Background: Prenatal exposure to perfluoroalkyl substances (PFAS) has been associated with lower birth weight in epidemiologic studies. This association could be attributable to glomerular filtration rate (GFR), which is related to PFAS concentration and birth weight. Objectives: We used a physiologically based pharmacokinetic (PBPK) model of pregnancy to assess how much of the PFAS–birth weight association observed in epidemiologic studies might be attributable to GFR. Methods: We modified a PBPK model to reflect the association of GFR with birth weight (estimated from three studies of GFR and birth weight) and used it to simulate PFAS concentrations in maternal and cord plasma. The model was run 250,000 times, with variation in parameters, to simulate a population. Simulated data were analyzed to evaluate the association between PFAS levels and birth weight due to GFR. We compared simulated estimates with those from a meta-analysis of epidemiologic data. Results: The reduction in birth weight for each 1-ng/mL increase in simulated cord plasma for perfluorooctane sulfonate (PFOS) was 2.72 g (95% CI: –3.40, –2.04), and for perfluorooctanoic acid (PFOA) was 7.13 g (95% CI: –8.46, –5.80); results based on maternal plasma at term were similar. Results were sensitive to variations in PFAS level distributions and the strength of the GFR–birth weight association. In comparison, our meta-analysis of epidemiologic studies suggested that each 1-ng/mL increase in prenatal PFOS and PFOA levels was associated with 5.00 g (95% CI: –21.66, –7.78) and 14.72 g (95% CI: –8.92, –1.09) reductions in birth weight, respectively. Conclusion: Results of our simulations suggest that a substantial proportion of the association between prenatal PFAS and birth weight may be attributable to confounding by GFR and that confounding by GFR may be more important in studies with sample collection later in pregnancy.

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Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-26Bitstream added on 2014-06-13T19:59:19Z : No. of bitstreams: 1 donatelli_ljp_me_botfm.pdf: 3238455 bytes, checksum: 32d07fd19eb9209d7934df74ace655ed (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Estudo epidemiológico descritivo de acidentes ocupacionais envolvendo exposição a material biológico em cirurgiões-dentistas, auxiliares odontológicos, estudantes de Odontologia, atuando na cidade de Bauru-SP, de 2000 a 2004. As fontes de informações foram prontuários e fichas de notificação de acidentes. Os casos foram descritos segundo atributos dos acidentados, serviço de ocorrência, objeto causador da lesão, matéria orgânica envolvida na exposição, circunstância do acidente e coeficiente de incidência. As providências adotadas antes e depois da ocorrência do acidente, bem como acompanhamento sorológico dos acidentados também foram descritos. Comparou-se, para o mesmo período, os resultados obtidos em Bauru com os resultados do SINABIO em profissionais de Odontologia do Estado de São Paulo. Foram identificados 179 acidentes, envolvendo 174 profissionais. O maior número de casos, quarenta e nove, ocorreu em 2000. Houve predomínio de casos em mulheres e em jovens, sobretudo, estudantes de Odontologia. Constatou-se que o procedimento odontológico envolvendo exposição percutânea com agulha contaminada com sangue foi a circunstância do acidente predominante. Sondas, brocas curetas e limas foram outros instrumentos envolvidos. A maioria dos acidentados utilizava luvas e máscara, e estava vacinado contra hepatite B. Observou-se que a realização de Anti-HBs pós vacinal foi efetuada raramente. Grande parte dos pacientes-fonte era conhecido e, destes, apenas 39,2% teve resultados de exames sorológicos para HIV registrados, 10,7% para HBV e 2,1% para HCV. Medicação anti-retroviral foi ministrada em 85,5% dos casos; 3,9% dos acidentados receberam gamaglobulina hiperimune para hepatite B; 19,0 % foram vacinados contra hepatite B. Não foram registradas soroconversões para nenhum dos três vírus considerados (HIV, HBV e HCV)... / A descriptive epidemiological study of occupational accidents involving biological material exposure to dentists, dental assistants, and dentistry students in Bauru-SP, from 2000 to 2004. Source information was obtained from patient charts and accident notification forms. All cases were described according to the accident victims' personal and professional details, the location of the accident, the device causing the injury, the organic material exposed to, the circumstances of the accident, and the index of accident incidence. Procedures taken before and after any accident are described, as are the resulting serological proceedings. Results from Bauru were compared with those of dentistry professionals from the State of São Paulo, during the same period, registered by SINABIO (Notification System for Biological accidents of the STD/AIDS programme of the Sao Paulo State Health Organization). 179 accidents were identified, involving 174 professionals. The majority of cases, 49, occurred in 2000. Women and young people were more often affected, being mainly those among dentistry students. The predominant circumstance for accidents registered was during dentistry procedures involving percutaneous exposure with needles contaminated by blood. Other devices involved in accidents were probes, burs, curettes and files. The majority of accident victims were wearing gloves and masks when the accident occurred and were hepatitis B vaccinated. The Anti-HB S reaction test was rarely done. In most cases sources were known, and from these only 39.2% had serological exam results registered for HIV, 10.7% for HBV and 2.1% for HCV. 84.5% of the professionals involved in accidents did not follow all the postexposure... (Complete abstract click electronic access below)

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-02-02T09:47:42Z No. of bitstreams: 1 palomarodriguessalazar.pdf: 1611326 bytes, checksum: 57f37a4505099af22e2f8b26affc02f4 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-02-02T11:42:37Z (GMT) No. of bitstreams: 1 palomarodriguessalazar.pdf: 1611326 bytes, checksum: 57f37a4505099af22e2f8b26affc02f4 (MD5) / Made available in DSpace on 2016-02-02T11:42:37Z (GMT). No. of bitstreams: 1 palomarodriguessalazar.pdf: 1611326 bytes, checksum: 57f37a4505099af22e2f8b26affc02f4 (MD5) Previous issue date: 2014-03-20 / De acordo com a OMS (2011), o uso do tabaco continua sendo a principal causa de morte evitável para 6 milhões de pessoas no mundo a cada ano. O tabagismo acarreta perda de produtividade de trabalho (por doença ou morte), aposentadorias precoces e pensões, gerando danos a fumantes e não fumantes. Muitas estratégias têm sido estabelecidas para limitação da comercialização do tabaco, proteção da exposição à poluição tabagística ambiental e apoio para tratamento dos dependentes. O ambiente profissional é apontado como favorável para abordagem dos trabalhadores e implantação de programas de prevenção que estimulem a mudança no estilo de vida. Os objetivos deste trabalho foram: caracterizar quanto ao perfil sociodemográfico os trabalhadores técnico-administrativos em educação da Universidade Federal de Juiz de Fora - MG; identificar a presença do tabagismo, o grau de dependência ao consumo do tabaco e a frequência da exposição à poluição tabagística entre esses trabalhadores e correlacionar os dados referentes ao grau de dependência ao uso do tabaco com as variáveis socioeconômicas, idade e sexo dos participantes do estudo. Trata-se de um estudo epidemiológico descritivo-exploratório, tipo transversal, do qual participaram 721 técnicos-administrativos em educação efetivos da Universidade Federal de Juiz de Fora - MG. A coleta de dados foi realizada por meio de um questionário autopreenchível. As questões analisadas foram as referentes ao perfil sociodemográfico, ao uso do tabaco, à exposição à poluição tabagística e ao grau de dependência do tabagista, verificado pelo Questionário de Fagerström. Buscou-se associar o grau de dependência com variáveis sociodemográficas. Foram realizadas análises descritivas por medidas de frequência e bivariada com auxílio do programa SPSS versão 15.0. Os resultados apontaram que a população apresenta uma distribuição uniforme entre servidores do sexo masculino e feminino, a faixa etária predominante foi de 51 a 60 anos, de cor branca, pós-graduados, casados ou em união estável, com renda familiar de dez ou mais salários mínimos e trabalham exclusivamente no setor público. Faziam uso do tabaco 12,2% da amostra, com iniciação do hábito na adolescência e juventude. O grau de dependência com maior frequência foi o muito baixo e baixo, com média de idade de 24,1 anos. Não houve significância estatística entre o grau de dependência e as variáveis sociodemográficas analisadas. A exposição à poluição tabagística ambiental foi de 34,5%. Espera-se que este estudo sustente novas investigações sobre esta temática pouco explorada entre trabalhadores e que subsidie ações de promoção, prevenção e cessação do tabagismo entre os mesmos. / According to the World Health Organization (2011), tobacco use remains as the leading preventable cause of death for 6 million people worldwide each year. Smoking causes loss of work productivity (due to illness or death) and early retirements and pensions, being harmful to smokers and nonsmokers. Many strategies have been established in order to reduce tobacco sales, to hedge exposure to environmental tobacco pollution and to support treatment for dependents. The professional environment is favorable to approach workers and to implement prevention programs that encourage changes in lifestyle. This study aimed (a) to characterize the sociodemographic profile of the technical and administrative employees of the public University of Juiz de Fora – MG; (b) to identify the occurrence of tobacco use, the degree of dependence on tobacco consumption and the frequency of exposure to tobacco pollution amongst these workers; and (c) to correlate the data on the degree of dependence to tobacco use with socioeconomic, age and sex variables of the study participants. This is a descriptive-exploratory study, cross-sectional, in which participated 721 administrative technicians in effective education of the public University of Juiz de Fora – MG. The data was collected through a self-managed survey. The issues considered were related to the sociodemographic profile, tobacco use, exposure to tobacco pollution and degree of smoking dependence, verified by the Fagerström Questionnaire. We aimed to associate the degree of dependency with the sociodemographic variables. Descriptive statistics for measures of frequency and bivariate were performed with the SPSS software, version 15.0. The results showed that the population is composed similar number of men and women, with ages from 51 to 60 years, white, post-graduated, married or in a stable union, with a family income of ten or more minimum wages and working exclusively in the public sector. 12.2% of them used tobacco, with initiation of the habit in the youth. The predominant degree of dependence was very low and low, with a mean age of 24.1 years. There was no statistical significance between the degree of dependency and the sociodemographic variables analyzed. The exposure to environmental tobacco pollution was 34.5 %. It is hoped that this study supports further investigation of this underexplored issue amongst workers, and subsidizes health promotion, prevention and the tobacco use cessation among them.

Abstract Temporomandibular disorders (TMD) are described as a variety of dysfunctions and pains related to the masticatory system. Clicking in the temporomandibular joints (TMJs) and pain in the masticatory muscles are the most common symptoms and signs of TMD. Other frequently reported symptoms are headache, facial pain, and symptoms in the ears. The prevalence of TMD signs in the adult population has been shown to vary between 33% and 86%, being more common in women than in men. TMD has been found to be most prevalent at 20–50 years of age. The aim of this cross-sectional study was to investigate the prevalence of TMD and associated risk factors in the Finnish adult population based on the Northern Finland Birth Cohort (NFBC) 1966. Altogether 1 962 cohort subjects at the age of 46 years (1 050 women, 912 men) responded to questionnaires and participated in a clinical medical and dental examination in 2012–2013. The stomatognathic examination was performed according to a modified protocol of diagnostic criteria for TMD (DC/TMD). The prevalence of TMD signs among the examined cohort subjects was 34.2%; women had clinical signs of TMD more often than men. Clinical signs were registered more often than self-reported TMD symptoms. The most common clinical signs were clicking in the TMJs (26.2%) and palpation pain in the masticatory muscles (11.2%). The most common diagnosis was disc displacement with reduction (7.0%). TMD signs were associated with unstable occlusion. Occlusal disturbances were associated with palpation pain in the masticatory muscles, as well as myalgia and arthralgia diagnoses. Pain-related TMD symptoms and clinical signs correlated strongly with a poor self-reported health condition as well as with painful general health problems. / Tiivistelmä Purentaelimistön toimintahäiriöt (engl. temporomandibular disorders, TMD) on yhteisnimitys leukanivelten, puremalihasten, hampaiston ja niihin liittyvien kudosten sairaus- ja kiputiloille. Leukanivelen naksuminen ja kipu purentaelimistön alueella ovat tavallisimmat oireet, mutta myös päänsärky, kasvokipu ja korvaoireet ovat yleisiä TMD-potilailla. Väestötutkimuksissa on havaittu suurta vaihtelua TMD:n esiintyvyydessä (33–86 %). TMD:n oireita sekä löydöksiä todetaan tavallisimmin 20–50-vuotiailla ja naisilla enemmän kuin miehillä. Tutkimuksen tarkoituksena oli selvittää TMD:n esiintyvyyttä ja riskitekijöitä suomalaisessa aikuisväestössä Pohjois-Suomen syntymäkohortti 1966:n (Northern Finland Birth Cohort, NFBC) aineistossa. Vuosina 2012–2013 tutkittiin 1 962 kohortin henkilöä 46 vuoden ikäisinä (1 050 naista, 912 miestä). Tutkimus koostui kyselyistä sekä lääketieteellisestä ja suun terveydentilan kliinisestä tutkimuksesta. Purentaelimistön tutkimuksessa käytettiin kansainvälistä TMD:n diagnostista kriteeristöä (engl. diagnostic criteria for TMD, DC/TMD). TMD-löydösten esiintyvyys tutkitussa kohorttiaineistossa oli 34,2 %. Kliiniset löydökset tutkituilla henkilöillä olivat yleisempiä kuin heidän raportoimansa oireet. Yleisimmät löydökset olivat leukanivelen naksuminen (26,2 %) ja palpaatiokipu puremalihaksissa (11,2 %). Yleisin diagnoosi oli leukanivelen välilevyn palautuva virheasento (7,0 %). TMD-löydösten ja epästabiilin purennan välillä havaittiin yhteys. Purennassa olevien häiriöiden ja puremalihasten palpaatiokivun sekä leukanivelkivun välillä todettiin selvä yhteys. TMD-löydöksillä ja niihin liittyvillä kivuilla havaittiin tilastollisesti merkitsevä yhteys koettuun heikentyneeseen terveydentilaan sekä kivuliaisiin yleissairauksiin.

É muito importante que se reconheça os fatores relacionados com à má oclusão que ocorrem em uma determinada população à fim de que medidas preventivas e tratamentos ortodônticos possam ser conduzidos. O objetivo do presente estudo epidemiológico foi obter dados representativos sobre fatores relacionados com as más oclusões na dentição decídua e mista no Equador. Os responsáveis por 400 crianças, de 3 a 9 anos, em atendimento na Faculdade de Odontologia da Universidade Central do Equador foram questionados, incialmente, quanto aos dados pessoais, histórico familiar e saúde. Em sequência as crianças foram examinadas, clinicamente, extra e intra oralmente. O exame funcional, avaliação de hábitos e nível socioeconômico também foram conduzidos por um único avaliador. Os dados obtidos foram tabulados para se obter tabelas de frequência e porcentagem. Foi aplicado o Teste Qui quadrado ou Teste de Fisher (p<0,05). Um número maior de crianças com má oclusão (77%) foi encontrado do que crianças com oclusão adequada (p=0,00001). Não se pode afirmar que houve correlação significativa entre classe socioeconômica e má oclusão (p=0,12). Houve predomínio do hábito de morder objetos estranhos e onicofagia. 33,33% das crianças com mordida aberta apresentavam respiração bucal, no entanto, entre as crianças que apresentaram outros tipos de oclusão, 32,47% tinham respiração bucal. A sucção digital foi encontrada em 14% das crianças. Conclui-se que existe um número significante de má oclusão; há correlação entre interferências oclusais e a presença de mordida cruzada; a atrição fisiológica desenvolve-se com o avanço da idade; não houve associação significativa entre respiração bucal e mordida aberta e o nível sócio econômico não interfere nas características de oclusão. / It is very important to recognize the factors related to bad occlusion that occur in a certain population so that the measures Preventive and orthodontic treatments can be carried out. The objective of the present epidemiological study was to obtain representative data on factors related to malocclusions in deciduous and mixed dentition in Ecuador. Those responsible for 400 children, from 3 to 9 years old, in care in School of Dentistry of the Central University of Ecuador were respondents, in terms of personal data, family history and Health. In sequence the children were examined, clinically, extra and intra orally. Functional examination, evaluation of habits and socioeconomic status They were conducted by a single researcher. The data They were tabulated to obtain frequency and percentage tables. The application was applied Chi square test or Fisher\'s test (p <0.05). A greater number of Children with malocclusion (77%) were found to be children with correct occlusion (p = 0.00001). It cannot be said that there was significant correlation between socioeconomic class and bad occlusion (p = 0.12). A predominance was observed the habit of biting foreign objects and Onychophagia. 33.33% of children with open bite had mouth breathing, however, among children who presented other types of occlusion, 32.47% had mouth breathing. The digital suction 14% of children were found. It is concluded that there is a significant number of malocclusion; there is correlation between occlusal interferences and the presence of a crossbite; Physiological attrition develops as Age advances; there was no significant association between mouth breathing and open bite and socioeconomic status does not interfere with the characteristics of occlusion.

Asthma affects nearly two and a half million people in Canada. In Saskatchewan, the prevalence of asthma has increased across all age groups since 1981. Current literature indicates that the purchase of all asthma medications increased in the last 20 years both province and nationwide. Since the early 1990s, the Canadian Consensus Guidelines (CCG) for the treatment of asthma recommended increasing the use of inhaled corticosteroids as a mainstay for controlling asthma symptoms. The CCG have also encouraged decreasing the use of short-acting, inhaled beta2-agonist medication. <p>The objective of this descriptive epidemiological study was to investigate asthma medication prescribing at the individual level among physician-diagnosed asthma patients, aged 0 to 64 years, in Saskatchewan from January 1, 1991 to December 31, 2000. Saskatchewan residents covered under the provincial health insurance plan who received a physicians diagnosis of asthma, identified each calendar year, were included in the study (296,430 asthma patients in total). <p> Nearly 80.0% of this asthma population purchased at least one asthma medication in each calendar year. From 1991 to 2000, users and the mean number of prescriptions of short-acting beta2-agonists decreased slightly. The proportion of users and mean number prescriptions per year of inhaled corticosteroids increased. The highest mean numbers of prescriptions and users of inhaled corticosteroids were among the 0-4 year olds. <p>Short-acting beta2-agonists, inhaled corticosteroids, and oral corticosteroids were the most popular medications. Users of theophyllines and cromoglycates decreased. The 15-34 year old males showed the greatest "inappropriate" use as high users of short-acting beta2-agonists and low users of inhaled corticosteroids. <p>There was increasing compliance with the CCG over the ten years. The combination of beta2-agonists with inhaled corticosteroids usurped beta2-agonist monotherapy as the most popular form of asthma therapy by the year 2000. Users of combination therapy increased from 19% to 38.7%, while users of beta2-agonists alone decreased from 34.5% to 23.1%. <p>From 1996 to 2000, the monthly number of both short-acting beta2-agonists and inhaled corticosteroids prescriptions decreased for all users in July and August. Peak increases in the number of short-acting beta2-agonist prescriptions, for children under 15, occurred in September. For adults, peak increases occurred in December for both medications. <p>These study results will enhance the understanding of asthma medication use among children and adults and will help healthcare professionals develop new treatment programs for the management of asthma.

Asthma affects nearly two and a half million people in Canada. In Saskatchewan, the prevalence of asthma has increased across all age groups since 1981. Current literature indicates that the purchase of all asthma medications increased in the last 20 years both province and nationwide. Since the early 1990s, the Canadian Consensus Guidelines (CCG) for the treatment of asthma recommended increasing the use of inhaled corticosteroids as a mainstay for controlling asthma symptoms. The CCG have also encouraged decreasing the use of short-acting, inhaled beta2-agonist medication. <p>The objective of this descriptive epidemiological study was to investigate asthma medication prescribing at the individual level among physician-diagnosed asthma patients, aged 0 to 64 years, in Saskatchewan from January 1, 1991 to December 31, 2000. Saskatchewan residents covered under the provincial health insurance plan who received a physicians diagnosis of asthma, identified each calendar year, were included in the study (296,430 asthma patients in total). <p> Nearly 80.0% of this asthma population purchased at least one asthma medication in each calendar year. From 1991 to 2000, users and the mean number of prescriptions of short-acting beta2-agonists decreased slightly. The proportion of users and mean number prescriptions per year of inhaled corticosteroids increased. The highest mean numbers of prescriptions and users of inhaled corticosteroids were among the 0-4 year olds. <p>Short-acting beta2-agonists, inhaled corticosteroids, and oral corticosteroids were the most popular medications. Users of theophyllines and cromoglycates decreased. The 15-34 year old males showed the greatest "inappropriate" use as high users of short-acting beta2-agonists and low users of inhaled corticosteroids. <p>There was increasing compliance with the CCG over the ten years. The combination of beta2-agonists with inhaled corticosteroids usurped beta2-agonist monotherapy as the most popular form of asthma therapy by the year 2000. Users of combination therapy increased from 19% to 38.7%, while users of beta2-agonists alone decreased from 34.5% to 23.1%. <p>From 1996 to 2000, the monthly number of both short-acting beta2-agonists and inhaled corticosteroids prescriptions decreased for all users in July and August. Peak increases in the number of short-acting beta2-agonist prescriptions, for children under 15, occurred in September. For adults, peak increases occurred in December for both medications. <p>These study results will enhance the understanding of asthma medication use among children and adults and will help healthcare professionals develop new treatment programs for the management of asthma.

Les essais randomisés split-mouth, sont fréquents en médecine buccodentaire. Cependant, certains auteurs ont suggéré que les effets traitement estimés différaient de ceux fournis par les essais en bras parallèles. Par ailleurs, l'enregistrement prospectif des essais est actuellement la meilleure solution pour lutter contre le biais de publication. Premièrement, nous avons comparé les effets traitement estimés entre essais split-mouth et en bras parallèles par une étude méta-épidémiologique. Nous n'avons pas mis en évidence de différence statistiquement significative dans l'estimation de l'effet traitement entre essais randomisés split-mouth et en bras parallèles à question clinique identique. Ces résultats suggèrent que les auteurs de revues systématiques devraient exploiter toutes les preuves disponibles, et qu'en particulier les essais randomisés split-mouth devraient être inclus dans les méta-analyses avec une analyse appropriée.Deuxièmement, nous avons évalué l'enregistrement prospectif sur des registres publics des essais randomisés split-mouth et en bras parallèles publiés en 2013 dans un échantillon de revues de médecine bucco-dentaire. Sur un échantillon de 317 essais randomisés, nous avons montré que seuls 23% des essais étaient enregistrés. Parmi les essais enregistrés, 91% étaient enregistrés rétrospectivement. Nous n'avons pas mis en évidence de différence statistiquement significative entre essais split-mouth et essais en bras parallèles.En conclusion, nous avons proposé des recommandations relatives à l'intégration des essais randomisés split-mouth au sein de la recherche, tant du point de vue du chercheur que de celui des éditeurs de revue médicale. / Split-mouth RCTs are common in oral health medicine. However, some authors have suggested that intervention effect estimates from split-mouth and parallel-arm RCTs may differ. Besides, prospective registration of RCTs is currently the best solution to reporting bias. First, we performed a meta-epidemiological study to compare intervention effect estimates between split-mouth RCTs and parallel-arm RCTs. There was no sufficient evidence for a difference in intervention effect estimates derived from split-mouth and parallel-arm RCTs investigating the same clinical question. Our results support the use of all available evidence in systematic reviews, including that from split-mouth and parallel-arm RCTs, and authors should consider including split-mouth RCTs in their meta-analyses with suitable and appropriate statistical analysis. Second, we assessed how many split-mouth and parallel-arm RCTs with results published in 2013 in a sample of oral health journals had been prospectively registered in trial registries. Of 317 identified RCTs, we showed that only 23% of RCTs were registered. Among those, 91% were registered retrospectively. We did not find any statistically significant difference between split-mouth and parallel-arm RCTs. In conclusion, we have proposed recommendations regarding the integration of splitmouth RCTs in research, from the point of view of researchers and of medical journal editors.

Les asthmes en relation avec le travail (ART) incluent l’asthme professionnel (AP), dû à des causes et conditions attribuables à un environnement professionnel particulier, et l’asthme aggravé par le travail (AAT), qui est une forme pré-existante ou coïncidente d’asthme, aggravée par l’environnement professionnel. Le diagnostic des ART constitue un véritable enjeu. Le premier chapitre est une revue de la littérature, mettant en évidence les points discutés et notamment la place éventuelle des marqueurs de l’inflammation. Le deuxième chapitre présente une analyse de données épidémiologiques chez 417 apprentis coiffeurs et boulangers, des filières à risques d’AP. Des modèles mixtes montrent une association entre le degré de sensibilisation à douze allergènes communs et l’hyperréactivité bronchique (HBR) ainsi que les niveaux de FeNO expiré. Ce dernier est plus élevé de 83% (p<0,01) chez les sujets fortement sensibilisés et de 30% chez les sujets faiblement sensibilisés (p<0,01) comparé au groupe des sujets non sensibilisés. Le troisième chapitre relate l’élaboration d’un protocole de recherche (ARPEIGE) visant à acquérir des connaissances cliniques, épidémiologiques et économiques sur les ART, et aux développement et choix des outils et algorithmes décisionnels. L’analyse des questionnaires de repérage montre qu’en visite de routine en médecine du travail, une part non négligeable de salariés déclare des symptômes respiratoires évoquant un asthme actif, dont certains pourraient être en lien avec le travail. Ce protocole met en évidence la difficulté d’effectuer un dépistage des ART par le faible taux de retours des questionnaires approfondis. Malgré l’importance du diagnostic des ART, les stratégies diagnostiques restent discutées. Si les données chez les apprentis ont montré une association entre certains marqueurs de l’inflammation bronchique (FeNO) et des marqueurs d’atopie (tests cutanés), leur place dans le diagnostic clinique de l’asthme reste discutée. Au-delà des stratégies visant au diagnostic individuel, se pose également la question des stratégies diagnostiques utilisables en population professionnelle. Dans l’étude ARPEIGE, un questionnaire de repérage des symptômes fournit des données relatives à la prévalence des symptômes évocateurs d’asthme. Cependant, peu de sujets repérés acceptent de poursuivre les investigations, d’où l’importance de réfléchir à des stratégies qui permettraient un dépistage des ART au-delà de l’étape de repérage. / Work-related asthma (WRA) includes work aggravation of preexisting asthma (WEA) and new-onset asthma induced by occupational exposure (OA). Making an accurate diagnosis of WRA is important, the condition having significant health consequences and substantial socio-economic impacts. The first part is based on a literature review including data on prevalence, risk factors and diagnosis procedures of WRA. The issues in diagnosing WRA are also discussed, as well as the use of airway inflammation markers (FeNO levels and sputum eosinophils). The second part shows an analysis of epidemiological data in 417 apprentices in baking, pastry-cooking and hairdressing, which are populations at risk of OA. Mixed-effect models were applied and showed that the degree of sensitization was related to bronchial hyperresponsiveness (BHR) and FeNO levels. Compared to non-sensitized subjects, FeNO levels were 83% higher (p>0,01) in highly sensitized subjects and 30% higher (p<0,01) in weakly sensitized subjects. The third part describes the protocol of a field study aiming to collect new data on clinical, epidemiological and economical aspects of WRA. It focuses especially on the design of tools and decision algorithms, such as a screening questionnaire, and more advanced questionnaires on control, quality of life, expositions and socio-economic consequences, and a peak-flow journal. Screening results show that a substantial number of workers declare asthma-like respiratory symptoms, some of which being possibly related to work. Despite the importance of WRA diagnosis, diagnostic procedures are still being discussed. Although the apprentice study showed an association between airway inflammation markers (FeNO levels) and atopy markers (prick-tests), their use in the diagnostic procedure is still under discussion. Diagnostic procedures that could be used in populations at work are also subject to think about, in particular in epidemiological study, with the difficulty of differentiating OA from WEA. Thus, in the ARPEIGE study, a screening questionnaire was useful to collect data on asthma-like respiratory symptoms. Nevertheless, few screened workers agreed to go further and fill in the peak flow journal. Similarly, in the literature asthma and COPD screening campaigns using spirometry seemed difficult to implement. There is a lack of strategies that would enable a more accurate screening of WRA.