[An epidemiological and evolutionary profile of occupational asthma of Tunisian workers]. / Profil épidémiologique et évolutif de l'asthme professionnel des travailleurs tunisiens.

INTRODUCTION: This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes. METHODS: We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan. RESULTS: All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic. CONCLUSION: Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition.

Contribution of Patch Tests with Occupational Handled Products in the Diagnosis of Occupational Contact Dermatitis: A 10-year Review.

Introduction: Allergic contact dermatitis (ACD) is a common occupational disease. Its diagnosis is essentially based on interrogation and patch tests. However, commercially available batteries are sometimes not appropriate for the working conditions and the handled products, which must then be tested. In Tunisia, no previous study has focused on the contribution of patch tests with handled products in the workplace. The objective of this study is to establish the sociodemographic and occupational profile of the patients benefiting from patch tests with handled products in the workplace to identify the characteristics of these products as well as to evaluate the relevance of their positivity and their contributions in terms of aetiological diagnosis of occupational ACD. Methods: This is a retrospective descriptive epidemiological study conducted for a period of 10 years from January 1st, 2006, to December 31, 2015, among patients exercising a professional activity and consulting the Dermato-Allergology Unit of the Occupational Medicine ward of the University Hospital Farhat Hached of Sousse for the exploration of ACD. Results: During the study period, 113 patients received patch tests of handled products in the workplace with a prevalence of 7.3% of patch-tested patients during the same period. The mean age was 35.79 ± 9.45 years with a male predominance (sex ratio = 1.35). The most represented activity sectors were the health sector in 30.1% and the textile sector in 21.2%. The majority of patients were professionally active (61.9% of the study population) with an average professional seniority of 10.28 ± 8.49 months. In total, 138 patch tests with handled products were carried out of which 46 tests were positive (33.3%). After the analytical study, variables independently significantly associated with the positivity of patch tests with handled products in the workplace were the male gender and the working in the plastics industry. An occupational disease was declared to the National Health Insurance Fund for 8 patients, i.e., 7.1% of cases. Conclusion: Patch tests with handled products in the workplace can provide strong arguments for the professional origin of the ACD.

Evaluation of daily Laurus nobilis tea consumption on anxiety and stress biomarkers in healthy volunteers.

Laurus nobilis is known in the field of herbal medicine and in vitro studies for its antibacterial, antifungal, anti- diabetes, and anti-inflammatory beneficial effects. Laurus nobilis tea consumption was investigated with regard to its effects on anxiety and stress in healthy individuals, measured by subjective tools and by plasmatic cortisol levels. The study included thirty healthy Tunisian volunteers aged between 20 and 57 years consuming Laurus nobilis infusion, prepared from 5g of dried Laurus nobilis leaves in 100 ml boiled water, once a day during 10 days. Plasma concentrations of serum cortisol were measured before Laurus nobilis consumption and at the end of the experiment. Laurus nobilis tea consumption significantly decreased the concentration of plasmatic cortisol ([cortisol] D0= 93.5± 43.01ng/mL, D11=72.23± 25.37, p=0.001). A statistically significant decrease in PSS and STAI scores (p=0.006 and p=0.002 respectively) was also noted.These findings highlight the decrease in blood cortisol levels, which means a possible positive effect on reducing the risk of stress related-diseases in healthy volunteers consuming Laurus nobilis tea. However, more powerful studies with extended treatment periods are required.

Occupational Noise Exposure and Diabetes Risk.

Introduction: Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim: To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods: This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results: The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference (p=0.08). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion: Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.

Effects of music therapy on occupational stress and burn-out risk of operating room staff.

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

Impact of Allergic Contact Dermatitis on the Quality of Life and Work Productivity.

BACKGROUND: Allergic contact dermatitis (ACD) is a common chronic skin disease that generates considerable public-health and socioeconomic costs. This disease affects the quality of life and the occupational activity of patients. AIMS: To assess the quality of life (QOL) of patients with ACD and study the impact of this disease on their work productivity. METHODS: This is a cross-sectional study carried out from January 2012 to December 2014. All patients diagnosed with ACD in the Dermato-Allergology Unit of the Occupational Medicine Department at Farhat Hached University Hospital, in Sousse, were included. The impact of skin disease on the QOL of affected persons was assessed using the Dermatology Life Quality Index (DLQI). The work productivity was measured using the Work Productivity and Activity Impairment Allergic Specific questionnaire (WPAI: AS). RESULTS: The study population consisted of 150 patients. The average score of DLQI was 6.5. Over the previous 7 days, absenteeism rate was 25.9 ± 15.3%, presenteeism rate was 50.2 ± 32%, overall work productivity loss was 29.6 ± 19.4%, and daily activity impairment was 50.4 ± 32.3%. The DLQI score was significantly associated with atopy (p = 0.03), relapses strictly greater than 10 (p = 0.02), presenteeism (p <10-3), overall work productivity loss (p = 0.01), and daily activity impairment (p = 0.03). CONCLUSION: The impact of ACD on QOL and occupational activity seems important and requires specific attention from the occupational physician.

[Impact of occupational noise in the development of arterial hypertension: A survey carried out in a company of electricity production]. / Impact du bruit professionnel sur le développement de l'hypertension artérielle : enquête réalisée au sein d'une centrale de production d'électricité et de gaz en Tunisie.

BACKGROUND: Noise pollution is one of the major environmental pollutants that can adversely affect public health. Cardiovascular diseases are the primary out-auditory adverse outcome caused by occupational noise exposure. AIMS: To investigate the association between occupational exposure to high level of noise and blood pressure among a group of workers in a company of electricity production in the Centre of Tunisia. MATERIAL AND METHODS: A total of 120 occupational noise-exposed workers and 120 non-exposed employees were recruited to conduct a cross-sectional survey exploring the association between occupational noise-exposed and arterial hypertension. Data collection was based on a questionnaire, a clinical exam and biomarkers. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. The occupational noise level was measured with a portable calibrated sound meter. Multiple logistic regression was used to calculate the odds ratio (OR) and 95 % confidence interval (CI) of noise exposure adjusted by potential confounders. RESULTS: The noise level to which our population was exposed ranged from 75dB to 103dB with an average noise level of 89dB. Mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and the prevalence of hypertension were significantly higher in exposed individuals than in non-exposed. In multivariate analysis, elevated SBP in exposed workers was associated with high-salt diet (OR adjusted=1.71, 95% CI adjusted [1.14-1.98]) and occupational seniority more than 8 years (adjusted OR=5.31, 95% CI [2.22-12.72]). The factors associated with high BP in the exposed group were diabetes (OR adjusted to 15.31; 95% adjusted CI [2.61-89.58]), history of hypertension in the family (OR adjusted to 11.46; 95% adjusted CI [5.18-83][1.58-83.05]), mean of age (OR adjusted to 6.65; 95% adjusted CI [1.87-23.59]) and high-salt diet (OR adjusted to 0.29; 95% adjusted CI [0.09-0.95]). CONCLUSION: Occupational chronic noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure in companies of electricity production.

[Specificities of occupational asthma in women and its interactions with hormonal status]. / Spécificités de l'asthme professionnel chez les femmes et son interaction avec le statut hormonal.

BACKGROUND: Occupational asthma (OA) is described as the most common respiratory disease in industrialized countries. A female predominance characterizes many populations of asthmatic workers. Differences in occupational exposures by gender as well as hormonal variations could affect OA in women. PURPOSE: To identify the socio-occupational and medical characteristics of OA in women compared to men and to investigate a possible hormonal influence on OA in women. MATERIAL AND METHODS: This is a retrospective study, based on medical records of out patients of the Department of Occupational Medicine during the period between 1st January 2009 and 30 June 2016 for OA completed by a phone call to collect missing data. RESULTS: Over 222 cases of OA, a female predominance was noted (60.81%), which was predominantly in the textile sector (61.5%). Clinically, men had more exercise dyspnea and wheezing, whereas the association with rhinitis was significantly greater in women. The majority of women with asthma had irregular menstrual cycles (46.2%), they were multiparous in 54%, menopaused in 13% of cases with a mean age of menarche of 12±1.65 years. A worsening of OA was noted in 58% of women during their perimenstrual period, 75% during pregnancy and 14% of women when taking hormonal contraceptives. In asthmatic women, only the presence of non-specific bronchial hyperreactivity was significantly associated with menarche age (P=0.007). CONCLUSION: Differences between men and women in OA with variability of symptoms during female genital life have been identified. Further studies to personalized care strategies for women need to be undertaken.

The effect of environmental factors on the incidence of perforated appendicitis.

BACKGROUND: Acute appendicitis is the most common abdominal emergency. Its etiopathogenesis appears to be multifactorial. Several studies suggested a relationship between the development of acute appendicitis and some environmental factors. Air pollution predisposes some people to develop perforated appendicitis. However, data are relatively scarce and the results still controversial. AIM: Determine the seasonal variation of acute appendicitis and study the association between perforated appendicitis and short-term exposure to climatic factors and to air pollutants. METHODS: A cross-sectional study was conducted including patients hospitalized in the general surgery department of Farhat Hached University Hospital in Sousse for acute appendicitis between January 1st and December 31st, 2014. Climatic conditions were collected from the National Institute of Meteorology. Data on air pollution were given by the National Agency for the Protection of the Environment and obtained by the modeling of the atmospheric pollution. For statistical analysis, we used mean concentrations of each environmental factor corresponding to the day of hospital admission and lagged by the 7 previous days. These factors were compared between the group of patients with perforated appendicitis and patients with nonperforated appendicitis. RESULTS: We collected 246 cases of acute appendicitis. Perforated appendicitis was reported in 15.2% of the cases. The incidence of acute appendicitis was higher during summer. Compared to nonperforated appendicitis, perforated appendicitis was significantly associated with the mean relative humidity of the 5 day lag (p = 0.046), rainfall of the 7 day lag (p = 0.043), and consultation delay (p <10-3). Furthermore, perforated appendicitis was significantly associated with the daily mean concentration of carbon dioxide (p = 0.042), the 2- day lag mean concentration of particulate matter less than 10 µ (PM10 ) (p = 0.016), and the 2-day lag mean concentration of ozone (p = 0.048). After multivariate statistical analysis, predictive factors for perforated appendicitis were the consultation delay (OR: 1.621, 95% CI [1.288 - 2.039]; p<10-3) and the 2 day lag mean concentration of PM10 (OR: 1.066, 95% CI [1.007- 1.130]; p = 0.029). CONCLUSION: Short-term exposure to particulate matter was associated with perforated appendicitis. Further large-scale studies are needed to support this conclusion. KEY WORDS: Air pollution, Appendicitis, perforated appendicitis, Climateparticulate matter.

[Quality of life in adult patient (Tunisian) with severe OSA]. / Qualité de vie du patient (tunisien) adulte atteint de SAOS sévère.

INTRODUCTION: The negative impact of obstructive sleep apnea (OSA) on quality of life of affected individuals is a central consequence of this disease. The recognition of the quality of life as a therapeutic target is a relatively new concept. OBJECTIVES: To evaluate the quality of life and its determinants in patients with OSA. MATERIALS AND METHODS: We conducted a cross-sectional study during the period from 1st July 2012 to 30th June 2013. The target population was patients with OSA and in employment examined in consultations of pneumology in the teaching hospital Farhat-Hached in Sousse (Tunisia). This study was based on a generic questionnaire (SF-36) to assess the quality of life. RESULTS: The study population included 103 cases with a mean age of 55.15±11.4years and a sex ratio of 0.71. Our patients were obese in 95.1 % of cases with an average BMI of 39.13±7.19kg/m2. The majority of our patients had an impaired quality of life with an average score of 44.76 (SF36) and extremes of 22 and 70. There was a positive linear relationship between physical and mental components of the SF-36 and gender, age, BMI, and anxiety and depressive disorders. CONCLUSION: The OSA is a demanding disease whose impact on the quality of life seems important and requires special attention. The management of this disease should not be limited to controlling the disease but aspire to overall patient satisfaction.

[Impact of COPD on quality of life and mental health among one hundred Tunisian patients]. / Impact de la BPCO sur la qualité de vie et l'état de santé mentale chez cent patients tunisiens.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) constitutes a penalty in physical activities of patients. Its mental repercussions are important and expressed in a significant impairment of quality of life. OBJECTIVES: To evaluate the quality of life and its determinants in Tunisian patients with COPD. METHODS: We conducted a cross-sectional study over a period of 6 months from January 2008 to June 2008 and focused on patients with COPD hospitalized and monitored in the department of respiratory diseases in Farhat Hached Teaching hospital of Sousse in Tunisia. We used the French version of Saint George's respiratory questionnaire (SGRQ) to study the quality of life and the Hospital Anxiety Depression (HAD) for the exploration of anxiety and depression. RESULTS: Among 100 patients included in the study, the SGRQ overall score average was 44.31 ± 13.85%. Ten patients had depression and 9 patients had an anxiety state. The results of the multiple linear regression analysis showed that four factors were associated significantly with impaired quality of life: dyspnea, the number of exacerbations, comorbidity and depression. CONCLUSION: The psychological impact and effect on quality of life of COPD are additional tools combined with physical and spirometric data during the follow-up of treatment of patients and should be systematically sought by practitioners, which is still rare in Tunisia.

[Occupational asthma in the Tunisian central region: etiologies and professional status]. / L'asthme professionnel dans la région du centre tunisien : étiologies et devenir professionnel.

OBJECTIVE: To study the etiologies of occupational asthma and determine its impact on the professional status of asthmatic subjects. METHODS: The authors carried out a descriptive study on all of the cases of asthma recognized as an occupational disease and declared in the private sector over nine years (2000-2008) in the Tunisian central region. RESULTS: Cases (219) of occupational asthma were listed, accounting for 16.8% of all of the occupational diseases recognized during the period studied. Occupational asthma concerned young adults (40±8.2 years), with a predominance of women (67.7%). The textile sector dominated (74.9%). The majority of the employees were exposed to high molecular weight allergens (82.3%) and cotton dust was the principal offending agent (75.3%). Involuntary unemployment was observed in about half of the cases (46.6%) and was associated with an age lower or equal to 35 years (p = 0.01) and under 15 years of professional seniority (p=0.03). CONCLUSION: Occupational asthma in the Tunisian central region prevails in the textile sector thereby justifying the reinforcement of preventive measures in this branch of industry.