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Biomedical subjects

D Lahaye

Publications and source records attributed to D Lahaye.

At least 19 recordsLinked to original sources
PubMed2006

Does enhanced information exchange between social insurance physicians and occupational physicians improve patient work resumption? A controlled intervention study.

BACKGROUND: Patient work resumption after sickness absence varies even among patients with similar pathologies and characteristics. Explanations remain uncertain. One newly investigated field is "information asymmetry", a situation in which critical information is not appropriately exchanged between stakeholders in disability management. It is hypothesised that information asymmetry between social insurance physicians and occupational physicians prolongs sickness absence. OBJECTIVES: To assess the influence of enhanced information exchange between these physicians on patient outcome. METHODS: Non-randomised controlled intervention study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. Inclusion criteria were: employee, age 18-50, and subacute (more than one month) sickness absence. The intervention was a structured information exchange (through the use of a communication form) between the patient's social insurance physician and occupational physician. The intervention started when the patient's sickness absence reached the subacute stage, and ended when the sickness absence benefit was ceased or the duration exceeded one year. The primary outcome measure was the sickness absence benefit status of the patient assessed one year after benefit onset. RESULTS: Of the 1883 patients asked to enroll in the study, 1564 (84%) participated; 505 (32%) of 1564 patients were assigned to the intervention group and 1059 (68%) to the control group; 1553 (99%) of 1564 patients completed the study. In the intervention group, 86% received no sickness absence benefit at the end of the study, versus 84% in the control group (95% CI 0.91-1.15). No significant differences in other outcome parameters were obtained. CONCLUSIONS: Information exchange between physicians may not be enough to influence work resumption among patients on sickness absence. Further research on stakeholders' information asymmetry and its effect on the outcome of patients are necessary. The complexity of information asymmetry in disability management cannot be underestimated.

Adolescent↗
PubMed1999

Return to work after surgery for lumbar disc herniation. A rehabilitation-oriented approach in insurance medicine.

STUDY DESIGN: An intervention study by the medical advisers of a social security sickness fund on a mandatorily insured patient population after open discectomy for herniated lumbar intervertebral disc. The medical advisers were randomized into two groups: a control group (n = 30) and an intervention group (n = 30). OBJECTIVES: To compare a rehabilitation-oriented approach in insurance medicine focused primarily on early mobilization and early resumption of professional activities with the usual claim-based practice. SUMMARY OF BACKGROUND DATA: This study included 710 patients, with a mean age of 39.2 years, who underwent surgery for herniated lumbar disc. METHODS: Medical advisers in the rehabilitation-oriented group examined the patients monthly, starting at 6 weeks after the surgical intervention. They used a newly developed protocol to motivate the patients and treating physicians toward social and professional reintegration. RESULTS: At 52 weeks, 10.1% of the patients guided by medical advisers from the rehabilitation-oriented group had not resumed work in contrast to 18.1% of the patients in the control group. It was statistically proven that this effect also holds during the follow-up period. CONCLUSIONS: A rehabilitation-oriented approach by the medical advisers of social security can increase the probability of a return to work for patients after lumbar disc herniation surgery.

Adult↗
PubMed1992

Survey of cobalt exposure and respiratory health in diamond polishers.

This cross-sectional study was undertaken after the discovery of cobalt-related fibrosing alveolitis and bronchial asthma in diamond polishers occupationally exposed to cobalt. A total of 194 workers from 10 diamond polishing workshops and 59 workers from three other workshops from the diamond industry (control subjects) were studied; a questionnaire was administered and spirometry was performed. Cobalt exposure was assessed by environmental air sampling using both area and personal sampling and by measuring urinary cobalt concentration. When considered on a workshop basis, these environmental and biologic indices of exposure correlated well with each other. These measurements led to the definition of three cobalt exposure categories: a no exposure group, a low exposure group, and a high exposure group. The high exposure was, however, still below the present threshold limit value for cobalt (50 micrograms/m3). Spirometry showed that indices of ventilatory function (FVC and FEV1) were significantly (p less than 0.05) lower in the group with the highest exposure to cobalt. These differences were not due to differences in smoking habits. The results were confirmed when the data were analyzed by covariance analysis of lung function indices against smoking status, taking mean cobalt exposure in each workshop as a covariate, and when the data were analyzed by multiple regression analysis. This analysis showed that cobalt exposure correlated with decreased pulmonary function. Our results suggest that, during diamond polishing, exposure to cobalt at levels below the current threshold limit value is associated, on a group basis, with measurable effects on lung function parameters. The relationship between these cross-sectional epidemiologic findings and the occurrence of overt lung disease in diamond polishers remains to be established.

Air Pollutants, Occupational↗
PubMed1990

Exposure of diamond polishers to cobalt.

Interstitial pulmonary fibrosis due to 'hard metal' exposure is well known, and the presence of cobalt has always been considered as the causative factor. Recently interstitial pulmonary fibrosis has been described in diamond polishing workers. In this study the dust composition in different polisher's workplaces where diamond disks are in use has been determined. Careful investigation showed that the exposure to respirable dust was comparable to that of 'hard metal' workers. The dust consists mainly of iron and cobalt particles and small amounts of silica. No 'hard metals' have been found, and other fibrogenic agents such as beryllium have been excluded. These observations lend support to the hypothesis that crystalline cobalt particles can be responsible for pulmonary fibrosis even in the absence of carbides.

Air Pollutants, Occupational↗
PubMed1989

Value of the diagnostic sodium calcium edetate mobilization test as a criterion of lead absorption.

Among the laboratory tests available for the follow-up of lead-exposed workers, the EDTA mobilization test is presently underestimated in the diagnosis of lead intoxication. The authors present the results of regression comparison between the urinary lead excretion 3 h (PbU 3) or 6 h (PbU 6) after EDTA injection and blood lead (PbB), urinary aminolaevulinic acid (ALAU) and urinary lead (PbU). The results were collected from 133 medical examinations of workers exposed to lead, who put in a claim for compensation to the 'Fund of Occupational Diseases' in Belgium. On the basis of the regression curves, PbU 3 and PbU 6 limit values are calculated for different cut-off values of PbB in excessive lead absorption and lead intoxication. For each of these values the 'sensitivity', 'specificity' and 'validity' are calculated. As a result the authors still consider the EDTA mobilization test as a valuable parameter in the diagnosis of lead absorption.

Belgium↗
PubMed1989

[Hydrocholecystitis in children and newborn infants. Apropos of 3 cases].

We report two cases of hydrocholecystitis in children and one in a neonate. One child had hepatitis A and the other had typhoid fever. A beta-hemolytic group B streptococcal infection was found in the neonate. In all three cases, the first manifestation was an abdominal mass and treatment of the causative disease ensured recovery. These three observations provided us with the opportunity for reviewing the literature. Isolated hydrocholecystitis is distinguished from hydrocholecystitis as a symptom. The clinical evaluation and diagnostic investigations are described in detail; special attention is given to abdominal ultrasonography. Etiology and pathophysiology, as well as management are discussed. Our three cases and the review of the literature confirm the benign prognosis of this condition.

Child, Preschool↗
PubMed1987

Cost-benefit analysis of hepatitis-B vaccination.

Since 1983 the Belgian insurance Fund for Occupational Disease (FOD) has refunded the cost of hepatitis-B (HB) vaccination. Vaccination has been carried out by occupational physicians selectively on staff in hospitals and medical-care institutions. At the end of 1986, 40,000 people at high risk of HBV infection had been vaccinated. The vaccination costs are largely offset by the benefits resulting from the striking fall in the number of HB cases. The financial investment has proved economically beneficial for the insurance fund.

Belgium↗
PubMed1984

Neurochemical investigations in vitro with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in preparations of rat brain.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in concentrations ranging from 10(-8) M to 10(-6) M induced a decrease, and at 10(-5) M an increase of both basal and electrically evoked tritium outflow from [3H]dopamine-prelabeled rat striatal slices. These effects of MPTP were almost abolished in the presence of nomifensine. Chromatographic separation of the released tritium compounds revealed that the decrease of tritium outflow was mostly due to a decrease in the outflow of the dopamine metabolite [3H]3,4-dihydroxyphenylacetic acid (DOPAC) and the increase of tritium outflow due to a massive release of [3H]dopamine. MPTP inhibited oxidative deamination of [3H]dopamine non-competitively in a crude mitochondrial preparation of rat brain, with an apparent Ki value of 4.5 microM. No relevant effect of MPTP on adenylate cyclase activity in homogenates and on basal and electrically evoked tritium outflow from [3H]choline-prelabeled slices of rat striatum could be detected. In contrast, MPTP facilitated both basal and electrically evoked tritium outflow from [3H]noradrenaline-prelabeled rat cerebral occipital cortex slices. Furthermore, MPTP counteracted the inhibitory effect of clonidine on evoked tritium outflow from rat cerebral occipital cortex slices. Moreover, in the presence of cocaine, the effect on basal, but not that on electrically evoked tritium outflow was attenuated. These results are compatible with the view that MPTP has no affinity to dopamine receptors but is preferentially taken up into dopaminergic nerve terminals by the nomifensine-sensitive uptake system where it reaches a concentration sufficient to inhibit intraneuronal monoamine oxidase (MAO). In contrast, the facilitatory effect of MPTP on evoked tritium outflow from [3H]noradrenaline prelabeled rat cerebral occipital cortex slices appears to result from antagonistic effects at presynaptic alpha 2-adrenoceptors. The observation that MPTP at lower concentrations (10(-8) to 10(-7) M) inhibits basal tritium outflow from rat cerebral occipital cortex slices suggests that this compound inhibits also intraneuronal deamination of noradrenaline by MAO in noradrenergic nerve terminals.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1984

X ray anomalies occurring in workers exposed to vibration caused by light tools.

A high frequency of radiological anomalies (vacuoles, cysts, enostoses) was found in workers exposed to vibration caused by light tools (screw drivers, nutrunners) compared with a non-exposed group. The lesions were mostly localised in the spongy carpal bones (os capitatum, os lunatum, os scaphoideum). There was no significant difference between the sexes, nor between the "active" or "passive" hand, both hands being simultaneously exposed. These findings support the need to implement preventive measures.

Adolescent↗
PubMed1984

Cobalt lung in diamond polishers.

Five diamond polishers with interstitial lung disease attributed to cobalt not alloyed to carbides of hard metals are described. The exposure originated from high-speed grinding tools with a polishing surface of microdiamonds cemented in very fine cobalt. Mineralogic analysis of lung tissue, lavage fluid, filtered air, and exhaust dust in the work environment revealed cobalt as the only toxic agent. Complaints consisted of work-related rhinitis, cough, chest tightness, dyspnea, anorexia, and weight loss, and were intensified in the absence of an adequate exhaust ventilation. Three subjects were in a rather subacute stage, as documented by open lung biopsy in 2 of them, and had a severe restrictive defect and markedly decreased diffusing capacity. Two patients presented a more chronic histologic pattern and had a less decreased diffusing capacity. Open lung biopsies showed in these 4 a fibrosing alveolitis, mainly of the centrilobular zones. In the former 2 patients, subacute lesions consisting of a mural mononuclear cell infiltrate, marked intra-alveolar desquamation, and multinucleated giant cells were found, whereas in the latter 2, centrilobular fibrosis with some microcyst formation was also already seen. Multiple multinucleated giant cells were present in the bronchoalveolar lavage fluid. Interruption of the exposure, with or without corticotherapy, caused a rapid regression of the complaints and a partial improvement of lung function.

Adolescent↗
PubMed1983

In vitro effect of the racemic mixture and the (-)enantiomer of N-n-propyl-3-(3-hydroxyphenyl)-piperidine (3-PPP) on postsynaptic dopamine receptors and on a presynaptic dopamine autoreceptor.

The racemic mixture and the (-)enantiomer of the putative dopamine autoreceptor agonist 3-PPP were investigated in vitro using dopamine-sensitive adenylate cyclase in homogenates of rat striatum as a model for a postsynaptic D1-receptor type and inhibition of electrically-evoked tritium overflow from rat striatal slices preincubated with [3H]choline and [3H]dopamine as a model for a postsynaptic D2- and a presynaptic dopamine autoreceptor type, respectively. In contrast, to apomorphine, neither the racemic mixture nor the (-)enantiomer exerted any effect, suggesting agonistic properties in all three receptor models. However, both (+/-)3-PPP and (-)3-PPP were weak antagonists at postsynaptic D1- and D2-receptors. The results of the present investigation suggest that the in vivo effects of 3-PPP are either the result of metabolic activation or that this drug activates an other dopamine autoreceptor type, pharmacologically different from that one modulating dopamine release.

Adenylyl Cyclases↗
PubMed1982

Actual hazard of methyl bromide fumigation in soil disinfection.

Methyl bromide, a highly toxic and ready penetrating fumigant, is widely used against rodents, insects, mites, and a range of pathogenic organisms in soil, compost, and timber. To disinfect soil in greenhouses, methyl bromide is brought under pressure from outside by a vaporiser and blown on to ground under a polyethylene cover. The gas being three times heavier than air easily penetrates the ground. Depending on the local ventilation, a considerable amount of gas evaporates into the surrounding atmosphere, this emission being especially serious during the fumigation procedure and at the removal of the plastic cover. Previously, mechanical injection of methyl bromide on to the ground within closed areas was prohibited, since this technique exposed at least four disinfection workers at a time, who were provided with only a canister respirator, to gas concentrations of over 1000 ppm CH3Br. The present study established that fumigation with methyl bromide also carries risks for the well-protected worker inside, as well as for the one controlling the vaporiser. The concentration during application varies from 30 to 3000 ppm. Concentration in the air declines with time to 4 ppm CH3Br five days after application. Discarding the plastic sheet involves exposure to peak values as high as 200 ppm for a few seconds. On the ninth day after application, milling the soil can expose workers to up to 15 ppm; on the eleventh day no CH3Br concentration in the air could be found.

Agriculture↗
PubMed1981

Dangerous concentrations of methyl bromide used as a fumigant in Belgian greenhouses.

In the disinfection of soil in greenhouses, methyl bromide can be applied to the soil by injection or by fumigation on the surface. The concentrations of methyl bromide in the air are measured, and the differences between each technique discussed. Concentrations during injection vary between 100 and 1,000 ppm with peaks up to 3,000 (10,000 in one case) ppm, but drop below 200 ppm if preventive measures are taken. During fumigation concentrations remain between 100 and 1,000 ppm. Large variations occur within a technique depending on the quality both of the material and operator.

Air Pollutants, Occupational↗
PubMed1980

The comparison of different calculation formulas for the interpretation of the pure-tone audiometry in the evaluation of professional hearing-loss.

The authors report the analysis of 761 cases of auditive impairment, of which 676 are due to professional noise exposure. They compare the different interpretation formulas of the pure-tone audiometry (Fletcher-Fournier-Fund of Occupational Diseases (FOD) the one to the other by means of regression analyses. Moreover, different cut-off values are discussed on the basis of their sensibility, specificity and validity in comparison with the subjective repercussion of the impairment on the social relations of the individual. The authors demonstrate the advantage of the use of the FOD formula for the evaluation of subjective hearing loss. For the professional hearing loss the limits of 50 or 55 dB FOD give the highest validity. For the hearing loss of non professional origin the highest validity is obtained with the cut-off value of 60 dB FOD corresponding to 50 dB Fletcher or Fournier. The differences between the latter two formulas are unsignificant.

Audiometry↗