 patients (77.3%), 73 patients kept the same job (56.6%), 20.9% had an occupational reclassification, 13.9% were dismissed, 6.2% abandoned their job and 2.3% were put in disability. The analytical study of the quality of life showed that: - The global score was correlated with the fact of keeping the same job and the application of preventive measures. - The score in the "symptoms" area was correlated with working in the textile sector and the association with an occupational rhinitis. - The score in the "activity limitation" area was correlated with age. The analytical study of the professional future revealed that maintaining the same job was correlated with low rates of permanent partial disability. CONCLUSION: Our study revealed the need to implement early preventive measures and to establish a systematic review of the permanent partial disability rate attributed to workers suffering from occupational asthma before the end of the legal period of five years.

Influence of shift work on the physical work capacity of Tunisian nurses: a cross-sectional study in two university hospitals.

INTRODUCTION: This study has been performed to determine the influence of rotating shift work on physical working capacity of Tunisian nurses and to design recommendations to managers so that they implement effective preventive measures. METHODS: It is a cross-sectional design using a standardized questionnaire and many physical capacity tests on a representative sample of 1181 nurses and nursing assistants from two university hospital centers of the school of Medicine of Monastir located in the Tunisian Sahel. 293 participants have been recruited by stratified random sampling according to gender and departments. Maximum Grip strength, 30s sit-to-stand test, one leg test, Fingertip-to-Floor test, Saltsa test and peak expiratory flow were used to assess physical capacity. Work ability was assessed through the workability index. RESULTS: Mental and physical loads were heavily perceived in shift healthcare workers (p=0.01; p=0.02). The maximum grip force was stronger in rotating shift work nurses (p=0.0001). Regarding to the seniority subgroups in each kind of work schedule, the Body Mass Index was increasing with seniority in both schedules. All the physical tests, were better in less-than-ten-year groups. Peak Flow and grip strength were significantly better in less-than-ten-year seniority in shift work group. CONCLUSION: There is a need to improve the design of the existing shift systems and to reduce as much as possible shift schedule as well as to avoid shift schedule for over-10-year-seniority nurses.

Determinants of Grip Strength in Tunisian Nurses: A Bicentric Study.

BACKGROUND: Grip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature. OBJECTIVE: To describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector. METHODS: This is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer. RESULTS: Handgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002). CONCLUSION: Grip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.

Neuropsychological Effects of Mercury Exposure Among Dentists in Monastir City.

AIMS: The aim of this study is to assess the neuropsychological manifestations of mercury exposure in dentists. METHODS: A cross-sectional study was carried out including 64 dentists matched to a control group according to age and gender. This study protocol included a neurological evaluation, a questionnaire assessing the study groups' general characteristics and personal factors that may affect mercury urinary excretion in both groups. EUROQUEST questionnaire and Hospital Anxiety and Depression scale (HADS) were used to evaluate the neuropsychological symptoms reported during the last 12 months. In both groups, mercury impregnation was assessed by monitoring urinary mercury. RESULTS: In the exposed group, scores of neurological symptoms, memory disturbances and anxiety were found to be significantly higher than those in controls (p < 0.01). Mean scores of HAD Depression's scale were higher in the exposed group than in controls. Most of the neurotoxic manifestations were correlated to the levels of urinary mercury excretion in the exposed group. Mean levels of urinary mercury were significantly higher in the dentists group than in controls, with respective values of 21.1 ± 19.6 µg/g of creatinine and 0.05 ± 0.9 µg/g of creatinine. In nine dentists having urinary mercury levels higher than 35 µg/g of creatinine, neurological examination showed a bilateral and symmetric intentional tremor in both upper limbs. In the exposed group, the neuropsychological manifestations and levels of urinary mercury were found to be significantly correlated. CONCLUSION: Increased levels of urinary mercury observed in dentists suggest that exposure to mercury vapour emissions adversely affects dental professionals, therefore prevention measures should be strengthened, with a special medical supervision program of dentists exposed to mercury vapours should be implemented. We have also outlined some relevant patents in this article.

Assessment of chromosomal aberrations and micronuclei in peripheral lymphocytes from tunisian hospital workers exposed to ionizing radiation.

Epidemiological studies suggest that cytogenetic biomarkers, such as micronuclei (MN) in peripheral blood lymphocytes may predict cancer risk because they indicate genomic instability. The objective of the present study was to evaluate the frequencies of MN and chromosome aberrations (CA) in peripheral blood lymphocytes of hospital workers exposed to ionizing radiation and healthy subjects. The study was conducted using peripheral blood lymphocytes from 30 workers from the radiology department and 30 from the cardiology department. This study included 27 healthy age- and sex-matched individuals as the control group. The assessment of chromosomal damage was carried out by the use of CA and micronucleus assays in peripheral lymphocytes. Our results show that CA and micronucleus frequencies were significantly higher among the exposed groups when compared to controls. Our finding of significant increase of CA and MN frequencies in peripheral lymphocytes in exposed workers indicates a potential cytogenetic hazard due to this exposure. The enhanced chromosomal damage of subjects exposed to genotoxic agents emphasizes the need to develop safety programs.

Adverse effects of pesticides on biochemical and haematological parameters in Tunisian agricultural workers.

Biomonitoring of effects in agricultural workers is necessary to assess the individual risk of handling pesticides. In this study, biochemical and haematological parameters were measured to evaluate the effects of exposure to these compounds in agricultural workers. The study was carried out in 110 workers and 97 control subjects. Several haematological and biochemical parameters were analysed. Assessment of haematological parameters revealed that the mean cell volume and haematocrit levels were significantly lower in workers than in controls (P=0.002 and 0.013, respectively), while mean corpuscular haemoglobin concentrations were higher in workers (P<0.001). There was also a significant inhibition of butyrylcholinesterase activity in workers compared with that in controls (P<0.001). Assessment of biochemical parameters further showed significantly higher activities of transferases, lactate dehydrogenase (P<0.001), alkaline phosphatase (ALP) (P=0.006) and creatine kinase (CK) (P<0.015), as well as higher levels of proteins (P<0.001), creatinine (P=0.001) and urea (P=0.001) in workers compared with controls, along with significantly higher uric acid levels (P=0.012). Furthermore, the number of years exposed to pesticides predicted higher activities of alanine aminotransferase, CK, ALP, as well as uric acid levels. Overall, chronic exposure to pesticides appeared to affect several biochemical parameters. These biomarkers seem to be indicative of adverse effects of pesticides in agricultural workers, confirming their use for routine monitoring of effects.

[Sacrum B cell-non-Hodgkin's lymphoma complicating a chronic viral hepatitis C related to a blood exposure: a case report]. / Lymphome B non hodgkinien du sacrum compliquant une hépatite virale C chronique liée à un accident d'exposition au sang : à propos d'une observation.

Frequency of the association between non-Hodgkin's lymphoma (NHL) and the hepatitis C virus (HCV) infection is variable according to previous studies. Besides, direct and/or indirect implication of the HCV infection in the development of NHL is probable but, its pathophysiological mechanisms remain unclear. In this report, we described the case of a 49-year-old patient with a B-cell NHL of the sacrum complicating a chronic HCV related to a blood exposure, and we report the recent data of this association.

Factors influencing plasma butyrylcholinesterase activity in agricultural workers.

We studied the influence of some factors on plasma butyrylcholinesterase activity (BChE) and we assessed the health status of agricultural workers and looked for the effects of chronic exposure to pesticides, in the aim to determinate factors that must be considered for interpretation of BChE, for occupational monitoring of workers exposed to pesticides. The study was carried out in 110 workers from the Sahel region of Tunisia exposed to pesticides and in 97 controls. All individuals have undergone clinical examination. BChE activity was measured by spectrophotometric method. The mean of BChE activity of workers was significantly lower than that of control group (P < 0.001). Among the 44% of farmworkers with at least one neurologic or neuropsychic symptom, 29% had BChE activity lower than 6000 IU/L. Headache was observed in 20% of workers. Ancientness of exposure equal to 10 years or more, last exposure dates back to 60 days or less, exposure for 2 days or more per week, exposure exceeding 150 h per year and to organophosphorus-carbamates mixture were implicated in significant decreases of BChE activity and can be considered as risk factors of cholinergic toxic effects. Thus, BChE activity is a useful indicator to monitor workers chronically exposed to pesticides. However, it should be accompanied by periodical health examination, taking into account risk factors, for an early identification of workers at increased risk.

Work related asthma in the textile industry.

Nowadays, occupational asthma is the most common form of occupational lung disease in the world. In some countries the textile industry remains an important source of potential agents causing occupational asthma. In the textile industry several agents such as cotton dust and dyes may cause occupational asthma. In this review, we discuss the epidemiology, pathogenesis/mechanisms, clinical presentations, management and prevention specific to occupational asthma in the textile industry.Work-related asthma risk is considerable. Current understanding of the mechanisms by which many textile agents cause occupational asthma is limited, especially for low molecular-weight sensitizers and irritants. The diagnosis is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination or reduction of exposure to the offending agent and early use of convenient therapy according to disease severity may play an important role in the prevention of long-term persistence of asthma. Its prevention in the textile industry should be both technical and medical. It depends on the difficulties to reduce dust level, the limits in arranging work station or in occupational rehabilitation. These difficulties are increased in small textile industry companies. Persistent occupational asthma in this sector is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reduce the burden of asthma attributable to occupational exposures. This review also outlines different patents on the diagnosis and treatment of asthma.

Occupational allergy in healthcare workers.

Occupational healthcare may expose to various allergens and irritants. Thus, the allergic manifestations in nursing staff are frequent and their prevalence is increasing all over the world. In fact, many new substances continuously appear in the medical practices. These allergic manifestations include a wide spectrum of clinical symptoms such as ocular, nasal and especially bronchial symptoms, which can be isolated or associated. These diseases can be a source of many problems related to the occupational aptitude. All these conditions justify prevention procedure strengthening, which mainly consist in substituting the sensitizing agents, and applying collective and individual prevention measures. This article also refers to some patents on the treatment of allergy.

Prevalence and factors associated to low back pain among hospital staff.

OBJECTIVES: Because of its frequency and consequences on professional life, low back pain (LBP) represents a real health care problem. Our study is aimed at determining the prevalence of LBP among hospital staff, analyzing the medical and professional consequences as well as investigating into the factors associated to this health problem. METHODS: We have conducted an inquiry among 350 employees at Fattouma Bourguiba teaching hospital. The employees have answered a pre-established questionnaire including 51 items. RESULTS: The cumulative life-prevalence was 57.7% of the cases. The annual prevalence was 51.1% of the cases. Chronic LBP prevalence was 12.8% of the cases. Medical care was required in 61.9% of the cases. Radiological explorations were performed in 45% of the cases. Sick leave was observed in 26.1% of the cases and an occupational change was necessary in two cases. Factors associated to LBP were age (P <0.01), female gender (P = 0.024), high BMI (P = 0.01), the fact of being married or divorced (P < 0.01), smoking (P = 0.016), past medical LBP history (P < 0.0001), extra professional activity (P < 0.01), migraine (P < 0.001), years' service (P = 0.007) as well as heavy weight lifting (P = 0.008). Exercise is rather a protecting factor against LBP (P = 0.019). CONCLUSION: The prevalence of LBP among hospital staff as well as the socio-professional drawbacks is important. Many factors are associated to LBP urging medical teams to take some preventive measures to reduce this affliction.