Charfeddine Amri

Occupational allergy in healthcare workers.

Occupational healthcare may expose to various allergens and irritants. Thus, the allergic manifestations in nursing staff are frequent and their prevalence is increasing all over the world. In fact, many new substances continuously appear in the medical practices. These allergic manifestations include a wide spectrum of clinical symptoms such as ocular, nasal and especially bronchial symptoms, which can be isolated or associated. These diseases can be a source of many problems related to the occupational aptitude. All these conditions justify prevention procedure strengthening, which mainly consist in substituting the sensitizing agents, and applying collective and individual prevention measures. This article also refers to some patents on the treatment of allergy.

Work Related Asthma in the Textile Industry

Nowadays, occupational asthma is the most common form of occupational lung disease in the world. In some countries the textile industry remains an important source of potential agents causing occupational asthma. In the textile industry several agents such as cotton dust and dyes may cause occupational asthma. In this review, we discuss the epidemiology, pathogenesis/mechanisms, clinical presentations, management and prevention specific to occupational asthma in the textile industry.Work-related asthma risk is considerable. Current understanding of the mechanisms by which many textile agents cause occupational asthma is limited, especially for low molecular-weight sensitizers and irritants. The diagnosis is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination or reduction of exposure to the offending agent and early use of convenient therapy according to disease severity may play an important role in the prevention of long-term persistence of asthma. Its prevention in the textile industry should be both technical and medical. It depends on the difficulties to reduce dust level, the limits in arranging work station or in occupational rehabilitation. These difficulties are increased in small textile industry companies. Persistent occupational asthma in this sector is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reduce the burden of asthma attributable to occupational exposures. This review also outlines different patents on the diagnosis and treatment of asthma.

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.

Préoccupations de carrière chez les médecins de travail des groupements de Médecine de travail en Tunisie

INTRODUCTION Career dissatisfaction among occupational physicians (OP) may affect their performance and the quality of healthcare services provided. Our study aims to assess the job satisfaction of OP serving on the Institutes for Occupational Safety and Health(IOSH) in Tunisia and to identify the determinant factors. METHODOLOGY We conducted a national cross-sectional validated SAPHORA JOB survey among all the OP serving on 22 IOSH. RESULTS 58% of OP serving on the IOSH were dissatisfied with their career. Career satisfaction was statistically influenced by the number of healthcare facilities for which they were responsible (p=0.016), the work organisation (p=0.010), the work impact (p=0.011), the salary (p‹10-3) and knowledge on current regulation (p=0.047). CONCLUSION The standardisation of pay scale and career ladders for OP serving on the IOSH based on a revision of legislative texts is recommended. Improving organization and working conditions may allow success in the workplace and benefit enhancement.

Evaluation of Student’s Competencies on Social Medicine Internship with the Objective Structured Clinical Examination Method

The aim of the current study is to evaluate OSCE (Objective Structured Clinical Examination) stations elaborated to asses competencies of external students on the 5th year of Social Medicine internship at the Faculty of Medicine of Monastir, in Tunisia, carried out over a year. The total number of OSCE stations was 32 with an average of 5.3 ± 2.3 stations per session, each station lasting five minutes. More than half of OSCE stations were a clinical vignette type (68.7%), followed by photo-type stations in 8 cases (25%). The total number of tasks required was 76.The number of stations about a single task was 18.75%. Morethan two-thirds of tasks involved competencies of cognitive level type III (72.1%). The number of elements per correction grid varied between 4 and 10 with an average of 6.44 ± 1.8 elements. At the end of the different examination sessions, the success rate was low (15-19 / 30) for 61% of learners with a discrimination index -0.41 and a difficulty index of tests 66%. These results attest the feasibility of OSCE stations for evaluation of skills in medical specialty. However, a regular and more thorough evaluation of this method is necessary in order to promote skills of future general practitioner

Determinants of Grip Strength in Tunisian Nurses: A Bicentric Study

Background Grip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature. Objective To describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector. Methods This is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer. Results Handgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002). Conclusion Grip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.