Evaluation of the tuberculin skin test and the interferon-γ release assay for TB screening in French healthcare workers

<p>Abstract</p> <p>Introduction</p> <p>Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-γ Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients.</p> <p>Methods</p> <p>Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST ≥ 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered.</p> <p>Results</p> <p>All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST ≥ 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation.</p> <p>Conclusion</p> <p>The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.</p

Gene expression profiling in sinonasal adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>Sinonasal adenocarcinomas are uncommon tumors which develop in the ethmoid sinus after exposure to wood dust. Although the etiology of these tumors is well defined, very little is known about their molecular basis and no diagnostic tool exists for their early detection in high-risk workers.</p> <p>Methods</p> <p>To identify genes involved in this disease, we performed gene expression profiling using cancer-dedicated microarrays, on nine matched samples of sinonasal adenocarcinomas and non-tumor sinusal tissue. Microarray results were validated by quantitative RT-PCR and immunohistochemistry on two additional sets of tumors.</p> <p>Results</p> <p>Among the genes with significant differential expression we selected <it>LGALS4, ACS5, CLU, SRI and CCT5 </it>for further exploration. The overexpression of <it>LGALS4, ACS5, SRI</it>, <it>CCT5 </it>and the downregulation of <it>CLU </it>were confirmed by quantitative RT-PCR. Immunohistochemistry was performed for LGALS4 (Galectin 4), ACS5 (Acyl-CoA synthetase) and CLU (Clusterin) proteins: LGALS4 was highly up-regulated, particularly in the most differentiated tumors, while CLU was lost in all tumors. The expression of ACS5, was more heterogeneous and no correlation was observed with the tumor type.</p> <p>Conclusion</p> <p>Within our microarray study in sinonasal adenocarcinoma we identified two proteins, LGALS4 and CLU, that were significantly differentially expressed in tumors compared to normal tissue. A further evaluation on a new set of tissues, including precancerous stages and low grade tumors, is necessary to evaluate the possibility of using them as diagnostic markers.</p

Les manipulateurs en radiologie face aux risques de troubles musculosquelettiques (analyse et prévention des risques à l'hôpital Läennec de Nantes)

La prise en compte du bien-être physique des soignants, surtout lorsqu'il s'agit d'une activité telle que la manutention des malades, ne fait pas nécessairement partie des préoccupations majeures de ceux qui pensent efficacité de l'Institution Hospitalière, qualité des soins et innovation thérapeutique. Notre étude vise, de façon très concrète et très pragmatique, à analyser les tâches de manutention des soignants d'un service de radiologie pour prévenir et réduire les risques de TMS liés à leur activité. La méthode s'appuie sur une description détaillée des tâches de manutention, effectue une cotation de pénibilité au moyen de deux méthodes (celle proposée par l'INRS et la méthode NIOSH) et analyse les facteurs de risques associés aux manutentions les plus pénibles. L'étude met en évidence l'importance de la charge physique et les fortes contraintes biomécaniques supportées par les organismes. Même si les accidents déclarés liés aux manutentions restent relativement peu nombreux, le risque est réel et on peut craindre une accentuation des " maladies d'usure " sous le double effet de l'intensification du travail et du vieillissement de la population des soignants. Des solutions existent : aménagement ergonomique de l'environnement de travail, aides techniques adaptées, formation spécifique à la manipulation des malades, aménagement des horaires, meilleure répartition des charges de travail, etcCe que l'étude montre aussi, c'est que l'analyse des risques de TMS constitue une excellente porte d'entrée pour une approche globale de la vie au travail. Les soignants que nous avons écoutés, nous ont aussi parlé de leur vécu au sein de l'institution et quand ils évoquent la pénibilité de leur travail, c'est aussi une demande de reconnaissance et de valorisation professionnelle qu'ils expriment. Prévenir les TMS va au delà d'un réaménagement ergonomique du poste de travail, c'est aussi poser la question du bien-être au travail et de l'identité professionnelle.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Étude contrôlée randomisée de l’impact à deux ans d’un programme d’intervention sur l’empowerment d’équipes médico-soignantes

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Longitudinal psychological empowerment profiles, their determinants, and some health-related outcomes

International audienceThis research relies on bifactor models to help improve our understanding of the dimensionality of the psychological empowerment construct. We also examined the configurations, or profiles, taken by psychological empowerment dimensions, and documented their stability over time as well as the associations between these profiles and theoretically-relevant predictors (workload, supervisor support, overall organizational justice, and role clarity) and outcomes (alcohol consumption, sleeping difficulties, and depressive symptoms). A sample of 750 healthcare workers completed a questionnaire twice over a one-year period. First, our results showed that employees' psychological empowerment ratings simultaneously reflected a global overarching construct co-existing with four specific dimensions (competence, impact, meaning, and self-determination). Then, five profiles were identified and found to be highly stable over time: Low Empowerment, Moderately High Empowerment and Impact, Normative, High Empowerment, and Moderately High Empowerment and High Meaning. Role clarity was also associated with a higher likelihood of membership into the High Empowerment profile and a lower likelihood of membership into the Low Empowerment one relative to the other profiles. Finally, employees' depressive symptoms were the highest in the Low Empowerment profile

702 Association between reported work in cold environments and stroke occurrence in the CONSTANCES cohort

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A longitudinal investigation of structural empowerment profiles among healthcare employees

PurposeResearch on structural empowerment has typically adopted a variable-centered perspective, which is not ideal to study the combined effects of structural empowerment components. This person-centered investigation aims to enhance our knowledge about the configurations, or profiles, of healthcare employees’ perceptions of the structural empowerment dimensions present in their workplace (opportunity, information, support, and resources). Furthermore, this study considers the replicability and stability of these profiles over a period of two years, and their outcomes (perceived quality of care, and positive and negative affect). DesignParticipants completed the same self-reported questionnaires twice, two years apart.MethodsA sample of 633 healthcare employees (including a majority of nurses and nursing assistants) participated. Latent transition analyses were performed.ResultsFive profiles were identified: Low Empowerment, High Information, Normative, Moderately High Empowerment, and High Empowerment. Membership into the Normative and Moderately High Empowerment profiles demonstrated a high level of stability over time (79.1% to 83.2%). Membership in the other profiles was either moderately stable (43.5% for the High Empowerment profile) or relatively unstable (19.7% to 20.4% for the Low Empowerment and High Information profiles) over time. More desirable outcomes (i.e., higher positive affect and quality of care, and lower negative affect) were observed in the High Empowerment profile. ConclusionsThese results highlight the benefits of high structural empowerment, in line with prior studies suggesting that structural empowerment can act as a strong organizational resource capable of enhancing the functioning of healthcare professionals. These findings additionally demonstrate that profiles characterized by the highest or lowest levels of structural empowerment were less stable over time than those characterized by more moderate levels.Clinical RelevanceFrom an intervention perspective, organizations and managers should pay special attention to employees perceiving low levels of structural empowerment, as they experience the worst outcomes. In addition, they should try to maintain high levels of structural empowerment within the High Empowerment profile, as this profile is associated with the most desirable consequences. Such attention should be fruitful, considering the instability of the High Empowerment and Low Empowerment profiles over time.Registration: NCT04010773 on ClinicalTrials.gov (04 July, 2019

Association between reported work in cold environments and stroke occurrence in the CONSTANCES cohort: a prospective study

International audienceObjective Cold environments are a potential risk factor for stroke. The aim of this study was to investigate the association between performing work tasks in cold environments and the occurrence of a first stroke event. Methods From the French population-based cohort CONSTANCES (‘ Cohorte des consultants des Centres d'examens de santé ’ in French), we collected data from baseline questionnaires along with medical interviews on cardiovascular risk factors and reported exposure to cold temperatures (<10°C) at work. Exposures were categorised as rare (<2 hours/day), often (≥2 and <4 hours/day) and almost always (≥4 hours/day). Incidence of stroke was retrieved from the French National Health database. Bivariate and multivariable logistic regression models were used to assess the association between working in cold environments and the incidence of stroke. Stratified analyses on stroke types were also conducted. Results There were 160 782 participants and 224 strokes (168 ischaemic and 76 haemorrhagic) included in our study. No significant increase in stroke was found for working in cold environments; the adjusted OR for often or almost always exposed was 1.14 (95% CI 0.46 to 2.84). Conclusions This study did not reveal a significant excess risk of stroke for occupational exposures to low temperatures. Further studies are needed to better assess the effect of preventive measures and very low temperature on occurrence of cardiovascular diseases