The purpose of this study on hand injury from powered wood splitters was to describe injury epidemiology and anatomy, to rate injury severity, to evaluate the outcome after injury and to describe factors of possible importance for the occurrence of injury. By searching a computerized patient registry, 131 patients injured by wood splitters from 1995 to 2001 were identified. Information was obtained from hospital records and radiographs, a written questionnaire and a structured telephone interview. Injury severity was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (DASH) and, in 26 of the most severely injured patients, with the Sollerman test. Forty-six percent of the injuries occurred during April or May. Wedge splitters caused 82 % of all injuries and most often injured the index finger, while screw splitters caused 18 % of all injuries and most often injured the metacarpus. Screw splitters caused palmar perforation and thumb avulsion. Sixty-three percent of all patients had an amputation or devascularising injury. The reliability of HISS rating was good. The mean Hand Injury Severity Score (HISS) was 63 which is equivalent to a severe hand injury. The mean ISS was 3.7. Nineteen percent of patients had minor, 31 % had moderate, 23 % had severe and 27 % had major injury according to the HISS system. Children had more severe injuries than adults. There was no significant difference regarding HISS or DASH scores between wedge and screw splitter injuries. The mean DASH score was 15, indicating moderate residual sequelae, but patients without sequelae and patients with grave sequelae were found in all HISS severity grades. There was a weak but significant correlation between the HISS and DASH scores. The mean Sollerman score in the injured hand was 66, indicating significantly impaired hand function. Twenty-nine percent of splitters were home-made. Very few machines had the safety measures required by European Standards. Children were present during splitting in at least 15 % of cases. Not being alone at the machine was one cause of wedge splitter injury. Glove use was one cause of screw splitter injury. Hand injury from powered wood splitters is a significant problem. Many of the injuries are severe, and cause long term sequels and impairment of hand function. Prevention is essential and should focus on unsafe machines and dangerous patterns of use.

Officiellement généralisée par la loi du 11 octobre 1946, la médecine du travail s’impose aujourd’hui à tous les secteurs d’activité. Pour veiller sur la santé et la sécurité des travailleurs, la loi a confié aux médecins du travail une mission de prévention consistant à « éviter toute altération de la santé des travailleurs du fait de leur travail, notamment en surveillant leurs conditions d'hygiène au travail, les risques de contagion et leur état de santé, ainsi que tout risque manifeste d'atteinte à la sécurité des tiers évoluant dans l'environnement immédiat de travail» (Code du travail –article L.4622-3). Bien que tous les médecins du travail remplissent des fonctions identiques, les règles qui leur sont applicables varient en fonction de leurs secteurs d’activités. En conséquence, on constate une grande hétérogénéité des statuts. Cette étude présente le statut des médecins du travail des services de santé au travail non agricole et le statut des médecins du travail des fonctions publiques. A travers un état des lieux, la thèse apporte un éclairage précis sur l’hétérogénéité de leur statut et conduit à s’interroger sur la mise en place des règles plus homogènes. / Officially extended by the law of October 11th, 1946, occupational health has nowadays become part of all business sectors. To ensure the workers’ health and safety, the law entrusted the occupational health practitioners with a risk prevention with the aim ‘to avoid any deterioration of the workers’ health due to their work, including looking after their work hygiene conditions, the contagion risks and their state of health. It also covers all clear risks linked to third party safety working in the immediate work environment (labour law – article L.4622-3).Although all occupational health practitioners have similar duties, the rules that they apply can vary according the business sectors. Therefore we notice a wide variety of status. This study deals with the status of the occupational health practitioners in the occupational health department of the non-farm and public service. By analyzing the current situation, this thesis gives a precise perspective on the heterogeneousness of their status and leads to questioning setting up more homogenous rules.

<p>14 juni 2007 beslutade regeringen att tillkalla en särskild utredare med uppdrag att utforma förslag till en svensk veteranpolitik, som skulle innefatta ansvaret för personalen före, under och efter internationella militära insatser. Utredningen, som tog namnet Veteransoldatutredningen, lämnade i oktober 2008 sitt slutbetänkande. Syftet med denna uppsats var att kritiskt granska utredningens förslag till förbättring i frågan om psykologisk ohälsa, stressprevention, inför insats och med utgångspunkt i litteraturen försöka förutsäga om förslaget skulle komma att ge effekt</p><p> Metodvalen i denna uppsats har utgjorts av kvalitativ textanalys samt deskription. Tyngdpunkten i essän ligger i att definiera stressreaktioner samt åtgärder för stressprevention. Därefter följer analysen för att kunna se om det finns en förankring i aktuell forskning, och mot slutet granskas om förslagen kommer att ge effekt.</p><p>I uppsatsen söktes svar på följande frågeställningar:</p><p>-          Finns det en förankring i förslagen från Veteransoldatutredningen i aktuell forskning med inriktning på preventiva åtgärder?</p><p>-          Är det rimligt att anta att med stöd av aktuell forskning att förslagen kan förebygga psykisk ohälsa efter internationell insats?</p><p>De viktigaste slutsatserna som har dragits från denna studie är:</p><p>Förslagen från veteransoldatutredningen finns till del förankrade i aktuell litteratur. De förslag som väntas kunna förebygga psykisk ohälsa efter internationell insats är som följer.</p><p>-          En förbättrad och mer effektiv rekrytering genom större personlig kontakt medger en noggrannare rekrytering som gör att man får rätt människor, på rätt plats med godkända vitsord samt psykisk lämplighet och detta minskar i sin tur risken för stressreaktioner.</p><p>-          Utökad och bättre information till allmänheten från den politiska ledningen och från Försvarsmakten om missioner minskar förhoppningsvis samhällets opposition genom att öka förståelsen för Försvarsmakten och dess uppgifter. Detta nedbringar i sin tur den kumulativa stress i soldatens vardag p g a externa stressorer från samhälle och media.</p><p>-          Ytterligare utbildning i mänskliga rättigheter och krigets lagar bidrar till att skapa trygghet i vad soldater får - och inte får - göra. Genom dylik utbildning kan frustrationen, som uppstår då soldaterna inte vet hur de skall hantera specifika situationer, minskas. </p> / <p>This essay - <em>Veteransoldatutredningen – a review of its proposals for improving the matter of mental ill-health</em> – is written by cadet Josefine Nilsson. The aim is to study the <em>Veteransoldatutredning’</em>s suggestions for improvement when it comes to e.g. stress prevention and psychological ill-health ahead on an international mission.</p><p>The methods used are description and trial of a hypothesis. Through a study of the immediate literature and by analyzing the proposals, my conclusions are that an improved and more efficient recruitment allows for a more accurate recruitment; increased and better information to the public from the political body and from the Armed Forces will reduce external stress that the soldiers sometime feel, and also that additional education in human rights and the law of war contributes to create a security in what the soldiers can, and can not do.</p>

Santé et sécurité au travail, prévention des risques professionnels (risque routier, risques psychosociaux), intensification du travail… Autant de questions essentielles auxquelles l’entreprise est confrontée. Y répondre suppose souvent le croisement des regards et des compétences. Les services de santé au travail, qui ont pour mission exclusive d’éviter toute altération de la santé des travailleurs du fait de leur travail, y concourent. Acteurs de terrain, ils devraient constituer la pièce maîtresse du système de santé au travail ; ils sont pourtant victimes d’un désamour collectif. La délicate coexistence des concepts d’aptitude et de prévention y contribue. L’institution a, depuis 1942, connu de profondes métamorphoses nées, pour nombre d’entre elles, de la conjugaison, parfois source de tensions, du droit du travail et du droit de la santé publique. Le rattachement de l’institution, lors de la Libération, au ministère du Travail a longtemps scellé la domination du droit du travail. La montée en puissance du droit de la santé publique la remet progressivement en cause. La réforme du 20 juillet 2011 en a offert illustration. L’analyse des rapports entre droit du travail et droit de la santé publique invite à proposer de nouvelles logiques au service de la santé des travailleurs fondées sur l’idée - qui est aussi un constat - selon laquelle le service de santé au travail n’est pas un prestataire parmi d’autres : il participe de l’intérêt général. / Health and security at work, occupational risk prevention (road risk, psychosocial risks), intensification of labor conditions… A number of questions that the enterprise has to take into account. Answering them assumes a variety of points of view and skills. Occupational health services, that have the exclusive mission to prevent any worker health alteration occurring from their work, contribute to this debate. Due to their unique position, as a field actor, they should be the master piece of the occupational health system ; these services are, however, victim of a collective disaffection. The delicate combination of the “medical fitness for work” concept and the occupational risk prevention concept contributes to this disaffection. Since 1942, the institution has seen deep metamorphoses, a number of them appearing from the combination (sometimes being a cause for tension) of the labor law and the public health law. After the Liberation, the incorporation of the institution to the Ministry of Labor, sealed a long domination of the Labor law. The growing power of the Public Health has been jeopardizing progressively this domination. The reform dated 20th July 2011 illustrates this change of balance. The analysis of the links between the Labor Law and the Public Health Law suggests to propose a new paradigm for the sake of the workers’ health, based upon the idea – which is also a fact – that the occupational health service cannot be compared to other providers : this service contributes to the general interest.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.

BACKGROUND: Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that exposure to organic solvents can cause neuropsychological deficits in exposed offspring; however, there is limited data from prospective controlled human studies. OBJECTIVE: To compare neuropsychological functioning between children whose mothers were occupationally exposed to organic solvents during pregnancy with a non-exposed matched comparison group. METHODS: Participants were 48 women who had previously contacted the Motherisk Program in Toronto, Canada during pregnancy regarding occupational exposure to organic solvents and a matched comparison group of women with no known exposure to teratogens during pregnancy. Children (18 months to 8 years 11 months at time of study) were compared in areas of cognitive, language, motor, and behavioral functioning. RESULTS: Children whose mothers were exposed to organic solvents during pregnancy displayed a lower level of functioning when compared with their matched peers in areas of cognitive, language, motor, and behavioral domains. Although the scores on measures of behavioral functioning were not in the clinical range, the mothers of exposed children reported more challenging behavioral problems. In order to determine whether exposure predicted neuropsychological outcomes above and beyond maternal intellectual functioning, hierarchical regressions were run with maternal IQ and maternal education at Step 1and exposure status added at Step 2. In utero exposure to organic solvents predicted lower sores on global measures of Verbal IQ, receptive and expressive language scales above and beyond maternal intellectual functioning. Factors associated with higher levels of exposure (detecting odor, longer duration and total number of toxicity symptoms) was associated with poorer outcome on behavioral and motor functioning tests. CONCLUSION: Despite the fact that the exposed mothers experienced minimal symptoms of toxicity, detrimental effects were still evident in their offspring. Current safety standards for exposure were designed for adults and need to be reevaluated. Further studies addressing exposure to specific organic solvents, dose, and gestational timing of exposure are warranted.

Hintergrund: Im Zuge der Eindämmung der COVID-19-Pandemie mitsamt der einhergehenden erhöhten Hautbelastung wurde bei Beschäftigten in Pflegeberufen im Gesundheitswesen eine erhebliche Zunahme von beruflich bedingten Handekzemen verzeichnet. Zielsetzung: Entwicklung und Exploration eines Konzeptes zur Prävention beruflich bedingter Handekzeme im Gesundheitswesen während der COVID-19-Pandemie. Methoden: Durchführung einer kontrollierten, prospektiven Interventionsstudie mit 302 Beschäftigten in Pflegeberufen im Gesundheitswesen. 135 Teilnehmende wurden der Interventionsgruppe (IG) und 167 Teilnehmende wurden der Kontrollgruppe (KG) zugeteilt. Die IG erhielt eine Online-Schulung und wurde für die Beobachtungsphase von Dezember 2020 bis Juni 2021 in der Hochphase neuer beruflicher COVID-19-Infektionen im Gesundheitswesen ad libitum mit einem Hautreinigungs- und Hautpflegeprodukt ausgestattet. Der Hautbefund wurde zu Beginn (T0) und nach 6 Monaten (T2) dermatologisch erhoben. Zudem wurde zu T0, nach 3 Monaten (T1) und zu T2 in beiden Gruppen der Hautzustand, das Hautschutz- und Hautpflegeverhalten und das Wissen zu Handekzemen mit Fragebögen erfasst. Die Anwenderakzeptanz der Produkte wurde in der IG zu T2 mit einem Fragebogen erhoben. Ergebnisse: Die Drop-out Rate betrug 16,9%. Im Beobachtungszeitraum traten in der IG bei keinem der 115 zu T2 Teilnehmenden und in der KG bei 12 (8,8%) der 136 zu T2 Teilnehmenden neue Handekzeme auf. Bei gleichem Ausgangsbefund (1,5 Punkte zu T0 in beiden Gruppen) zeigte der Osnabrueck Hand Eczema Severity Index zu T2 signifikant bessere Werte in der IG als in der KG (0,6 Punkte vs. 2,1 Punkte, p<0,001). Zu T2 lagen in der IG im Vergleich zur KG signifikant bessere Werte hinsichtlich der täglichen Eincremefrequenz der Hände im beruflichen (4,5 Mal vs. 2,9 Mal, p<0,001) und privaten Bereich (4,1 Mal vs. 2,6 Mal, p<0,001) vor. Für den Berufsdermatosen-Wissenstest lag eine stärkere Verbesserung in der IG als in der KG vor (Interaktion zwischen Bedingung und linearer Zeitvariable, p=0,003; Interaktion zwischen Bedingung und quadratischer Zeitvariable, p<0,001). Zu T2 konnten sich 91,3% der 115 Teilnehmenden der IG vorstellen, das im Sinne eines proof of concept erprobte Handpflegekonzept weiterhin anzuwenden. Fazit: Die Wirksamkeit des Interventionskonzeptes hinsichtlich einer Verbesserung des Hautzustandes, einer Optimierung des Hautschutz- und Hautpflegeverhaltens sowie einer Zunahme des Wissens über die Pathogenese und Prävention von beruflich bedingten Handekzemen wurde nachgewiesen. Es ist als belegt anzusehen, dass sich das vorliegende Interventionskonzept zur Prävention von beruflich bedingten Handekzemen in der Berufsgruppe der Beschäftigten in Pflegeberufen im Gesundheitswesen unter COVID-19-Pandemiebedingungen eignet. Das Interventionskonzept kann zukünftig im Rahmen der Prävention von beruflich bedingten Handekzemen bei Beschäftigten in Pflegeberufen im Gesundheitswesen Einsatz finden und somit einen dauerhaften und nachhaltigen Beitrag zur betrieblichen Gesundheitsförderung leisten. Die Hautschutz- und Hautpflegeempfehlungen können ferner für weitere Risikoberufe für berufliche Hauterkrankungen sowie für die Allgemeinbevölkerung in Pandemie-Zeiten adaptiert werden.