Suchergebnisse

Abstract

Objective
Ultrafine particles (UFPs) are generated from common work processes and have thus existed for a long time. Far more prevalent than engineered nanoparticles, they share common toxicological characteristics with them. However, there is no existing retrospective assessment tool specific to UFPs, for example, for epidemiological purposes. Thus, we aimed to develop a job-exposure matrix dedicated to UFPs.


Method
Fifty-seven work processes were identified as well as the chemical composition of UFPs emitted, following a literature review and the input of an expert panel. These work processes were associated with occupational codes as defined by the ISCO 1968 classification. The probability and frequency of UFP exposure were assessed for each combination of occupational code and process. Summarized probabilities and frequencies were then calculated for all ISCO occupational codes associated with several processes. Variations in exposure over time or across industrial sectors were accounted for in the assessment of each occupational code.


Results
In the ISCO classification, 52.8% of the occupational codes (n = 835) assessed were associated with exposure to UFPs, consisting mainly of carbonaceous, metallic, and mineral families (39.5%, 22 and, 15.8%, respectively). Among them, 42.6% involved very probable exposure, and at a high frequency (regularly or continuously).


Conclusion
These results suggest that occupational exposure to UFPs may be extensive at the workplace and could concern a wide variety of workers. Pending the integration of a third parameter assessing the intensity of UFP exposure, the MatPUF JEM already constitutes a promising and easy-to-use tool to study the possible adverse health effects of UFPs at work. It may also guide prevention policies in the occupational environments concerned, including those involving engineered nanoparticles.

International audience ; In France, more than 2.5 million patients are currently treated with levothyroxine, mainly as the marketed product Levothyrox ®. In March 2017, at the request of French authorities, a new formulation of Levothyrox ® was licensed, with the objective of avoiding stability deficiencies of the old formulation. Before launching this new formulation, an average bioequivalence trial, based on European Union recommended guidelines, was performed. The implicit rationale was the assumption that the two products, being bioequivalent, would also be switchable, allowing substitution of the new for the old formulation, thus avoiding the need for individual calibration of the dosage regimen of thyroxine, using the thyroid-stimulating hormone level as the endpoint, as required for a new patient on initiating treatment. Despite the fact that both formulations were shown to be bioequivalent, adverse drug reactions were reported in several thousands of patients after taking the new formulation. In this opinion paper, we report that more than 50% of healthy volunteers enrolled in a successful regulatory average bioequivalence trial were actually outside the a priori bioequivalence range. Therefore, we question the ability of an average bioequivalence trial to guarantee the switchability within patients of the new and old levothyroxine formulations. We further propose an analysis of this problem using the conceptual framework of individual bioequivalence. This involves investigating the bioavailability of the two formulations within a subject, by comparing not only the population means (as established by average bioequivalence) but also by assessing two variance terms, namely the within-subject variance and the variance estimating subject-by-formulation interaction. A higher within individual variability for the new formulation would lead to reconsideration of the appropriateness of the new formulation. Alternatively, a possible subject-by-formulation interaction would allow a judgement on the ability, or ...

Aud Johannessen,1,2 Kjerstin Tevik,3 Knut Engedal,1 Gro Gade Haanes,2 Anne-Sofie Helvik1,3 1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; 2University of South-Eastern Norway (USN), Department of Nursing and Health Sciences, Kongsberg, Norway; 3General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NorwayCorrespondence: Aud JohannessenNorwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, P.O. Box 2136, Tønsberg, NO-3103, NorwayTel +47 97547979Email aud.johannessen@aldringoghelse.noBackground: Alcohol consumption among older people is expected to increase in the years ahead. Health professionals' experiences of, and reflections on, alcohol consumption and its relation to well-being are thus important to the provision of adequate and high-quality treatment and care.Aim: To investigate health professionals' experiences and reflections about alcohol consumption among older people and how it is related to their health and well-being.Methods: A case study design approach was adopted, incorporating three qualitative studies involving Norwegian health professionals. The health professionals interviewed included workers in nursing homes, home care professionals and general practitioners.Results: The study revealed a diversity of views and reflections on alcohol consumption, its facilitation, and the impact on the health and well-being of older patients and care recipients. Six themes were revealed by the three studies: (i) the facilitation of alcohol consumption to promote and normalize life in nursing homes, (ii) the restriction of unhealthy alcohol consumption, (iii) attempts to discuss alcohol consumption with care recipients, (iv) the initiation of collaboration with informal caregivers in restricting alcohol consumption, (v) minimalizing the dialogue regarding alcohol consumption to guard patient privacy and (vi) a desire for joint action and a national political strategy.Conclusion: Health professionals working in NHs, in-home and GPs find it difficult to discuss the use and elevated use of alcohol with older people for whom they have care and treatment responsibilities. In general, they are concerned that such conversations infringe on the principles governing an individual's autonomy. However, because they are aware that elevated alcohol intake may have a negative impact on health and well-being, they also express a need for guidelines how they in a better and open minded way can discuss the use and elevated use of alcohol with the patients they care for.Keywords: case-study, elderly, harmful use of alcohol, narrative interviews, municipality staff, older adult, older oldest

"Based on 50 years of research, the alcohol field has shifted from a monolithic abstinence-oriented view of alcohol problems, treatment approaches, and recovery pathways to a pluralistic view that recognizes the heterogeneous, multi-dimensional nature of these central features of alcohol use disorder (AUD). Positive change is a dynamic process that occurs over time and ranges from reduced alcohol use and associated problems to abstinence and improved functioning and wellbeing. Although extant recovery definitions vary with respect to the emphasis placed on abstinence, consensus has emerged that successful recovery is broader than beneficial reductions in drinking practices and entails improvements in health, functioning, and well-being. Most individuals who develop an AUD or have sub-clinical problems eventually reduce their risky drinking practices and experience AUD symptom reduction, and some will further achieve and maintain "recovery" broadly defined as encompassing improved health, wellbeing, and life circumstances"--

Comprend : Autres auteurs : Kerivel, Aude ; James, Samuel ; Appartient à l'ensemble documentaire : BnSP000

Comprend : Autres auteurs : Kerivel, Aude ; James, Samuel ; Appartient à l'ensemble documentaire : BnSP000

WI docs no.: Aud.3:36, 38, 40 ; Mode of access: Internet.

Cognitive dysfunction is commonly observed among individuals with Alcohol Use Disorder (AUD) and trauma exposure and is, in turn, associated with worse clinical outcomes. Accordingly, disruptions in cognitive functioning may be conceptualized as a trans-disease phenomenon representing a potential high-yield target for intervention. Less is known though about how different cognitive functions co-vary with alcohol use, craving, and posttraumatic stress symptom severity among trauma exposed individuals with AUD. Sixty-eight male and female trauma exposed military Veterans with AUD, entering treatment trials to reduce alcohol use, completed measures assessing alcohol use and craving, posttraumatic stress symptom severity, and cognitive functioning. In multivariate models, after controlling for posttraumatic stress symptom severity, poorer learning and memory was associated with higher alcohol consumption and higher risk-taking/impulsivity was associated with stronger pre-occupations with alcohol and compulsions to drink. Alcohol consumption and craving, but not performance on cognitive tests, were positively associated with posttraumatic stress symptom severity. Findings suggest that interventions to strengthen cognitive functioning might be used as a preparatory step to augment treatments for AUD. Clinicians are encouraged to consider a standard assessment of cognitive functioning, in addition to posttraumatic stress symptom severity, in treatment planning and delivery for this vulnerable and high-risk population.

Abstract Background To plan integrated care at end of life for people with either heart failure or lung disease, we used a case conference between the patient's general practitioner (GP), specialist services and a palliative care consultant physician. This intervention significantly reduced hospitalisations and emergency department visits. This paper reports estimates of potential savings of reduced hospitalisation through end of life case conferences in a pilot study. Methods We used Australian Refined Diagnosis Related Group codes to obtain data on hospitalisations and costs. The Australian health system is a federation: the national government is responsible for funding community based care, while state and territory governments fund public hospitals. There were 35 case conferences for patients with end stage heart failure or lung disease, who were patients of the public hospital system, involving 30 GPs in a regional health district. Results The annualised total cost per patient was AUD$90,060 before CC and AUD$11,841 after CC. The mean per person cost saving was AUD$41,023 ($25,274 excluding one service utilisation outlier). For every 100 patients with end of life heart failure and lung disease each year, the case conferencing intervention would save AUD$4.1 million (AUD$2.5 million excluding one service utilisation outlier). Conclusions Multidisciplinary case conferences that promote integrated care among specialists and GPs resulted in substantial cost savings while providing care. Cost shifting between national and state or territory governments may impede implementation of this successful health service intervention. An integrated model such as ours is very relevant to initiatives to reform national health care. Trial registration Australian and New Zealand Controlled Trials Register ACTRN12613001377729 : Registered 16/12/2013.

National audience ; Le moteur principal de la prise en compte du bien‐être animal dans les pratiques lors des phases d'élevage, de transport et d'abattage en Europe a été la réglementation. Toutefois, à l'instar de pays tiers, de nombreuses démarches et de divers statuts intègrent désormais la dimension bien‐être à des degrés variables. Cela va du simple respect de la réglementation (labels nationaux, tel IKB aux Pays‐Bas) à des normes plus exigeantes (label Bio), une sensibilisation accrue des acteurs par la formation et des outils d'auto‐contrôle (code of welfare de Nouvelle‐Zélande) ou des audits plus élaborés d'évaluation (TGI en Allemagne, WelfareQuality®).Ceci reflète l'aspect multifactoriel du bien‐être. Différents types de mesures sont utilisés, sur l'animal et/ou son environnement. D'autres informations peuvent être collectées, tels que des documents techniques. La qualité de l'évaluation dépend dans tous les cas de la qualité des mesures (validité, répétabilité, robustesse) et le choix des indicateurs est lié à la nature de la démarche et de la finalité de l'outil (contrôle/certification, analyse de risque, intervention/conseil). L'objectif de la synthèse est de présenter les modalités de construction des outils de suivi d'élevage intégrant une dimension bien-être, de préciser les différents buts recherchés et les différentes démarches existantes. Nous évaluons ensuite les perspectives de développement de ces initiatives dans le contexte politique et réglementaire présent et à venir dans l'Union Européenne.

National audience ; Le moteur principal de la prise en compte du bien‐être animal dans les pratiques lors des phases d'élevage, de transport et d'abattage en Europe a été la réglementation. Toutefois, à l'instar de pays tiers, de nombreuses démarches et de divers statuts intègrent désormais la dimension bien‐être à des degrés variables. Cela va du simple respect de la réglementation (labels nationaux, tel IKB aux Pays‐Bas) à des normes plus exigeantes (label Bio), une sensibilisation accrue des acteurs par la formation et des outils d'auto‐contrôle (code of welfare de Nouvelle‐Zélande) ou des audits plus élaborés d'évaluation (TGI en Allemagne, WelfareQuality®).Ceci reflète l'aspect multifactoriel du bien‐être. Différents types de mesures sont utilisés, sur l'animal et/ou son environnement. D'autres informations peuvent être collectées, tels que des documents techniques. La qualité de l'évaluation dépend dans tous les cas de la qualité des mesures (validité, répétabilité, robustesse) et le choix des indicateurs est lié à la nature de la démarche et de la finalité de l'outil (contrôle/certification, analyse de risque, intervention/conseil). L'objectif de la synthèse est de présenter les modalités de construction des outils de suivi d'élevage intégrant une dimension bien-être, de préciser les différents buts recherchés et les différentes démarches existantes. Nous évaluons ensuite les perspectives de développement de ces initiatives dans le contexte politique et réglementaire présent et à venir dans l'Union Européenne.

Ein Beitrag zur Geschichte des Liberalismus. Humboldt wird gewürdigt als "eine der letzten großen Persönlichkeiten Deutschlands mit liberaler Grundeinstellung". (AuD-Hrn)