Neila Chaari

Assessment of Chromosomal Aberrations and Micronuclei in Peripheral Lymphocytes from Tunisian Hospital Workers Exposed to Ionizing Radiation

Epidemiological studies suggest that cytogenetic biomarkers, such as micronuclei (MN) in peripheral blood lymphocytes may predict cancer risk because they indicate genomic instability. The objective of the present study was to evaluate the frequencies of MN and chromosome aberrations (CA) in peripheral blood lymphocytes of hospital workers exposed to ionizing radiation and healthy subjects. The study was conducted using peripheral blood lymphocytes from 30 workers from the radiology department and 30 from the cardiology department. This study included 27 healthy age- and sex-matched individuals as the control group. The assessment of chromosomal damage was carried out by the use of CA and micronucleus assays in peripheral lymphocytes. Our results show that CA and micronucleus frequencies were significantly higher among the exposed groups when compared to controls. Our finding of significant increase of CA and MN frequencies in peripheral lymphocytes in exposed workers indicates a potential cytogenetic hazard due to this exposure. The enhanced chromosomal damage of subjects exposed to genotoxic agents emphasizes the need to develop safety programs.

Genotoxic damage in hospital workers exposed to ionizing radiation and metabolic gene polymorphisms.

Of all workers exposed globally to synthetic sources of radiation, medical personnel represent the largest group, but receive relatively low doses. Accidental or therapeutic acute radiation exposure of humans was observed to induce various forms of cytogenetic damage, including the possibility of increasing the incidence of micronuclei (MN) and chromosomal aberrations (CA). The aim of this study was to assess occupationally induced chromosomal damage in a large population of hospital workers exposed to low doses of ionizing radiation (IR). The cytokinesis-block MN and comet assays were used to examine peripheral blood lymphocytes (PBL) of 31 exposed workers to IR and 33 control subjects corresponding in gender, age, and smoking. Glutathione S-transferases (GSTM1, GSTT1, and GSTP1) are postulated to be involved in the detoxification of endogenous and exogenous genotoxicants. The association between these biomarkers and polymorphic genes of xenobiotic metabolizing enzymes was thus also assessed. MN frequency was significantly higher in the exposed subjects compared controls. Comet assay results showed a significant increase of tail length in workers exposed to IR. Data obtained suggest that GSTM1, GSTT1, and GSTP1 polymorphism do not modify significantly the genotoxic potential of IR. Therefore, the exposed medical personnel need to carefully apply radiation protection procedures and minimize, as low as possible, IR exposure to avoid possible genotoxic effects.

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.

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 2u2009hours 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.

Influence de la sédentarité sur la santé mentale des administratifs du secteur de la télécommunication

Objectifs Evaluer l’influence de la sedentarite et de l’activite physique sur la sante mentale des administratifs de l’entreprise de telecommunication (TELECOM). Materiels et methodes Etude transversale sur 3xa0mois, aupres du personnel administratif de la TELECOM de la ville de Monastir-Tunisie. Le recueil des donnees s’est base sur un questionnaire portant sur les caracteristiques sociodemographiques et professionnelles, l’activite physique (evaluee par l’International Physical Activity Questionnaire [IPAQ]), ainsi que la sante mentale (evaluee par l’echelle hospitaliere d’anxiete et de depression (HADS) et le questionnaire de KARASEK). L’analyse statistique a ete realisee par le logiciel SPSS21. Les tests de Chi2, d’Anova et de t de Student ont ete utilises pour l’etude analytique. Le seuil de signification a ete fixe a 5xa0%. Pour l’analyse multivariee, le taux de significativite a ete fixe a 0,25. Resultats Quatre-vingt-quatre salaries ont participe a l’etude, soit un taux de reponse de 82,35xa0%. L’âge moyen de notre population d’etude etait de 39,8xa0ans [25–59xa0ans], avec un sex-ratio de 0,45xa0et une anciennete professionnelle moyenne de 13,16xa0±xa06,49xa0ans. Le score IPAQ median etait de 4053xa0Met-min/semaine. Six pour cent des salaries etaient classes comme inactifs, 41,7xa0% avaient une activite minimale et 52,4xa0% etaient qualifies d’hyperactifs. Au total, 30,9xa0% des administratifs ont juge leur charge mentale au travail de forte a moderee. Le score moyen d’anxiete selon le HADS a ete de 6,04xa0±xa03,38, celui de la depression etait de 2,42xa0±xa02,85. Aucune relation statistiquement significative n’a ete retrouvee entre la sedentarite et la charge mentale de travail percue (pxa0=xa00,54). De meme, la regression lineaire n’a montre aucune influence significative de la sedentarite aussi bien sur la depression que sur l’anxiete. L’activite physique, toutes categories confondues, n’a montre aucune influence significative sur l’exigence au travail. En revanche, l’activite physique au travail ameliorait significativement la latitude decisionnelle chez les administratifs de la TELECOM (pxa0=xa00,03xa0; βxa0=xa00,23). Conclusion De nombreuses etudes epidemiologiques temoignent de l’interet grandissant de l’activite physique dans les domaines de la promotion de la sante mentale au travail. Il serait judicieux de suivre l’evolution de la sante mentale chez notre population d’etude apres implantation d’un programme de prevention base sur la promotion de l’activite physique sur les lieux de travail en collaboration avec le service medical de travail de la societe.

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

INTRODUCTIONnCareer 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.nnnMETHODOLOGYnWe conducted a national cross-sectional validated SAPHORA JOB survey among all the OP serving on 22 IOSH.nnnRESULTSn58% 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).nnnCONCLUSIONnThe 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.Introduction Linsatisfaction de carrière des médecins de travail (MT) peut influencer leur performance et la qualité des prestations fournies. Lobjectif de notre étude est dévaluer la satisfaction au travail des MT du terrain de lensemble des Groupements de médecine de travail (GMT) de la Tunisie et préciser les facteurs déterminants. Méthodes Il sagit dune étude nationale transversale portant sur les MT de 22 GMT, basée sur le questionnaire, validé SAPHORA JOB. Résultats 58% des MT des GMT étaient insatisfaits de leur carrière. La satisfaction de carrière était statistiquement influencée par le nombre dentreprises en charge (p=0,016), lorganisation du travail (p=0,010),le ressenti du métier (p=0,011),le salaire (p‹10-3) et linformation sur la réglementation en vigueur (p=0,047). Conclusion Lhomogénéisation des grilles salariales et des échelons de carrière des MT des GMT basée sur une révision des textes législatifs est indiquée. Lamélioration de lorganisation et des conditions de travail peut permettre un épanouissement au travail et une amélioration des prestations.

Influence of Shift Work on Manual Dexterity and Reaction Time in Tunisian Nurses

BACKGROUNDnMajor effects of shift schedule are related to sleep alertness and performance, but also to long term health outcomes. For nurses, these negative effects have consequences not only on the individual, but also on the workplace, as decreased alertness and reduced job performance could endanger human lives.nnnOBJECTIVEnThe specific aim of our study is to assess the influence of shift schedule on nurses´ cognitive ability and rapidity of execution.nnnMETHODnOur survey is a cross sectional study which had been conducted for 15 months; it involved a sample of 293 participants representative of 1118 nurses working in two Tunisian university hospitals. It included an evaluation of the rapidity of execution performance through the manual dexterity test and the reaction time test. The study was completed by an assessment of the workability Index through a 7- item survey.nnnRESULTSnNo association was found between the groups of work schedules and the cognitive ability of execution speed. However, we found a significant decrease in cognitive performance in the nurses exceeding 10 years of job seniority for both schedules.nnnCONCLUSIONnWe concluded to an impaired cognitive performance speed in the over 10-year seniority groups in both schedules. Recommendations should be focused on implementing periodic assessment of cognitive performance based on OConnor finger dexterity test and time reaction test and on implementing effective preventive measures in hospitals after ten years of seniority at work.

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.

Approche préventive de la violence au travail chez le personnel de la consultation

Objectifs La maitrise des risques professionnels et l’amelioration des conditions de travail afin de promouvoir la sante au travail constituent un veritable facteur de performance d’un etablissement de sante. L’agression subie par le personnel de soin mettant en peril son bienetre et la stabilite de son travail constitue un de ces risques majeurs. Suite a des actes repetes d’agression du personnel du bureau d’accueil et d’enregistrement des consultations externes du CHU de Monastir, une demande d’intervention ergonomique a ete formulee aupres du service de Medecine du travail. Methodologie L’intervention menee est une etude exploratoire des conditions potentielles d’agression survenues aux bureaux d’inscription, elle s’est basee sur l’etude de l’activite a travers une observation du terrain. Resultats L’observation de l’activite au bureau d’inscription des consultations externes a montre l’existence d’une combinaison de facteurs generateurs a l’origine de declenchement des actes agressifs. La majorite des facteurs declencheurs constates etaient secondaires au dysfonctionnement organisationnel existant. Ainsi, les bureaux d’inscription etaient negliges et non pris en compte dans les projets d’amenagement menes par la direction de l’hopital. Cette activite professionnelle n’a jamais fait l’objet d’etude malgre l’augmentation considerable du nombre des consultants. Les conditions actuelles de travail dans ce milieu sont la cause d’une insatisfaction chez le personnel et sources de stress au travail. Des difficultes majeures de communication sont a l’origine de conduites agressives documentees au cours de cette etude. Par ailleurs, ce milieu qui accueille des gens souffrant de diverses maladies et dont le nombre ne cesse d’augmenter, ne dispose pas d’un systeme d’accueil et d’information adequats. Dans un autre volet, nous avons constate l’absence de developpement des competences du personnel en matiere d’habilites de communication et d’accueil et en matiere de gestion des conflits afin de les empecher a se transformer en agressions. Conclusion Des mesures preventives visant une meilleure organisation du travail a travers la mise en service d’une application informatisee de gestion des rendez-vous, l’avancement de l’heure de debut des consultations pour eviter la file d’attente ont ete proposes. Dans un autre registre, une meilleure prise en charge des victimes des actes agressifs et l’utilisation de l’arbre des causes de ces agressions afin d’identifier les causes directes et de les eviter ulterieurement ont ete proposes. De meme que la creation d’un comite de securite au travail et le recrutement d’un psychologue de travail.