[Pandemic forced telework, a new psychosocial risk. Reflections on the health issues and the necessary support]. / Télétravail contraint en pandémie, nouveau risque psychosocial : réflexions sur les enjeux santé et l'accompagnement nécessaire.

With the COVID-19 pandemic, barrier measures also concerned the world of work. In particular, teleworking was encouraged over a long period in France and then generalized in April 2021, promoting social isolation. The anxious climate linked to the pandemic and the precipitous nature of this decision induced a new psychosocial risk factor. The psychological manifestations linked to stress: anxiety, depressive disorders and others justify without delay a global action plan with systematic support measures by local management, systematic screening for possible maladjustment by the occupational health services and support people in difficulty. For this purpose and in these circumstances, self-questionnaires, directed questionnaires and video interviews appear to be the most suitable means. The chosen and part-time teleworking making it possible to reconcile family and professional life will remain a solution at certain times of life, but full-time teleworking cannot constitute an univocal and lasting solution.

Job satisfaction evaluation in low back pain: a literature review and tools appraisal.

UNLABELLED: Among occupational risk factors of recurrence, chronicity and no return to work in low back pain, poor job satisfaction is the only high evidence-based factor. OBJECTIVE: To find out any validated questionnaire usable to assess job satisfaction in low back pain patients, both in clinical practice and research setting. METHOD: A systematic literature search on Pubmed and Cochrane library databases and un-indexed literature was made. "Job satisfaction" and "low back pain" keywords were used. Only English and French relevant articles were retained. A double assessment was made of listed questionnaires according to psychometric properties and daily practice use. RESULTS: Among the 40 articles retained only four used a validated questionnaire. Among the 12 different questionnaires, only two are validated in their English version (Job Descriptive Index [JDI] and the Work Environment Scale [WES]) and one in its French Version (JDI). Because they are time consuming, use these questionnaires in daily practice seems difficult. CONCLUSION: Based on literature review and questionnaire heterogeneity, at this time, there is no reference job satisfaction questionnaire. For daily practice, global job satisfaction visual analog scale could be useful. For research and intervention, JDI is more suitable despite its validity is still questionable.

Shift of the 2009-2011 measles outbreak from children to adults: an observational review at the University Hospital of Clermont-Ferrand, France.

In 2009-2011, 113 adult in- and outpatients with measles were referred to the University Hospital of Clermont-Ferrand (centre of France): 71 (62.8 %) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients. The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected.

[Stress and auto-immunity]. / Stress et auto-immunité

The etiology of auto-immune disorders is multifactorial. Stress is probably a participating factor. Indeed, a high proportion of patients with auto-immune diseases report uncommon stress before disease onset or disease flare. The biological consequences of stress are increasingly well understood. Glucocorticoids and catecholamines released by hypothalamic-pituitary-adrenal axis during stress will alter the balance Th1/Th2 and the balance Th17/Treg. Stress impairs cellular immunity, decreases immune tolerance and stimulates humoral immunity exposing individuals to autoimmune disease among others. The treatment for autoimmune disease should include stress management.

[Pasteurella multocida meningitis in a 93-year-old woman following a cat bite]. / Méningite àPasteurella multocida chez une femme de 93ans après morsure par un chat.

Pasteurella multocida is commensal of the normal nasopharynx or gastrointestinal flora in many domestic and wild animals. Cat and dog bites usually cause soft tissue infections. P. multocida is an unusual causative agent of meningitis which tends to affect neonates or aged patients. The authors report a case (a 93-year-old woman) of P. multocida meningitis induced by a cat bite with dramatic sequels leading to complete patient disability.

[Cost/effectiveness comparison of the vaccine campaign and reduction of sick leave, after vaccination against influenza among the Clermont-Ferrand University Hospital staff]. / Comparaison coût/bénéfice de la campagne vaccinale et de la réduction de l'absentéisme, après vaccination contre la grippe du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The aim of this study was to compare the cost of vaccination for the Clermont-Ferrand University hospital (CHU) personnel and the cost of sick leave among vaccinated and non-vaccinated employees in 2003, 2004, and 2005. DESIGN: The study included 7256 CHU staff (medical and non-medical personnel). The cost of sick leave was calculated on the basis of short-term disease (four to nine days) over the three months of the epidemic season in 2004, 2005, and 2006. RESULTS: In 2005, the overall cost of vaccination was 4.02 euros per vaccinated employee. Over the three years, the total sick leave reached 804 days for employees vaccinated against 5670 for non-vaccinated employees. In 2003, 2004, and 2005, the vaccinal coverage was 13, 20.5, and 30.1%, the mean duration of sick leave was 0.16, 0.17, and 0.18 day among vaccinated staff, and 0.26, 0.39, and 0.34 day among non-vaccinated staff corresponding to a benefit per vaccinated employee of 5, 26, and 20 euros, respectively for each year. The total benefit for the institution was 86,458 euros (4630+38,168+43,660). If the vaccinated rate of 75% recommended by the Haute Autorité de santé (HAS) had been reached, the additional benefit would have been 250,193 euros (33,157+152,256+65,180). CONCLUSIONS: The number of sick leave days and the related cost were approximately twice less important for vaccinated employees, economically justifying this vaccination including a period of weak epidemic, as checked over three consecutive years.

[Relation between the level of knowledge and the rate of vaccination against the flu virus among the staff of the Clermont-Ferrand University hospital]. / Relation entre le niveau de connaissance et le taux de vaccination contre le virus de la grippe parmi le personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The main aim of this study was to determine how much staff at the Clermont-Ferrand university hospital, France, knew about influenza and its relation with the vaccinal rate. The other aim was to develop better-targeted information campaigns and prevention policy in the work place. DESIGN: A self-administered questionnaire was sent to the 7601 salaried staff of the hospital in May 2005. The staff was asked to give details on socioprofessional characteristics, vaccinal status, and knowledge about the influenza virus (mode of transmission, contagiousness, measures of prevention, populations affected, mortality, vaccination schedule, and vaccination target populations). Multiple-choice questions on knowledge of influenza were scored according to the answer given. RESULTS: The response rate was 26.5%. The 2011 completed questionnaires were representative of the working staff. They showed a positive correlation between the rate of vaccination and knowledge of influenza, with a 0.98 coefficient. They also showed that the staff was very largely unaware of population groups most at risk for influenza (1% of correct answers). CONCLUSIONS: Primary prevention campaigns will only be effective if the target population has a better awareness of the issues involved. This study highlights the areas in which knowledge was heterogeneous or inadequate, and the information that could be decisive in increasing vaccinal coverage among staff. This information should focus on modes of transmission, contagiousness, mortality, and above all on populations at risk.

[Analysis of motivations for antiflu vaccination of the Clermont-Ferrand University Hospital staff]. / Analyse des motivations à la vaccination antigrippale du personnel du CHU de Clermont-Ferrand.

OBJECTIVE: The vaccination of hospital staff decreases patient mortality and disorganization of services due to sick leave. The main aim of our study was to determine the Clermont-Ferrand University hospital (CHU) personnel's motivations for or against antiflu vaccination to increase the effectiveness of prevention campaigns. DESIGN: An autoquestionnaire with multiple choices was given to the 7601 CHU staff in May 2005. It documented socioprofessional characteristics, vaccinal status, and reasons for vaccination, nonvaccination, or stopping antiflu vaccination. RESULTS: The answer rate was 26.5% (2011 autoquestionnaires returned) and representative of the CHU staff. The rate of vaccination in 2004 was 36.35% with a strong correlation between vaccination and former influenza infection (p<0.001). Five of the six principal reasons for vaccination were altruistic including the first two: avoiding transmission to patients (61.8%) and his family (59.8%). The main reason for stopping was the lack of time. The reasons for nonvaccination were linked to a feeling of invulnerability: conviction of not being at risk, of being too young, or in good health. CONCLUSIONS: The Haute Autorité de santé's objective of vaccinal coverage against influenza for 75% of the health professionals requires their active compliance. The effectiveness of future campaigns could aim at improving knowledge by insisting particularly on the young age of the risk populations. The lack of time can be compensated by offering on-site vaccination, including at night and by proposing larger schedules for vaccination.

Hepatitis B in Moroccan health care workers.

AIM: To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). METHODS: Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. RESULTS: Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. CONCLUSION: HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.

[Impact study of an active antiflu vaccination programme on the Clermont-Ferrand Teaching Hospital staff]. / Etude d'impact d'une campagne active de vaccination antigrippale du personnel hospitalier du CHU de Clermont-Ferrand. achamoux@chu-clermontferrand.fr

OBJECTIVE: Protecting health care units from influenza epidemics has a double purpose: to decrease the mortality rate of patients at risk and to reduce work-leave in medical staff. An annual vaccination appears to be the most effective prevention against influenza. In France however the vaccinal coverage of health workers does not exceed 15%. METHOD: In the 2003-2004 winter, the department of occupational health and the nosocomial disease committee of the Clermont-Ferrand Teaching Hospital initiated an active vaccination campaign. Three joint actions were carried out: date and place of vaccination sessions were individually addressed to every healthcare worker, meetings on prevention of influenza were held, as well as vaccination sessions on the work place in exposed units. RESULTS: Significant results were noted: vaccination rate increased 2.6 fold compared to the previous year (4.8 to 12.6%) and a vaccinal coverage rate of 29% in the exposed units. COMMENTS: The results even if far from national objectives encourage the pursuit of the campaigns promoting information and vaccination on the work place. The high frequency of reported postinjection adverse effects (1 out of 3) should be taken into account in future information campaign.

[Do circannual rhythm of cortisol and testosterone interfere with variations induced by other events?]. / Les rythmes circannuels du cortisol et de la testostérone interfèrent-t-ils avec les variations de ces hormones liées à d'autres évènements?

OBJECTIVE: Cortisol and testosterone are two hormones whose levels may vary in response to sports or occupational events. We wondered if the circannual rhythm of these hormones could have an influence on such responses or whether changes can always be ascribed to a single cause. METHOD: For cortisol, we conducted a cross-sectional study among 102 adult men (mean age 42 years) using saliva samples taken one half hour after awakening. The values were combined over three-month periods corresponding to the four seasons. For testosterone, conclusions were drawn from data reported in the literature. RESULTS: The mean annual cortisol level was 14.36+/-0.44 nmol/l. There was no significant difference between average and peak values nor between maximal and minimal values. For testosterone, there have been a limited number of studies and it is unclear whether there is a seasonal change. In any case, the amplitude of variations is weak (9.7% between peak and annual average), which is partly ascribable to individual and interindividual variability. CONCLUSION: We conclude that there is no seasonal (or circannual) rhythm in cortisol levels to a degree which could interfere with effects resulting from other events. For testosterone, the circannual rhythm may account for 10% of the variation.

[Occupational risk for blood exposure and staff behaviour: a cross-sectional study in 3 Moroccan healthcare centers]. / Comportement et conditions de travail exposant au sang: analyse des pratiques dans trois établissements de soins du Maroc.

OBJECTIVE: As in other countries, Moroccan health-care workers are exposed to occupational blood exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and hygiene conditions determining the OBE risk for health-care workers. WORKERS AND METHODS: In March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals and health centers, as well as in a Rabat public medical analysis laboratory. RESULTS: The participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of 41.4 years (+/-7 years). Health-care workers answered that: occupational hygiene and safety were inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of OBE was 1.5 (+/-4.3) per capita. If we consider the whole career of health-care workers, the incidence reached about 14.3+/-28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule. CONCLUSION: The study shows that there is a need to improve occupational hygiene and safety conditions for Moroccan health-care workers in order to reduce OBE hazards.

Biological and psychological responses to two rapid shiftwork schedules.

This study presents the biological responses to shiftwork in two groups of workers with different shiftwork rotas. Biological responses were studied by recording the heart rate and the changes in the circadian profile of salivary cortisol over 24 h (RIA assays). Various items were recorded through questionnaires aimed at determining self appreciation of sleep quantity, stress, health, satisfaction at work and in private lives. Thirty two male subjects aged from 23 to 56, working for the same company, having given their informed consent, took part in the study. The study was carried out under realistic conditions (at the work place) under the control of an occupational physician. Sixteen day-workers (8 am-6 pm) served as a reference group. Eight shiftworkers included in alternate schedules (morning M 4 am-12 am, evening E 12 am-8 pm, night N 8 pm-4 am) according to a system M, S, N 3/2, (3 work, 2 rest) and eight according to a system 7/5 (3M/2S/2N/5R, 2/3/2/5, 2/2/3/5) constituted the groups of shiftworkers respectively named 3/2 and 7/5. All subjects had comparable ages and BMIs. Shiftworkers expressed a higher stress level and frequency of health problems and a lower satisfaction at work than the control. Among the three groups, the 7/5 group had the best health and fitness score and was in need of less sleep. Heart rate was not affected by shift work. Conversely, consistent changes appeared in cortisol circadian profiles, the greatest changes appearing for the night shift and among the two groups of shiftworkers, more particularly for the 7/5 group. These changes correlated with self-perceived constraints of work and showed the difficulties of adaptation to shiftwork.

Elevated salivary cortisol levels as a result of sleep deprivation in a shift worker.

BACKGROUND: This paper reports a case from a group of 63 shift-workers for whom adaptation to shift-work was evaluated through measurement of salivary cortisol levels. METHODS: Workers' saliva was sampled and cortisol levels measured at intervals of 2 h during morning, evening and night shifts. RESULTS: For one subject among the 63, very high values of cortisol (an approximately 6-fold increase) were observed for the morning (M) shift, but with normal values found for evening (E) and night (N) shifts. Individual mean and peak cortisol values were 48.4 and 67.8 nmol/l against group mean and peak cortisol values of 8.9 and 11.0 nmol/l. Retrospective questioning showed that this subject was healthy and there were no indicators of long-term stress. CONCLUSION: This cortisol rise was deduced to be caused by sleep deprivation as a result of rapidly rotating shift patterns.

Median maximal heart rate for heart rate calibration in different conditions: laboratory, field and competition.

The objective of this study was to evaluate the variability of maximal heart rate in three different conditions: laboratory tests, field tests, and competitions. Sixteen male endurance volunteers were tested in five exhaustive tests for each condition. All exhaustive events were heart rate monitored (Accurex plus, Polar Electro, Finland) and true maximal heart rates were assessed and compared with each other and with predicted maximal heart rates. Results show that under the three conditions HR(peaks) were not statistically different (p = 0.62, NS, Friedman test). Mean HR(peaks) (SD) were: laboratory = 194.3 (7.8), field = 193.8 (11.8), competition = 192.3 (10.1) beats x min(-1). Conditions for reaching individual heart rate peak were in the laboratory (treadmill VO(2)max protocol) for 5 subjects, in field tests for 7 subjects and in competitions for 6 subjects (two circumstances for two subjects). A large intra-individual variation existed in the three circumstances (+/- 6 beats x min(-1)). Absolute median maximal heart rate was 190.0 bpm (9.32) i.e 7.6 bpm lower than heart rate peak. Both were highly related (rho = 0.89, z = 3.449, p = 0.0006, Spearman test). Median maximal heart rates inter-condition relationship were higher. Median maximal heart rate was more stable and took more information into account than an isolated peak. It gives a central value that minimizes the potential risk of under or over estimation when calibrating exercise intensities with HR.

Components and variations in daily energy expenditure of athletic and non-athletic adolescents in free-living conditions.

The objectives of the study were to determine: (1) daily energy expenditure (EE) of athletic and non-athletic adolescents of both sexes in free-living conditions; (2) day-to-day variations in daily EE during 1 week; (3) energy costs of the main activities; and (4) the effect of usual activity on EE during sleep, seated and miscellaneous activities. Fifty adolescents (four groups of eleven to fifteen boys or girls aged 16-19 years) participated in the study. Body composition was measured by the skinfold-thickness method, and VO2max and external mechanical power (EMP) by a direct method (respiratory gas exchanges) on a cycloergometer. Daily EE and partial EE in free-living conditions were computed from heart-rate (HR) recordings during seven consecutive days using individual prediction equations established from the data obtained during a 24 h period spent in whole-body calorimeters with similar activities. Fat-free mass (FFM), VO2max, EMP, daily EE and EE during sleep were significantly higher in athletic than in non-athletic subjects. After adjustment for FFM, VO2max, EMP, daily EE and EE during exercise were still higher in athletic than in non-athletic adolescents (P < 0.001). However, adjusted sleeping EE was not significantly different between athletic and non-athletic adolescents. Increases in exercise EE were partly compensated for by significant reductions in EE during schoolwork and miscellaneous activities. Thus, the differences in daily EE between athletic and non-athletic subjects resulted mainly from increases in FFM and EE during exercise (duration and energy cost).

Heart rate monitors and abnormal heart rhythm detection.

We test the accuracy of two third generation heart rate monitors (HRM), Accurex Plus and Vantage NV and compare these data with those of an older monitor, PE 4000. Then we investigate responses of the HRM's to abnormal heart rhythms (HR). Accurex Plus and Vantage NV, and PE 4000 were tested in the laboratory under both stable and transient conditions. The Phantom 320 HR simulator gave 7 stable heart rates, each lasting 3 min. The responses of the HRM's to abnormal heart rhythms were tested with an automatic arrhythmia program lasting 17 min. The new HRM's, Accurex Plus and Vantage NV, were more accurate (89 to 94% and over 98% at +/-3 beats per min) in the stable state than the PE 4000. They all showed a smoothing effect in transient measurements, which was stronger in decelerating HR (1st case) than in accelerating HR (2nd case). - 1st case: Accurex Plus =Vantage NV >PE 4000 -2nd case: PE 4000 >Accurex =Vantage. Most isolated heart rhythm disorders (missing beat, pause < 4 s, SVEA, and SVT) were either not detected or rejected. Signal changes such as changes in QRS (ventricular bigeminy) may cause detection losses, and so modify calculated heart rate. HR signal rising/dropping slopes caused by sudden heart rhythm disorders, was notably attenuated, with a consequent loss of HR accuracy. Although the usefulness of HRM's in detecting HR disorders is limited, they have some value with serious disorders, like pause >4 s, important bradycardia or tachycardia.