L'arboretum d'Amance. Bilan au 01/01/1985

*Unite regionale de documentation INRA Nancy Diffusion du document : Unite regionale de documentation INRA NancyNational audienc

Imagerie tomodensitométrique thoracique après exposition à l’amiante

International audienceThe complementary examination recommended in France for the follow-up of populations previously exposed to asbestos is the thoracic computed tomography (CT) examination, without injection of contrast product, with millimetric sections. The most frequently observed abnormalities related to this exposure are localized fibrosis of the parietal pleura (or pleural plaques), a benign condition with no therapeutic issue but involving significant medico-social issues in France (in particular recognition as an occupational disease, compensation by the Fund compensation for asbestos victims). In a French study, involving more than 5,000 subjects previously exposed to asbestos, discrepancies in interpretation were reported according to the expertise of the doctor in charge of interpreting the CT scan (substantial percentage of false positives, and even higher frequency of false negatives for pleural plaques when comparing the interpretation of the radiologist who performed the examination and that of a radiologist expert in thoracic imaging). Given the medico-social issues and from a perspective of social equity, it seems important to be very rigorous in the technical methods of carrying out and interpreting the chest CT examinations performed in the follow-up assessments after exposure to asbestos, in particular with a view to medico-social requests. It is recommended that the occupational physician involved in asbestos post-exposure follow-up, and also the physician in charge of examining a case for compensation, request a re-reading by an expert physician based on the tools offered by the Haute Autorité de santé and updated in 2019.L’examen complémentaire recommandé en France pour le suivi des populations antérieurement exposées à l’amiante est l’examen tomodensitométrique (TDM) thoracique, sans injection de produit de contraste, avec des coupes millimétriques. Les anomalies les plus fréquemment observées liées à cette exposition sont une fibrose localisée de la plèvre pariétale (ou plaques pleurales), affection bénigne sans enjeu thérapeutique mais comportant des enjeux médico-sociaux importants en France (notamment reconnaissance en maladie professionnelle, indemnisation par le Fonds d’indemnisation des victimes de l’amiante). Il a été rapporté dans une étude française, portant sur plus de 5000 sujets antérieurement exposés à l’amiante, des discordances d’interprétation en fonction de l’expertise du médecin en charge de l’interprétation de l’examen TDM (pourcentage substantiel de faux positifs et pourcentage encore plus élevé de faux négatifs, pour les plaques pleurales). Compte tenu des enjeux médico-sociaux et dans une perspective d’équité sociale, il apparaît important d’être très rigoureux dans les modalités techniques de réalisation et d’interprétation des examens TDM thoraciques réalisés dans les bilans de suivi après exposition à l’amiante, en particulier en vue de demandes médico-sociales. Il est recommandé que le médecin du travail impliqué dans le suivi post-exposition à l’amiante, comme le médecin en charge de l’instruction d’un dossier en vue d’indemnisation, sollicite une relecture par un médecin expert s’appuyant sur les outils proposés par la Haute Autorité de santé et mis à jour en 2019

Rôle des SPST (Services de Prévention et de Santé au Travail) pour la traçabilité des expositions, le SPE (Suivi Post-Exposition) et le SPP (Suivi Post-Professionnel) : cadre juridique, questions à traiter, outils disponibles et recommandations de la Société française de médecine du travail

National audienceThe purpose of these recommendations is to clarify the legal framework, delineate the role of occupational health services and make recommendations on the implementation of the visits prior to post-exposure or post professional survey.L’objectif de ces recommandations est de préciser le cadre juridique, délimiter le rôle des Services de prévention et de santé au travail et effectuer des recommandations sur la mise en œuvre des visites en vue d’un suivi post-exposition ou post-professionnel

The significance of preschool behaviour problems for adjustment in later life

‘A child is born into a world of phenomena all equal in their power to enslave. It sniffs, it sucks — it strokes its eyes over the whole uncomfortable range. Suddenly, one strikes. Why? Moments snap together like magnets, forging a chain of shackles. Why? I can trace them. I can even with time pull them apart again. But why at the start they were ever magnetized at all —just those particular moments of experience and no others — I don't know. And nor does anyone else.’ from Equus by Schaffer (1974). Quoted in Chess, S. and Thomas, A. (1984)Origins and Evolution of Behaviour Disorders: from infancy to early adult life. Brunner Mazel, NY. The discussion of the significance of preschool behaviour problems for later adjustment begins by grounding the issue in the wider theoretical framework of developmental psychology. Transactionalismis identified as a global theory which now governs our understanding of developmental processes. It is shown to have a powerful explanatory value in relation to the long‐term effects of early adjustment problems. Longitudinal studies are reviewed and the development, maintenance and conversion of early problems (or indeed their disappearance or moderation) can be identified as transactional processes. The concept of risk and resilience are of central importance; some individuals show ‘competence’ and resist adversity but establishing why is beset with methodological and conceptual problems which may obscure actual vulnerability or misconstrue risk variables. Finally, research is found to be of limited value which does not address and explore the processes and mechanisms underlying resilience. A recent review of the impact of maternal depression on children exemplifies a transactional approach to understanding behavioural problems and also addresses the demand for a description of mechanisms involved. However, the issue of risk remains a major challenge