Interventions externes en santé et en sécurité du travail : Influence du contexte de l’établissement sur l’implantation de mesures préventives

Un modèle d’analyse a été construit pour rendre compte de l’influence du contexte de l’établissement sur l’issue d’interventions de prévention en santé et en sécurité du travail. Il a été constitué à partir d’une étude de cas en profondeur de sept interventions réalisées par des conseillers externes. L’étude examine l’influence du degré de développement des activités en prévention avant l’intervention, qui apparaît lui-même fortement lié aux caractéristiques structurelles des établissements. Une typologie des modes de régulation sociale de la santé et de la sécurité observés au sein des milieux de travail est présentée ; ces régulations jouent également un rôle dans la mise en oeuvre des mesures préventives. L’étude met en évidence l’apport des interventions externes à la prévention en santé et en sécurité du travail, et de leur collaboration soutenue avec les milieux de travail, au cours d’interventions successives.Various studies have shown that worker health and safety are related, among other things, to the characteristics of the organization to which workers belong, and the social interactions taking place within the organization. Our study centres on understanding what influence the context has on creating positive change, in terms of occupational health and safety prevention, resulting from external interventions.Our theoretical framework is based on three complementary sources: the work of Dawson et al. (1988) for whom the organization’s “capacity” and “willingness” play a role in explaining the scope and limits of a regime based on the principle of self-regulation; the theory of labour market segmentation, where the influence of the structural characteristics of organizations is examined, and the research undertaken by Reynaud (1988, 1991, 1997) which focuses on the relationships between the actors in the workplace.Seven case studies were carried out during the same number of interventions by joint occupational health and safety sector-based association advisors, in six workplaces. These workplaces varied greatly in terms of size, worker qualification levels, gender and ethnic origin, wage levels and staff turnover. The first case study began in September 1999, and the last ended in the spring of 2000. The data consisted of (non participatory) observations carried out during visits the advisors made at the workplaces (43), semi-structured interviews (50) and telephone conversations (8) with the advisors’ contacts and with those actors in a position to influence the intervention and the outcome of the proposed changes. Twenty-six interviews and 41 telephone conversations with the advisors were also analyzed, as were ten other interviews and height telephone conversations for validation purposes. In total, 186 data sources were thus analyzed. Each proposed change was recorded and its outcome documented (accepted or not, implemented or not).Observations support the hypothesis that the structural characteristics of the workplace influence the degree to which prevention activities had been developed at the outset of the intervention, these activities being more developed in cases where the structural characteristics of the workplace match the characteristics of the primary segment of the labour market. However, in the cases studied, this relation does not seem to be determinative. Furthermore, similarity with the characteristics of the primary segment does not necessarily “guarantee” a high level of organization in prevention. Sustained cooperation between the workplace and the sector-based associations, in setting up an Occupational Health and Safety Joint Committee and establishing a structured set of prevention activities, also helped to further develop these activities. This external support appears to have a moderating effect on the trend defined by the structural characteristics. Observations suggest that prevention activities can be classified in accordance with three large structural stages of prevention. Moving from one level to the next involves a significant qualitative leap in prevention. The outcome of the change proposals was partly contingent on the magnitude of the gap between the activities already in place (and the assets available to sustain them), on the one hand, and the capacities required to put the new activities in place, on the other. The spontaneous structuring of prevention does not follow a logic based on the preventive efficiency of each measure taken, but rather that of the assets that are required. This stresses the relevance of external advice and statutory provisions aiming to organize prevention and ensure worker representation. In order to understand the context in which the interventions take place, our study also examines how, within the framework in the context defined by the structural characteristics of the workplace, the actors regulate the risks associated with the workplace, through their own actions and interactions. Social regulations observed around OHS matters in the different workplaces can be compared with each other and situated in a continuum where, at one end, they can be qualified as being “unorganized” (due to the “exit” associated with high employee turnover), and at the other end, “organized” with workers forming a collective body allowing for an expression of their “voice” in discussions with their employer on the subject of occupational health and safety. This can either be informal, between employees and supervisors, or formal, through a joint health and safety committee, negotiations between a trade union and an employer, etc. This interaction, however, does not guarantee action in the field of prevention, although the formation of a collective body by workers does seem to be an essential step. Results point to the contribution of external advice in structuring the prevention measures. Government intervention is also seen as necessary in order to ensure the organization of prevention and workers representation.Se ha construido un modelo de análisis para ilustrar la influencia del contexto de establecimiento en el resultado de las intervenciones de prevención en salud seguridad ocupacional. Se basa en un estudio de caso en profundidad de siete experiencias de intervención realizadas por consejeros externos. El estudio examina la influencia del nivel de desarrollo de las actividades de prevención previas a la intervención, el cual se encuentra, a su vez, fuertemente ligado a las características estructurales de los establecimientos. Se presenta una tipología de los modelos de regulación social de la salud y seguridad ocupacional observados en los medios de trabajo. Estas regulaciones juegan un rol en la implantación de las medidas preventivas. El estudio pone en evidencia la contribución de las intervenciones externas en la prevención en salud y seguridad ocupacional así como su colaboración sostenida con los respectivos medios de trabajo a lo largo de intervenciones sucesivas

Conditions et processus menant à des changements à la suite d’interventions en santé et en sécurité du travail : l’exemple d’activités de formation

Cet article traite des conditions et processus menant à des changements à la suite d’interventions en santé et en sécurité du travail ; il utilise l’exemple d’activités de formation. Des observations et entrevues ont été réalisées lors de quatre interventions de conseillers d’associations sectorielles paritaires en SST. Trois dimensions du contexte influencent les changements : le degré préalable de développement des activités en prévention ; la présence d’acteurs en mesure de s’en faire les « relais » et « maîtres d’œuvre » ; la présence d’enjeux favorables. La collaboration passée avec l’organisme conseil contribue aux deux premières, suggérant l’intérêt du suivi soutenu par l’organisme de prévention. Différentes stratégies sont déployées pour développer les capacités manquantes et soulever les enjeux favorables. Divers processus menant à des changements sont observés : une transformation de la représentation qu’ont les travailleurs de leur capacité à agir ; la légitimation de leur action sur les risques ; le partage d’expérience en prévention ; un processus collectif de résolution de problème.This article deals with the conditions and processes that lead to changes following occupational health and safety interventions, with training activities being used as an example. Observations and interviews were conducted during four training interventions carried out by advisors from joint OHS sector-based associations. Three aspects of the context influence the changes: the previous degree of development of prevention activities; the presence of “relay” actors; and the presence of favourable issues. Previous collaboration with the prevention organization contributes to the presence of the first two, suggesting the relevance of sustained follow-up by the prevention organization. Different strategies are used to develop these capacities and to raise favourable issues. Different processes leading to changes were observed: a change in the workers’ perception of their capacity to take action; legitimization of their action on risks; sharing of prevention-related experience; and a collective problem-solving process.Utilizando como ejemplo las actividades de formación, este artículo trata de las condiciones y procesos que conducen a los cambios que siguen las intervenciones en salud y seguridad en el trabajo (SST). Se realizaron observaciones y entrevistas durante las intervenciones de cuatro consejeros de las asociaciones sectoriales paritarias en SST. Tres dimensiones del contexto influencian los cambios : el grado previo de desarrollo de las actividades de prevención ; la presencia de actores que pueden servir de « relevo » y de “maestros de obra” y la presencia de características de la situación que son favorables. La colaboración pasada con el organismo consejero contribuye a las dos primeras, sugiriendo el interés de un seguimiento continuo por parte del organismo de prevención. Diferentes estrategias son desplegadas para desarrollar las capacidades que faltan y para revelar los factores favorables. Observamos diversos procesos que conducen a cambios : una transformación de la representación que tienen los trabajadores en cuanto a su capacidad de actuar, la legitimación de su acción sobre los riesgos, el compartir la experiencia en prevención ; un proceso colectivo de resolución de problemas

Agronomie Oasienne. Projet de Coopération Franco-Tunisien. Proposition d'un projet de Coopération technique : "Recherches pour le Développement de l'agriculture d'oasis dans le Sud Tunisien". Rapport de missions Synthèse et propositions

Ce document est le résultat des missions réalisées au cours du premier semestre 1991 dans le cadre du projet d'appui à la recherche sur l'agriculture d'oasis en Tunisie. Il regroupe deux dossiers : - Rapports de missions et - Synthèses et propositions. Dans la première partie du document, après une brève présentation du projet, 4 volets sont détaillés : - "Inventaire du patrimoine génétique Oasien", - "Protection des cultures", "Agronomie et Développement", et "Technologie post-récolte". La deuxième partie du rapport présente les moyens, la programmation ainsi que le suivi et évaluation du proje

Decompression sickness in urban divers in France

Background: Decompression sickness (DCS) can occur in SCUBA divers. DCS is treated with oxygen, preferably given under hyperbaric conditions. Although Paris (France) is located at a distance from the sea or lakes, some injured divers require hyperbaric oxygen treatment (HBOT) in this city, sometimes within a specific time frame. Thus, this study investigated the epidemiology and outcomes of such urban divers. Aim: We conducted an observational study of SCUBA divers admitted to the Raymond Poincaré Hyperbaric centre near Paris from 1993 to 2003. Materials and methods: We prospectively enrolled 69 consecutive SCUBA divers presenting DCS. Common risk factors were reported, especially aeroplane flight and training dives. Symptoms are very often atypical (63%) and onset time of symptoms is often too long (59% after 2 h) due to denial of symptoms. First aid is generally inadequate, with only 23% of victims receiving oxygen, fluid loading and aspirin together. HBOT was given for 42 (61%) patients although their examination results were considered as normal. Conclusions: Diving pits and diving travel agencies should do more to warn divers of the need for treatment with normobaric oxygen and hydration pending HBOT. Moreover, hyperbaric physicians should better clarify HBOT indications for both symptoms of late onset and atypical presentations

Channel-based key generation for encrypted body-worn wireless sensor networks

Body-worn sensor networks are important for rescue-workers, medical and many other applications. Sensitive data are often transmitted over such a network, motivating the need for encryption. Body-worn sensor networks are deployed in conditions where the wireless communication channel varies dramatically due to fading and shadowing, which is considered a disadvantage for communication. Interestingly, these channel variations can be employed to extract a common encryption key at both sides of the link. Legitimate users share a unique physical channel and the variations thereof provide data series on both sides of the link, with highly correlated values. An eavesdropper, however, does not share this physical channel and cannot extract the same information when intercepting the signals. This paper documents a practical wearable communication system implementing channel-based key generation, including an implementation and a measurement campaign comprising indoor as well as outdoor measurements. The results provide insight into the performance of channel-based key generation in realistic practical conditions. Employing a process known as key reconciliation, error free keys are generated in all tested scenarios. The key-generation system is computationally simple and therefore compatible with the low-power micro controllers and low-data rate transmissions commonly used in wireless sensor networks

Heterochromatic Genes Undergo Epigenetic Changes and Escape Silencing in Immunodeficiency, Centromeric Instability, Facial Anomalies (ICF) Syndrome

Immunodeficiency, Centromeric Instability, Facial Anomalies (ICF) syndrome is a rare autosomal recessive disorder that is characterized by a marked immunodeficiency, severe hypomethylation of the classical satellites 2 and 3 associated with disruption of constitutive heterochromatin, and facial anomalies. Sixty percent of ICF patients have mutations in the DNMT3B (DNA methyltransferase 3B) gene, encoding a de novo DNA methyltransferase

Safety of hyperbaric oxygen therapy in mechanically ventilated patients

Background: To evaluate the epidemiology of patients who require mechanical ventilation during hyperbaric oxygen therapy. Materials and methods: One-hundred-fifty patients who required mechanical ventilation during hyperbaric oxygen therapy were prospectively studied during a 6-year period in a French university hyperbaric centre. We analysed the indication of hyperbaric oxygen therapy, agent used for sedation, presence of a chest tube, need for vasopressor agents and tolerance and appearance of side effects. Finally, we compared the outcomes of patients according to the presence or absence of acute respiratory distress syndrome (ARDS). Results: Eleven children and 139 adult patients were included (n = 150) in the study. In both populations, carbon monoxide poisoning (51%) and iatrogenic gas embolism (33%) were the two main causes of intubation and mechanical ventilation. The combination of midazolam and sufentanil was used in 85 (67%) patients. All of the patients were given a bolus of a neuromuscular blocker during the hyperbaric session, despite the presence of ARDS in 35 patients. Patient-ventilator asynchrony was the most frequent side effect in 6 (5%) patients and was often the consequence of suboptimal sedation. Mortality was higher in the group with ARDS (23%). Conclusions: Carbon monoxide poisoning and iatrogenic gas embolism are the two main diseases of the patients who required mechanical ventilation during hyperbaric oxygen therapy in this study. Mechanical ventilation is a safe method for patients during hyperbaric oxygen therapy. Sedation needs to be perfected to avoid patient-ventilator asynchrony.

US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases.

Purpose: To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods : This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results : No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion : US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications

BMJ Med

OBJECTIVE: To evaluate the efficacy of covid-19 convalescent plasma to treat patients admitted to hospital for moderate covid-19 disease with or without underlying immunodeficiency (CORIPLASM trial). DESIGN: Open label, randomised clinical trial. SETTING: CORIMUNO-19 cohort (publicly supported platform of open label, randomised controlled trials of immune modulatory drugs in patients admitted to hospital with moderate or severe covid-19 disease) based on 19 university and general hospitals across France, from 16 April 2020 to 21 April 2021. PARTICIPANTS: 120 adults (n=60 in the covid-19 convalescent plasma group, n=60 in the usual care group) admitted to hospital with a positive SARS-CoV2 test result, duration of symptoms 40. MAIN OUTCOME MEASURES: Primary outcomes were proportion of patients with a WHO Clinical Progression Scale score of ≥6 on the 10 point scale on day 4 (higher values indicate a worse outcome), and survival without assisted ventilation or additional immunomodulatory treatment by day 14. Secondary outcomes were changes in WHO Clinical Progression Scale scores, overall survival, time to discharge, and time to end of dependence on oxygen supply. Predefined subgroups analyses included immunosuppression status, duration of symptoms before randomisation, and use of steroids. RESULTS: 120 patients were recruited and assigned to covid-19 convalescent plasma (n=60) or usual care (n=60), including 22 (covid-19 convalescent plasma) and 27 (usual care) patients who were immunocompromised. 13 (22%) patients who received convalescent plasma had a WHO Clinical Progression Scale score of ≥6 at day 4 versus eight (13%) patients who received usual care (adjusted odds ratio 1.88, 95% credible interval 0.71 to 5.24). By day 14, 19 (31.6%) patients in the convalescent plasma group and 20 (33.3%) patients in the usual care group needed ventilation, additional immunomodulatory treatment, or had died. For cumulative incidence of death, three (5%) patients in the convalescent plasma group and eight (13%) in the usual care group died by day 14 (adjusted hazard ratio 0.40, 95% confidence interval 0.10 to 1.53), and seven (12%) patients in the convalescent plasma group and 12 (20%) in the usual care group by day 28 (adjusted hazard ratio 0.51, 0.20 to 1.32). In a subgroup analysis performed in patients who were immunocompromised, transfusion of covid-19 convalescent plasma was associated with mortality (hazard ratio 0.39, 95% confidence interval 0.14 to 1.10). CONCLUSIONS: In this study, covid-19 convalescent plasma did not improve early outcomes in patients with moderate covid-19 disease. The efficacy of convalescent plasma in patients who are immunocompromised should be investigated further. TRIAL REGISTRATION: ClinicalTrials.gov NCT04345991

GASCON : Gestion agro-écologique de la santé des cultures et des organismes nuisibles

Le croisement des sciences agronomiques, de l’écologie appliquée à la gestion des agroécosystèmes,et des sciences humaines et sociales, qu’implique la transition agroécologique, pose de nouveaux défis pour répondre aux enjeux agricoles: intégrer des connaissances de différentes disciplines et produites à différentes échelles d’organisation pour agir en situation; développer des cadres d’analyse et démarches intégrant la diversité de situations à gérer par les acteurs et permettant de construire des réponses adaptées à chaque situation; et concevoir et mettre en œuvre des pratiques d’enseignement et d’apprentissage, qui dotent les apprenants de capacités à penser leur action en contexte, en mobilisant des savoirs et savoir-faire multiples en termes de contenus disciplinaires et des savoir-être pour construire des solutions avec une diversité d’acteurs. Dans le champ de la formation, ces défis nécessitent dès lors de revisiter les contenus des enseignements dispensés, les modalités pédagogiques et les dispositifs de formation existants, de manière à appréhender au mieux la complexité des processus à l’œuvre. Pour autant, peu de travaux s’attardent sur les modalités pratiques de ce changement et de ses implications, alors même que de nombreuses initiatives en matière de pédagogie et d’agroécologie se développent ces dernières années. L’objectif de ce séminaire est de promouvoir une information partagée et l’échange d’expériences pour répondre aux enjeux posés par l’agroécologie dans la formation (transversalité, pluridisciplinarité, approche systémique, pédagogies actives). Ces enjeux peuvent se décliner suivant plusieurs entrées : les thématiques enseignées (agriculture, élevage, territoire, alimentation, ...); les pratiques et les dispositifs pédagogiques mis en œuvre pour aborder ces questions (enseignement numérique, dispositifs expérimentaux, projets professionnels, référentiels, ...);les publics d’apprenants: élèves, étudiants, professionnels, ..