La santé au travail : Comprendre où en est la recherche

Les Cahiers de la Recherche (Santé, Environnement, Travail) forment une collection thématique, qui dresse un panorama des projets de recherche financés dans le cadre de programmes nationaux de recherche tels que le PNRPE et le PNR EST. Leur but est d’expliciter les questions que se posent les scientifiques en amont de leurs projets, et de donner des exemples de résultats qu’ils peuvent ainsi produire. Ces projets traitent de questions de sécurité sanitaire qui, souvent, interpellent l'opinion publique. Ces questions sont associées à des agents physiques, biologiques ou chimiques, présents dans l'environnement ou dans le milieu professionnel.Améliorer la santé et la sécurité au travail constitue un enjeu majeur pour l’Anses qui contribue, depuis 2005, à la prévention des risques professionnels. Des efforts ont été engagés pour évaluer et connaître les risques professionnels notamment émergents (ex. pesticides, nanoparticules, perturbateurs endocriniens, champs électromagnétiques) et élaborer des recommandations de valeurs limites d’exposition professionnelles (VLEP) afin de protéger les travailleurs. L’évolution de la société, mais aussi celle des technologies et leur impact sur le milieu professionnel, suscitent de nouvelles questions. C’est pourquoi le développement et le soutien à la recherche publique permet d’améliorer la connaissance des effets des expositions professionnelle sur la santé humaine, d’évaluer et d’analyser les risques dans le cadre de l’activité de travail

Les perturbateurs endocriniens: Comprendre où en est la recherche

Pour réduire l’exposition de la population et de l’environnement aux perturbateurs endocriniens, la France est le premier pays à s’être doté d’une stratégie nationale sur les perturbateurs endocriniens (SNPE), mise en oeuvre dans le plan national Santé-Environnement 2015-2019 (PNSE 3). Dans un contexte où l’incertitude sur les risques encourus, sur les mécanismes d’action et les effets de ces substances reste forte, la recherche est au coeur de la stratégie. Elle vise notamment à acquérir de nouvelles connaissances pour alimenter l’expertise dans ce domaine et développer des tests permettant de mesurer l’effet de ces substances sur les systèmes biologiques. Mobiliser la communauté scientifique sur la thématique de l’exposome chimique, auquel les perturbateurs endocriniens participent, constitue par ailleurs l’un des défis majeurs de la recherche dans le domaine de la santé environnementale pour les prochaines années. Depuis 2014, l’Anses anime le programme national de recherche Environnement-Santé-Travail (PNR EST) inscrit dans la SNPE. Ce nouveau numéro des Cahiers de la Recherche est consacré à ces projets

A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes

Purpose: Older people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training. Design/methodology/approach: Two trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings. Findings: Trainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present. Research limitations/implications: The authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk. Originality/value: This is the first study of learning needs for GP trainees to provide integrated care for older care home residents

Variability of Symmetric Dimethylarginine in apparently healthy dogs

Background: Symmetric dimethylarginine (SDMA) is a screening tool for early kidney dysfunction and monitoring treatment in cases of chronic kidney disease (CKD). There are no current studies describing the suitability of this test for use with published populationbased reference intervals. Hypothesis/Objectives: To determine the components of biological variability, the index of individuality (IOI), the critical difference between sequential measurements (CD) and the number of measurements required to assess the homeostatic set point (HSP), for both SDMA and serum creatinine (sCr), in apparently healthy dogs. Animals: Twenty apparently healthy adult dogs owned by clients or staff at a veterinary teaching hospital. Methods: Prospective, observational study. Blood was collected from each dog on 9 occasions, and SDMA and sCr were measured in duplicate using commercially available assays. Results: SDMA and sCr had intermediate and low IOI values of 0.87 and 0.28, respectively. The CD of SDMA and sCr, was 1.34 mg/dL and 0.89 mmol/L, respectively. The sample numbers required for estimation of an individual’s HSP (with 90 and 95% CI) for SDMA and sCr were 8 and 45, and 2 and 12 sequential measurements, respectively. Conclusions and Clinical Importance: Based on our findings, in comparison to sCr, SDMA is better suited for use with population based reference intervals. False-negative test results could occur when comparing a single test result from an individual to such intervals. Ideally CD should be used with sequential measurements

Les plantes envahissantes des corridors fluviaux (traits biologiques, impacts de Ludwigia péploides et L.grandiflora en Loire moyenne et implications pour la gestion.)

Dans le bassin de la Loire, et plus particulièrement en Loire moyenne, deux espèces de Jussies (Ludwigia peploides (Kunth) Raven subsp. montevidensis (Spreng.) Raven, L. grandiflora (Michx.) Greuter & Burdet subsp. hexapetala (Hook. & Arn.) Nesom & Kartesz) amphiphytes exotiques invasives colonisent principalement les annexes hydrauliques et les grèves du lit endigue . Cette thèse étudie la biologie (reproduction, implantation, dissémination, ) de ces deux taxons, leurs impacts sur les communautés végétales et animales (macroinvertébrés aquatiques) afin de mieux adapter leur gestion. Les résultats des suivis de terrain et des expérimentations in situ et ex situ démontrent en particulier: (i) des différences entre les deux espèces concernant leurs traits reproductifs et leur développement sur les annexes hydrauliques et les grèves, (ii) la possibilité d un cycle de reproduction sexuée complet sous le climat ligérien, (iii) un impact nul sur les communautés végétales d hydrophytes mais négatif sur les communautés riveraines étudiées, (iv) peu de différences entre la diversité et la structuration des communautés d invertébrés dans les herbiers de macrophytes autochtones et exotiques. A partir de ces résultats, nous proposons de mettre en oeuvre un protocole de veille et de gestion des Jussies dans les deux types d habitats (annexes hydrauliques et grèves), en intégrant tout particulièrement la nouvelle donnée de forte probabilité de reproduction sexuée.In the Loire catchment, and particularly in the middle Loire River, two species of water primroses (Ludwigia peploides (Kunth) Raven subsp. montevidensis (Spreng.) Raven and L. grandiflora (Michx.) Greuter & Burdet subsp. hexapetala (Hook. & Arn.) Nesom & Kartesz) which are invading exotic amphiphytes. They, mainly colonize former channels and river banks in the in between-dykes floodplain. This thesis studies the biology (reproduction, establishment, dispersal, ) of those two taxa, their effects on plant and animal communities (aquatic macro-invertebrates) in order to optimize their management. The results of the field surveys as well as in situ and ex situ experimentations show in particular: (i) differences between the two species concerning their reproduction features and their development in former channels and river banks, (ii) the possibility of a complete sexual reproduction cycle in the climatic conditions of the middle Loire River, (iii) the absence of effetcs on hydrophyte communities but a negative one on riparian communities, (iv) few differences between the diversity and the structure of invertebrate communities in stands of both native macrophytes and exotic ones. From those results we suggest a survey and management protocol for water primroses in the two types of habitats (former channels and river banks), including in particular the new piece of data on high probability of sexual reproduction.TOURS-Bibl.électronique (372610011) / SudocSudocFranceF

Crystallization and preliminary X-ray diffraction analysis of BipD, a virulence factor from Burkholderia pseudomallei

BipD is likely to be a component of a type-III protein secretion system (TTSS) in B. pseudomallei. Native and selenomethionyl-BipD proteins have been expressed and crystals have been obtained which diffract to 2.1 Å

Compact and accurate concept of laser wavemeters based on ellipsometry

Common laser wavemeters are based on a scanning Michelson interferometer. Displacements of the moving mirror as long as tens of centimeters are needed to reach a relative accuracy of 1 × 10−6 (1σ) on the unknown laser wavelengths. Such a long displacement range makes the system very sensitive to mechanical vibrations and to misalignments of the laser beams. The purpose of this paper is to demonstrate a new concept of laser wavemeter based on the measurements of the ellipsometric parameters ψ and of the laser beams. Experimental results show that a 10−6 (1σ) accuracy level could be reach with a displacement range of only 4 μm. Implementations of the device are described. Comparisons between our polarimetric wavemeter and a calibrated wavemeter are presented for two lasers, an extended cavity laser diode at 656 nm and a 532 nm green line Nd:YAG laser

The use of global rating scales for OSCEs in veterinary medicine

OSCEs (Objective Structured Clinical Examinations) are widely used in health professions to assess clinical skills competence. Raters use standardized binary checklists (CL) or multi-dimensional global rating scales (GRS) to score candidates performing specific tasks. This study assessed the reliability of CL and GRS scores in the assessment of veterinary students, and is the first study to demonstrate the reliability of GRS within veterinary medical education. Twelve raters from two different schools (6 from University of Calgary [UCVM] and 6 from Royal (Dick) School of Veterinary Studies [R(D)SVS] were asked to score 12 students (6 from each school). All raters assessed all students (video recordings) during 4 OSCE stations (bovine haltering, gowning and gloving, equine bandaging and skin suturing). Raters scored students using a CL, followed by the GRS. Novice raters (6 R(D)SVS) were assessed independently of expert raters (6 UCVM). Generalizability theory (G theory), analysis of variance (ANOVA) and t-tests were used to determine the reliability of rater scores, assess any between school differences (by student, by rater), and determine if there were differences between CL and GRS scores. There was no significant difference in rater performance with use of the CL or the GRS. Scores from the CL were significantly higher than scores from the GRS. The reliability of checklist scores were .42 and .76 for novice and expert raters respectively. The reliability of the global rating scale scores were .7 and .86 for novice and expert raters respectively. A decision study (D-study) showed that once trained using CL, GRS could be utilized to reliably score clinical skills in veterinary medicine with both novice and experienced raters

Attenuation of Congenital Portosystemic Shunt Reduces Inflammation in Dogs

Liver disease is a major cause of morbidity and mortality. One of the most significant complications in patients with liver disease is the development of neurological disturbances, termed hepatic encephalopathy. The pathogenesis of hepatic encephalopathy is incompletely understood, which has resulted in the development of a wide range of experimental models. Congenital portosystemic shunt is one of the most common congenital disorders diagnosed in client owned dogs. Our recent studies have demonstrated that the pathophysiology of canine hepatic encephalopathy is very similar to human hepatic encephalopathy, which provides strong support for the use of dogs with a congenital portosystemic shunt as a naturally occurring model of human hepatic encephalopathy. Specifically, we have demonstrated an important role for ammonia and inflammation in the development of hepatic encephalopathy in dogs with a congenital portosystemic shunt. Despite the apparent importance of inflammation in driving hepatic encephalopathy in dogs, it is unclear whether inflammation resolves following the successful treatment of liver disease. We hypothesized that haematological and biochemical evidence of inflammation, as gauged by neutrophil, lymphocyte and monocyte concentrations together with C-reactive protein concentrations, would decrease following successful treatment of congenital portosystemic shunts in dogs. One hundred and forty dogs with a congenital portosystemic shunt were enrolled into the study. We found that the proportion of dogs with a monocyte concentration above the reference range was significantly greater in dogs with hepatic encephalopathy at time of initial diagnosis. Importantly, neutrophil and monocyte concentrations significantly decreased following surgical congenital portosystemic shunt attenuation. We also found a significant decrease in C-reactive protein concentrations following surgical attenuation of congenital portosystemic shunts. Our study demonstrates that haematological and biochemical indices of inflammation reduce following successful treatment of the underlying liver disorder

Feline low-grade alimentary lymphoma: an emerging entity and a potential animal model for human disease

Background: Low-grade alimentary lymphoma (LGAL) is characterised by the infiltration of neoplastic T-lymphocytes, typically in the small intestine. The incidence of LGAL has increased over the last ten years and it is now the most frequent digestive neoplasia in cats and comprises 60 to 75% of gastrointestinal lymphoma cases. Given that LGAL shares common clinical, paraclinical and ultrasonographic features with inflammatory bowel diseases, establishing a diagnosis is challenging. A review was designed to summarise current knowledge of the pathogenesis, diagnosis, prognosis and treatment of feline LGAL. Electronic searches of PubMed and Science Direct were carried out without date or language restrictions. Results: A total of 176 peer-reviewed documents were identified and most of which were published in the last twenty years. 130 studies were found from the veterinary literature and 46 from the human medicine literature. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. The pathophysiology of feline LGAL still needs to be elucidated, not least the putative roles of infectious agents, environmental factors as well as genetic events. The most common therapeutic strategy is combination treatment with prednisolone and chlorambucil, and prolonged remission can often be achieved. Developments in immunohistochemical analysis and clonality testing have improved the confidence of clinicians in obtaining a correct diagnosis between LGAL and IBD. The condition shares similarities with some diseases in humans, especially human indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Conclusions: The pathophysiology of feline LGAL still needs to be elucidated and prospective studies as well as standardisation of therapeutic strategies are needed. A combination of conventional histopathology and immunohistochemistry remains the current gold-standard test, but clinicians should be cautious about reclassifying cats previously diagnosed with IBD to lymphoma on the basis of clonality testing. Importantly, feline LGAL could be considered to be a potential animal model for indolent digestive T-cell lymphoproliferative disorder, a rare condition in human medicine