[Pandemic forced telework, a new psychosocial risk. Reflections on the health issues and the necessary support]. / Télétravail contraint en pandémie, nouveau risque psychosocial : réflexions sur les enjeux santé et l'accompagnement nécessaire.

With the COVID-19 pandemic, barrier measures also concerned the world of work. In particular, teleworking was encouraged over a long period in France and then generalized in April 2021, promoting social isolation. The anxious climate linked to the pandemic and the precipitous nature of this decision induced a new psychosocial risk factor. The psychological manifestations linked to stress: anxiety, depressive disorders and others justify without delay a global action plan with systematic support measures by local management, systematic screening for possible maladjustment by the occupational health services and support people in difficulty. For this purpose and in these circumstances, self-questionnaires, directed questionnaires and video interviews appear to be the most suitable means. The chosen and part-time teleworking making it possible to reconcile family and professional life will remain a solution at certain times of life, but full-time teleworking cannot constitute an univocal and lasting solution.

Shift of the 2009-2011 measles outbreak from children to adults: an observational review at the University Hospital of Clermont-Ferrand, France.

In 2009-2011, 113 adult in- and outpatients with measles were referred to the University Hospital of Clermont-Ferrand (centre of France): 71 (62.8 %) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients. The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected.

[Pasteurella multocida meningitis in a 93-year-old woman following a cat bite]. / Méningite àPasteurella multocida chez une femme de 93ans après morsure par un chat.

Pasteurella multocida is commensal of the normal nasopharynx or gastrointestinal flora in many domestic and wild animals. Cat and dog bites usually cause soft tissue infections. P. multocida is an unusual causative agent of meningitis which tends to affect neonates or aged patients. The authors report a case (a 93-year-old woman) of P. multocida meningitis induced by a cat bite with dramatic sequels leading to complete patient disability.

Hepatitis B in Moroccan health care workers.

AIM: To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). METHODS: Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. RESULTS: Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. CONCLUSION: HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.

[Cost/effectiveness comparison of the vaccine campaign and reduction of sick leave, after vaccination against influenza among the Clermont-Ferrand University Hospital staff]. / Comparaison coût/bénéfice de la campagne vaccinale et de la réduction de l'absentéisme, après vaccination contre la grippe du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The aim of this study was to compare the cost of vaccination for the Clermont-Ferrand University hospital (CHU) personnel and the cost of sick leave among vaccinated and non-vaccinated employees in 2003, 2004, and 2005. DESIGN: The study included 7256 CHU staff (medical and non-medical personnel). The cost of sick leave was calculated on the basis of short-term disease (four to nine days) over the three months of the epidemic season in 2004, 2005, and 2006. RESULTS: In 2005, the overall cost of vaccination was 4.02 euros per vaccinated employee. Over the three years, the total sick leave reached 804 days for employees vaccinated against 5670 for non-vaccinated employees. In 2003, 2004, and 2005, the vaccinal coverage was 13, 20.5, and 30.1%, the mean duration of sick leave was 0.16, 0.17, and 0.18 day among vaccinated staff, and 0.26, 0.39, and 0.34 day among non-vaccinated staff corresponding to a benefit per vaccinated employee of 5, 26, and 20 euros, respectively for each year. The total benefit for the institution was 86,458 euros (4630+38,168+43,660). If the vaccinated rate of 75% recommended by the Haute Autorité de santé (HAS) had been reached, the additional benefit would have been 250,193 euros (33,157+152,256+65,180). CONCLUSIONS: The number of sick leave days and the related cost were approximately twice less important for vaccinated employees, economically justifying this vaccination including a period of weak epidemic, as checked over three consecutive years.

[Analysis of motivations for antiflu vaccination of the Clermont-Ferrand University Hospital staff]. / Analyse des motivations à la vaccination antigrippale du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel's motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns. DESIGN: An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination. RESULTS: The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p<0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health. CONCLUSIONS: The Haute Autorité de santé's objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination.

[Relation between the level of knowledge and the rate of vaccination against the flu virus among the staff of the Clermont-Ferrand University hospital]. / Relation entre le niveau de connaissance et le taux de vaccination contre le virus de la grippe parmi le personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The main aim of this study was to determine how much staff at the Clermont-Ferrand university hospital, France, knew about influenza and its relation with the vaccinal rate. The other aim was to develop better-targeted information campaigns and prevention policy in the work place. DESIGN: A self-administered questionnaire was sent to the 7601 salaried staff of the hospital in May 2005. The staff was asked to give details on socioprofessional characteristics, vaccinal status, and knowledge about the influenza virus (mode of transmission, contagiousness, measures of prevention, populations affected, mortality, vaccination schedule, and vaccination target populations). Multiple-choice questions on knowledge of influenza were scored according to the answer given. RESULTS: The response rate was 26.5%. The 2011 completed questionnaires were representative of the working staff. They showed a positive correlation between the rate of vaccination and knowledge of influenza, with a 0.98 coefficient. They also showed that the staff was very largely unaware of population groups most at risk for influenza (1% of correct answers). CONCLUSIONS: Primary prevention campaigns will only be effective if the target population has a better awareness of the issues involved. This study highlights the areas in which knowledge was heterogeneous or inadequate, and the information that could be decisive in increasing vaccinal coverage among staff. This information should focus on modes of transmission, contagiousness, mortality, and above all on populations at risk.

[Do circannual rhythm of cortisol and testosterone interfere with variations induced by other events?]. / Les rythmes circannuels du cortisol et de la testostérone interfèrent-t-ils avec les variations de ces hormones liées à d'autres évènements?

OBJECTIVE: Cortisol and testosterone are two hormones whose levels may vary in response to sports or occupational events. We wondered if the circannual rhythm of these hormones could have an influence on such responses or whether changes can always be ascribed to a single cause. METHOD: For cortisol, we conducted a cross-sectional study among 102 adult men (mean age 42 years) using saliva samples taken one half hour after awakening. The values were combined over three-month periods corresponding to the four seasons. For testosterone, conclusions were drawn from data reported in the literature. RESULTS: The mean annual cortisol level was 14.36+/-0.44 nmol/l. There was no significant difference between average and peak values nor between maximal and minimal values. For testosterone, there have been a limited number of studies and it is unclear whether there is a seasonal change. In any case, the amplitude of variations is weak (9.7% between peak and annual average), which is partly ascribable to individual and interindividual variability. CONCLUSION: We conclude that there is no seasonal (or circannual) rhythm in cortisol levels to a degree which could interfere with effects resulting from other events. For testosterone, the circannual rhythm may account for 10% of the variation.

[Impact study of an active antiflu vaccination programme on the Clermont-Ferrand Teaching Hospital staff]. / Etude d'impact d'une campagne active de vaccination antigrippale du personnel hospitalier du CHU de Clermont-Ferrand. achamoux@chu-clermontferrand.fr

OBJECTIVE: Protecting health care units from influenza epidemics has a double purpose: to decrease the mortality rate of patients at risk and to reduce work-leave in medical staff. An annual vaccination appears to be the most effective prevention against influenza. In France however the vaccinal coverage of health workers does not exceed 15%. METHOD: In the 2003-2004 winter, the department of occupational health and the nosocomial disease committee of the Clermont-Ferrand Teaching Hospital initiated an active vaccination campaign. Three joint actions were carried out: date and place of vaccination sessions were individually addressed to every healthcare worker, meetings on prevention of influenza were held, as well as vaccination sessions on the work place in exposed units. RESULTS: Significant results were noted: vaccination rate increased 2.6 fold compared to the previous year (4.8 to 12.6%) and a vaccinal coverage rate of 29% in the exposed units. COMMENTS: The results even if far from national objectives encourage the pursuit of the campaigns promoting information and vaccination on the work place. The high frequency of reported postinjection adverse effects (1 out of 3) should be taken into account in future information campaign.

[Occupational risk for blood exposure and staff behaviour: a cross-sectional study in 3 Moroccan healthcare centers]. / Comportement et conditions de travail exposant au sang: analyse des pratiques dans trois établissements de soins du Maroc.

OBJECTIVE: As in other countries, Moroccan health-care workers are exposed to occupational blood exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and hygiene conditions determining the OBE risk for health-care workers. WORKERS AND METHODS: In March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals and health centers, as well as in a Rabat public medical analysis laboratory. RESULTS: The participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of 41.4 years (+/-7 years). Health-care workers answered that: occupational hygiene and safety were inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of OBE was 1.5 (+/-4.3) per capita. If we consider the whole career of health-care workers, the incidence reached about 14.3+/-28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule. CONCLUSION: The study shows that there is a need to improve occupational hygiene and safety conditions for Moroccan health-care workers in order to reduce OBE hazards.

Heart rate recording method validated by whole body indirect calorimetry in 10-yr-old children.

The aim of the study was to validate the heart rate (HR) recording method against whole body indirect calorimetry in prepubertal children. Nineteen 10.5-yr-old healthy children (10 boys, 9 girls) participated in this study. HR and energy expenditure (EE) were recorded through laboratory tests. Individual relationships between HR and EE were computed (equation established in laboratory). Several models were tested and validated from 24-h measurements of EE and HR by whole body indirect calorimetry. The best fit was obtained with individual polynomial relationships. Mean differences between predicted (equation established in laboratory) and measured total daily EE averaged 7.6 +/- 20.1%. The causes of the differences and the means of improving the accuracy of the prediction equation are discussed.

Heart rate monitors and abnormal heart rhythm detection.

We test the accuracy of two third generation heart rate monitors (HRM), Accurex Plus and Vantage NV and compare these data with those of an older monitor, PE 4000. Then we investigate responses of the HRM's to abnormal heart rhythms (HR). Accurex Plus and Vantage NV, and PE 4000 were tested in the laboratory under both stable and transient conditions. The Phantom 320 HR simulator gave 7 stable heart rates, each lasting 3 min. The responses of the HRM's to abnormal heart rhythms were tested with an automatic arrhythmia program lasting 17 min. The new HRM's, Accurex Plus and Vantage NV, were more accurate (89 to 94% and over 98% at +/-3 beats per min) in the stable state than the PE 4000. They all showed a smoothing effect in transient measurements, which was stronger in decelerating HR (1st case) than in accelerating HR (2nd case). - 1st case: Accurex Plus =Vantage NV >PE 4000 -2nd case: PE 4000 >Accurex =Vantage. Most isolated heart rhythm disorders (missing beat, pause < 4 s, SVEA, and SVT) were either not detected or rejected. Signal changes such as changes in QRS (ventricular bigeminy) may cause detection losses, and so modify calculated heart rate. HR signal rising/dropping slopes caused by sudden heart rhythm disorders, was notably attenuated, with a consequent loss of HR accuracy. Although the usefulness of HRM's in detecting HR disorders is limited, they have some value with serious disorders, like pause >4 s, important bradycardia or tachycardia.

Determination of maximum aerobic velocity by a five minute test with reference to running world records. A theoretical approach.

Field measurement of the maximal aerobic velocity (MAV) is closely linked to effort-duration then to the used protocol. We construct the relationship between running speed and running-duration logarithm from running world records. It appears a noteworthy point at 4.97 minutes, to be suggested as MAV duration point. By agreement, MAV could be measured on field by a five minute test whatever the sport may be.

Maximal aerobic velocity measured by the 5-min running field test on two different fitness level groups.

The aim of the study was to verify the validity and the accuracy of the 5-min running field test (5RFT) relatively to the classical treadmill test. Two groups of subjects were tested, the first one being made of sub-elite runners (G1, n = 18) and the second one of athletes of other individual or collective disciplines (G2, n = 23). To check the field technique, maximal aerobic velocity (vamax) and an approached VO2max calculated from vamax during the 5RFT were compared with the corresponding values directly determined during a treadmill test. vamax obtained on treadmill (vamax(t)) or during a 5RFT (vamax(5)) were significantly higher in G1 than in G2 (+3.7 km.h-1 and +3.6 km.h-1 among the test). In each group, the difference between vamax(t) and vamax(5) was not significant (19.4 +/- 1.0 vs 19.5 +/- 0.9 km.h-1 in G1; 15.7 +/- 2.2 vs 15.9 +/- 1.2 km.h-1 in G2). A significant correlation was found between vamax(t) and vamax(5) (slope = 0.92; r = 0.86 in G1; slope = 0.71; r = 0.84 in G2). In each group, the approached VO2max(5) was significantly higher than VO2max(t) (respectively 67.8 +/- 2.9 vs 63.7 +/- 3.5 in G1; 54.8 +/- 3.9 vs 52.0 +/- 3.2 ml.min-1.kg-1 in G2. Weak but significant correlations were found between VO2(t) and vamax(5) (r = 0.69 and r = 0.56 respectively in G1 and G2). In conclusion, the 5RFT allows to measure vamax accurately whatever the physical fitness of the subjects but more closely in runners than in non-runners. The low correlation between VO2max(t) and vamax(5) for both groups indicates that a vamax running field test is specific and cannot evaluate VO2max with reasonable accuracy whatever the group, runners or non-runners.

[Is a 11-year-old tennis player indifferent to competition stress?]. / A 11 ans le joueur de tennis est-il indifférent au stress de la compétition?

BACKGROUND: In adults, competition generates a relatively important level of stress. This could be revealed by psychological questionnaires and adrenocortical responses. This study was aimed to evaluate the load of stress in young tennis players in situations of competition compared to that observed during a training session. POPULATION AND METHODS: The 16 best young tennis players of the Auvergne area (mean age: 10.9 +/- 1.7 years) entered the study. The degree of anxiety was measured with the aid of the Martens' SCAT questionnaire and the result of salivary cortisol testing during a training session, and after each of the three competition rounds of the Auvergne championship (three samples were collected at each time: at rest, before and after exercise. RESULTS: Regarding the degree of anxiety, no significant difference was found between the competition and the training session. Cortisol levels did not change during the training session: during the competition, same moderate increase (less than 50%, P < 0.05) was noted for the first two rounds between rest and post-competition values. No difference was found at the third round. CONCLUSION: The high levels of stress described in adults are not found in young tennis players.

[Chemical odor intolerance. 5 cases]. / Le syndrome d'intolérance aux odeurs chimiques. 5 observations.

BACKGROUND: Chemical odor intolerance is a benign, non-specific, generally subjective syndrome triggered by inhalation of non-toxic doses of chemical compounds or products which had been previously well tolerated. We report five characteristic cases and discuss current data. CASE REPORTS: Five patients (3 women, 2 men; age range 23-52 years) presented the basic criteria of chemical odor intolerance: acquired syndrome, non-specific signs (headache, nausea, vertigo ...) triggered by the odor of one or more chemical substances. Physical examination and exploratory tests were normal. In 3 cases, the course was favorable after evicting the causal substances. For the other 2 cases, intolerance spread to other compounds. Four of the patients changed their work situation because of the chemical odor intolerance. DISCUSSION: The diagnosis is clinical. Different pathogenic hypotheses have been put forward in the literature: immunological, toxic, neurobiological, psychological, and psychiatric mechanisms have been proposed. The mechanism is probably multifactorial but psychological factors appear to play an important role either as predisposing or triggering factors. CONCLUSION: Due to the social and occupational consequences of chemical odor intolerance, better knowledge of its prevalence and mechanism would be most helpful in managing these patients.

[Seroprevalence of markers of viral hepatitis A, B and C in hospital personnel at the Clermont-Ferrand University Hospital Center]. / Séroprévalence des marqueurs des hépatites virales A, B et C, parmi le personnel hospitalier du centre hospitalo-universitaire de Clermont-Ferrand.

OBJECTIVES: Evaluate risk of hepatitis A, B and C infection and anti HBV vaccination policy in hospital personnel. METHODS: A sample of 440 health care workers (7.5% of the personnel at the Clermont-Ferrand University Hospital) representing 74.5% people directly involved in health care and 25.5% other workers were selected at random and stratified by work classification and age. A questionnaire was used to establish personal data on viral hepatitis status and blood samples were drawn for serological tests. RESULTS: Seroprevalence for hepatitis A was 52% with no significant difference between health care and other workers. For hepatitis B, 88.3% of the population had been vaccinated and anti-HBs titre was > or = 10 mIU/ml for 91.6% and > or = 50 mIU/ml for 86.1%. Seroprevalence for anti-HBc was 7% and none of the subjects were positive for HBs antigen. Anti-hepatic C antibodies were found in 2 health care workers (0.7%). CONCLUSION: These findings emphasize the need to persue further preventive actions against hepatitis A, B and C and the requirement for continued efforts in elementary hygiene.

[Stress and auto-immunity]. / Stress et auto-immunité

The etiology of auto-immune disorders is multifactorial. Stress is probably a participating factor. Indeed, a high proportion of patients with auto-immune diseases report uncommon stress before disease onset or disease flare. The biological consequences of stress are increasingly well understood. Glucocorticoids and catecholamines released by hypothalamic-pituitary-adrenal axis during stress will alter the balance Th1/Th2 and the balance Th17/Treg. Stress impairs cellular immunity, decreases immune tolerance and stimulates humoral immunity exposing individuals to autoimmune disease among others. The treatment for autoimmune disease should include stress management.

Job satisfaction evaluation in low back pain: a literature review and tools appraisal.

UNLABELLED: Among occupational risk factors of recurrence, chronicity and no return to work in low back pain, poor job satisfaction is the only high evidence-based factor. OBJECTIVE: To find out any validated questionnaire usable to assess job satisfaction in low back pain patients, both in clinical practice and research setting. METHOD: A systematic literature search on Pubmed and Cochrane library databases and un-indexed literature was made. "Job satisfaction" and "low back pain" keywords were used. Only English and French relevant articles were retained. A double assessment was made of listed questionnaires according to psychometric properties and daily practice use. RESULTS: Among the 40 articles retained only four used a validated questionnaire. Among the 12 different questionnaires, only two are validated in their English version (Job Descriptive Index [JDI] and the Work Environment Scale [WES]) and one in its French Version (JDI). Because they are time consuming, use these questionnaires in daily practice seems difficult. CONCLUSION: Based on literature review and questionnaire heterogeneity, at this time, there is no reference job satisfaction questionnaire. For daily practice, global job satisfaction visual analog scale could be useful. For research and intervention, JDI is more suitable despite its validity is still questionable.