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Epidemiology of Occupational Asthma in Tunisia: Results of a First national Study

Occupational Diseases and Environmental Medicine 2016年第2期4卷 27-36页

作者： Maoua Maher El Maalel Olfa Boughattas Wided Chatti Souhail Gharbi Ezzeddine Kammoun Houda Kalboussi Houda Mlaouah Jabrane Abbassi Ammar Brahem Aicha Loukil Mouna Haj Salah Habib Ben Khdimallah Khaled Masmoudi Tasnim Benzarti Mohamed Debbabi Faten mrizak néjib Occupational Medicine and Professional Pathologies Department Faculty of Medicine of Sousse Sousse Tunisia University of Sousse Sousse Tunisia CnAM Regional Centers of Sousse Tunis and Sfax Tunisia English Department Faculty of Medicine of Sousse Sousse Tunisia Forensic Medicine Department Faculty of Medicine of Sousse Sousse Tunisia Department of Pneumology and Allergology Farhat Hached Teaching Hospital Sousse Tunisia

Introduction: Apart from its increasingly important frequency, occupational asthma (OA) has become the most important cause of occupational respiratory disorders in developed countries. The number of etiological agents continues to grow following the constant introduction of new harmful substances in industry. Objectives: Determine the prevalence and incidence of OA in our country, the socio-occupational characteristics of asthmatics, and study the forensic and social impact of such pathology. Material and Methods: An exhaustive retrospective epidemiological study was conducted in Tunisia about charts of occupational asthma cases recognized by the competent commissions of the national Medical Care Fund (CnAM) during the period ranging from January 1st 2000 to December 31st 2008. Results: 361 occupational asthma cases, accounting for a prevalence of 7.17% of all occupational diseases, were recognized during the period of the study. Occupational asthma annual incidence was estimated to be 24.42 cases per 1000000 workers. Our study population was mainly women with a sex ratio of 0.86. More than a half (57.6%) of recognized OA cases were working in the textile industry sector. Concerning the asthmatics’ professional career, most of recognized OA cases (n = 225 i.e. 70.6% of cases) kept their jobs, whereas 58 patients did not. The professional career was linked to gender with a job loss that is 1.79 time more important in asthmatic women. Conclusion: The incidence of occupational asthma in Tunisia is comparable with that found in other Mediterranean countries. A rigorous and adequate prevention is necessary and allows reducing the importance of this occupational pathology and its serious consequences.

关键词： Epidemiology Occupational Asthma Pneumology Allergology Tunisia

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Outcome of nurses with Occupational Dermatitis

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Open Journal of nursing 2024年第6期14卷 239-251页

作者： Amira Omrane Chayma Harrathi Asma Kheder Maher Maoua Malek Ben Abdelkader Taoufik Khalfallah najib mrizak Mohamed Akrout Mohamed Adnene Henchi Hichem Bel Hadj Ali Department of Occupational Medicine and Ergonomics Taher Sfar Teaching Hospital Mahdia Tunisia Department of Occupational Medicine Houcine Bouzaiene Teaching Hospital Gafsa Tunisia Department of Occupational Medicine Farhat Hached Teaching Hospital Sousse Tunisia Department of Occupational Medicine and Ergonomics Fattouma Bourguiba Teaching Hospital Monastir Tunisia Department of Dermatology Fattouma Bourguiba Teaching Hospital Monastir Tunisia

Background: Occupational dermatitis is considered as the second most common occupational disease. It accounts for 25% of all lost workdays. Several international studies reported a prevalence of occupational dermatitis in healthcare workers between 17% and 55%. This study aims to identify factors that affect the professional outcome of nurses suffering from occupational dermatitis. Methods: This was a multicenter cross-sectional study concerning nurses declared having occupational dermatitis in the central region of Tunisia. A synoptic sheet related to socio-professional and administrative data was completed. A self-administered Questionnaire going over medical and occupational characteristics was completed during a direct interview. Results: The study involved forty nurses working in four public hospitals in the center of Tunisia. Only 37 workers were included in the study. A professional reclassification was introduced among 19 workers (51% of study population). Work-station adaptation was requested in 14 cases (38%). Exposure to allergens in the workplace was eliminated in 20 cases. Two study participants were transferred to other departments (5.4%) and three people retired (8.1%). A statistically significant association was found between professional reclassification and a history of allergic manifestations (p = 0.003). Similarly, a significant association was found between professional reclassification and the allergic agent (p = 0.014). Workstation layout was significantly associated with a history of allergic manifestations (p = 0.039), the palm hand location (p = 0.04), professional eviction (p Conclusion: This study identified the main factors influencing the occupational outcome of nurses suffering from occupational dermatitis. This outcome depended on a history of atopy (especially allergic rhinitis) and sensitization to allergens (thiuram mix).

关键词： nursing Occupational Dermatitis Hospital

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Low Back Pain among nurses: Prevalence, and Occupational Risk Factors

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Occupational Diseases and Environmental Medicine 2017年第1期5卷 26-37页

作者： Wided Boughattas Olfa El Maalel Maher Maoua Iheb Bougmiza Houda Kalboussi Aicha Brahem Souhaiel Chatti Fethi Mahjoub néjib mrizak Department of Occupational Medicine Faculty of Medicine Ibn El Jazzar Sousse Tunisia Department of Community Health Faculty of Medicine Ibn El Jazzar Sousse Tunisia

Objectives: Low back pain is a major occupational problem especially among nursing staff. The objectives of our study are to evaluate the prevalence of low back pain among nurses and to look for physical and psychosocial risk factors. Methods: It is a cross-sectional study based on a self-administered questionnaire destined for all nurses working in Farhat Hached Teaching hospital of Sousse (Tunisia). Results: Our study included 203 nurses with an average age of 39.8 years. The prevalence of low back pain over the last twelve months was 58.1%. The factors that are significantly associated to low back pain were: high BMI, number of pregnancies, arthritis, poor physical condition, daily frequency of inappropriate posture for the activity being performed, and the layout of materials in the workplace. Conclusion: Our study evidenced the high prevalence of LBP among nurses and allowed bringing to light the role of individual and ergonomic physical factors in the genesis of LBP. Such identification permits to undertake targeted preventive actions. The association between psychosocial factors and LBP was not emphasized.

关键词： Low Back Pain Prevalence nurses Physical Factors Psychosocial Factors

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Occupational Allergic Contact Dermatitis in Tunisia: Epidemiology and Occupational Outcome

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Occupational Diseases and Environmental Medicine 2018年第3期6卷 107-117页

作者： Asma Aloui Maher Maoua Houda Kalboussi Imène Kacem Sana El Guedri Aicha Brahem Olfa El Maalel Faten Debbabi Souhaiel Chatti néjib mrizak Department of Occupational Medicine Faculty of Medicine of Sousse University of Sousse Farhat Hached Teaching Hospital Sousse Tunisia

Background: Occupational allergic contact dermatitis (ACD) is one of the most frequent diseases on the workplace worldwide. Its national incidence and prevalence were not previously studied in Tunisia. Objective: To assess incidence of occupational allergic contact dermatitis and its occupational outcome in Tunisia. Methods: Descriptive epidemiological study of all cases of occupational allergic contact dermatitis reported from 2002 to 2012 in Tunisia and recognized by the medical commissions of the national Health Insurance Fund. Results: 315 cases of occupational ACD were collected representing an annual incidence of 31.65 cases/100.000 workers in the private sector in Tunisia. The mean age of our population was 42.70 ± 9.02 years with a male predominance (sex ratio 3.03). The most affected sectors were the clothing sector (14.3% of cases) and the cement industry (13.7% of cases). Patch tests were positive in 188 patients (59.67%). The most frequently positive allergen was potassium dichromate in 27.3% of the cases. Overall, 25.4% of patients had lost their jobs. After multiple binary logistic regression, job loss had a statistically significant relationship with localization of lesions on the face and on dominant hand. Conclusion: Occupational ACD is frequent in Tunisia and is responsible for an important rate of job loss. Preventive measures must be reinforced, especially the wearing of protective gloves.

关键词： Epidemiology Occupational Disease Allergic Contact Dermatitis Job Loss Tunisia

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Buerger’s Disease and Fitness for Work in a Flight Personnel: A Case Report

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Occupational Diseases and Environmental Medicine 2022年第2期10卷 71-77页

作者： Imen Jammeli Asma Aloui Malek Ben Abdelkader Zeineb Athimni Marwa Bouhoula Chouchene Asma Imen Kacem Maher Maoua Aicha Brahem Houda Kalboussi Olfa El Maalel Souhaiel Chatti nejib mrizak University Hospital Farhat Hached Sousse Tunisia Department of Occupational Medicine University Hospital Ibnou El Jazzar Faculty of Medicine of Sousse University of Sousse Sousse Tunisia

Buerger’s disease, also called thromboangiitis obliterans (TAO), is an inflammatory disease affecting small and medium size blood vessels of the limbs. Several risk factors are strongly associated with this disease. In fact, heavy smokers represent 99% of patients diagnosed with Buerger’s disease and smoking cessation can slow down the progression of the pathology. Ulcers and gangrene are very common complications and TAO may also cause a vasculitis as well as ischemic damage to the distal part of the limbs that can eventually lead to limb amputation. Here, we report the case of a 43 years old patient, a flight personnel working in a Tunisian airline company who consults for a lesion of the left toe that appeared 2 weeks ago. He is a chronic inveterate smoker with 36 pack-years. The diagnosis of TAO was made based on the clinical presentation and the results of the Doppler Ultrasound of the left toe. This disease has a major impact on the quality of life due to the risk of necrotic ulcers and amputation. navigation is a profession that requires a high level of physical and mental fitness. According to the international and Tunisian standards, the applicant or the holder of medical certificate must not have a cardiovascular condition that may affect the safety of the exercise.

关键词： Buerger’s Disease Flight Personnel Medical Fitness

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Healing Humor: The Use of Humor in the nurse-Patient Relationship

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Occupational Diseases and Environmental Medicine 2022年第3期10卷 217-231页

作者： Farah Chelly Imène Kacem Amen Moussa Amal Ghenim Imen Krifa Feriel Methamem Asma Chouachane Asma Aloui Aicha Brahem Houda Kalboussi Olfa El Maalel Souhail Chatti Maher Maoua Sameh Bannanou nejib mrizak Université de Sousse Faculty of Medicine of Sousse Sousse Tunisia Department of Occupational Medicine Farhat Hached Academic Hospital Sousse Tunisia University of Sciences Arts and Techniques of Sousse Sousse Tunisia

Objective: To identify the importance of using humor in patient/nurse relationship, its factors, its conditions and the barriers that might limit its use. Methods: We systematically searched PubMed, Science Direct and Google Scholar, for relevant articles published in English between 2010 and 2019. We included the studies that investigated humor between nurses and their patient’s relationship. Results: From the initial 287 articles found, 15 were included for final revision. Data allowed retrieving information on humor definition;its applicability as a nursing intervention;humor as a tool to improve nurse-patient communication and relationship;influencing factors;humor benefits in health care context and the limits that come against its use. Conclusion: Humor is considered a powerful communication tool, it promotes well-being, relieves anxiety and stress, helps deal with stressful situations but it should be used cautiously in order to prevent undesired consequences.

关键词： Humor Patient/nurse Relationship Communication

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Effects of change in smoking habits on bladder cancer incidence in Tunisia

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Health 2011年第10期3卷 613-619页

作者： Dhafer mrizak Fatma B'chir Mehdi Jaidane Maurice Jean Arnaud Saad Saguem 不详

Bladder cancer is among the most frequently diagnosed cancer. Tobacco smoking exposures involving nitrosamines and aromatic amines are the main cause of bladder cancer. Although cigarette consumption has gradually decreased, an increased incidence of bladder cancer was registered among males Tunisian for the last two decades. A similar increased incidence of lung adenocarcinoma and bladder cancer was registered among Tunisian males. Epidemiological results suggest that changes in cigarette smoking may be the cause of the increased incidence of bladder cancer. The relationship between CYP1A2 enzyme activities, a key enzyme for activation of bladder carcinogens, and bladder cancer risk was investigated. Variations in CYP1 A2 activities measured in patients with bladder cancer and healthy smokers showed a signifycantly higher CYP1A2 metabolic activity in patient group. Changing in cigarette smoking habits associated to the variation in CYP1A2 activity seem to explain partly the increase incidence of bladder cancer observed in Tunisian male population.

关键词： Cigarette Filter Smoking Bladder Cancer CYP1A2 Activity

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Mycosis Fungoides in Relation to Environmental and Occupational Exposures: A Case-Control Study in the Tunisian Center

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International Journal of Clinical Medicine 2018年第6期9卷 528-539页

作者： I. Kacem M. Hafsia L. Bousoffara n. Ghariani Fetoui O. El Maalel W. Boughattas n. Ghariani M. Denguezli A. Brahem S. El Guedri H. Kalboussi S. Chatti n. mrizak Occupational Medicine Department Teaching Hospital Farhat Hached Sousse Tunisia Dermatology Department Teaching Hospital Farhat Hached Sousse Tunisia

Introduction: The mycosis fungoides (MF) is the most common cutaneous T-cell lymphomas representing about 50% of all cutaneous lymphomas. Its pathogenesis remains poorly understood. Thus, its rising incidence rates call for an explanation. Several environmental and occupational factors have been implicated in the pathogenesis of this disease. Objective: To determine the potential occupational factors correlated in the occurrence of MF. Methods: Case-control study was carried out at the teaching Hospital Farhat Hached of Sousse (Tunisia) to investigate associations of MF and occupational risk factors. A questionnaire on lifetime job history was administered to 24 cases and controls. Cases were patients with MF and whose diagnosis was suspected by a dermatologist and confirmed by pathological examination. Controls were patients consulting in the occupational medicine department and matched to cases by age and gender. Bivariate analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The average age of onset of the disease was 55.41 ± 17.4 years with a sex ratio of 2.42. We found an increased risk of MF associated with tobacco consumption higher than 40 Pack-year (OR = 6.6;95% CI = 1.22 to 35.4), exercise in the textile sector (OR = 9.4;CI = 1.06 to 84.3) and exposure to diesel exhaust (OR = 9.47;95% CI = 1.06 to 84.3). Conclusion: Occupational factors could play a role in the pathogenesis of MF. Regarding our study, smoking, working in the textile industry and exposure to diesel exhaust appear to be involved in the pathogenesis of MF. Further investigation is needed to confirm these findings.

关键词： Mycosis Fungoides Occupational Factors Tobacco Textile Sector Diesel Exhaust

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Hospital night Shift and Its Effects on the Quality of Sleep, the Quality of Life, and Vigilance Troubles among nurses

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International Journal of Clinical Medicine 2014年第10期5卷 572-583页

作者： Wided Boughattas Olfa El Maalel Ridha Ben Chikh Maher Maoua Kalboussi Houda Aicha Braham Houssem Rhif Souheil Chatti Faten Debbabi Mohamed Dogui nejib mrizak neurophysiology Department Sahloul Teaching Hospital Sousse Tunisia Occupational Medicine and Professional Pathologies Department Medicine Faculty of Sousse Sousse Tunisia

Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our s

关键词： night Shift nurse Quality of Life Sleep Vigilance

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Parental Occupational Exposure and Risk of Acute Leukemia in Children: A Tunisian Population-Based Case-Control Study

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International Journal of Clinical Medicine 2016年第3期7卷 193-203页

作者： H. Kalboussi Y. Ben Youssef I. Bougmiza F. Aloui A. Aloui W. Boughattas M. Maoua A. Brahem S. Chatti O. El Maalel F. Debbabi A. Khlif n. mrizak Occupational Medicine and Occupational Pathologies Department Farhat Hached Teaching Hospital Sousse Tunisia Hematology Department Farhat Hached Teaching Hospital Sousse Tunisia Community Medicine Department Faculty of Medicine of Sousse University of Sousse Sousse Tunisia

Background: In recent decades, the incidence of children’s hematological malignancies has been increasing worldwide including Tunisia. Their severity is reflected in the importance of the medical, social and economic impact. This increase remains fully unexplained, and the involvement of genetic, environmental and occupational factors is strongly suspected. Materials and methods: Our study was a cross-sectional survey of the type case-control conducted in the University Hospital of Farhat Hached of Sousse during the period ranging between 1 July 2011 and 30 June 2012, and which included children with acute leukemia compared to children unharmed by neoplastic disease. Cases and controls were matched by age and gender. Our objective was to describe the socio-occupational characteristics of the parents of children with acute leukemia and to identify potential occupational factors implicated in the genesis of acute leukemia. Results: The number of acute leukemia cases in the Hematology Service and day hospital of the University Hospital of Farhat Hached during the study period was 66 cases divided into in 40 boys and 26 girls with a sex ratio of 1.53. Our cases and controls were matched by age and gender. The risk of incidence of leukemia in children from smoking fathers was higher (p = 0.02, OR = 2.24, IC = [1.11 - 4.52]). The risk of incidence of leukemia in children from alcoholic fathers was higher with p = 0.009, OR = 3.9;CI = [1.33 - 11.39]. After adjusting different variables, the difference persisted significantly with pa = 0.03 and ORa = 3.5, ICa = [1.09 - 11.6]. 25.7% of cases had a family history of blood disease and neoplasia, whereas no control presented that. The difference was statistically significant (p = 0.006, OR = 1.46, IC = [1.38 - 1.56]). The parental occupational exposures associated to the occurrence of acute leukemia in children were pesticides with a statistically significant difference (p = 0.03, OR = 2.94, IC = [1.06 - 8.13]). This difference

关键词： Occupational Medicine Hematology Leukemia Children Case Control Survey

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