Amira Omrane

Asthme professionnel indemnisé dans le centre tunisien: étude transversale sur huit ans

INTRODUCTION Our study aimed to highlight the epidemiological profile of patients compensated for occupational asthma in the Tunisian Center, to identify their professional characteristics and to determine compensation practices for this occupational disease. METHODS We conducted an exhaustive retrospective study over a period of eight years. This case study included workers with occupational asthma diagnosed and compensated in the Tunisian Center by the only two medical commissions empowered to set rates for permanent partial disability caused by either a work-related injury or an occupational diseases in the seven central governorates. RESULTS A total of 129 workers, with average age of 40.6 ± 7.75 years were compensated for occupational asthma during the study period. Sex ratio was 0.66. The most incriminated etiologic agents were vegetable dust pollution in the textile industry (75.2%), wood dust, flour and isocyanates. Nonspecific bronchial hyperreactivity was found in 38% of cases, a high rate of IgE in 14% of cases and positive skin prick test in 10.9% of cases. The average rate of permanent partial disability was 25.6 ± 14.2%. On the basis of the analytical study, this rate was related to patients age and to the medical commission which had set this rate. CONCLUSION This study of workers compensated for occupational asthma provides relevant data about epidemiological and clinical features of diagnosed patients and committee practices in particular, in term of application of the voluntary indicative scale, but it does not allow an assessment of the prevalence of this pathology which is often underestimated.

1045 Musculoskeletal disorders among nurses: epidemiological and semi-quantitative study

Introduction This study aimed to identify biomechanical risk factors of musculoskeletal disorders (MSD) among nurses. Methods A cross sectional survey-structured by the Nordic MSDs questionnaire- was conducted through a representative sample of the 1179 paramedics providing nursing care in two university hospital in Tunisia (n=301). A representative work period in each department was identified. A multidisciplinary working group, according to estimated usual physical load, divided theses departments into four homogeneous groups. Semi quantitative biomechanical constraints based on 56 direct observations with encoding software and over 2 hours each one was conducted, in accordance with the homogeneous exposure group sampling table. Physical load scores were elaborated according to the posture adopted, gestures performed and characteristic of handling (type, assistance, weight and autonomy of the patient) and assessed on the Chamoux physical strain scale. Results The prevalence of the back MSDs was equal to 70.3%. Variable prevalence of the upper limbs MSDs was noted according to the anatomical area (43.68% for neck, 40.27% for shoulders, 15.01% for elbows and 29.35% for wrists).Observational study concluded that handling activity, as well as type and duration of constraining postures, were variable in function of the department of assignment. According to Chamoux scale the average physical load score was variable from 7.76 in departments with ‘heavy physical requirement» to 7.25 in those associated to ‘low’ physical requirement. Multivariate analysis showed a significant difference concerning the thrust and the traction of light and heavy load, the activity of handling and the characteristics of the handled patients. It also concluded that paramedics affected to departments associated to heavier and less autonomous patient handling activity, were most affected by back MSD. Discussion Our investigation identifies biomechanical risk factor of MSD among nurses and suggests the necessity of preventive actions according to exposure leve.

983 Thermal stress and constrain in a tunisian steel industry

Introduction The hardship at work in the steel industry is linked to the important thermal constraints related to production processes. This study aims to identify the heat strain at work in the steel industry in Tunisia through the assessed metabolism by cardiovascular heart rate recording and to evaluate the thermal stress based on the various of measurable parameters. Methods A cross-sectional exhaustive study was conducted among the 80 workers in a steel company. The recommendation of the ‘analysis’ level of the international standard ISO 8996 ‘ Ergonomics of the thermal environment -- Determination of metabolic rate was adopted for the evaluation of the thermal strain. The international standard ISO 7933 ‘ Ergonomics of the thermal environment -- Analytical determination and interpretation of heat stress using calculation of the predicted heat strain’ was adopted for the assessment of the thermal stress. Thus, metabolism was evaluated based on the recording of heart rate during work withen steel workers. Moreover, physical parameters of thermal stress (air temperature, relative humidity, air velocity, globe temperature, clothing isolation, working metabolism) were assessed. Results The equivalent metabolism was equal to 292.7 W±59.8 W. Thus, workload was ‘acceptable’ for the majority of workers (84.8%). Concerning the thermal stress level, 68.18% of the subjects were at risk of a long-term constraint (discomfort and risk of dehydration after several hours of exposure) and 30,3% of them faced a short term constraint (risk for Health after 30 to 120 min of exposure). Discussion The present study objectively quantified the physical workload in the steel sector. For most workers, the workload was light to moderate. The long-term and short-term thermal stress objectified in this study was the source of a workstation layout and a prevention strategy.

Ergonomic Analysis of the Operators’ Activity in an Industrial Agri-Food Workshop

The current intervention was carried out in a leading company in the agri-food sector in Tunisia. The initial request was the reduction of absenteeism related to musculoskeletal disorders.

Ergonomic Evaluation of Physical Workload Among Steelworkers

Our study aims, to assess the physical workload among steel workers through heart rate recordings and to develop a preventive strategy. Methods: A Cross-sectional study conducted within 65 steelworkers. The physical load was evaluated by the estimation of occupational metabolism based on recording the heart rate during a representative period of the working day as recommended by ISO 8996 (level 3). Results: The study population was exclusively male. The mean age was 37.8 years ± 9.5 years The equivalent metabolism was estimated at 282.4 ± W 80,6 W. Interpretation of the workload has concluded that this charge was “Acceptable” for the entire population study except 3 workers for which the workload was considered as “Inadmissible”. Conclusion: Urgent preventive actions have been proposed, associated to general recommendations to increase automation of production processes, improvement of work conditions, and tasks organization and strengthening the medical supervision of these workers.

Prevalence and determinants of musculoskeletal disorders upper limbs in the Tunisian craftsmen

Musculoskeletal disorders (MSDs) of the upper limbs are a major occupational health problem. We report the results of a cross-sectional survey of 334 craftsmen from the governorate of Monastir in Tunisia. The objectives of this study were to assess the prevalence of MSDs among these workers and determine their risk factors. A pre-established questionnaire based on the Nordic MSD questionnaires, Karassik and the one developed by Malchaire in 2000 was used. In the 12 months prior to the survey, the prevalence of MSDs was 92.0%. The risk factors identified were related to individual characteristics, psychosocial factors and work organization. Appropriate preventive measures seem necessary in this sector.

Ergonomic Intervention in the Sector of Waste Collection, with the Use of Deparis Guide Method: Case of the Municipality of Monastir in Tunisia

Despite the evolution of tools, equipment and work-organization, the collection of waste remains a difficult and dangerous sector. In the town of Monastir, in 2013, the number of operators assigned to the direction of cleanliness and environment was 63 and they ensured in average 1800–2000 tons of collected waste per month up to 3000 tons during the summer season. The current intervention had followed a request of the Mayor of the Municipality of Monastir which focused on the reorganization of the activity of collection of household and similar waste, with the objective to improve both the efficiency and the safety of work and the health of collectors and drivers of vehicles. We based our intervention on the 1st level of the Sobane Strategy: the Deparis guide on its initial version. The focus group was composed of ten actors in the business of waste collection, including key operators (drivers and garbage collectors) but also representatives of local of supervision and also of management (responsible for the municipal park district coordinator). The diagnosis had focused on physical work environments (buildings, equipment, tools, air hygiene, urban transport) but also on team organization and psychosocial factors. Consultation between the team work allowed to retain a number of proposed corrective actions focusing on machines and tools work, but also actions to re-design the work organization. Among these propositions we mention the design and development of new work spaces in the municipal park taking into consideration both the needs but also the activities of operators and the organization of collective work. Over 80 % of the actions proposed by the working group were retained and implemented. Other more complicated aspects of the work situation were chosen as subject of future ergonomic intervention (e.g. computerization of the organizational process of the park) or further reflection objects in budgeting (installation alarm systems).