Impact of Allergic Contact Dermatitis on the Quality of Life and Work Productivity.

BACKGROUND: Allergic contact dermatitis (ACD) is a common chronic skin disease that generates considerable public-health and socioeconomic costs. This disease affects the quality of life and the occupational activity of patients. AIMS: To assess the quality of life (QOL) of patients with ACD and study the impact of this disease on their work productivity. METHODS: This is a cross-sectional study carried out from January 2012 to December 2014. All patients diagnosed with ACD in the Dermato-Allergology Unit of the Occupational Medicine Department at Farhat Hached University Hospital, in Sousse, were included. The impact of skin disease on the QOL of affected persons was assessed using the Dermatology Life Quality Index (DLQI). The work productivity was measured using the Work Productivity and Activity Impairment Allergic Specific questionnaire (WPAI: AS). RESULTS: The study population consisted of 150 patients. The average score of DLQI was 6.5. Over the previous 7 days, absenteeism rate was 25.9 ± 15.3%, presenteeism rate was 50.2 ± 32%, overall work productivity loss was 29.6 ± 19.4%, and daily activity impairment was 50.4 ± 32.3%. The DLQI score was significantly associated with atopy (p = 0.03), relapses strictly greater than 10 (p = 0.02), presenteeism (p <10-3), overall work productivity loss (p = 0.01), and daily activity impairment (p = 0.03). CONCLUSION: The impact of ACD on QOL and occupational activity seems important and requires specific attention from the occupational physician.

The effect of environmental factors on the incidence of perforated appendicitis.

BACKGROUND: Acute appendicitis is the most common abdominal emergency. Its etiopathogenesis appears to be multifactorial. Several studies suggested a relationship between the development of acute appendicitis and some environmental factors. Air pollution predisposes some people to develop perforated appendicitis. However, data are relatively scarce and the results still controversial. AIM: Determine the seasonal variation of acute appendicitis and study the association between perforated appendicitis and short-term exposure to climatic factors and to air pollutants. METHODS: A cross-sectional study was conducted including patients hospitalized in the general surgery department of Farhat Hached University Hospital in Sousse for acute appendicitis between January 1st and December 31st, 2014. Climatic conditions were collected from the National Institute of Meteorology. Data on air pollution were given by the National Agency for the Protection of the Environment and obtained by the modeling of the atmospheric pollution. For statistical analysis, we used mean concentrations of each environmental factor corresponding to the day of hospital admission and lagged by the 7 previous days. These factors were compared between the group of patients with perforated appendicitis and patients with nonperforated appendicitis. RESULTS: We collected 246 cases of acute appendicitis. Perforated appendicitis was reported in 15.2% of the cases. The incidence of acute appendicitis was higher during summer. Compared to nonperforated appendicitis, perforated appendicitis was significantly associated with the mean relative humidity of the 5 day lag (p = 0.046), rainfall of the 7 day lag (p = 0.043), and consultation delay (p <10-3). Furthermore, perforated appendicitis was significantly associated with the daily mean concentration of carbon dioxide (p = 0.042), the 2- day lag mean concentration of particulate matter less than 10 µ (PM10 ) (p = 0.016), and the 2-day lag mean concentration of ozone (p = 0.048). After multivariate statistical analysis, predictive factors for perforated appendicitis were the consultation delay (OR: 1.621, 95% CI [1.288 - 2.039]; p<10-3) and the 2 day lag mean concentration of PM10 (OR: 1.066, 95% CI [1.007- 1.130]; p = 0.029). CONCLUSION: Short-term exposure to particulate matter was associated with perforated appendicitis. Further large-scale studies are needed to support this conclusion. KEY WORDS: Air pollution, Appendicitis, perforated appendicitis, Climateparticulate matter.

[Quality of life in adult patient (Tunisian) with severe OSA]. / Qualité de vie du patient (tunisien) adulte atteint de SAOS sévère.

INTRODUCTION: The negative impact of obstructive sleep apnea (OSA) on quality of life of affected individuals is a central consequence of this disease. The recognition of the quality of life as a therapeutic target is a relatively new concept. OBJECTIVES: To evaluate the quality of life and its determinants in patients with OSA. MATERIALS AND METHODS: We conducted a cross-sectional study during the period from 1st July 2012 to 30th June 2013. The target population was patients with OSA and in employment examined in consultations of pneumology in the teaching hospital Farhat-Hached in Sousse (Tunisia). This study was based on a generic questionnaire (SF-36) to assess the quality of life. RESULTS: The study population included 103 cases with a mean age of 55.15±11.4years and a sex ratio of 0.71. Our patients were obese in 95.1 % of cases with an average BMI of 39.13±7.19kg/m2. The majority of our patients had an impaired quality of life with an average score of 44.76 (SF36) and extremes of 22 and 70. There was a positive linear relationship between physical and mental components of the SF-36 and gender, age, BMI, and anxiety and depressive disorders. CONCLUSION: The OSA is a demanding disease whose impact on the quality of life seems important and requires special attention. The management of this disease should not be limited to controlling the disease but aspire to overall patient satisfaction.

[Impact of COPD on quality of life and mental health among one hundred Tunisian patients]. / Impact de la BPCO sur la qualité de vie et l'état de santé mentale chez cent patients tunisiens.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) constitutes a penalty in physical activities of patients. Its mental repercussions are important and expressed in a significant impairment of quality of life. OBJECTIVES: To evaluate the quality of life and its determinants in Tunisian patients with COPD. METHODS: We conducted a cross-sectional study over a period of 6 months from January 2008 to June 2008 and focused on patients with COPD hospitalized and monitored in the department of respiratory diseases in Farhat Hached Teaching hospital of Sousse in Tunisia. We used the French version of Saint George's respiratory questionnaire (SGRQ) to study the quality of life and the Hospital Anxiety Depression (HAD) for the exploration of anxiety and depression. RESULTS: Among 100 patients included in the study, the SGRQ overall score average was 44.31 ± 13.85%. Ten patients had depression and 9 patients had an anxiety state. The results of the multiple linear regression analysis showed that four factors were associated significantly with impaired quality of life: dyspnea, the number of exacerbations, comorbidity and depression. CONCLUSION: The psychological impact and effect on quality of life of COPD are additional tools combined with physical and spirometric data during the follow-up of treatment of patients and should be systematically sought by practitioners, which is still rare in Tunisia.

[Knowledge, attitudes and behaviors of hospital staff members towards smoking and anti-smoking regulations: results of a survey in F.-Hached University Teaching Hospital of Sousse (Tunisia)]. / Connaissances, attitudes et comportements du personnel hospitalier vis-à-vis du tabagisme et de la réglementation anti-tabac : résultats d'une enquête réalisée au CHU F.-Hached de Sousse (Tunisie).

BACKGROUND: Promoting a smoke-free hospital is a priority component for tobacco control strategies. The aim of our investigation was to study the attitudes and behaviors of the hospital staff of the F.-Hached UH of Sousse towards smoking, and to assess their knowledge about the harms of passive smoking and about tobacco regulations in the hospital. METHODS: We conducted a descriptive cross-sectional study using an anonymous self-administered questionnaire. In January-February 2008, the questionnaire was submitted to hospital staff members selected at random from the care units at F.-Hached UH of Sousse, Tunisia. RESULTS: The response rate was 92.8% (452 participants). The average age of the population was 39.7±19 years; all professional categories were represented. The prevalence of active smoking among the staff interviewed was 19% (89.5% males). About 75% of the smokers stated they smoked on the work site and 8% in the presence of patients. The majority of the smokers wished to stop smoking. Discomfort from exposure to tobacco smoke was reported by 83.4% of respondents. The large majority of staff respondents (95%) knew that tobacco smoke is dangerous and 80% were aware of the existence of a law that prohibits smoking in the hospital. CONCLUSION: The prevalence of smoking remains high among male hospital workers. In our hospital, the majority of the care staff favored promotion of a tobacco-free hospital. The success of this project will depend on education, implicating the entire hospital staff in the anti-smoking battle. Smoking staff members should be supported in their attempts to stop smoking.

[Occupational asthma in the Tunisian central region: etiologies and professional status]. / L'asthme professionnel dans la région du centre tunisien : étiologies et devenir professionnel.

OBJECTIVE: To study the etiologies of occupational asthma and determine its impact on the professional status of asthmatic subjects. METHODS: The authors carried out a descriptive study on all of the cases of asthma recognized as an occupational disease and declared in the private sector over nine years (2000-2008) in the Tunisian central region. RESULTS: Cases (219) of occupational asthma were listed, accounting for 16.8% of all of the occupational diseases recognized during the period studied. Occupational asthma concerned young adults (40±8.2 years), with a predominance of women (67.7%). The textile sector dominated (74.9%). The majority of the employees were exposed to high molecular weight allergens (82.3%) and cotton dust was the principal offending agent (75.3%). Involuntary unemployment was observed in about half of the cases (46.6%) and was associated with an age lower or equal to 35 years (p = 0.01) and under 15 years of professional seniority (p=0.03). CONCLUSION: Occupational asthma in the Tunisian central region prevails in the textile sector thereby justifying the reinforcement of preventive measures in this branch of industry.

[Cardiovascular risk factors among shift workers in company of electricity production in the centre of Tunisia]. / Facteurs de risque cardiovasculaire chez les travailleurs postés d'une centrale de production d'électricité au centre tunisien.

THE PURPOSE OF THE STUDY: The aim of the present study was to investigate relationship between shift work and the cardiovascular risk factors. METHODS: A cross-sectional study was included 330 subjects worked in a company of electricity production in the Centre of Tunisia. The collection of data was based on a questionnaire, a clinical exam and biomarkers. RESULTS: A total of 290 workers was participated in our study (128 shift workers and 162 daytime workers). A raised prevalence but not statistically significant of some factors of cardiovascular risks was found in the shift workers: obesity (25.8 % versus 17.9 %), smoking (44.5 % versus 39.5 %), impaired fasting glucose (11.7 % versus 9.9 %), hypertriglyceridemia (28.1 % versus 25.9 %) and hypercholesterolemia (14.8 % versus 12.4 %). Whereas the prevalence of the alcohol consumption (25.8 % versus 16.0 %) was significantly higher in the shift workers (p=0.04). CONCLUSION: The high prevalence of the cardiovascular risk factors, observed in our shift workers, justify the adoption of measures to protect this category of workers.

Clustering of cardiovascular risk factors among obese urban schoolchildren in Sousse, Tunisia.

Against a background of increasing obesity among Tunisians, we conducted a transversal survey of 1569 children aged 13-19 years selected by multistage cluster sampling to evaluate the prevalence of obesity and clustering of cardiovascular risk factors among obese schoolchildren in the urban area of Sousse. Obese children were found to have higher blood pressure, higher triglyceride levels and lower high-density lipoprotein cholesterol levels than children of normal weight. In both genders, the mean height and weight across all age groups was significantly higher in urban than in rural children. Our study indicates that obesity and the adverse effects of being over the ideal body weight are no longer limited to industrialized countries.

Clustering of cardiovascular risk factors among obese urban schoolchildren in Sousse, Tunisia

Against a background of increasing obesity among Tunisians, we conducted a transversal survey of 1569 children aged 13-19 years selected by multistage cluster sampling to evaluate the prevalence of obesity and clustering of cardiovascular risk factors among obese schoolchildren in the urban area of Sousse. Obese children were found to have higher blood pressure, higher triglyceride levels and lower high-density lipoprotein cholesterol levels than children of normal weight. In both genders, the mean height and weight across all age groups was significantly higher in urban than in rural children. Our study indicates that obesity and the adverse effects of being over the ideal body weight are no longer limited to industrialized countries

[Trigeminal somatosensory evoked potentials in workers handling trichloroethylene]. / Potentiels évoqués somesthésiques du trijumeau chez des travailleurs manipulant le trichloréthyléne.

Trigeminal somatosensory evoked potentials (TSEP) were studied in 33 workers manipulating trichlorethylene for 3 to 22 years and in 33 control subjects. A significant excessive latency delay of N13, P17 and N45 waves in workers was found. Evoked potential abnormalities found in 15 exposed subjects (45%) were as following: excessive latency delay in 9 cases (27%), decrease of amplitude in 2 cases (6%) and asymmetrical responses in 4 cases (12%). Among 5 workers (15%) presenting clinical abnormalities of trigeminal nerve impairment, only one had normal evoked potential. TSEP were altered in 11 workers (33%) who had no clinical impairment. We suggest that TSEP should be confirm trigeminal impairment in chronic cases of workers exposed to carbon tetrachloride and to predict infraclinic lesions.