Precision and Recall of Search Strategies for Identifying Studies on Work-Related Psychosocial Risk Factors in PubMed.

PURPOSE: This study aims to report on the effectiveness of various search strategies and keywords to find studies on work-related psychosocial risk factors (PRF) in the PubMed bibliographic database. METHODS: We first selected by hand-searching 191articles published on PRF and indexed in PubMed. We extracted 30 relevant MeSH terms and 38 additional textwords. We then searched PubMed combining these 68 keywords and 27 general keywords on work-related factors. Among the 2953 articles published in January 2020, we identified 446 articles concerning exposure to PRF, which were gathered in a Gold Standard database. We then computed the Recall, Precision, and Number Needed to Read of each keyword or combination of keywords. RESULTS: Overall, 189 search-words alone or in combination were tested. The highest Recall with a single MeSH term or textword was 43% and 35%, respectively. Subsequently, we developed two different search strings, one optimizing Recall while keeping Precision acceptable (Recall 98.2%, Precision 5.9%, NNR 16.9) and one optimizing Precision while keeping Recall acceptable (Recall 73.1%, Precision 25.5%, NNR 9.7). CONCLUSIONS: No single MeSH term is available to identify relevant studies on PRF in PubMed. Locating these types of studies requires the use of various MeSH and non-MeSH terms in combination to obtain a satisfactory Recall. Nevertheless, enhancing the Recall of search strategies may lead to lower Precision, and higher NNR, although with a non-linear trend. This factor must be taken into consideration when searching PubMed.

Vigilance and sleepiness in nurses working 12-hr shifts and their coping strategies.

AIM: To describe the progression of vigilance and sleepiness over the shift and the coping strategies of nurses working 12-hr day or night shifts. BACKGROUND: The spread of 12-hr shift work in nursing raises the question of whether sufficient vigilance can be maintained to ensure quality of care. METHOD: 18 nurses working 12-hr shifts filled out a Karolinska Sleepiness Scale questionnaire and a Brief Psychomotor Vigilance Test, at the beginning of the shift and then every 3 hr. Coping strategies and quality of care were assessed on self-administered questionnaires, filled out at 3 hr, 6 hr, 9 hr and 12 hr after the start of the shift. RESULTS: The present investigation did not show significantly excessive sleepiness or vigilance impairment or poor self-perception of quality of work during 12-hr nursing work shifts, although Psychomotor Vigilance Test results gradually deteriorated slightly over duty time (from start to end of shift). Certain coping strategies were preferred such as 'having a nap' later in the night shift. CONCLUSION: Attention needs to be paid to the health status of nurses working 12-hr shifts, with regular medical monitoring by the occupational health service. IMPLICATIONS FOR NURSING MANAGEMENT: Coping strategies to maintain sufficient vigilance to ensure quality of care should be facilitated.

Assessment of search strategies in Medline to identify studies on the impact of long COVID on workability.

Objectives: Studies on the impact of long COVID on work capacity are increasing but are difficult to locate in bibliographic databases, due to the heterogeneity of the terms used to describe this new condition and its consequences. This study aims to report on the effectiveness of different search strategies to find studies on the impact of long COVID on work participation in PubMed and to create validated search strings. Methods: We searched PubMed for articles published on Long COVID and including information about work. Relevant articles were identified and their reference lists were screened. Occupational health journals were manually scanned to identify articles that could have been missed. A total of 885 articles potentially relevant were collected and 120 were finally included in a gold standard database. Recall, Precision, and Number Needed to Read (NNR) of various keywords or combinations of keywords were assessed. Results: Overall, 123 search-words alone or in combination were tested. The highest Recalls with a single MeSH term or textword were 23 and 90%, respectively. Two different search strings were developed, one optimizing Recall while keeping Precision acceptable (Recall 98.3%, Precision 15.9%, NNR 6.3) and one optimizing Precision while keeping Recall acceptable (Recall 90.8%, Precision 26.1%, NNR 3.8). Conclusions: No single MeSH term allows to find all relevant studies on the impact of long COVID on work ability in PubMed. The use of various MeSH and non-MeSH terms in combination is required to recover such studies without being overwhelmed by irrelevant articles.

Evolution of work conditions for employees driving for work in France based on data from the 2003, 2010 and 2017 SUMER surveys (Surveillance Médicale des expositions aux risques Professionnels).

INTRODUCTION: The occupational road-accident risk on public roads and the work conditions for professional driving is still an important issue in occupational health despite lower road-accident rates. This study presents the evolution over time of the work-related constraints for these employees based on the Sumer surveys carried out in 2003, 2010 and 2017. METHOD: Data from the 2010 and 2017 surveys were restricted to match the scope of the 2003 survey in order to enable prevalence data to be compared in equivalent populations. The main variable of interest was "driving (car, truck, bus, and other vehicles) on public thoroughfares" for work (during the last week of work: yes/no). Work time characteristics, work rhythm, autonomy and scope for initiative, collective work group, standards and evaluations variables were completed by the occupational health physicians. A self-administered questionnaire was also provided to employees and contained the Job Content Questionnaire, which assesses decision latitude, social support and psychological demands, the reward scale of Siegrist questionnaire, the hostile behaviour with inspired questions for Leymann, sick leave and work accidents during the past 12 months and job satisfaction. Finally, prevention in the workplace was also completed by the occupational health physicians. RESULTS: About 25% of employees in France were exposed to work-related driving in 2017, which was stable in comparison with 2003 and 2010. However, the population was older and there were more females, more often from the clerical staff/middle manager category and working in companies with fewer than 10 employees. Employees exposed to work-related driving were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. CONCLUSIONS: The percentage of employees exposed to occupational road accident risk, i.e., exposure to work-related driving, remained stable at about 25% in 2017 compared with previous surveys. These employees were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. PRACTICAL APPLICATIONS: Prevention campaigns on work-related road accident risk should be provided to all employees in all companies since all jobs can be concerned.

Factors associated with anxiety disorders among healthcare workers (HCWS) involved in the first wave of the COVID-19 pandemic.

BACKGROUND: In a context of reorganization of the activity, of increase of the psychological, emotional and physical constraints of the nursing staff induced by the first wave of the COVID-19 pandemic, an increase of the anxiety disorders could occur. OBJECTIVE: This study aims to assess the prevalence of anxiety disorders in healthcare workers (HCWs) by wards and to investigate medical, personal, and occupational factors associated with anxiety disorder. METHODS: In France, in May 2020, a monocentric observational cross-sectional study was proposed to 285 HCWs of the University Hospital of Saint Etienne, working in 3 types of randomly selected care wards. Information was collected using an anonymous self-questionnaire offered to eligible HCWs. Validated questionnaires were used to assess anxiety (Hospital anxiety and Depression Scale) and burnout (Maslach Burnout Inventory). RESULTS: Of the 164 HCWs who participated in the study (57% participation rate), 69 (42%) caregivers had anxious symptomatology. The prevalence of anxiety disorders did not differ significantly by type of wards. Anxiety disorders are significantly associated with occupational factors (increased COVID-19 stress level, increased emotional load, increased mental load, high work/life stress during confinement, emotional exhaustion and loss of empathy), with medical factors (medical history of anxiety disorders, psychotropic treatment and impaired sleep quality) and personal factors (concern about working conditions and/or media reports). CONCLUSIONS: Preventive actions focusing on organizational factors could be carried out to reduce the emotional and mental load, the level of stress and the burnout of HCWs.

Sleep Habits and Disturbances in Healthcare Workers: A Cross-Sectional Survey in French Public Hospitals.

Purpose: To describe the sleep habits (bedtime hours, waking hours, sleep duration) and to assess the prevalence of sleep disturbances (acute and chronic insomnia, insufficient sleep, perceived sleep debt) among French healthcare workers. Participants and Methods: Nurses and assistant nurses working in public hospitals from the Loire department at different work schedules (2x12h, 2x8h, fixed daytime, fixed nighttime) were asked about their socioprofessional and demographic information, their sleep habits and disturbances during night shifts, and the acceptability of a 20-min nap opportunity. Results: A total of 297 healthcare workers completed the survey with 76% reporting a sleep debt with a lower prevalence for fixed nighttime workers (62%) and a higher prevalence for 2x12 h (84%) workers. The prevalence of acute insomnia was 76% with a significant difference between fixed nighttime (60%) and 2x12 h (82%); whereas the prevalence of chronic insomnia was 35% without any significant difference between working schedules. Moreover, 18% of healthcare workers reported excessive daytime sleepiness, while 13% admitted to using sleep medication at least once a week. Conclusion: French healthcare workers reported poor sleep quality with a high prevalence of sleep debt, acute and chronic insomnia symptoms without an obvious impact of working schedules.

The influence of burnout on cardiovascular disease: a systematic review and meta-analysis.

Background: Burnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease. Methods: Studies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks. Results: We included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case-control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions. Conclusions: Burnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.

Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study.

BACKGROUND: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population. OBJECTIVE: We evaluated, on the scale of a city's population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. METHODS: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. RESULTS: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted ß coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted ß coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ≥60 years (adjusted ß coefficient=0.25, 95% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted ß coefficient=0.10, 95% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted ß coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted ß coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ≥60 years (adjusted ß coefficient=0.25, 95% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase-polymerase chain reaction) positivity (adjusted odds ratio 0.80, 95% CI 0.69-0.94; corrected P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20% on average. CONCLUSIONS: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city's population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens' behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health.

Factors Contributing to Delayed Return to Work among French Healthcare Professionals Afflicted by COVID-19 at a Hospital in the Rhône-Alpes Region, 2021.

COVID-19 is an emerging disease whose impact on the return to work of hospital staff is not yet known. This study was aimed at evaluating the prevalence of delayed return to work associated with medical, personal, and professional factors in hospital staff who tested positive for COVID-19 during the second epidemic wave. A descriptive, analytical observational study was conducted. The source population consisted of all staff of a French University Hospital Center who had an RT-PCR test or an antigenic test positive for SARS-CoV-2 during the period from 6 September to 30 November 2020. A delayed return to work was defined as a return to work after a period of at least 8 days of eviction, whereas before the eviction period decided by the French government was 14 days. Data collection was carried out through an anonymous online self-questionnaire. The participation rate was 43% (216 participants out of 502 eligible subjects). Moreover, 40% of the staff had a delayed return to work, and 24% of them reported a delayed return to work due to persistent asthenia. Delayed return to work was significantly associated with age, fear of returning to work, and persistent asthenia, but the number of symptoms lasting more than 7 days was the only factor that remained significantly associated after multivariate analysis. From this study, it appears that interest in identifying the number of persistent symptoms as a possible indicator of delayed work emerges. Moreover, persistent asthenia should be given special attention by practitioners to detect a possible long COVID.

General practitioners' management of patients consulting for "mental distress at work".

BACKGROUND: Mental distress at work is a complex multifactorial phenomenon liable to impact health and personal life. OBJECTIVE: To assess the proportion of general practice consultations for mental distress at work and determine how general practitioners (GPs) manage these patients and the factors leading to consultation. METHODS: The frequency of consultations for mental distress at work was assessed on a self-administered questionnaire sent to the general practitioners (GPs) of the Loire administrative Département (France). Information on factors leading to consultation on management was obtained by a self-administered questionnaire in a sample of GPs and patients. RESULTS: Twenty-two patients were included by 16 GPs. 27% of patients were referred to an occupational physician. The frequency of consultations for mental distress at work was about 2%. Patients may wait several weeks or months before consulting, although a majority reported an impact on family life and health. A triggering event was often present, but no work accident procedure was undertaken. CONCLUSION: This study highlights the importance of better identifying adverse experience of working conditions and impaired mental health and reporting this to an occupational physician who can undertake preventive measures. Communication between occupational physician, employee and GP needs to be improved.

Vaccines for healthcare associated infections without vaccine prevention to date.

In spite of the widespread implementation of preventive strategies, the prevalence of healthcare-associated infections (HAIs) remains high. The prevalence of multidrug resistant organisms is high in HAIs. In 2019, the World Health Organization retained antimicrobial resistance as one of the ten issues for global health. The development of vaccines may contribute to the fight against antimicrobial resistance to reduce the burden of HAIs. Staphylococcus aureus, Gram negative bacteria and Clostridium difficile are the most frequent pathogens reported in HAIs. Consequently, the development of vaccines against these pathogens is crucial. At this stage, the goal of obtaining effective vaccines against S.aureus and Gram negative bacteria has not yet been achieved. However, we can expect in the near future availability of a vaccine against C. difficile. In addition, identifying populations who may benefit from these vaccines is complex, as at-risk patients are not great responders to vaccines, or as vaccination may occur too late, when they are already confronted to the risk. Vaccinating healthcare workers (HCWs) against these pathogens may have an impact only if HCWs play a role in the transmission and in the pathogens acquisition in patients, if the vaccine is effective to reduce pathogens carriage and if vaccine coverage is sufficient to protect patients. Acceptance of these potential vaccines should be evaluated and addressed in patients and in HCWs.

COVID-19 Health Crisis Workloads and Screening for Psychological Impact in Nursing Home Staff: A Qualitative and Quantitative Survey.

Background: Nursing homes were particularly affected by the COVID-19 pandemic. The purpose of this study was to evaluate qualitatively and quantitatively with the use of a self-reported questionnaire as a tool for screening for mental disorders in nursing home staff. Methods: A multicenter epidemiological study was conducted in 12 nursing homes in France with 1117 nursing home staff eligible. Socio-demographic, occupational, and medical data were collected by anonymous self-reported questionnaire using validated scales to assess anxiety/depressive symptoms (HAD scale) and post-traumatic stress disorder (PCL-5). A total of 12 semi-structured interviews were conducted to assess acceptance and expectations for the use of the questionnaire. Results: The participation rate was 34.5%. Data from 373 questionnaires were included in the analysis. The questionnaire was well accepted by the participants and met their wishes for prevention action. The sample was 82% female. More than half reported a feeling of powerlessness and lack of time or staffing. The prevalence of anxiety symptoms was 22%, depressive symptoms 10%, and post-traumatic stress 7%. Conclusions: This study underlines the interest in screening for mental disorders by self-reported questionnaire and deploying preventive actions in the workplace to reduce stress and facilitate the reconciliation of family and working life in this context of the pandemic.

Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review.

Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure.

Factors Associated with Psychological Distress in French Medical Students during the COVID-19 Health Crisis: A Cross-Sectional Study.

BACKGROUND: The purpose of this study was to assess the prevalence of psychological distress in medical students during the COVID-19 health crisis and to identify factors associated with psychological distress. METHODS: A cross-sectional observational study was presented to 1814 medical students (from first to sixth year) in a French university hospital center. Sociodemographic, occupational and medical information (psychological distress measured on the French GHQ12 scale) were collected via an online anonymous self-administered questionnaire. Variables associated with psychological distress were investigated using univariate analysis and multivariate analysis (modified Poisson regression). RESULTS: In total, 832 medical students responded (46%) and 699 completed the questionnaire in full (39%); 625 (75%) showed signs of psychological distress and 109 (15%) reported suicidal ideation. Female gender, psychological trauma during the COVID-19 health crisis, change in alcohol consumption, and difficulties with online learning emerged as risk factors for psychological distress, whereas a paid activity, a feeling of mutual aid and cooperation within the studies framework, and recognition of work appeared to be protective factors. CONCLUSIONS: Mental health care or suicide prevention should be provided to students at risk in the aftermath of the pandemic. Knowing the educational and medical factors associated with psychological distress enables areas for prevention to be identified.

Telework and Psychological Health in Hospital Staff during the First Wave of the COVID-19 Epidemic in France.

BACKGROUND: The COVID-19 pandemic led to a change in work organization with the development of telework. The purpose of this study was to assess the prevalence of anxiety and depressive symptoms in teleworking staff in a university hospital center in France during the first lockdown, and to identify personal, medical and occupational factors associated with anxiety disorder. METHODS: A cross-sectional observational study was conducted in 474 hospital staff working from home during the first lockdown. The sociodemographic, occupational and medical information (anxiety and depressive disorders measured on the Hospital Anxiety and Depression (HAD) scale) was collected by an anonymous online self-administered questionnaire. The variables associated with anxiety disorder were investigated by a univariate analysis (chi² and Fisher tests) and a multivariate analysis (logistic regression model). RESULTS: Three hundred and forty hospital staff participated in the study (72% response rate). Of the participants, 106 subjects (32.1%) showed signs of an anxiety disorder and 26 (7.65%) of a depressive disorder. An anxiety disorder was significantly associated with mental workload, changes in working hours, difficulties in teleworking due to issues of internet connection or due to noise, difficulties in combining family and occupational life, sleep disturbance, worry about media information and worry about the health of a loved one. An anxiety disorder remained associated with occupational stress and personal stress during lockdown after a multivariate logistic regression. CONCLUSIONS: This study highlighted the association between an anxiety disorder and perceived occupational and personal stress levels in hospital staff teleworking during the first lockdown. Stress management workshops could be proposed to hospital staff. Prevention of anxiety requires reinforced medical monitoring and reduced stress.

Relationship between Occupational Exposure to Airborne Nanoparticles, Nanoparticle Lung Burden and Lung Diseases.

The biomonitoring of nanoparticles in patients' broncho-alveolar lavages (BAL) could allow getting insights into the role of inhaled biopersistent nanoparticles in the etiology/development of some respiratory diseases. Our objective was to investigate the relationship between the biomonitoring of nanoparticles in BAL, interstitial lung diseases and occupational exposure to these particles released unintentionally. We analyzed data from a cohort of 100 patients suffering from lung diseases (NanoPI clinical trial, ClinicalTrials.gov Identifier: NCT02549248) and observed that most of the patients showed a high probability of exposure to airborne unintentionally released nanoparticles (>50%), suggesting a potential role of inhaled nanoparticles in lung physiopathology. Depending on the respiratory disease, the amount of patients likely exposed to unintentionally released nanoparticles was variable (e.g., from 88% for idiopathic pulmonary fibrosis to 54% for sarcoidosis). These findings are consistent with the previously performed mineralogical analyses of BAL samples that suggested (i) a role of titanium nanoparticles in idiopathic pulmonary fibrosis and (ii) a contribution of silica submicron particles to sarcoidosis. Further investigations are necessary to draw firm conclusions but these first results strengthen the array of presumptions on the contribution of some inhaled particles (from nano to submicron size) to some idiopathic lung diseases.

Prevalence of cardiovascular risk factors in a population of French firefighters.

Firefighters' activities increase the risk of sudden cardiac events. The main objective of this study was to describe the Loire firefighters' cardiovascular risk factors according to their cardiovascular risk and to their professional status. A retrospective study of the entire population of firefighters of the Loire department was conducted. Risk factors derived from the data collected during the occupational health follow-up medical examinations were described and the cardiovascular risk was assessed for 417 firefighters. The most frequent cardiovascular risk factors were: overweight and obesity (62.1%), high blood pressure (27.8%) and active smoking (16,1%). There were no significant differences between career firefighters and volunteers. The prevalence of risk factors for cardiovascular diseases is less than in the general population. Obesity remains the most common risk factor, especially among firefighters with high cardiovascular risk.

Stress among Emergency Health Care Workers on Nuclear or Radiation Disaster: A Preliminary State Survey.

BACKGROUND: The nuclear or radiation disaster risk within the French Auvergne-Rhone-Alpes state is low (but not absent) due to its proximity to four Nuclear Power Generation Centers and two regional cancer control centers. This study aims to compare subjective stress ratings for emergency health care workers regarding nuclear and radiation disasters between two locations: at work versus at home. MATERIALS AND METHODS: We distributed an anonymous online questionnaire via RedCap® to all emergency health care workers who could be involved in patient care after a nuclear or radiation disaster. It comprised 18 questions divided into three parts-theoretical knowledge and practical assessment, stress assessment, and sociodemographic criteria. RESULTS: We analyzed 107 responses. There was a significant 11-point increase in stress levels between work and home regarding nuclear or radiation disaster risks (p = 0.01). Less than 25% of emergency health care workers surveyed benefited from annual training. CONCLUSION: The stress levels of emergency health care workers regarding nuclear or radiation disaster were higher at work than at home and increased without annual training. It is important to increase knowledge about these protocols and to mandate yearly training for all workers potentially involved in these disasters.

Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. METHOD: PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. RESULTS: We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = -0.89. 95% CI -0.99 to -0.80) and in the group which conducted exercise both at-home and at another setting (-0.73. -0.86 to -0.59). Similarly, functional limitation also decreased in both groups (-0.75. -0.91 to -0.60, and -0.70, -0.92 to -0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. CONCLUSION: Home-based exercise training improved pain intensity and functional limitation parameters in LBP.

A longitudinal study of SARS-CoV-2-infected patients reveals a high correlation between neutralizing antibodies and COVID-19 severity.

Understanding the immune responses elicited by SARS-CoV-2 infection is critical in terms of protection against reinfection and, thus, for public health policy and vaccine development for COVID-19. In this study, using either live SARS-CoV-2 particles or retroviruses pseudotyped with the SARS-CoV-2 S viral surface protein (Spike), we studied the neutralizing antibody (nAb) response in serum samples from a cohort of 140 SARS-CoV-2 qPCR-confirmed infections, including patients with mild symptoms and also more severe forms, including those that required intensive care. We show that nAb titers correlated strongly with disease severity and with anti-spike IgG levels. Indeed, patients from intensive care units exhibited high nAb titers; conversely, patients with milder disease symptoms had heterogeneous nAb titers, and asymptomatic or exclusive outpatient-care patients had no or low nAbs. We found that nAb activity in SARS-CoV-2-infected patients displayed a relatively rapid decline after recovery compared to individuals infected with other coronaviruses. Moreover, we found an absence of cross-neutralization between endemic coronaviruses and SARS-CoV-2, indicating that previous infection by human coronaviruses may not generate protective nAbs against SARS-CoV-2. Finally, we found that the D614G mutation in the spike protein, which has recently been identified as the current major variant in Europe, does not allow neutralization escape. Altogether, our results contribute to our understanding of the immune correlates of SARS-CoV-2-induced disease, and rapid evaluation of the role of the humoral response in the pathogenesis of SARS-CoV-2 is warranted.