Post-traumatic stress disorder in hospital doctors after the COVID-19 pandemic.

BACKGROUND: Prior studies showed that during the coronavirus disease 2019 (COVID-19) pandemic healthcare workers had a higher risk of developing post-traumatic stress disorder (PTSD) symptoms. However, studies conducted among doctors several years after the beginning of the COVID-19 pandemic are scarce. AIMS: To evaluate the prevalence of PTSD among hospital doctors and to describe potential explanatory factors. METHODS: The Protec-Cov study was an observational, cross-sectional, multicentre study, which used an anonymous online questionnaire to evaluate PTSD in doctors from six hospitals in France between December 2021 and March 2022. The presence of PTSD was assessed using the Post-traumatic Stress Disorder Checklist Scale (PCLS) questionnaire with a cut-off of 44. RESULTS: Among the 307 doctors included, 18% presented a PCLS ≥44. The multivariate analysis showed that factors associated with a PCLS ≥44 were having a higher workload than before the COVID-19 pandemic (odds ratio [OR] = 4.75; 95% confidence interval [CI] 1.68-13.38), not feeling recognized within the professional environment (OR = 2.83; 95% CI 1.26-6.33), and feeling isolated because of the lockdown (OR = 4.2; 95% CI 1.97-8.95). Approximately 30% of hospital doctors (n = 91) felt a need for psychological support but only 31% of them (n = 28) received support. CONCLUSIONS: Based on our findings, a high prevalence of PTSD was observed among hospital doctors 2 years after the beginning of the COVID-19 pandemic. This study supports an early diagnosis of PTSD in this category of healthcare workers and warrants further study.

[Analysis of the profile of employees declared unfit for the job : How do societal or extra-professional factors contribute, and what are the consequences for employment?] / Analyse du profil des salariés déclarés inaptes au poste de travail : quelle place pour les facteurs sociétaux ou extra-professionnels et quelles conséquences sur l'emploi ?

INTRODUCTION: Professional career can be modified by health problems. Professional impairment, certified by an occupational health physician, can be followed by a redeployment or occupational disintegration. OBJECTIVES: To describe the profiles of workers declared unfit for their workplace and the profiles of those who have no remaining work capacity (RWC). METHODS: The workers followed by an inter-enterprise occupational health service composed of 20 occupational physicians. The characteristics of workers declared unfit for work were extracted from the medical files: age, gender, activity sector (Naf), socioprofessional category (PCS), pathology leading to professional impairment (CIM10), status of obligation to employ disabled workers (BOETH). Factors associated with unfitness to work due to no remaining work capacity (RWC) were identified by logistic regression models. RESULTS: In 2019, 82678 workers in France were followed by the SPSTI and 554 (0.67%), of whom 162 had no RWC, were declared unfit to work by an occupational health physician. Professional impairment rates were highest for women and workers > 55 years old. Psychological (29%) and rheumatic (50%) pathologies were the most frequent causes of professional impairment. BOETH status was identified among 63%. Age > 45 and psychological pathology were significantly associated with absent RWC, whereas gender, activity sector and PCS were not. DISCUSSION: No comprehensive public administration records of professional impairment exist in France. While past studies have described the profiles of workers who were unfit for their workplace, none have characterized those without RWC, who are high risk of precarity. CONCLUSIONS: Psychological pathologies generate the most professional impairment in persons without RWC. Prevention of these pathologies is essential. While rheumatic disease is the first cause of professional impairment, the proportion of workers with these diseases who have no remaining work capacity is relatively low; this may be due to the efforts made to facilitate their return to work.

Inequities in occupational diseases recognition in France.

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

Assessment of nivolumab exposure and clinical safety of 480 mg every 4 weeks flat-dosing schedule in patients with cancer.

Background: A nivolumab monotherapy flat-dosing regimen of 480 mg every 4 weeks (Q4W) has been approved in several markets, including the United States, Canada, and European Union, as an alternative dosing regimen for several indications. Approvals of this Q4W regimen were based on population pharmacokinetic (PK) analyses, established flat exposure-response relationships, and clinical safety. The objective of this study was to compare the PK exposure of 480 mg Q4W with 3 mg/kg every 2 weeks (Q2W) and 240 mg Q2W using modeling and simulation, and to evaluate clinical safety of the Q4W regimen. Patients and methods: Nivolumab PK exposure for the 480 mg Q4W schedule was simulated for 3817 patients across multiple tumor types and compared with those for the 3 mg/kg Q2W and 240 mg Q2W schedules. The safety profile of the Q4W schedule was assessed by analysis of clinical data from 61 patients who transitioned to nivolumab 480 mg Q4W from 3 mg/kg Q2W during four phase III clinical trials. Results: Compared with 3 mg/kg Q2W, nivolumab 480 mg Q4W produced similar time-averaged concentration, approximately 16% lower trough concentration, and 45% higher peak concentration at steady state. The peak concentration for 480 mg Q4W was significantly lower than that of 10 mg/kg Q2W, a dose previously shown to have an acceptable tolerability and safety profile. Treatment-related adverse events (TRAEs) that started after transitioning from 3 mg/kg Q2W to 480 mg Q4W were reported in 14.8% of patients, with 1.6% of patients reporting grades 3-4 TRAEs. Pooled safety data for these patients are consistent with those for the 3 mg/kg Q2W schedules, and no new safety signals were identified. Conclusions: The time-averaged steady-state exposure and safety profile of nivolumab 480 mg Q4W are consistent with that of 3 mg/kg Q2W across multiple tumor types. Nivolumab 480 mg Q4W represents a new dosing schedule option, and in addition to 240 mg Q2W, provides convenience and flexibility for patient care. Clinical trial numbers: NCT01721772, NCT01668784, NCT01673867, NCT01642004.

Prospective health students' perceptions of the pharmacist role in the interprofessional team.

Negative perceptions or underdeveloped understanding of healthcare team member roles can impact the functionality of the team and stunt innovations in interprofessional practice and education. Therefore, the intent of this study was to explore the perception of pharmacists' role on the healthcare team by future team members: prospective health professional students. The study utilised a survey to examine these perceptions in prospective health professional students (n = 34) nearing the application process to health professional school. A coding process was used to explore open-ended text responses through a line-by-line analysis and identify emerging themes regarding perception of pharmacists' roles, responsibilities, and practice settings. Quantitative data examined perception of pharmacists by intended prospective profession, healthcare experience, and pharmacy experience. Results indicate that while prospective health professional students find pharmacists to be an important part of the healthcare team, they lack a developed understanding of pharmacists' roles, responsibilities, and practice settings. Identifying and addressing prospective health professional students' misperceptions surrounding pharmacists' roles and responsibilities may encourage them to make informed career decisions and shape them into more knowledgeable future professionals with the ability to better impact patient care on interprofessional teams.

Incidence of tuberculosis among nurses and healthcare assistants in France.

BACKGROUND: Health care workers (HCWs) are considered to be at higher risk of tuberculosis (TB) than the general population. However, a decreasing incidence in the general population as well as improvement in preventive measures in hospitals has reduced the risk for HCWs. AIMS: To quantify the actual incidence of TB in nurses and health care assistants in a low-incidence country. METHODS: We performed a retrospective study of 80 hospitals throughout France, employing 233389 health care staff (physicians excluded). We calculated the number of pulmonary TB cases over 3 years (700166 person-years) and the total number of staff members in each job category (nurses, health care assistants, administrative staff) in each hospital, to calculate the incidence. RESULTS: Overall, the incidence rate varied between 1.27 and 6/100000 for administrative staff and nurses, respectively (non-significant difference). The incidence varied according to the geographical area. However, the incidence in nurses and health care assistants was not different from the general population (7.5/100000). CONCLUSIONS: In a low-incidence country, such as France, the implementation of measures to prevent occupational TB among HCWs has been effective. These preventive measures should be maintained but medical follow-up could be revised.

Searching for rare diseases in PubMed: a blind comparison of Orphanet expert query and query based on terminological knowledge.

BACKGROUND: Despite international initiatives like Orphanet, it remains difficult to find up-to-date information about rare diseases. The aim of this study is to propose an exhaustive set of queries for PubMed based on terminological knowledge and to evaluate it versus the queries based on expertise provided by the most frequently used resource in Europe: Orphanet. METHODS: Four rare disease terminologies (MeSH, OMIM, HPO and HRDO) were manually mapped to each other permitting the automatic creation of expended terminological queries for rare diseases. For 30 rare diseases, 30 citations retrieved by Orphanet expert query and/or query based on terminological knowledge were assessed for relevance by two independent reviewers unaware of the query's origin. An adjudication procedure was used to resolve any discrepancy. Precision, relative recall and F-measure were all computed. RESULTS: For each Orphanet rare disease (n = 8982), there was a corresponding terminological query, in contrast with only 2284 queries provided by Orphanet. Only 553 citations were evaluated due to queries with 0 or only a few hits. There were no significant differences between the Orpha query and terminological query in terms of precision, respectively 0.61 vs 0.52 (p = 0.13). Nevertheless, terminological queries retrieved more citations more often than Orpha queries (0.57 vs. 0.33; p = 0.01). Interestingly, Orpha queries seemed to retrieve older citations than terminological queries (p < 0.0001). CONCLUSION: The terminological queries proposed in this study are now currently available for all rare diseases. They may be a useful tool for both precision or recall oriented literature search.

Multidisciplinary department of "Return to Work After a Cancer": a French experience of support groups for vocational rehabilitation.

This qualitative pilot exploratory study focuses on support groups for vocational rehabilitation after cancer implemented in a French and innovative multidisciplinary department of "Return to Work after a Cancer." Sixty-three patients were invited to participate to constitute two support groups of 20 participants. Questionnaires are sent to assess their benefit according to the participants' point of view. For 58% of participants, support groups helped the return to work, and for 70% it provided personal, family, and relational support. Support groups are a relevant response to expectations and specific issues of patients experiencing return to work after cancer.

Hazard information needs and information seeking in French workers.

BACKGROUND: Data about perceived needs of workers for information on occupational hazards or diseases (OHDs) are scarce and the behaviour of workers seeking information on these matters is not well known. AIMS: To describe workers' needs and behaviour in seeking information about OHDs. METHODS: All workers attending for consultation at an occupational health service in Upper Normandy within 1 week were invited to fill in an anonymous questionnaire. RESULTS: Of the 2640 workers responding 58% declared a need for information about OHD, but only 37% actually sought that information. Whereas 82% of workers mentioned the internet and their general physician (GP) as sources of information on OHD, only 43% mentioned their occupational physician (OP). Furthermore, information received from OPs was not considered more reliable than that from GPs. CONCLUSIONS: Workers report a need for information about OHDs. Although most of them trust information given by OPs, they do not use OPs to obtain OHD information, but instead use less reliable sources such as the internet or their GPs.

Research on return to work in European Union countries.

BACKGROUND: Research on return to work (RTW) is increasing. It is important to benefit from studies originating from different countries since certain factors influencing the RTW process are specific to each country. AIMS: To compare RTW research in Europe with the USA and to describe research on RTW in Europe. METHODS: Medline was scanned with specific search strings to identify studies concerning RTW in Europe, in the USA and in the rest of the world. Characteristics of the European studies were analyzed with two specific tools for bibliometrics research. RESULTS: Four thousand five hundred and twenty-five studies were identified (1100, 1005 and 2420 coming from Europe, the USA and the rest of the world, respectively). The European countries producing the greatest number of research papers standardized for population of that country were Sweden, the Netherlands, Finland and Denmark. Sweden was 5.7 times more prolific than the USA. Specialties covered by the European publications included occupational medicine (the subject of 66% of the articles), neurology (36%), environment and public health (32%), physical medicine and rehabilitation (26%) and rheumatology (24%). CONCLUSIONS: There is a worldwide trend upwards in the number of publications on RTW. Europe recently overtook the USA in the number of publications per head of population, although there were large differences in publication rates among the European countries. The publications of European researchers on RTW are spread over a wide variety of journals, making access to this research difficult.

Follow-up of children suffering from lead poisoning or at risk of lead poisoning in Greater Paris, 1992--2002.

BACKGROUND: It is essential for children suffering from or at risk of lead poisoning to have regular follow-up, and specifically for their blood lead (Pb) levels to be monitored. The present study assessed the occurrence of late follow-up testing of blood lead levels in children in Greater Paris, and factors related to such delays. METHODS: Since 1992, the SSSIILF has been systematically recording data on lead levels in blood tests conducted for screening and follow-up in Greater Paris. For Pb greater or equal to 45 microg/dL (Group 4), a further blood lead test has to be done within three weeks. For levels of 25 microg/dL < or = Pb < 45 microg/dL (Group 3) and 10 microg/dL < or = Pb < 25 microg/dL (Group 2), a second test must be done within 6 months. For Pb less than 10 microg/dL combined with one or more risk factors (Group 1: children at risk of poisoning), a second test is required within 6 to 12 months. Children aged 1 to 6 years who were screened between 1992 and 2002 were selected. The occurrence of late follow-up testing was estimated, and the independent effect of each variable associated with a delay was measured using a logistic regression model. RESULTS: Delays in re-testing were reported for 66.9% of Group 4 children (n=356), 45.3% of Group 3 children (n=921), 74.1% of Group 2 children (n=5,466), and 88.7% of Group 1 children (n=15,612). In the three groups with Pb greater or equal to 10 microg/dL, there was better follow-up (i.e. less delay to re-testing) for children screened most recently, those whose initial blood lead test results were elevated, those who lived in sub-standard housing built before 1949, and those who lived in suburban districts of Paris. The delay was longer for children aged 4 to 6 compared to younger children. When the size of the group was large enough, these differences were significant. In Group 1, similar results were observed except for a home address in a suburban district. Furthermore, follow-up was better for children of Sub-Saharan African parents, children whose initial prescription had been issued by a "PMI" mother/child healthcare centre and children from large families. CONCLUSION: Despite substantial delays in carrying out follow-up blood lead level testing, these delays were shorter for the populations with the greatest exposure.