Made available in DSpace on 2014-07-29T15:04:41Z (GMT). No. of bitstreams: 1 Santos, Silvana.pdf: 1374305 bytes, checksum: 77f10539cefd889f796d4266c623b502 (MD5) Previous issue date: 2005-12-22 / This is a descriptive study carried out in Higher Education Institutions (HEI) at the State of Goiás Andergraduating students from the last term/grade of courses in the health field took part in this study We aimed at characterizing the exposure to biohazards among andergraduating students from courses in the health area within the State of Goiás; identifying the vaccinal profile of the andergraduating students; characterizing HEI performance on orienting students towards vaccination against immune-preventable diseases of major importance to health professionals (HP) and verifying on students who vaccinated against Hepatitis B the procedure of anti-HBs exam and its outcome A sample test was carried out and with the support of the software Epi-info version 2004 we scored n=651 corresponding to 54% of the population with reliability interval of 95% The research ethic-legal aspects were observed Data was collected by questionnaires validated by three jurors Its application ocurred in a classroom setting Database was structured and processed in the program Epi-info version 2004 and data was presented in figures tables and analysed through descriptive statistics 777 (68,5%) graduating students enrolled on the last grade in 2005 participated in this study Aged between 20 and 55 years mean 34,7 years of age and 83,6% between 20 and 30 years of age Females are predominant with 73,8% 25,4% of graduating students had already been exposed to biological material 64,2% were exposed to sharp instruments together with contact with bloody skin and/or body fluids Among those who were involved in accidents only 35,2% reported them Students showed greater adherence to anti-hepatitis B vaccine referied by 84,9% and only 34,0% took the anti-Hbs tests 73,0% of them called themselves respondents and 10,0% of them did not know about it There was also 46,8% adherence to vaccine against diphtheria and tetanus and 25,8% of adherence to anti-yellow-fever vaccine 92,0% of students affirmed having been oriented about immunization 94,8% recognize anti-hepatitis B as recommendable vaccine to HP 77,3% for anti-diphtheria and tetanus and 48,3 % of accounts suggest anti-yellow-fever vaccine Data sources for the graduating students about recommended vaccine to HP were curricular discipline with 32,3% followed by the college direction with 13,6% of accounts Although HEI in the State of Goiás have been addressing this issue they do so in a fragmented and little consistent way We consider it critical for HEI to set urgently a policy of vaccine establishment before clinical practice as well as to reflect about prevention, and control of infection aiming at interdisciplinarity and above all the quality of teaching which will be reflected on the health professionals profile / Estudo descritivo realizado em Instituições de Ensino Superior (IES) do Estado de Goiás Fizeram parte do estudo graduandos do último ano/semestre dos cursos da área de saúde Objetivou caracterizar a exposição a material biológico entre os graduandos de cursos da área de saúde no Estado de Goiás; Identificar o perfil vacinal destes graduandos; caracterizar a atuação das IES na orientação do graduando quanto à vacinação às doenças imunopreveníveis de importância para os profissionais da área de saúde (PAS) e verificar nos graduandos vacinados contra hepatite B a realização e a resposta do exame anti-Hbs Realizamos o teste piloto e com auxílio do software Epi-info versão 2004 calculamos um n=651, o que corresponde a 54,0 % da população com intervalo de confiabilidade de 95% Foram observados os aspectos ético-legais da pesquisa Os dados foram obtidos por meio de questionário que foi validado por três juízes A aplicação do instrumento foi em sala de aula O banco de dados foi estruturado e processado no programa Epi-info versão 2004 e os dados apresentados em figuras e tabelas e analisados por meio de estatística descritiva Participaram do estudo 777 (68,5%) dos graduandos matriculados no último ano em 2005 Idade entre 20 e 55 anos média de 34,7 anos moda 23 anos e 83,6% entre 20 a 30 anos O sexo feminino é o predominante com 73,8% Já haviam sido expostos a material biológico 25,4% dos graduandos quanto ao tipo de acidente 64,2% afirmaram terem se acidentado tanto com perfurocortantes quanto com exposição de pele e mucosas Dentre os que se envolveram em acidentes somente 35,2% os notificaram Os graduandos apresentaram maior adesão às vacinas anti-hepatite B que foi referida por 84,9% e apenas 34,0% realizaram o teste anti-HBs; destes 73,0% referiram ser respondedores e 10,0% não sabiam Houve também adesão às vacinas anti-difteria e tétano por 46,8% e anti-amarílica por 25,8% dos graduandos Afirmaram terem sido orientados sobre imunização 92,0% dos estudantes Reconhecem como vacinas recomendadas aos PAS: a anti- hepatite B em 94,8% a anti-difteria e tétano em 77,3% e anti-amarílica em 48,3% das citações As fontes de informação aos graduandos sobre as vacinas recomendadas aos PAS foram: disciplina curricular com 32,3% seguida pela direção da faculdade com 13,6% das citações Embora as IES no Estado de Goiás estejam abordando esta temática a fazem de forma fragmentada e pouco consistente Consideramos imprescindível que as IES estabeleçam com urgência uma política de instituição das vacinas antecedendo a prática clínica e repensem o ensino sobre a prevenção e controle de infecção visando a interdisciplinaridade e principalmente a qualidade do ensino o que refletirá no perfil dos profissionais da área de saúde

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-11-06T20:32:32Z No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-11-10T20:09:55Z (GMT) No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-11-10T20:09:55Z (GMT). No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-07 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The dental care practice is characterized by the constant possibility of the staff and patients exposure to biological material (BM) potentially contaminated with infectious various agents, and requiring the epidemiology expertise of these exposures in order to develop the risk management procedures. The present study aimed to analyze the epidemiology of occupational accidents with exposure to BM among dental professionals and students in the State of Goias, and as specific goals, to ferify the frequency and profile of the accidents with biological material exposure among the dental care students and professionals enrolled in a reference hospital with service in compliance with occupational exposure to BM, to characterize the pre-and postexposure behavior and monitoring program recommended for this population and to analyze the socio-demographic and labor factors related to the accidents with BM by percutaneous exposure between dental care professionals and students assisted in a reference service. This is an epidemiological, retrospective and analytical study developed in a referral hospital for the treatment of occupational accidents with exposure to BM of the State of Goiás. All records of the accidents with BM between dental care professionals and students attended in this institution by December 2010 were analysed. Data were collected by completing a standardized form containing personal information, description of the accident, time elapsed between the accident and the first service, and post-exposure and prophylaxis procedures. The data were analyzed by SPSS 15.0 and the OpenEpi 2.3.1., Statistical analysis was performed by descriptive frequency measures and univariate analysis using qui-square and Fisher exact test. 628 accidents were recorded between dental care professionals and students from 1996, the year of first registration, to 2010, in which 77.1% were women. Some individuals reported more than one accident, totalling 701 accidents with exposure to BM that comprise the study population. Among the accidents, the majority (97, 13.8%) occurred in 2008 and 48.6% between dentists. In 92.2% of cases, hepatitis B vaccination status of the victims was described, and out of these, 70.8% received all three doses. In 84.9% of cases there was no record of the completion of anti-HBs by the victims. The accidents were predominantly (658, 93.9%) percutaneous, being the needle the instrument that caused the injury in 49.7%. Performing any dental care procedure was the most comum circumstance in which the accidents occurred most frequently (388, 55.4%), and the finger, the body area most affected (493, 70.3%). We highlight the lack of information in many cases, especially in relation to BM involved in the accident, the use of personal protective equipment at the time of the accident, where the victims performed their activities at the time of the accident and / or were linked and fullfilling of Work Accident Communication form. With the post-exposure procedures, the majority (635, 90.6%) of the institution accidents enrollments occurred within 72 hours, however only 44.9% were in the first two hours. The use of chemoprophylaxis and prophylaxis of hepatitis B in 14.8% and 12.8% of the cases, respectively were recommended. In 82.6% of the accidents, the patients were identified, and their HIV, HBV and HCV condition ignored in 93.6% of records. Among the accidents in which the victim must return to the intitution for the post-exposure follow up (264, 37.7%), only 20.8% returned and 3.8% were discharged. Accidents by percutaneous exposures showed a high prevalence for all variables analysed. It was observed that the higher is the demand for the service the less is the individual chance to undergo a percutaneous exposure (p = 0.000). The occurrence of accidents among dental auxiliaries was significant (p = 0.016) compared to dentists. The lack of data in the records of the institution reveals the need for greater disclosure of ministerial protocols for caring the victims of occupational accidents by BM among professionals responsible for this service. The integration of biosafety, infection control procedures for dental care practice and prevention and prophylaxis for BM accidents issues with undergraduate, graduate courses should develop and provide effective behavior changes. / A prática odontológica é caracterizada pela constante possibilidade de exposição tanto da equipe quanto dos pacientes a material biológico (MB) potencialmente contaminados com diversos agentes infecciosos, sendo necessário o conhecimento da epidemiologia dessas exposições para o desenvolvimento de medidas de gerenciamento de risco. O presente estudo teve como objetivo geral analisar a epidemiologia dos acidentes ocupacionais com exposição a MB entre profissionais e estudantes de odontologia em Goiás e como específicos verificar a frequência e o perfil dos acidentes com MB em estudantes e profissionais de odontologia atendidos em um serviço de referência para atendimento à exposição ocupacional com MB, caracterizar as condutas pré e pós-exposição e de acompanhamento recomendadas para essa população e analisar os fatores sociodemográficos e laborais associados à ocorrência de acidentes com MB por exposição percutânea entre profissionais e estudantes de odontologia atendidos em um serviço de referência. Trata-se de um estudo epidemiológico, retrospectivo e analítico desenvolvido em um hospital de referência para o atendimento de acidentes ocupacionais com exposição a MB do Estado de Goiás. Foram analisadas todas as fichas de registro de acidente com MB entre profissionais e estudantes de odontologia atendidos nessa instituição até dezembro de 2010. Os dados foram coletados por meio do preenchimento de um formulário padronizado contendo informações pessoais, descrição do acidente, tempo decorrido entre o acidente e o primeiro atendimento, condutas pós-exposição e medidas profiláticas. Os dados foram analisados pelo SPSS 15.0 e pelo OpenEpi 2.3.1., foi realizada análise estatística descritiva pelas medidas de frequência e análise univariada por meio de testes qui-quadrado e exato de Fisher. Foram notificados 628 acidentes entre profissionais e estudantes de odontologia no período de 1996, ano do primeiro registro, a 2010, sendo que 77,1% eram do sexo feminino. Alguns indivíduos relataram mais de um acidente, totalizando assim 701 acidentes com exposição a MB que compõem a população do estudo. No ano de 2008 houve a maior frequência de registros de acidentes (97; 13,8%) e desses 18,6% eram CD. Em 92,2% dos casos, a situação vacinal contra hepatite B dos acidentados foi descrita, sendo que desses 70,8% receberam as três doses. Em 84,9% dos casos não havia registro da realização do anti-HBs pelas vítimas. Os acidentes foram predominantemente (658; 93,9%) percutâneos, sendo a agulha o instrumento causador da lesão em 49,7%. Durante a realização de algum procedimento odontológico, foi a circunstância em que os acidentes mais ocorreram (388; 55,4%), e o dedo da mão a área corporal mais atingida (493; 70,3%). Destacou-se a ausência de informações em diversos casos, principalmente em relação ao MB envolvido no acidente, uso de equipamento de proteção individuaI no momento do acidente, instituições onde as vítimas exerciam suas atividades no momento do acidente e/ou eram vinculadas e o preenchimento da Comunicação de Acidente de Trabalho. Quanto às condutas pós-exposição, na maioria (635; 90,6%) dos acidentes, o atendimento na instituição ocorreu em até 72 horas, entretanto apenas 44,9% foram nas primeiras duas horas. Foi recomendado o uso de quimioprofilaxia e profilaxia da hepatite B em 14,8% e 12,8% dos casos, respectivamente. Em 82,6% dos acidentes, os pacientes-fonte eram passíveis de identificação, sendo a condição dos mesmos, quanto à infecção pelo HIV, HBV e HCV, ignorada em 93,6% dos registros. Entre os acidentes em que a vítima deveria retornar ao ambulatório para a realização do acompanhamento pós-exposição (264; 37,7%), apenas 20,8% retornaram e 3,8% receberam alta. Os acidentes por exposições percutâneas apresentaram alta prevalência para todas as variáveis analisadas. Observou-se que quanto maior a procura pelo atendimento, menor a chance do indivíduo ter sofrido uma exposição percutânea (p=0,000). A ocorrência de acidentes entre auxiliares de saúde bucal foi significativa (p=0,016) comparada às CD. A ausência de dados nos registros da instituição revela a necessidade de maior divulgação dos protocolos ministeriais para o atendimento às vítimas de acidentes ocupacionais por MB entre os profissionais responsáveis por esse atendimento. A inserção de conteúdos como prevenção e controle de infecção na prática odontológica e medidas pré e pósacidentes com MB, nos cursos de graduação, aperfeiçoamento e pós-graduação têm o potencial de resultar em mudanças efetivas nas condutas.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-22T12:39:22Z No. of bitstreams: 2 Dissertação - Fabiana Ribeiro de Rezende - 2016.pdf: 1594544 bytes, checksum: a0bb8b9550bf1c5200f811c0056aaae8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-22T12:40:51Z (GMT) No. of bitstreams: 2 Dissertação - Fabiana Ribeiro de Rezende - 2016.pdf: 1594544 bytes, checksum: a0bb8b9550bf1c5200f811c0056aaae8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-22T12:40:51Z (GMT). No. of bitstreams: 2 Dissertação - Fabiana Ribeiro de Rezende - 2016.pdf: 1594544 bytes, checksum: a0bb8b9550bf1c5200f811c0056aaae8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-20 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / NTRODUCTION: Community Health Agents (CHA) are health care workers (HCW) who work in primary care through home visits. Legally their specific duties are not recognized as activities that carry risk of exposure to blood and body fluids (BBF). OBJECTIVE: To verify the involvement of CHA in training on biological risk (BR) and biosafety; identify occupational exposure of CHA to BBF; detail the avenues, circumstances, and BBF involved in the exposure; describe post-exposure conduct; verify immunization against hepatitis B virus (HBV); and identify risk factors associated with exposure BBF in this group. METHODS: Cross-sectional, descriptive and analytical study conducted in the Family Health Centers of a Health District of the City of Goiania, Goias following approval by the Research Ethics Committee of Hospital das Clinicas, Federal University of Goias (No. 1.012.706/2015). CHA participated who were performing their duties between September 8 and November 13, 2015, when data collection was performed. Data collection was via self-administered questionnaire during the work period. Vaccine cards were required for verification of immunization against HBV and provided to the researcher in person or by sending images using instant messaging. Suffering occupational exposure to BBF was the outcome variable, and the predictors were gender, age, education, professional practice time, completion of a training course on BR and biosafety, and immunization against HBV. Data were analyzed with SPSS software (version 20.0). Pearson's chi-square test was used and p values ​​< 0.05 were considered significant. RESULTS: Participants were 80 CHA, mostly females aged 36-50 years having completed secondary or higher education. Seventy-two reported training, and 52.8% reported that the content included some topics related to BR and biosafety. Twenty-three (28.8%) CHA experienced exposures, 10 (43.5%) of them having multiple exposures, totaling 58 incidents. Exposures were cutaneous, percutaneous, through mucous membranes and human bites involving saliva, urine, blood, feces, vomit and sputum. Most incidents involved saliva on unbroken skin, or mucous. Most of the CHA were exposed during activities legal for their profession, but there was a high number of professionals who performed tasks inappropriate for their job. After exposure, 63.8% washed the area, while 29.3% used soap and water. Sixty-six (82.5%) CHA were vaccinated against HBV and 30.0% mentioned anti-HBs testing to confirm immunity. There was no statistically significant association among the variables. CONCLUSION: The CHA participating in this study are occupationally exposed to saliva, blood and other human secretions with peculiar characteristics, but were mostly unprepared to perform the appropriate biosecurity measures. This requires a review of the characterization of this job class as free of BR, and appropriate risk management. / INTRODUÇÃO: Os Agentes Comunitários de Saúde (ACS) são trabalhadores da área da saúde (TAS) que atuam na Atenção Primária por meio de ações pautadas em visitas domiciliárias. Legalmente, possuem atribuições específicas, as quais não são reconhecidas como atividades de risco para exposição a material biológico (MB). OBJETIVOS: Verificar a participação de ACS em capacitações sobre RB e biossegurança; identificar exposições ocupacionais a MB humano entre ACS; caracterizar os modos e circunstâncias de exposição e o MB envolvido; descrever as condutas adotas após a exposição; verificar a imunização contra o vírus da hepatite B (HBV) e identificar fatores associados à exposição a MB nesse grupo. METODOLOGIA: Estudo transversal, descritivo e analítico, realizado em Centros de Saúde da Família, de um Distrito Sanitário do Município de Goiânia-GO, após aprovação por Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás (nº 1.012.706/2015). Participaram ACS que estavam no exercício de suas funções no período de 08 de setembro a 13 de novembro de 2015, quando foi realizada coleta de dados. A obtenção dos dados foi por meio de questionário autoaplicável durante o período de trabalho. Os cartões de vacina foram solicitados para verificação da imunização contra HBV e fornecidos ao pesquisador pessoalmente ou pelo envio de imagens com aplicativo de mensagem instantânea. Sofrer exposição ocupacional a MB humano foi a variável de desfecho e as de predição foram: sexo, idade, escolaridade, tempo de atuação profissional, realização de curso de capacitação sobre RB e biossegurança e imunização contra HBV. Os dados foram analisados com o software SPSS (versão 20.0). O teste qui-quadrado de Pearson foi utilizado, e os valores de p < 0,05 foram considerados significantes. RESULTADOS: Participaram 80 ACS, a maioria do sexo feminino com idade de 36 a 50 anos e ensino médio ou superior completo. Setenta e dois referiram capacitação, e 52,8% reconheceram a presença de algum conteúdo relacionado a RB e biossegurança. Vinte e três (28,8%) ACS sofreram exposições, sendo 10 (43,5%) deles reincidentes, totalizando 58 exposições. Houve exposições cutâneas, percutâneas, mucosas e mordedura humana envolvendo saliva, urina, sangue, fezes, vômito e escarro. Prevaleceram exposições envolvendo saliva em pele íntegra ou mucosa. A maior parte dos ACS se expôs durante atividades previstas em lei para a profissão, mas houve elevado índice de profissionais que realizava tarefas incompatíveis com suas funções. Após a exposição, 63,8% lavaram o local, sendo que 29,3% utilizaram água e sabão. Sessenta e seis (82,5%) ACS estavam vacinados contra HBV e 30,0% mencionaram realização de anti-HBs para verificação da imunidade. Não houve associação estatisticamente significante entre as variáveis. CONCLUSÃO: ACS participantes deste estudo se expuseram ocupacionalmente a saliva, sangue e outras secreções humanas com características peculiares, mas, predominantemente, não foram preparados para adotar as medidas de biossegurança cabíveis. Condições que requerem uma revisão da sua caracterização como isento de RB e medidas que o qualifiquem para o enfrentamento.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-09-09T17:59:04Z No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T14:30:18Z (GMT) No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-12T14:30:18Z (GMT). No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-30 / Accidents with biological material are reportable events, health care workers (TAS), victims of these accidents may be exposed to the hepatitis B and C and HIV, among others. The aims of this study were: to analyze the epidemiology of occupational accidents with biological material among health care workers of the metropolitan area of Goiania-GO (general); describe the socio-demographic and occupational profile of health care workers, victims of occupational accidents with biological material; describe the profile of accidents with biological material among health care workers; characterize the adoption of pre-exposure behaviours related to the latest accident; identify the serological status related to hepatitis B, C and HIV in victims of occupational accidents involving biological material and source patients, and establish the demographic and employment factors associated with the occurrence of multiple accidents among health care workers of the metropolitan area of Goiania-GO. Epidemiological Cross and analytical study which included all registration records of accidents involving biological material of HCW from two sources: A - records of injured HCW in a reference hospital for notification in Goiania, from the first record in 1989 to 2010, and B - records of Sinan, including the first record in 2006 until those available at 31/12/2014. Linkage of databases was performed and data analyzed using the Statistical Package for Social Sciences (SPSS). Socio-demographic and employment variables were the predictor variables and have suffered more than one accident, the outcome. Univariate analysis was performed and variables with P<0.10 were included in a logistic regression model. Ethical precepts were followed (Approval Ethics Committees: 033/2010 and 414.258/2013). A total of 11,536 accidents were recorded from 1989 to December 2014. Of these, 9,575 (83.0%) occurred among HCW and the majority was female. It was found that 665 (7.5%) of the HCW experienced more than one accident, while 70 (0.8%) experienced three or more accidents, totaling 8,825 victims. Nursing staff, auxiliary cleaning, physician, and dental and laboratory teams were the ones who were more frequently hurted, respectively. Most of the victims had completed high school (3,719 (48.0%). Blood/serum/plasma were the biological materials found to be the most involved (6,480/67.7%), at the time of administering medications/vascular access puncture occurring in 2.759 (28.9%), and involving needles with and without lumen in 6,097 (63.7%). A total of 6,653 (75.4%) HCW were vaccinated for hepatitis B. Incomplete information on Sinan records such as, use of PPE (gloves, masks, boots and safety glasses) and serological markers (HBsAg; Anti-HBs, Anti-HCV and Anti-HIV) was found to be the major factor that hampered data analysis. Age, type of material, and organic fluid were predictors risk factor for multiple accidents involving biological material among health care workers. / Os acidentes com material biológico são eventos de notificação compulsória. Os trabalhadores da área da saúde (TAS), vítimas desses acidentes, podem se expor aos vírus das hepatites B e C e HIV, dentre outros. Foram objetivos deste estudo: analisar a epidemiologia dos acidentes ocupacionais com material biológico entre trabalhadores de serviços de saúde, da região metropolitana de Goiânia-GO (geral); descrever o perfil sociodemográfico e laboral dos trabalhadores de serviços de saúde, vítimas de acidentes ocupacionais com material biológico; descrever o perfil dos acidentes com material biológico entre trabalhadores dos serviços de saúde; caracterizar a adoção das condutas pré-exposição relacionadas ao último acidente; identificar a situação sorológica referente às hepatites B, C e HIV, das vítimas de acidentes ocupacionais com material biológico e dos pacientes-fonte e estabelecer os fatores sociodemográficos e laborais associados à ocorrência de múltiplos acidentes entre trabalhadores de serviços de saúde da região metropolitana de Goiânia-GO (específicos). Estudo epidemiológico, transversal e analítico no qual foram incluídas todas as fichas de registro de acidentes de trabalho com material biológico de TAS a partir de duas fontes, A prontuários de TAS acidentados em um hospital de referência para notificação no município de Goiânia, desde o primeiro registro em 1989 até 2010 e B - fichas do Sinan, incluindo o primeiro registro em 2006, até os disponíveis em 31/12/2014. Foi realizado o Linkage dos bancos de dados que foram processados e analisados no Statistical Package for the Social Sciences (SPSS). As variáveis sociodemográficas e laborais foram as variáveis preditoras e ter sofrido mais de um acidente, o desfecho. Foi realizada a análise univariada, e as variáveis que apresentaram valor de p < 0,10 foram incluídas em um modelo de regressão logística. Preceitos éticos foram seguidos (aprovações em Comitês de Ética: 033/2010 e 414.258/2013). Foram registrados 11.536 acidentes, no período de 1989 a dezembro de 2014. Destes registros, 9.575 (83,0%) ocorreram entre os trabalhadores da área de saúde e a maioria era do sexo feminino. Verificou-se que 665 (7,5%) TAS sofreram mais de um acidente, 70 (0,8%) apresentaram três ou mais acidentes, perfazendo 8.825 vítimas. A equipe de enfermagem, o auxiliar de limpeza, médicos e a equipe de odontologia e de laboratório foram os que mais se acidentaram, respectivamente. A maioria das vítimas possuía o ensino médio completo 3.719 (48,0%). O sangue/soro/plasma foram os materiais biológicos mais envolvidos 6.480(67,7%), no momento de administrar medicamentos/punção de acesso vascular em 2.759 (28,9%), com o envolvimento de agulhas com e sem lúmen em 6.097 (63,7%). Em 6.653 (75,4%) dos TAS vacinaram para hepatite B. Para várias informações, predominou a falta de registro nas fichas do Sinan que dificultou a análise: uso dos EPI (luvas, máscaras, botas e óculos) e marcadores sorológicos (HBSAG; Anti-HBs, AntiHCV e o Anti-HIV). Verificou-se que idade, tipo de material, fluido orgânico foram fatores de risco preditores para múltiplos acidentes envolvendo material biológico, entre os trabalhadores dos serviços de saúde.

O benzeno é um hidrocarboneto aromático produzido pela combustão de produtos naturais. A exposição ocupacional ao benzeno é caracterizada por ambientes industriais que o empregam em seus processos produtivos. Nos laboratórios de indústria do petróleo ele é utilizado em forma pura para análise, e está presente como contaminante em derivados, como gasolina, hexano, querosene, tolueno, entre outros. No Brasil o valor recomendado pela legislação como limite de exposição ambiental ao benzeno é de 1ppm. O câncer hematológico é considerado um dos principais fatores de risco para a saúde dos trabalhadores expostos ao benzeno e a utilização de biomarcadores no monitoramento destes profissionais tem sido sugerida em diferentes países. O presente trabalho teve como objetivo avaliar diferentes biomarcadores em sangue periférico de trabalhadores homens, cronicamente expostos ao benzeno em refinarias e siderurgia (18 deles com diagnóstico de intoxicação), que estavam afastados de suas funções por períodos que variaram de cinco meses a 27 anos, com idade média de 46,8 ± 9,33 anos comparado com um grupo controle composto também de 20 homens, selecionados em Bancos de Sangue (idade média de 45,7 ± 8,00 anos), com diferentes ocupações não correlacionadas ao agente em estudo. Em ambos os grupos foram realizados hemograma completo, teste do micronúcleo em linfócitos com bloqueio da citocinese (CBMN), teste de FISH em linfócitos para a translocação t(15;17), bem como testes moleculares para avaliação de polimorfismos em genes envolvidos na metabolização do benzeno (MPO, NQO1, CYP1A1 e CYP2E1) e na eliminação de xenobióticos (GSTM1/GSTT1). Quanto ao hemograma à análise estatística realizada pelo teste t-Student revelou que os expostos ao benzeno apresentavam leucopenia com diferença altamente significante na contagem de leucócitos (p<0,001), neutrófilos (p<0,001), segmentados (p<0,001), linfócitos (p=0,013) e monócitos (p=0,010). A avaliação da série eritrocitária também revelou diferenças estatísticas entre os grupos para os índices de RDW-CV (p= 0,031) e RDW-SD (p=0,008), assim como para o VPM (p=0,001). Não foi verificada diferença entre os grupos quanto à frequência de polimorfismos nos genes CYP1A1, CYP2E1, MPO, NQO1, GSTM1, GSTT1. No teste do CBMN a contagem de células com MN e pontes núcleoplasmáticas foi três vezes maior nos expostos (1,95 ± 2,37) que nos controles (0,65 ± 0,75), diferença essa considerada estatisticamente significante (t=2,33; 38gl; p=0,024). Na análise de FISH para o rearranjo PML/RAR? os trabalhadores expostos também apresentaram frequência três vezes maior de células com pelo menos uma fusão gênica (9,79 ± 9,54) em comparação aos controles (3,95 ± 3,17), diferença essa considerada estatisticamente significante pelo teste t-Student (p=0,019). Os resultados obtidos na presente investigação parecem estar de acordo com os dados da literatura que revelam alteração nas células primordiais da medula, decorrente da exposição ocupacional ao benzeno, bem como ação genotóxica, identificada pelos testes do CBMN e FISH em linfócitos de sangue periférico. Embora o número de trabalhadores estudados seja reduzido, e a exposição ocupacional possivelmente inclua outros agentes potencialmente genotóxicos que não só o benzeno é interessante ressaltar que os resultados positivos foram observados após em média nove anos de afastamento profissional. A utilização do teste do CBMN e o estudo de outras translocações, que não só a PML/ RAR?, em linfócitos de trabalhadores expostos pode representar um biomonitoramento importante e menos invasivo no acompanhamento destes trabalhadores. A análise de um grupo maior de trabalhadores, inclusive expostos a baixas concentrações de benzeno pode ser fundamental na validação destes biomarcadores. / Benzene is an aromatic hydrocarbon produced by the burning of natural products. The occupational exposure to benzene is characterized by industrial environments that use in their production processes. In the laboratories of Petroleum industry it is used in the pure form for analysis, and it is present as a contaminant in other products like gasoline, hexane, kerosene, toluene, etc. In Brazil the threshold limit value recommended by law in environmental exposure to benzene is 1 ppm. The hematological cancer is considered one of the main risk factors for the health of workers occupationally exposed to benzene and the use of biomarkers in monitoring these professionals has been suggested in different countries. The aim of this study was to assess different biomarkers in peripheral blood lymphocytes from 20 men workers chronically exposed to benzene in Petroleum Refinery and Steel Industry (18 workers with poisoning diagnosis), who were removed from workplace for periods ranging from five months to 27 years, with average age 46.8 ± 9.33 years old compared to a control group consisting also of 20 men, selected in Blood Banks (average age 45.7 ± 8.00 years old), with different occupations unrelated to the agent under study. In both groups were performed blood cell counts, cytokinesis-block micronucleus assay (CBMN), FISH assay in peripheral blood lymphocytes for translocation t(15;17), and molecular tests for evaluation of genetic polymorphisms in genes involved in benzene metabolism (MPO, NQO1, CYP1A1 e CYP2E1) and detoxification (GSTM1/GSTT1). Despite blood cell counts the statistical analysis performed by t-Student test revealed that workers exposed to benzene had leukopenia with a highly significant difference in leukocyte count (p<0.001), neutrophils (p<0.001), segmented (p<0.001), lymphocytes (p=0.013) and monocytes (p=0.010). The evaluation of red blood cells also revealed statistically significant differences between groups for RDW-CV (0.031), RDW-SD (0.008) and MPV (0.001). There were no differences between groups regarding the frequency of genetic polymorphisms in CYP1A1, CYP2E1, MPO, NQO1, GSTM1, and GSTT1. In the CBMN test the cell counts with MN and nucleoplasmic bridges was three times higher in exposed (1.95 ± 2.37) than in controls (0.65 ± 0.75), and the difference was considered statistically significant (t=2.33;38gl;p=0.024). In the FISH analysis for the PML/RAR? rearrangement the exposed workers also showed three times higher frequency of cells with at least one signal fusion (9.79 ± 9.54) in comparison to controls (3.95 ± 3.17), and the difference was statistically significant by the t-Student test (p=0.019). The results obtained in this study seem to agree with the literature data that show alterations in the stem cells of the bone marrow, resulting from occupational exposure to benzene, as well genotoxicity, identified by CBMN and FISH assay in peripheral blood lymphocytes. Although the number of subjects evaluated is reduced, and the occupational exposure includes other potentially genotoxic agents not only benzene, it is interesting to note that positive results were observed after an average of nine years of removal professional. The use of the CBMN test and the study of other translocations, not only PML/ RAR?, in lymphocytes of workers exposed may represent an important biomonitoring and less invasive monitoring of workers. The analysis of a major number of individuals, including those exposed to low concentrations of benzene, may be essential in validation of these biomarkers.

Background: Only few studies deal with the workload of physical therapists and the health consequences, although this occupational group is quite important for the health care system in many industrialized countries (e.g. ca. 136 000 people are currently employed as physical therapists in Germany). Therefore, the current state of knowledge of work-related diseases and disorders of physical therapists is insufficient. The aim of the 'Physical Therapist Cohort' (PTC) study is to analyze the association between work-related exposures and diseases among physical therapists in Germany. This article describes the protocol of the baseline assessment of the PTC study. Methods/Design: A cross-sectional study will be conducted as baseline assessment and will include a representative random sample of approximately 300 physical therapists employed in Germany (exposure group), and a population-based comparison group (n = 300). The comparison group will comprise a sample of working aged (18–65 years) inhabitants of a German city. Variables of interest will be assessed using a questionnaire manual including questions regarding musculoskeletal, dermal, and infectious diseases and disorders as well as psychosocial exposures, diseases and disorders. In addition to subjective measures, a clinical examination will be used to objectify the questionnaire-based results (n = 50). Discussion: The study, which includes extensive data collection, provides a unique opportunity to study the prospective association of work-related exposures and associated complaints of physical therapists. Baseline results will give first clues with regard to whether and how prevalent main exposures of physiotherapeutic work and typical work areas of physical therapists are associated with the development of work-related diseases. Thereby, this baseline assessment provides the basis for further investigations to examine causal relationships in accordance with a longitudinal design.

No description available.

Le cancer du cerveau est associé à une morbidité importante et à un fardeau économique considérable pour les systèmes de santé, les patients et leur famille. Malheureusement, on en sait toujours très peu sur l’étiologie de cette maladie. Les métaux, les métalloïdes et les fumées de soudures constituent une grande famille de cancérogènes professionnels potentiels à laquelle des millions de travailleurs sont exposés. La littérature scientifique fournit certains éléments de preuve que l’exposition professionnelle à quelques composés métalliques pourrait augmenter le risque de cancer du cerveau, mais la plupart des études publiées étaient limitées dans leur taille d’échantillons et en leurs capacités de mesurer efficacement l’exposition professionnelle à vie. Cette thèse a pour objectif de fournir de nouveaux éléments de preuve concernant l’association entre l’exposition professionnelle à certains composés métalliques et les deux principaux sous-types histologiques du cancer du cerveau, le gliome et le méningiome. Deux projets existants constituent la base de cette thèse: INTEROCC, une grande étude internationale cas-témoins sur l’association entre l’exposition professionnelle et le cancer du cerveau, incluant 2 054 cas de gliome, 1 924 cas de méningiome et 5 601 témoins, ainsi que CANJEM, une nouvelle matrice emplois-exposition basée sur plus de 30 000 emplois. CANJEM est un tableau croisé de trois axes: un axe de codes professionnels, un axe de périodes de temps et un axe d’agents chimiques. CANJEM fournit diverses mesures d’exposition à des agents professionnels sélectionnés en fonction d’un titre occupationnel et d’une période de temps. CANJEM étant un outil complexe conçu pour offrir une flexibilité considérable à l’utilisateur, les deux premiers volets de cette thèse ont été consacrés à l’examen de certaines des considérations méthodologiques associées à l’utilisation de CANJEM dans le cadre d’une étude épidémiologique. Premièrement, nous avons examiné comment la modification de la résolution des axes de codes professionnels et de périodes de temps influençait la proportion d’emplois pouvant être liés à CANJEM dans l’étude INTEROCC. Nous avons ensuite comparé l’accord de paires de versions de CANJEM pour la probabilité d’exposition et la concentration pondérée par la fréquence d’exposition de 19 composés métalliques en utilisant le coefficient d’accord de Gwet (AC2). Nous avons observé que, selon la résolution utilisée, CANJEM pouvait lier entre 70,7% et 98,1% de l’ensemble des emplois disponibles dans l’étude INTEROCC. De plus, la modification de l’axe de code professionnel avait un impact plus important que la modification de l’axe de période de temps sur les mesures d’expositions. Deuxièmement, l’évaluation par des experts est généralement considérée comme l’étalon-or dans l’évaluation rétrospective de l’exposition professionnelle. Différents seuils peuvent être appliqués à la probabilité d’exposition fournie par CANJEM afin de distinguer «exposé» de «non exposé». Nous avons comparé les rapports de cotes (RC) obtenus à l’aide de plusieurs versions de variables d’exposition binaire et cumulative pour neuf cancérogènes potentiels du poumon avec des RC obtenus à l’aide de l’évaluation par des experts. Des modèles de régression logistique inconditionnels ont été utilisés pour examiner l’association entre chaque variable d’exposition et le cancer du poumon chez 1 200 cas de cancer du poumon et 1 505 témoin issus d’une étude cas-témoin basée à Montréal. La sensibilité de l’évaluation dérivée de CANJEM par rapport à l’évaluation par experts variait de 0,12 à 0,78, tandis que la spécificité variait de 0,84 à 0,99. Dans l’ensemble, CANJEM a été capable reproduire les associations obtenues avec l’évaluation par experts, l’utilisation de seuils de probabilité de 25% ou 50% fournissant généralement les meilleurs résultats. Finalement, nous avons examiné le lien entre l’exposition professionnelle à 21 composés métalliques et le gliome ainsi que le méningiome dans l’étude INTEROCC à l’aide de régressions logistiques conditionnelles. La stratégie analytique était basée sur les observations faites dans les deux premiers volets. Nous n’avons observé aucune preuve de la présence d’association entre les agents sélectionnés et le gliome, mais la présence d’associations positives entre ces agents et le méningiome a été suggérée. Des associations statistiquement significatives ont également été observées entre le méningiome et une exposition inférieure à 15 ans aux fumées de plomb (RC (intervalle de confiance de 95%)) (1,67 (1,02-2,74)), aux composés du zinc (2,14 (1,02-3,89)), aux fumées de soudure (1,80 (1,17-2,77)), aux fumées d’oxydes métalliques (1,51 (1,03-2,21)) et entre une faible exposition cumulée au chrome VI (1,99 (1,03-3,84)) et aux fumées de brasage (1,83 (1,17-2,87)). L’évaluation rétrospective de l’exposition constitue l’un des principaux défis de l’épidémiologie professionnelle. Dans cette thèse, nous avons constaté que CANJEM, bien qu’imparfaite, était une approche appropriée pour l’évaluation de l’exposition professionnelle dans les études épidémiologiques. Bien qu’il soit difficile de déterminer le rôle exact joué par chacun des agents examinés, nos résultats supportent la présence d’une association positive entre les composés métalliques et plus particulièrement les fumées métalliques et le méningiome. / Brain cancer is associated with substantial lifelong morbidity and considerable economic burden for public health systems, patients, and their families. Very little is known regarding the etiology of this disease. Metals, metalloids, and welding fumes are a large family of potential occupational carcinogens to which millions of workers are exposed. The literature provides some evidence that occupational exposure to a few metallic compounds could increase the risk of brain cancer, but most published studies were limited in sample size and ability to effectively measure lifetime occupational exposure. In this thesis, we aimed to provide new evidence concerning the association between occupational exposure to selected metallic compounds and glioma and meningioma, the two major histological subtypes of brain cancer. Two existing projects provided the basis for the thesis: INTEROCC, a large international pooled case-control study on the association between occupational exposures and brain cancer, including 2,054 glioma cases, 1,924 meningioma cases, and 5,601 controls; CANJEM a new job exposure matrix based on the expert assessment of > 30,000 jobs. CANJEM is a cross-tabulation of three axes: an occupation code axis, a time period axis, and a chemical agent axis that provides various metrics of exposure to selected occupational agents based on a job title and a time period. However, CANJEM is also a complex tool designed to offer considerable flexibility to the user. The first two components of this thesis focused on the examination of some of the methodological considerations associated with the use of CANJEM in the context of an epidemiological study. First we examined how changing the resolution of the occupational code and time period axes, affected the proportion of jobs in the INTEROCC study that could be linked to CANJEM. We then compared the agreement among pairs of versions of CANJEM for the probability and frequency weighted concentration of exposure to 19 metallic compounds using Gwet’s agreement coefficient (AC2). We observed that, depending on the resolution used, CANJEM could be linked to 70.7% to 98.1% of all jobs available in the INTEROCC study. Furthermore, we observed that varying the occupation code axis had a greater impact than varying the time period axis. Neither the metrics of exposure nor the linkage rate were strongly affected by other aspects of CANJEM examined. Second, expert assessment is usually considered the gold standard in retrospective occupational exposure assessment. Different cutpoints can be applied to the probability of exposure provided by CANJEM to distinguish “exposed” from “unexposed”. We compared odds ratios (ORs) obtained using multiple versions of a binary ever and a cumulative exposure variable for nine potential and known lung carcinogens with ORs obtained using expert assessment. Unconditional logistic regression models adjusted for potential confounders were used to examine the association between each exposure variable and lung cancer in 1,200 lung cancer cases and 1,505 controls from a Montreal based case-control study. Sensitivity of the CANJEM-derived assessment vs. the expert assessment ranged from 0.12 to 0.78 while Specificity ranged from 0.84 to 0.99. Overall, CANJEM was fairly successful in reproducing the associations obtained with the expert assessment method, with the use of probability thresholds of 25% or 50% generally providing the best results for both exposure variables. Finally, we examined the association between occupational exposure to 21 metallic compound and glioma and meningioma in the INTEROCC study using conditional logistic regression adjusted for potential confounders. The analytical strategy was based on the observations made in the two previous components. We observed no evidence of association between the selected agents and glioma, but there was evidence of positive associations between some of the agents and meningioma. Statistically significant associations with OR (95% confidence interval) were also observed between < 15 years of exposure to lead fumes (1.67 (1.02-2.74)), zinc compounds (2.14 (1.02-3.89)), soldering fumes (1.80 (1.17-2.77)), and metal oxide fumes (1.51 (1.03-2.21)) and low cumulative exposure to chromium VI (1.99 (1.03-3.84)) and soldering fumes (1.83 (1.17-2.87)) and meningioma. One of the main challenges in occupational cancer epidemiology is retrospective exposure assessment. In this thesis we found that, while imperfect, CANJEM was a cost-efficient approach to occupational exposure in epidemiological studies. Although it is difficult to determine the exact role played by individual agents examined, our results provide some support for the presence of a positive association between metallic compounds, and more particularly metallic fumes, and meningioma.

Es gibt berufliche Hautreinigungsmittel für verschiedene Arten und Grade von Verschmutzungen, allerdings ohne rechtlich bindende Vorgaben für die Hersteller bei der Produktauslobung. Das führt zur Anwendung diverser, herstellerabhängiger Prüfverfahren, die zu nicht vergleichbaren Angaben bei Hautreinigungsprodukten führen. Folglich ist eine begründete Produktauswahl aktuell für den Anwender nur begrenzt möglich. Ziel dieser Arbeit ist es, ein standardisiertes In-vivo-Reinigungsmodell zu entwickeln. Zentral in diesem Kontext sind die wissenschaftliche Begründung und Validierung von Modellschmutzen und die Standardisierung der Reinigungsprozedur. Um eine nachhaltige Umsetzung des In-vivo-Modells zu unterstützen, erfolgen einleitend eine einschlägige Literaturrecherche sowie eine Herstellerbefragung zu aktuell eingesetzten Produktprüfverfahren und zur Identifizierung von Anforderungen an das In-vivo-Modell. Ergebnisse dienen der Konzeption eines Kriterienkatalogs für das zu entwickelnde Modell. Für die Modellschmutzbegründung werden eine fragebogenbasierte Datenerhebung bei Beschäftigten und Arbeitssicherheitsbeauftragten und orientierende Betriebsbesichtigungen in unterschiedlichen Berufsgruppen zu Schmutzexpositionen am Arbeitsplatz vorgenommen. Diese so identifizierten Verschmutzungen werden im Anschluss nach physikochemischen Eigenschaften klassifiziert und begründen die mittels Modellschmutzen abzubildenden Schmutzeigenschaften für die Produktauslobung. Insgesamt werden sechs Modellschmutze theoretisch begründet, galenisch formuliert (Kutz 2009), anwendungsorientiert validiert (Elsner et al. 2011, Elsner et al. 2013a) und stehen nun für In-vivo-Reinigungsversuche zur Verfügung. Dabei handelt es sich um einen hydrophilen Modellschmutz (Typ „Mascara“), einen lipophilen Modellschmutz (Typ „W/O-Creme“), zwei filmbildende Modellschmutze (Typ „Dispersionslack“ und Typ „Acryllack“) und zwei Staub-Öl-Mischverschmutzungen unterschiedlicher Haftung (Typ „Altöl“ und Typ „Salbe“). Der Nachweis der Reinigungswirkung erfolgt chromametrisch anhand des L*-Wertes. Zu diesem Zweck sind die Modellschmutze schwarz gefärbt. Für die Standardisierung der Reinigungsprozedur wird der DGUV-Hautwaschapparat aus Osnabrück (OHWA) in Anlehnung an bzw. als Weiterentwicklung von vergleichbaren Geräten wie der Hautwaschmaschine von Schrader (1996) und dem „rotierenden Quirl“ von Tronnier (1965) konstruiert. Er ermöglicht eine standardisierte mechanische Einwirkung auf drei definierte Hautareale am volaren Unterarm und entspricht der Qualitätsnorm DIN EN ISO 13485 für Medizinprodukte. Anpressdruck, Rotation und Dauer der Einwirkung sind einstellbar. Auch geräteübergreifend führt der OHWA zu reproduzierbaren Reinigungseffekten. Durch die herstellerübergreifende Umsetzung der Methode können zukünftig Hautreinigungsmittel entsprechend ihrer Eigenschaften klassifiziert und dadurch die Möglichkeit einer gezielten Produktauswahl geschaffen werden. Ferner kann das Modell von Herstellern für die Produkt(weiter)entwicklung angewendet werden.

Actuellement, l’asthme est la 1ère maladie professionnelle respiratoire. L’utilisation de produits de nettoyage et de désinfection est un facteur de risque émergent de l’asthme lié au travail, surtout dans le secteur de la santé. Cependant, les produits spécifiques en cause dans l’asthme restent à identifier. L’évaluation de l’exposition professionnelle aux produits de nettoyage et de désinfection est difficile dans les études épidémiologiques. De plus, le biais du travailleur sain (HWE) est important à considérer dans les études épidémiologiques sur l’asthme lié au travail.L’objectif de la thèse comportait deux aspects : 1) un aspect méthodologique visant à améliorer l’évaluation des expositions professionnelles aux produits de nettoyage et de désinfection en développant des méthodes novatrices ; 2) un aspect étiologique visant à estimer le rôle des expositions professionnelles dans le contrôle de l’asthme en prenant en compte un potentiel HWE.Tout d’abord, des matrices emplois-expositions (MEE) et emplois-tâches¬-expositions (METE) ont été développées via les données de femmes non-asthmatiques tirées au sort dans une cohorte prospective d’infirmières américaine (NHSII : Nurse’s Health Study II). Puis, une méthode d’évaluation des expositions professionnelles aux produits de nettoyage et de désinfection utilisant une application smartphone scannant les codes-barres de produits et une base de données (BDD) a été développée. L’étude du rôle des expositions professionnelles aux produits de nettoyage et de désinfection dans le contrôle de l’asthme a été réalisée dans l’étude Épidémiologique des facteurs Génétiques et Environnementaux de l'Asthme disposant de données longitudinales détaillées sur l’histoire professionnelle et les phénotypes d’asthme. Afin de prendre en compte un potentiel HWE, un modèle marginal structural (MMS) a été appliqué.Une hétérogénéité de l’estimation des expositions par les MEE et METE était observée dans la plupart des métiers infirmiers, sauf pour les infirmières exerçant aux urgences et dans l’administration/la formation. Nous avons montré que la METE était plus adaptée que la MEE pour estimer les expositions, en particulier pour les métiers infirmiers ayant des tâches hétérogènes. Via l’application, 126 produits ont été recueillis auprès de 14 personnels hospitaliers de l’étude pilote, et des informations sur les composés étaient disponibles pour tous les produits via la BDD associée. Cette étude a montré que ce nouvel outil était simple à mettre en place, facile et rapide à utiliser pour les participants, et permettait d’évaluer de façon précise les expositions aux différentes substances. Ces résultats confirment la faisabilité et l’intérêt de cette méthode et suggèrent son déploiement dans les études épidémiologiques. Dans la partie étiologique, nous avons observé la présence d’un HWE dans notre échantillon d’étude. Malgré la prise en compte de ce HWE en utilisant un MMS, les résultats des associations ne permettaient pas de conclure sur le rôle des expositions professionnelles dans le contrôle de l’asthme. / Currently, asthma is the first occupational respiratory disease. The use of disinfectants and cleaning products has been identified as an emerging risk factor for work-related asthma, especially in the healthcare industry. However, identifying the specific products at risk for asthma remains challenging, partly because assessment of occupational exposure to disinfectants/cleaning products is difficult in epidemiological studies and needs improvement. Moreover, taking into account possible healthy worker effect (HWE) is essential in work-related asthma study.The aims of the thesis were to improve the methods for assessment of occupational exposure to disinfectants/cleaning products by developing new methods; and to study the association between occupational exposure to disinfectants/cleaning products and asthma control taking into account a possible HWE.First, job-exposure (JEM) and job-task-exposure matrices (JTEM) have been created using data from a random sample of women without asthma from a large prospective cohort of US nurses (NHSII: Nurse’s Health Study II). Second a new assessment method using a smartphone application with a barcode scanner and a database was designed to evaluate occupational exposure to disinfectants and cleaning products. The study of the association between occupational exposure to disinfectants and cleaning products and asthma control has used data from the French Epidemiological study on the genetics and environment of asthma. Longitudinal data were available on occupational history and asthma phenotypes. To control for a possible HWE, a marginal structural model (MSM) was used.For the first part, JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Through the smartphone application, 126 products were registered for 14 hospital workers of the pilot study. Information on components was available for all products in the database. The method developed is feasible and applicable to larger epidemiological studies. In the etiological part, a HWE was observed in the study sample. Even after controlling for a HWE, results did not allow concluding on the association between occupational exposures and control of asthma.