Intégration de la prévention des TMS dès la conception d\u27un aménagement : le cas des bibliothèques publiques

Les troubles musculo-squelettiques sont fréquents chez les personnels de bibliothèques, en raison des postures statiques prolongées, des mouvements répétés, de l\u27utilisation d\u27outils informatiques ou de tâches de manutention. Ce rapport fait état de travaux qui ont mené à l\u27élaboration d\u27un modèle d\u27intervention ergonomique pour contribuer aux projets d\u27aménagement et concevoir des situations de travail qui ne soient pas source d\u27atteintes à la santé pour le personnel. Ces travaux leur ont permis d\u27établir un lien entre les activités du travail en bibliothèque et de nombreux facteurs de risques de troubles musculo-squelettiques. Les auteurs ont documenté l\u27influence de différents choix faits pendant deux projets d\u27aménagement en bibliothèque sur l\u27apparition de telles lésions. Les résultats de leur étude ont servi de base à la rédaction de publications pratiques qui permettent aux gestionnaires et au personnel des bibliothèques, aux ergonomes et aux spécialistes municipaux en santé et en sécurité du travail d\u27effectuer des choix d\u27équipements et d\u27aménagement qui tiennent compte de la prévention des troubles musculo-squelettiques

Contribuer à un projet d’aménagement par l’analyse ergonomique du travail : le cas d’une bibliothèque publique

L’ergonomie est de plus en plus intégrée à la conception de situations de travail, que ce soit dans le cadre de projets industriels ou de projets architecturaux. Dans ce dernier cas, en participant à la définition des espaces, les ergonomes contribuent également à influencer, en partie, l’organisation du travail future. Lors d’une intervention dans un projet de construction d’une nouvelle bibliothèque, des ergonomes chercheurs ont accompagné le déroulement du projet, aux phases concours d’architecture, études de concepts et études préliminaires. C’est en s’appuyant essentiellement sur l’analyse ergonomique du travail effectuée dans la bibliothèque existante, de même que dans des sites de référence que les ergonomes ont pu analyser les propositions architecturales et élaborer, avec un groupe de travail, des suggestions de modifications au cadre futur de travail. Cet article rend compte des activités mises en œuvre par les ergonomes au cours de leur intervention, notamment l’analyse ergonomique du travail, et de la manière dont l’intervention a pu influencer l’espace et l’organisation du travail. La trajectoire de la conception de deux des trois étages du bâtiment de la nouvelle bibliothèque illustrera ce propos et nous amènera à discuter de la portée et des limites de l’intervention ergonomique d’accompagnement et des conditions qui en rendent possible une issue positive pour le travail futur.Ergonomic considerations are increasingly being factored into work situation design, in both industrial and architectural projects. In the latter case, by participating in the definition of spaces, ergonomists also have an impact, in part, on future work organisation. Ergonomic researchers accompanied the construction of a new library in the architectural competition, design study and preliminary study phases. Basing themselves primarily on the ergonomic work analysis of the existing library and reference sites, the ergonomists analyzed the architectural proposals and then developed, with a working group, suggestions for modifying the future work framework. This article discusses the intervention activities implemented by the ergonomists during their intervention, namely ergonomic work analysis, and how the intervention was able to affect the work space and work organization. The design trajectory of two of the new library’s three floors will illustrate this and lead to a discussion of the scope and limitations of the accompanying ergonomic intervention and the conditions necessary for a positive outcome for future work.Se integra cada vez más la ergonomía a la concepción de situaciones de trabajo, que sea como parte de proyectos industriales o de proyectos arquitectónicos. En este caso, al participar a la definición de los espacios, los ergonomistas también contribuyen a influir en parte sobre la organización del trabajo venidero. Mientras intervinieron en un proyecto de construcción de una nueva biblioteca, los investigadores ergonomistas acompañaron el desarrollo del proyecto hasta las fases del concurso de arquitectura, estudios de conceptos y estudios preliminares. Los ergonimistas pudieron analizar las proposiciones arquitectónicas y elaborar, con un grupo de trabajo, sugerencias de modificaciones en el contexto futuro del trabajo, basándose esencialmente sobre el análisis ergonómico del trabajo efectuado en la biblioteca existente así como en los sitios de referencia. Este artículo informa sobre las actividades puestas en práctica por los ergonomistas a lo largo de su intervención como el análisis ergonómico del trabajo, y sobre la manera con la cual la intervención pudo influir sobre el espacio y la organización del trabajo. La trayectoria del diseño de dos de los tres pisos del edificio de la nueva biblioteca ilustrará este estudio y nos llevará a debatir el alacance y los límites de la intervención ergonómica de apoyo y las condiciones que hacen posible una solución positiva para el trabajo venidero

Impact of donor age over 70 years in donation after circulatory death liver transplantation: a 15 years of experience

peer reviewedBackground: Advanced donor age has been identified as a risk factor in donation after circulatory death (DCD 3) liver transplantation (LT), associated with poor graft function and development of ischemic cholangiopathy. In this study, we evaluated the results after DCD 3 LT using grafts from donors over 70 years compared to younger grafts (<70 years). Methods: We retrospectively analysed outcome after DCD 3 LT (n=228), comparing donors 70 years (n=53) and <70 years (n=175) from our center between 2003 and 2020. The two age groups were compared in terms of graft and patient survivals at 1, 3 and 5 years, in terms of donor and recipient demographics, transplant conditions and labora- tory values. Results: The overall graft survivals at 1, 3 and 5 years were 88, 75, 70 per cent respectively. Graft survival rates were not significantly diffe- rent at 5 years between the two groups (P = 0,536). No difference was noted in incidence of acute rejection, biliary strictures, hepatic artery thrombosis or retransplantation rates between the two groups. The time of cold ischemia was significatively lower in the older group (mean 235 min; SD 72) than in younger donor (mean 258 min; SD 72) (p=0.012). The posttransplant AST peak was significatively higher in the advanced age donor group than the second group with 2201±2703 U/L vs 1561U/L (SD 2151±2151 U/L), respectively (p= 0.04).Conclusions: Results for DCD LT from 70-yr-old grafts were similar to those from younger donors. Advanced donors should not be discarded for liver donation if other donor risk factors (such as cold ischemia time and graft quality) are limited

Professional Service Utilisation among Patients with Severe Mental Disorders

<p>Abstract</p> <p>Background</p> <p>Generally, patients with serious mental disorders (SMD) are frequent users of services who generate high care-related costs. Current reforms aim to increase service integration and primary care for improved patient care and health-care efficiency. This article identifies and compares variables associated with the use by patients with SMD of services offered by psychiatrists, case managers, and general practitioners (GPs). It also compares frequent and infrequent service use.</p> <p>Method</p> <p>One hundred forty patients with SMD from five regions in Quebec, Canada, were interviewed on their use of services in the previous year. Patients were also required to complete a questionnaire on needs-assessment. In addition, data were collected from clinical records. Descriptive, bivariate, and multivariate analyses were conducted.</p> <p>Results</p> <p>Most patients used services from psychiatrists and case managers, but no more than half consulted GPs. Most patients were followed at least by two professionals, chiefly psychiatrists and case managers. Care access, continuity of care, and total help received were the most important variables associated with the different types of professional consultation. These variables were also associated with frequent use of professional service, as compared with infrequent service use. In all, enabling factors rather than need factors were the core predictors of frequency of service utilisation by patients with SMD.</p> <p>Conclusion</p> <p>This study reveals that health care system organisation and professional practice - rather than patient need profiles - are the core predictors of professional consultation by patients with SMD. The homogeneity of our study population, i.e. mainly users with schizophrenia, recently discharged from hospital, may partly account for these results. Our findings also underscored the limited involvement of GPs in this patient population's care. As comorbidity is often associated with serious mental disorders, closer follow-up by GPs is needed. Globally, more effort should be directed at increasing shared-care initiatives, which would enhance coordination among psychiatrists, GPs, and psychosocial teams (including case managers). Finally, there is a need to increase awareness among health care providers, especially GPs, of the level of care required by patients with disabling and serious mental disorders.</p