Occupational health for health Care workers
Literature Follow-up – August 2002
- Institute of Occupational Health - Rouen University Hospital
for Occupational Health for Health Care Workers
Transmission of Hemorrhagic Fever
Hepatitis C Virus Transmission From an Infected Gynecologist to Patients :
Results of a 7-Year Retrospective Investigation
recordkeeping activities and safety product use in California health care
facilities: : Pilot study results from the sharps injury control program
to pay to avoid sharps-related injuries: A study in injured health care workers
to HIV risk during training among medical technologist students of the faculty
of allied health science, Chulalongkorn university
for Quality Standards for Immunization
past and present
NHS staff attitudes to influenza immunisation
vaccines in adults
efficiency of influenza vaccine in prevention of influenza-like illness in
working adults: a 7 month prospective survey in EDF Gaz de France employees,
in Rhone-Alpes, 1996-1997
of the delivery and uptake of influenza vaccine among health care workers
against influenza: UK health care workers not on-message
CDC pushes for sterner measures to protect health care workers
exposure of patients and staff in an outpatient hemodialysis unit
absence due to influenza
of influenza in people of working age
transmission of influenza
in working populations: an overview
transmission, professionnal to patient
pain and lumbago-sciatica in nurses and a reference group of clerks: results
of a comparative prevalence study in Germany.
workload of student nurses and serum markers of collagen metabolism
Control for Gene Therapy: A Busy Physician's Primer
of handrubbing with alcohol based solution versus standard handwashing with
antiseptic soap: randomised clinical trial
Occupational hazard in hospitals
general surgery: insights into career choices of current medical students
stress in the children's hospice: causes, effects and coping strategies
the job fatigue
occupation and neural tube defect-affected pregnancies among Mexican Americans.
safety: meeting the challenge
carrières des personnels hospitaliers non médicaux (Avril 2002)
des infections invasives à méningocoque
pour la manipulation des médicaments cytotoxiques dans les établissements
de soins. Guide du C-CLIN Sud Ouest
d’immunisation Sixième édition – 2002
à l’hôpital : les urgentistes reçus par le ministre de l’intérieur
Air Pollutants, Occupational
Disease Transmission, Patient-to-Professional
Disease Transmission, Professional-to-Patient
Multiple chemical sensitivity
Medline search using above mentionned key-words
Systematic follow-up of major periodicals
J. G. Rigau-Pearez; L. J. Morse; L. Borio
JAMA 2002; 288 ( 5):571
To the Editor: In their Consensus Statement on hemorrhagic
fever viruses that may be used as biological weapons, Dr Borio and colleagues1
state, "There are no reported cases of person-to-person or nosocomial
spread of flaviviruses." At least 2 cases of nosocomial transmission
of dengue (a flavivirus) have been reported in the medical literature: one
through a needlestick injury and the other through bone marrow transplantation.
These events, although rare, suggest that nosocomial spread may also be possible
for a more feared flavivirusyellow fever.
Ross, R. Stefan MD. Viazov, Sergei PhD. Thormahlen, Marion
MD. Bartz, Lutz MD. Tamm, Jana. Rautenberg, Peter MD. Roggendorf, Michael
MD. Deister, Arno MD. and the Incident Investigation Team
Archives of Internal Medicine 2002;162(7):805-810.
Background: Currently, it is not known how often hepatitis
C virus (HCV) is transmitted from infected health care workers to patients
during medical care. In the present investigation, we tried to determine the
rate of provider-to-patient transmission of HCV among former patients of an
HCV-positive gynecologist after it was proven that he infected one of his
patients with HCV during a cesarean section.
Methods: All 2907 women who had been operated on by the HCV-positive
gynecologist between July 1993 and March 2000 were notified about potential
exposure and were offered free counseling and testing. The crucial differentiation
between HCV transmissions caused by the gynecologist and infections contracted
from other sources was achieved by epidemiological investigations, nucleotide
sequencing, and phylogenetic analysis.
Results: Of the 2907 women affected, 78.6% could be screened
for markers of HCV infection. Seven of these former patients were found to
have HCV. Phylogenetic analysis of HCV sequences from the gynecologist and
the women did not indicate that the virus strains were linked. Therefore,
no further iatrogenic HCV infections caused by the gynecologist could be detected.
The resulting overall HCV transmission rate was 0.04% (1 per 2286; 95% confidence
Conclusion: To our knowledge, this is the largest retrospective
investigation of the risk of provider-to-patient transmission of HCV conducted
so far. Our findings support the notion that such transmissions are relatively
rare events and might provide a basis for future recommendations on the management
of HCV-infected health care workers.
Gillen M, Davis M, McNary J, Boyd A, Lewis J, Curran C, Young
CA, Schuller M, Cone J.
Am J Infect Control 2002 Aug;30(5):269-76
BACKGROUND: In 1999, licensed health care facilities in California
(N = 2532) were invited to participate in a survey about occupational bloodborne
pathogens exposure surveillance activities, recordkeeping methods, and use
of safety-enhanced sharps devices.
RESULTS: A total of 1274 facilities responded to the survey
from January 1999 through August 1999 (response rate = 50%). Sharps-related
injuries were recorded for multiple departments on various forms in diverse
manners. Only 66% of hospitals, 37% of home health agencies, and 33% of skilled
nursing facilities reported sharps injuries on a mandated sharps injury log.
More than 70% of facilities stated that they used some type of safety device
or needleless system, but this figure varied by type of device and facility
type. Eighty-four percent of general acute care hospitals, 28% of home health
agencies and skilled nursing facilities each had evaluated at least 1 safety-enhanced
device. Almost 90% of all facilities expressed a need for educational materials
on topics such as device selection and evaluation.
CONCLUSIONS: Standardization of surveillance and recordkeeping
activities does not exist across facility types. Standards and regulations
demand complex recordkeeping activities. Increased funding for distribution
of educational materials and on-site training should accompany changes in
mandated reporting activities when appropriate. Increased testing and evaluation
of devices across facility types are necessary to ensure that safety-enhanced
devices are protective of health care workers and patients.
Fisman DN, Mittleman MA, Sorock GS, Harris AD.
Am J Infect Control 2002 Aug;30(5):283-287
BACKGROUND: Injuries caused by sharp medical devices are common
among health care workers and may result in the transmission of human immunodeficiency
virus and hepatitis C virus.
OBJECTIVE: The direct medical costs associated with treating
these injuries are well characterized but fail to capture the costs of such
intangible factors as worker anxiety and distress. The objective of this study
was to estimate these intangible costs.
SUBJECTS: Subjects included health care workers reporting
sharps-related injuries to 2 hospital occupational health services.
METHOD: A contingent valuation approach was used to assess
willingness to pay to avoid sharps-related injuries among recently injured
health care workers. Workers were presented with the option of paying out
of pocket for a hypothetical injury-prevention device. The median amount of
money subjects were willing to pay was estimated with logistic regression,
and multivariable regression was performed to assess confounding by worker
characteristics and circumstances surrounding injuries.
RESULTS: Study interviews were conducted for 116 subjects;
median time from injury to interview was 3 days (range, 0-15). Most subjects
were women (73%), and most were nurses (44%) or trainees (32%). The crude
median amount subjects were willing to pay to avert injury was $850 (US);
when adjusted for patient risk status (human immunodeficiency virus and hepatitis
C virus status), and working with an uncooperative patient at the time of
injury, median amount increased to $1270.
CONCLUSION: The high median amount sujects were willing to
pay to avoid a sharps-related injury suggests that the costs of "intangible"
aspects of worker injury, such as anxiety and distress, may equal costs associated
with the medical evaluation of these injuries. These costs should be incorporated
in economic analyses of sharps-injury prevention.
J Suwansaksri, V Wiwanitkit, S Sugaroon
Am J Infect Control 2002 Aug;30(5):320
Pierce Gardner, Larry K. Pickering, Walter A. Orenstein, Anne
A. Gershon, and Kristin L. Nichol.
Clinical Infectious Diseases 2002;35:503-511
This is an update of the 1997 Quality Standards for Immunization,
which is one of a series of guidelines commissioned by the Infectious Diseases
Society of America (IDSA) through its Practice Guidelines Committee. This
information is presented as a standard-of-care rather than practice guidelines
because the evidence for following these recommendations is so strong that
they should be implemented with rare exceptions. The purpose of these standard-of-care
guidelines is to provide assistance to clinicians who make decisions on providing
immunizations to infants, children, adolescents, and adults. This document
is a summary of evidence-based guidelines previously developed by national
organizations. A standard ranking system was used to determine the strength
of the recommendations, and the quality of evidence cited in the literature
was reviewed for each guideline. The targeted health care professionals are
pediatricians, family practitioners, internists (including specialists), obstetricians,
and others who provide immunizations. The panel members are experts in the
field of adult and pediatric infectious diseases. The document has been subjected
to external review by peer reviewers as well as by the Practice Guidelines
Committee, and it was approved by the IDSA Council. Indicators for measuring
compliance with the standards are included. The document will be posted on
the IDSA home page at http://www.idsociety.org/
Wolfe RM, Sharp LK.
BMJ 2002 Aug 24;325(7361):430-2.
Beach J, Hobson J.
Occup Med (Lond) 2002 Aug;52(5):237-8
Akinosi B, Ramaiah S, Pugh RN.
Commun Dis Public Health 2002 Jun;5(2):132-3
There was a low uptake of influenza vaccination among health
care workers in year 1999-2000. The study aimed to identify reasons for low
uptake and to use the results to improve uptake during current and future
Jefferson T, Bianco E, Demicheli V.
Occup Med (Lond) 2002 Aug;52(5):255-8
Available influenza vaccines contain inactivated viruses,
either whole or in parts, and are administered parenterally or intranasally.
Their composition varies yearly because of viral antigenic shifts and drifts.
Vaccines with a composition matching yearly World Health Organization recommendations
are 72% [95% confidence interval (CI) = 54-83%] efficacious (prevention of
influenza cases caused by influenza viruses A and B). Their effectiveness
[capacity to prevent clinical influenza, or influenza-like illness (ILI)]
is lower, at 37% (95% CI = 18-52%). A decision to vaccinate an adult population
has to take into account the efficacy of the vaccines and their effectiveness
(the likely proportion of ILI caused by influenza A and B viruses, amenable
to prevention by vaccination), as well as costs and likely compliance. As
the yearly levels of circulating A and B viruses are difficult to predict
during the decision time for a vaccination campaign, there is a considerable
element of uncertainty regarding the likely effectiveness of 'this year's'
Occup Med (Lond) 2002 Aug;52(5):281-92
Millot JL, Aymard M, Bardol A.
The efficiency of influenza vaccine was evaluated in the working
comparing the percentage of people presenting with an influenza-like
illness (ILI) according to their influenza immunization status, drug expenses
and workdays lost. A self-completed questionnaire about the vaccination was
sent to 5785 people randomly chosen among 18 249 workers. When any sick leave
was incurred amongst the respondents (63.3%), of whom 301 were vaccinated
and 3362 unvaccinated, a clinical form was completed by the private physician
and the medical adviser of the firm (Electricite de France and Gaz de France).
A final self-completed questionnaire was sent to people whose sick leave was
not documented by a physician's reported diagnosis. In total, we obtained
complete data for 90.9% of the sampling. The vaccine coverage rate of 8.2%
[95% confidence interval (95% CI) = 7.4-9.0%] was higher in men than in women,
increasing with age and professional category. Among the 775 subjects with
a medical diagnosis, the vaccine effectiveness was not significant: 27.3%
(95% CI = -13.8 to 53.5%). In the unvaccinated group, 9.6% had days absent
from work, versus 7.0% in the vaccinated group; the two populations were comparable
in terms of clinical symptoms, smoking habits, exposure to respiratory risk
factors and chronic pathology. The average duration of sick leave for ILI
was not significantly different between vaccinated (0.5 days) and unvaccinated
workers (0.6 days). Despite the large size of the population and the occurrence
of an epidemic due to a virus closely related to the vaccine strain (A/Wuhan/359/95),
the vaccine did not effectively protect the small vaccine group nor result
in an economic benefit, whatever the professional group.
Smedley J, Palmer C, Baird J, Barker M.
Occup Med (Lond) 2002 Aug;52(5):271-6
During the 1990s, policies for immunizing fit health care
workers against influenza varied between National Health Service (NHS) employers
and the uptake of influenza vaccine by NHS staff was poor. In light of recent
Department of Health recommendations to immunize key health care staff against
influenza, we explored the possible reasons for poor uptake and assessed the
impact of an intensive promotion campaign on vaccine acceptance. Among 290
doctors and nurses, the main perceived barriers to influenza immunization
were difficulty with practical access to vaccine and lack of time to attend.
Following intensive promotion and improved local access to influenza vaccine,
the uptake among health care workers was approximately doubled. However, the
overall proportion of staff immunized was low (5%) and the immunization rate
among medical staff was particularly poor (2%). The practical implications
for influenza immunization campaigns aimed at health care workers are discussed.
Harrison J, Abbott P.
Occup Med (Lond) 2002 Aug;52(5):277-9
Vaccination of health care workers against influenza is considered
to be important as a means of protecting patients from nosocomial infection.
Vaccine uptake rates have been reported to be no more than 40% and often between
20 and 30%. An evaluation of the performance of UK National Health Service
trusts, following a governmental directive to implement vaccination during
the winter of 2000-2001, has shown a poor uptake of vaccine. Reasons for accepting
or declining vaccine are discussed. There is a need for global leadership
on this issue to promote the value of vaccination and to change the behaviour
of health care workers.
AIDS Policy Law 1994 Dec 16;9(23):6
Linquist JA, Rosaia CM, Riemer B, Heckman K, Alvarez F.
Am J Infect Control 2002 Aug;30(5):307-310
BACKGROUND: Patients receiving hemodialysis are generally
considered to be at increased risk of developing tuberculosis (TB). We evaluated
a 13-station chronic outpatient hemodialysis unit associated with a community
hospital in northern California. Within 6 months, there were 2 incident source
cases in the unit of active smear positive pulmonary tuberculosis; the first
in a health care worker (HCW), diagnosed April 3, 1998, and the second in
a patient undergoing dialysis treatment in October 1998. We describe the cases;
the evaluation of exposures; and the institution of an intentional prospective
TB control plan, designed specifically for the unique hemodialysis setting.
METHODS: We evaluated 23 HCWs twice and 89 patients undergoing
hemodialysis treatment who were exposed to case 1 and 38 patients who were
exposed to case 2. All 23 HCWs had documented prior negative Sierbert purified
protein derivative of tuberculin (PPD) status and were retested at 12 weeks
after exposure. None of the patients had documentation of PPD status. All
of the patients were skin-tested initially with use of the 2-step method,
and those with positive test results were offered isoniazid (INH).
RESULTS: One of the 23 HCWs' negative baseline PPD skin test
status converted after exposure to case 1, and none of the remaining 22 converted
after exposure to case 2. Twelve of 89 exposed patients with no prior skin
test record had positive results for PPD after initial testing with the 2-step
method. Three of the 12 (25%) patients were treated with INH at the discretion
of their attending nephrologist. The 77 patients with negative results for
PPD still had negative test results when retested at 3 months. None of 38
patients who underwent dialysis on the same schedule as source case 2 had
a converted PPD test. Restriction fragment length polymorphism on TB isolates
from both source cases ultimately showed them to be unrelated strains.
CONCLUSION: Our experience with these exposures suggests that
TB screening of patient populations undergoing renal dialysis-though they
have intrinsic high anergy rates-is advisable with a designed prospective
plan before any inadvertent and/or repetitive exposure of that population
to active TB. A planned intentional TB control program increases HCW awareness
of TB, establishes baselines for evaluation, decreases "panic" in
the event of subsequent exposures, and emphasizes the rationale for preventive
O'Reilly FW, Stevens AB.
Occup Med (Lond) 2002 Aug;52(5):265-9
In addition to its recognized health effects, influenza has
socio-economic consequences, most notably sickness absence and associated
work disruption. It may account for 10-12% of all sickness absence from work.
Data on the impact of influenza on work are limited. Most research has assessed
the impact of an intervention, usually influenza immunization. Within the
available literature, there are five randomized controlled trials in the workplace
that have assessed the effectiveness of influenza immunization as an intervention:
two in the general working population and three in the health sector. If the
benefit desired is a reduction in sickness absence as a cost-effective measure,
the likely outcome is a modest gain in years when incidence of influenza is
increased in the community. There are some distinctive factors in the health
care industry: health care workers may exhibit different absence behaviour,
they may be more exposed to infection at work and they may pose a risk as
a source of nosocomial infection. From the occupational health perspective,
how do we best inform employers currently? The cost-effectiveness case has
not been absolutely proven. More research appears necessary, including assessment
of those factors that influence uptake of influenza immunization. In the interim,
a targeted approach to certain job categories may be the way forward.
Occup Med (Lond) 2002 Aug;52(5):259-63
Influenza is common, causing considerable morbidity and sickness
absence from work in most winters. Influenza vaccines have been available
for >40 years, but are not extensively used in the workforce (in the UK).
Amantadine has been available for 25 years as a treatment and prophylactic
against influenza A infection, but has scarcely been used. In the last 3 years,
two neuraminidase inhibitor antivirals, zanamivir and oseltamivir, have been
introduced to the market for the treatment and prophylaxis of influenza A
and B infections. This review focuses on aspects of prevention and treatment
of influenza appropriate to people of working age. Decisions based on the
cost-effectiveness of prevention and treatment options differ when viewed
from the perspective of the healthcare provider, the employer or the employee.
Options currently available need to be directed to a wider range of people
than those conventionally regarded as the target risk group.
Stott DJ, Kerr G, Carman WF.
Occup Med (Lond) 2002 Aug;52(5):249-53
Influenza is a common nosocomial infection. Serious outbreaks
occur typically in elderly long-term patients, but have also been reported
in renal, transplant and oncology units, neonatal intensive care and paediatrics.
It is likely that staff-patient cross-infection is common. Prompt diagnosis
of an outbreak lies at the heart of an effective influenza control programme.
This requires effective virological surveillance. There are a variety of strategies
that can help to prevent spread of influenza in health care settings. Basic
infection control should include isolating infected residents, restricting
circulation of nursing staff between patients, and restriction of visitors.
Annual influenza immunization should be offered to elderly patients, subjects
with chronic disease, and those in long-term residential or nursing home care.
Vaccination of health care workers has been shown to be effective in protecting
elderly patients in long-term care. Use of oral amantadine or rimantadine
is an additional possible strategy for prophylaxis or treatment during an
Stephenson I, Zambon M.
Occup Med (Lond) 2002 Aug;52(5):241-7
Influenza remains a globally important cause of febrile respiratory
illness. Influenza virus activity in the community results in significant
mortality, morbidity and economic disruption, particularly in those at high
risk of developing complications, such as the elderly and those with underlying
chronic medical conditions, including pulmonary disease and diabetes mellitus.
The occurrence in Hong Kong in 1997 of avian influenza H5N1 in man, which
resulted in six deaths, served to remind us of the importance of continuing
surveillance and preparation for the next pandemic.
Occup Med (Lond) 2002 Aug;52(5):239-40
Friedrich Hofmann, Ulrich Stössel, Martina Michaelis, Matthias
Nübling, Achim Siegel:
Int Arch Occup Environ Health (2002) 75: 484-490
Objectives. To gain more conclusive evidence on the question
of work-related low-back disorders in German nurses, a comprehensive study
with several methodological approaches was performed.
Methods. As part of this project, a cross-sectional study
on working conditions and prevalence of low back pain, a sample of 3,332 nurses
and 1,720 clerks as reference group was investigated by a questionnaire. In
this article, final results referring to a sub-sample of 2,207 nurses and
1,177 clerks who had always worked in their profession, so that we could exclude
confounding effects of former occupations, will be presented. Excluding the
confounding effects of several covariates by logistic regression, we computed
relative risks for different pain symptoms.
Results. The data suggest a considerably higher risk of low
back pain for nurses than for the reference population of clerks. Results,
however, differ markedly when specific pain symptoms are considered. With
respect to lumbago-sciatica and sciatica - which have to be regarded as indicators
for possible disc herniation - the study group's relative risk is the most
elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting
the results for several confounders and covariates leads to still higher estimations
of nurses' relative risk.
Kuiper JI, Verbeek JHAM, Straub JP, Everts V, Frings-Dresen
Scand J Work Environ Health 2002;28(3):168-175.
Objectives This study explored the association between biomarkers
of type I collagen metabolism and exposure to physical workload.
Methods In a prospective cohort study, serum concentrations
of markers of type I collagen synthesis and degradation were assessed monthly
for student nurses who worked as nurses for a period of 6 months and compared
with those of a reference group. The number of patient-handling activities
was estimated from observations at the workplace. Linear generalized estimating
equations were used to analyze differences in the serum concentrations of
the biomarkers between the exposed group and reference group, as well as to
analyze whether the number of patient-handling activities was associated with
serum concentrations of the biomarkers.
Results Serum concentrations of the biomarkers were found
to differ between the groups. The biomarkers reflected a higher anabolism
of type I collagen in the exposed group when compared with that of the reference
group. An analysis of the effect of the number of patient-handling activities
revealed that a higher exposure was associated with higher effective type
I collagen synthesis within the exposed group.
Conclusions These results indicate that serum concentrations
of these biomarkers of type I collagen metabolism can reflect differences
in exposure between contrasting groups, and also varying levels of exposure
between persons within an occupation.
Martin E. Evans and Judith
Clinical Infectious Diseases
Gene therapy is being
studied for the treatment of a wide variety of acquired and inherited disorders.
Retroviruses, adenoviruses, poxviruses, adeno-associated virus, herpesviruses,
and others are being engineered to serve as gene therapy vectors and are being
administered to patients in a clinical setting. Infection control professionals
will be asked to evaluate the use and safety of these agents in their clinics
and hospitals. This review summarizes key aspects of the biotechnology and
the vectors involved in gene therapy and makes recommendations for infection
Emmanuelle Girou, Sabrina
Loyeau, Patrick Legrand, Francoise Oppein, Christian Brun-Buisson.
Objective: To compare
the efficacy of handrubbing with an alcohol based solution versus conventional
handwashing with antiseptic soap in reducing hand contamination during routine
Design: Randomised controlled
trial during daily nursing sessions of 2 to 3 hours.
Setting: Three intensive
care units in a French university hospital.
Participants: 23 healthcare
with alcohol based solution (n=12) or handwashing with antiseptic soap (n=11)
when hand hygiene was indicated before and after patient care. Imprints taken
of fingertips and palm of dominant hand before and after hand hygiene procedure.
Bacterial counts quantified blindly.
Main outcome measures:
Bacterial reduction of hand contamination.
Results: With handrubbing
the median percentage reduction in bacterial contamination was significantly
higher than with handwashing (83% v 58%, P=0.012), with a median difference
in the percentage reduction of 26% (95% confidence interval 8% to 44%). The
median duration of hand hygiene was 30 seconds in each group.
Conclusions: During routine
patient care handrubbing with an alcohol based solution is significantly more
efficient in reducing hand contamination than handwashing with antiseptic
Today more than 5 million
U.S. hospital workers from many occupations perform a wide variety of duties.
They are exposed to many safety and health hazards, including violence. Recent
data indicate that hospital workers are at high risk for experiencing violence
in the workplace. According to estimates of the Bureau of Labor Statistics
(BLS), 2,637 nonfatal assaults on hospital workers occurred in 1999—a rate
of 8.3 assaults per 10,000 workers. This rate is much higher than the rate
of nonfatal assaults for all private-sector industries, which is 2 per 10,000
Several studies indicate
that violence often takes place during times of high activity and interaction
with patients, such as at meal times and during visiting hours and patient
transportation. Assaults may occur when service is denied, when a patient
is involuntarily admitted, or when a health care worker attempts to set limits
on eating, drinking, or tobacco or alcohol use.
The purpose of this brochure
is to increase worker and employer awareness of the risk factors for violence
in hospitals and to provide strategies for reducing exposure to these factors.
Gelfand DV, Podnos YD,
Wilson SE, Cooke J, Williams RA.
Arch Surg 2002 Aug;137(8):941-5;
HYPOTHESIS: The number
of unfilled general surgery programs in the United States increased from 4
in 1999 to 41 in 2001. This study seeks to determine if changes in student
attitudes occurring during their medical school careers and during the third-year
general surgery clerkship contribute to a decline in interest in a surgical
career. DESIGN: Prospective survey of medical students at a public medical
school in California. PARTICIPANTS AND METHODS: Each medical student received
a survey via the Internet. Responses were anonymous. Once quantified, chi(2)
analysis was used for comparison and analysis of survey results. Comparisons
were made between individual class years and on the basis of whether the respondent
completed the third-year general surgery clerkship. RESULTS: Of 368 surveys
sent, 232 (63%) were successfully completed and included in the study. Comparison
of students' attitudes before and after completion of their general surgery
clerkship showed that following surgical course exposure more students believed
surgery lacked breadth of expertise, limitations over stress, control over
one's time, regularity of schedule, adequacy of leisure time, and income commensurate
to workload (P<.05). These results are also consistent in comparisons between
individual class years. CONCLUSIONS: Data suggest that medical students seem
to be more concerned with issues of "controllable lifestyle" such
as adequacy of family and/or leisure time, high level of stress, and amount
of work and commitment. The erosion of income differential between demanding
and less taxing specialties was also an important cause cited for the flagging
interest in surgical disciplines.
Int J Palliat Nurs 2001
Although there are an
increasing number of hospices opening around the country, the concept of the
children's hospice is still relatively new. Although stress involved in giving
palliative care to adults has been examined quite extensively, very little
work has been done on the impact of caring for children in the hospice setting.
This article is a literature review, examining the causes and effects of staff
stress in the children's hospice, as well as the factors that enable staff
to cope with working in this environment. It concludes that the main causes
of stress are often related to conflicts within the staff group, communication
problems and role conflict. Poor relationships with the child's family as
well as the inability to relieve distressing symptoms the child may be experiencing
have also been identified as common sources of stress. Teamwork, good communication
and the home-like atmosphere of the hospice all contribute to enabling staff
to deal with work stress. Staff support groups may be beneficial, but need
to be run well, by someone experienced in leading such groups. Additionally,
stress can be reduced by providing staff with the appropriate training and
education and by encouraging them to take some responsibility for preventing
and relieving stress themselves.
Nurs BC 2001 Dec;33(5):5
Comment on: Nurs BC. 2001
Brender J, Suarez L, Hendricks
K, Baetz RA, Larsen R.
J Occup Environ Med 2002
In a case-control study,
we examined whether parental occupational exposures were related to neural
tube defect (NTD)-affected pregnancies among Mexican Americans living along
the Texas-Mexico border. Case women were 184 Mexican-American women with NTD-affected
pregnancies; control women were 225 study-area residents who delivered normal
babies during the same period as the case women. The women were interviewed
in person about maternal and paternal occupations and work exposures during
the periconceptional period. Compared with control women, case women were
more likely to have had occupational exposures to solvents (odds ratio [OR],
infinity; 95% confidence interval [CI], 2.4-infinity) and also were more likely
to have worked in cleaning (OR 9.5; 95% CI, 1.1 to 82.2) or health care
occupations (OR 3.0; 95% CI, 1.0 to 9.0) than control women. No compelling
associations were found between paternal work exposures or occupations and
NTDs in offspring in this population.
Healthc Hazard Manage
Monit 2002 Aug;15(12):1-6
Le guide des carrières
des personnels hospitaliers non médicaux est un outil destiné aux gestionnaires
des ressources humaines des établissements publics de santé. Il est aussi,
plus largement un moyen d'information précis et technique à l'intention des
Le document présente les
grilles indiciaires et les conditions d’avancement de grade des personnels
titulaires : personnels de direction, autres personnels administratifs, personnels
des services de soins, sages-femmes, psychologues, personnels socio-éducatifs,
techniques et ouvriers et des personnels contractuels : médecins du travail,
radiophysiciens, informaticiens et aumôniers
Il intègre l’ensemble
des modifications statutaires intervenues dans le cadre du protocole du 14
mars 2001 relatif aux filières de la fonction publique hospitalière (seule
la grille relative aux directrices d’écoles de sages-femmes actuellement en
cours de modification n’a pas été mise à jour).
Circulaire DGS/SD 5 C
n° 2002-400 du 15 juillet 2002 modifiant la circulaire DGS/SD 5 C n° 2001-542
du 8 novembre 2001 relative à la prophylaxie des infections invasives à méningocoque
La sixième édition du
Guide canadien d’immunisation renferme de nombreux changements
par rapport à la version
de 1998 tout en tentant de rester facile à consulter.
Chaque chapitre a été
révisé en profondeur et mis à jour au besoin. De nouveaux chapitres
ont été ajoutés sur le
vaccin contre la varicelle, le vaccin contre la maladie de Lyme
et les vaccins combinés
contre l’hépatite A et B. Nous avons aussi ajouté les nouveaux
vaccins conjugués dans
le chapitre sur le vaccin contre le pneumocoque et dans celui
sur le vaccin contre le
méningocoque. La section sur les effets secondaires a été élargie.
Un chapitre sur les communications
contenant de l’information sur les sites Web
recommandés a également
Voici quelques-uns des
principaux changements apportés au Guide :
utilisation du vaccin contre la varicelle durant
une éclosion et chez les travailleurs
de la santé;
vaccin conjugué contre le pneumocoque pour prévenir
une infection grave chez les
vaccin conjugué contre le méningocoque pour aider
à contenir cette maladie
usage limité du vaccin contre la maladie de Lyme,
sauf pour ceux qui se rendent
dans des régions d’endémie;
emploi du vaccin contre l’hépatite A dans la lutte
contre les éclosions;
usage possible du vaccin contre la coqueluche
chez les adolescents;
sites Internet intéressants;
discussion de l’immunisation avec les patients.
Le Quotidien du Médecin,
22 aout 2002
"Le ministre de l'Intérieur,
Nicolas Sarkozy, a reçu, le lundi 19 août, les médecins urgentistes. La sécurité
dans les services d'urgences hospitalières a été au centre des discussions
entre le président de l'Association des médecins urgentistes hospitaliers
de France (Amuhf), Patrick Pelloux, et le ministre de l’Intérieur. Ont été
évoqués les soucis de sécurité que posent les détenus hosp