Benefit of continuous positive airway pressure on work quality in patients with severe obstructive sleep apnea.

BACKGROUND: The objective of this prospective study was to assess the effect of CPAP therapy on job productivity and work quality for patients with severe obstructive sleep apnea (OSA). METHODS: A convenience sample of patients diagnosed with severe OSA using polysomnography or polygraphy and with a therapeutic indication for CPAP was enrolled in our study. Patients completed two self-administered questionnaires: the first before CPAP therapy and the second during the first 6 months after CPAP treatment. OSA symptoms were evaluated through self-administered questionnaires assessing potential effects on occupational activity: excessive daytime sleepiness was rated by the Epworth Sleepiness Scale (ESS), emotional status was rated by the Hospital Anxiety and Depression (HAD) scale, work quality was rated by the Work Role Functioning Questionnaire (WRFQ). RESULTS: Forty patients (30 men, mean age 47.3 ± 8.3, mean BMI 31.6 ± 7.4, mean apnea-hypopnea index 51.8 ± 16.3) showed a beneficial effect of CPAP therapy on ESS score (mean 11.6 to 8.2, p < 0.0001), the anxiety dimension (mean 57.5% to 20%, p = 0.0002), and the overall anxiety-depressive score (mean 50% to 22.5%, p = 0.0006). Mean WRFQ scores were significantly improved in the second questionnaire for the dimensions of timetable requirements (69.3% to 83.5%, p < 0.0001), productivity requirements (71.4% to 82.2%, p < 0.0001), mental requirements (72.0% to 84.3%, p < 0.0001), and social requirements (82.6% to 91.4%, p < 0.003). CONCLUSIONS: We observed that adherence to CPAP therapy for patients with severe OSA mitigates the impact of symptoms on work including excessive daytime sleepiness, impairment of work ability, and anxiety and depressive disorders.

Job Restrictions for Healthcare Workers with Musculoskeletal Disorders: Consequences from the Superior's Viewpoint.

Objective Many workers suffer from musculoskeletal disorders. In France, occupational physicians are able to set job aptitude restrictions obliging employers to adapt the worker's job. The present study explored the impact of job restriction from the point of view of the employees' supervisors. Methods A qualitative study was conducted in 3 public hospitals. 12 focus groups were organized, involving 61 charge nurses and head nurses supervising 1 or more workers restricted for heavy lifting or repetitive movements. Discussions were recorded for qualitative thematic analysis. Results Charge and head nurses complained that aptitude restrictions were insufficiently precise, could not be respected and failed to mention residual capability. A context of personnel cuts, absenteeism and productivity demands entailed a need for polyvalence and reorganization threatening the permanence of adapted jobs. Job restrictions had several negative consequences for the charge and head nurses, including overwork, increased conflict, and feelings of isolation and organizational injustice. Conclusion Protecting the individual interests of workers with health issues may infringe on the interests of their supervisors and colleagues, whose perception of organizational justice may go some way to explaining the support or rejection they show toward restricted workers. This paradox should be explicitly explored and discussed.

[Follow-up after occupational asbestos exposure: terms and devices in foreign]. / Suivi après exposition professionnelle à l'amiante : modalités et dispositifs étrangers.

INTRODUCTION: Diseases, including cancer induced by asbestos, usually occur after many years of latency. The follow-up of employees must therefore continue after the end of their employment (retirement, redundancy, etc.) and such an arrangement has existed in France since 1996. This article reviews the literature on the post-employment monitoring arrangements that exist outside of France, particularly in other European countries, and their characteristics. STATE OF ART: This research has revealed a limited number of national experiences in Germany, Spain, Finland, Italy, Norway, Poland, and Switzerland. The medical protocols generally involve: algorithm decisions, questionnaire, physical examination, chest radiography, CT scan, and/or spirometry. PERSPECTIVES: Internationally, various methods exist to select employees for follow-up and to determine the frequency of subsequent examinations. Unlike Germany, which has a long experience of such medical follow-up, several of these programs are more recent. CONCLUSIONS: Post-occupational medical surveillance of asbestos-related disease is uncommon, monitoring arrangements vary and depend on medical and also on social factors. The French system of post-occupational monitoring can undoubtedly improve but it bears comparison with arrangements in other countries, where these are even present.