2. Ld Thj Hudng (2010), Nghidn cOu hinh thai rdng vd hd thing ing tdy rdng so 5, so 7. di xuit dng dung trong diiu tri ndi nha, Ludn dn Tiln sT Y hpe, Hoe vien Quan y.
3. Stanley J. Nelson, Major M. 'Ash,'jr (2010), Wheeler's dental anatomy, physiology, and ocdusion, 9"^
edition,Chapter 9-10.
4. Riekne C. Sheid,Gabriela Weiss (2001), Woelfel's
dental anatomy. S"" edition, pp. 117-118.
5. Sikri V.K., Sikri P. (1994), " Mandibular premolar aben^tions in
6. Islam M.A. et la (2012), " Root canal morphology of the mandibular first premolars of Bangladeshi population ", Dental College Joumal, 2(2).
Tl LE HIEN MAC BENH CHAM TAY IT NHAN VIEN Y TE THANH PHO HO CHI MINH
D d VAN DUNG - Khoa Y, Dai hoc YDuac TPHCM
DANG THj NGOC BICH - Kftoa Kham benh, Benh vien An Binh TP HCM
TOM T A T
Muc tidu: Xac djnh ti Id hidn mic va dc yiu t6 nguy ca cda bdnh cham tay d nhin vidn y titai th^nh phi Hd Chi Minh.
Phuang phap: Nghi&n cUu duac thuc hien bing phuang phip quan sit dt ngang vdi bd cau hdi tu diin. Cd miu bao gim 478 nhin vidn y ti lam viec trong dc benh vidn cdng lip tai thanh phi Hi Chi Minh, vdi phuang phap chgn miu cum. Chin doin bdnh chdm tay dugc thuc hidn bdi cdc bac sT da lieu.
Bd ciu hdi tu diin ghi nhan cdc yiu ti lidn quan din benh vi tiin stS" bdnh. Xd Ip si lieu bing hdi qui logistic cho phin tich cum bing phin mdm state 12.
Kit qui: Ti Id mit miu li 13% (415/478). Ti Id hidn mic bdnh chim tay li 7,81%. Dang lam sdng thudng gdp nhit ii dgng mun nudc (79,5%). Cd 24,3% nhdn vidn y ti di tifng bi bdnh chim tay. Benh cd lidn quan vdi gidi tinh: nd bi chim tay nhidu han nam (OR=3,5; p=0,01; KTC 95% tO 1.3 - 9,5). Cac yiu ti tidn cin bdnh thi tang (ca dia) di dng cd lidn quan din chim tay bao gdm: tiin dn di img (0R=
3,3; p=0,02; KTC 95% td 1,2 - 9,2), tidn dn bi me day (OR=3,6; p=0.01; KTC95% td 1,3 - 9,7).
Kit luin: Tiid hidn mic bdnh chdm tay la 7,81%.
Dang lam sing thudng gdp la dang mun nudc. Bdnh cham tay cd lidn quan din gidi tinh, tidn cin ca dja dj dng.
TCr khda: Chdm tay, nhan vidn y ti, bdnh da nghd nghidp, tiin dn bdnh thi tang, yiu tinghd nghiep.
SUMMARY
PREVALENCE OF HAND DERMATITIS AMONG HEALTHCARE WORKERS IN HO CHI MINH CITY
Objectives: To investigate the prevalence of hand dermatitis and its risk factors among healthcare workers working in Ho Chi Minh City.
Methods: A survey of 478 healthcare workers working in hospitals in Ho Chi Minh City was perfomied with cluster collection. All information was recorded by questionnaire. Hand dermatitis were recognized by dermatologists. Data were analyzed with logistic regression and survey data analysis, using stata12.
Results: The participles rate was 87% (415 of 478). The prevalence of hand dermatitis was 7.8%.
The most common clinical form was vascular (79.5%). 24.3% of health workers had hand dermatitis history. Hand dermatitis related to gender, women had more hand dermatitis than men (OR=3.5: p-O.OI;
95%CI: 1.3 - 9.5). Alleigic history (0R= 3.3; p=0.02;
95%CI: 1.2 - 9.2) and urticarial history (0R= 3.6;
p=0.01; 95%CI: 1.3 - 9.7) were the fyctors significantiy related to hand dermatitis.
Conclusions: The prevalence of hand dermatitis among healthcare workers is 7.8%. The most common form v/as vesicular. Hand dermatitis related to: gender, atopic history.
Keywords: hand dermatitis: healthcare workers;
occupational skin disease, atopic history.
udDAU
Cham tay la mot benh nghe nghiep pho b i l n tren t h i gidi. Tl le hien mac bdnh chdm tay khdc nhau giUa ede nUdc tren the gidi tuy theo ddi tUdng nghidn cdu, phUdng phdp nghidn cdu. Benh dUde coi la benh da nghe nghidp d cac nUde Bae Au va My. Tai My, chdm tay chilm hdn 80% benh n g h l nghiep [1], Bdnh gay philn toai trong eupe sdng, anh hudng nhieu d i n ndng s u i t lao dpng, eha't lUdng cudc sdng vd gdy hao tdn v l kinh te. Benh cham ban tay thudng gdp trong ede nganh cdng nghidp c6 lien quan den: ehat tay rCte, thd udn tdc, ehe b i l n thuc pham, cham sdc sUc khoe, cong vide co khi, cdng nhan xdy dung, ngUdi ndi trd, cae vj eha me cd con nho...
d nude ta, tl le cham tay trong dan sd vdn chua dUde xae djnh eung nhu d cac nganh n g h l ed yeu td nguy cd cao nhu da ndu tren. Ben eanh dd, cd c h i bdnh sinh eiia benh cham (benh chdm tay) cd lien quan d i n midn dich dj Ung. Do vay, 6e tdi dude t i l n hanh nham cung d p cac diJ' lieu khoa hpc ve qui md benh d nhan vien y te thanh pho Hd Chi Minh, dang lam sang va mdi lien quan vdi t i l n d n the tang dj Ung;
vdi mong mudn gdp phan vao vide cham sde sUc khoe ban d i u , ndng cao nhdn thUe ve benh cham tay trong gidi lao dpng nham giam tidt thiet iiai do benh gdy ra, nang cao sUc khde, d i thien chat ludng cupe sdng.
PHl/ONG P H A P Thilt ke* nghien cUu
Nghien citu dUde tien hanh theo_ phuong phap quan sat d t ngang. Ddi tUdng chpn mdu la nhan vien y te (bac sT va d i l u dudng) lam viec tai thanh phd Hd Chf Minh, ddng f tham gia vdo nghien cUu va d mdt trong ngdy kham bdnh. Tidu ehuan loai ra gdm nhuhg ngudi khdng tnic tiep lam edng vide chuyen mdn (khdng tham gia cham sdc ngudi benh hode nhihig ngudi lam edng viee hanh chanh). Chpn mdu theo
Y HOC THVC HANH (950) - S 6 2/2015
phuong phap cum (benh vidn). Qudn nao ed nhieu bdnh vien se dUdc uu tien chpn. He sd thilt ke cho mdu cum Id 2. Cd m l u dupe Ude tfnh di udc lupng 6' Id eham tay vdi dp chfnh xac mong mudn (dp tin d y ) la 95%, sai sd 5%. P = 17% duoc Itiam Idiao tU mot nghien ciiu ve cham tay d a dieu dudng d Dai Loan [4]. Udc lupng kha nang mat mdu Id 10%. Do dd d m i u ude tfnh dupc la 478 ddi tupng. Chiing tdi tien hanh chpn m l u d 9 bdnh y\en, mdi benh vidn chpn 54 nhan vidn y t l (27 bde sT va 27 dieu dudng) tU tiiang 02/2013 d i n cudi thang 07/2013. Quin the nghien cOu bao gdm 3218 ddi tUdng. Tien d n dj Ung dupc ghi nhan bang bp d u hoi tu d i i n . Chan doan bdnh cham tay duoe thue hien bdi d e bac sT ehuyen khoa Da Lilu.
Phan tfeh thdng ke dude t i l n hdnh vdi phan mem statal 2 theo md hinh m l u cum (sun/ey data analysis).
Djnh nghTa bien s d
Tien d n suydn la benh suydn dd dupc bac sTehan doan. T i l n d n dj Ung la nhung tn/dng hdp di Ung (chay nude mat, nude mui, hae hoi) khi tiep xuc vdi bdng hoa, gia sue, gia d m . Day Id tridu chUng cd nang ciia vidm mui dj Urig. Tien d n me day la nhiihg tnidng hdp da tUhg di gdp bde sT vi bj m l day do thuc pham.
K^'T QUA
Cd 415 ngudi tham gia vao nghien eUu tU 9 benh vidn. TI Ld m i t m l u la 13%. Bang 1 eho thay dae dilm cda mhi nghien cUu gdm gidi tinh, tien d n cac benh t h i tang dj Uhg, tl Id hien mae va d c dang lam sang.
Bang 2 la bang thdng ke phan tfeh si!r dyng hdi qui logistic xem xet mdi lien quan giij^ cham tay va gidi tfnh, tien can benh. Phan tfeh hdi qui Logistic eho thay bdnh chdm tay cd lien quan vdi: gidi ti'nh (OR=3,5:
p=0,01; KTC 95% tU 1,3 - 9,5); t i l n can di Ung (0R=
3,3; p=0,02; KTC 95% tU 1,2 - 9,2) va t i l n edn bi m l day (0R= 3,6; p=0^01; KTC9_5% tU 1,3 - 9,7).
Bang 1: Dde diem cCia m l u nghien edu
Bang 2: Cham tay va d c y l u td tien quan
MSu (n): 415 Quin thg (N): 3218 Cum: 9 GiiSi linh TiSn cgn di Ong Tifin cSn suySn Tifin can mg day TiSn can cham tay
Thffl gian Irung binh cOa mflt dot Cham tay*
Tli^digapbacsT vi bi Cham lay*
TllShianmac banh diam lay Dang iam sang**
Nam NO C6 C«
C6 C6 vai ngay, chi/a d6i 1 tuan Trang 2 luan hoac iau hon
can nhu bi hoai C6 C6 Di <m. Idch Qm
Mun nudc TanqsCmq
% (KTC95%) 28,7(23,5-34,0) 71,3(66-76,5) 12,6(8,7-16,5) 5,0(2,3-7,8) 15,1(11,0-19,1) 24,3(18,8-29,6) 80,3(70,0-90,6) 12,0(3,7-20,3) 7,7(1,2-14,3) 20,1(10,6-29,7)
7,8(4,6-11,0) 16,7(0,6-32.9) 79,5(63,4-95,7)
3,8(3,3-4,2)
* n=82 (s6 nguM c6 tian can Cham tay) '*n=27($tingul^hianmlc(^amtay)
Chan doan GldlUnh Tian can dj ilng Ti€n can suySn Tien can ma day
OR 3.5 3.3 1.5 3.6
P 0.012 0.02 0.6 0,01
Khoang tin cay 95%
1,3-9,5 1,2-9,2 0.3-7.5 1.3-9.7
BAN LUAN T l le mat mau
Tl Id mat mdu chung la 13%, tuy nhien trong liie tfnh toan cd m l u , chiing tdi cung da du trCi mat mau 10% eho ndn mat m l u that su ehl la 3%.
Dac diem m l u
Trong m l u nghidn c i ^ eOa ehiing toi, tt Id nam it hdn nu" (bang 1). TI sd Nam/Nu" tai d c bdnh vidn khdng gidng nhau. Trong 9 benh vien khao sat thi c6 2 bdnh vien chuyen khoa ngoai, cdn 1^1 Id bdnh vien da khoa nen eae nhan vien y te khoa ndi tham gia vdo nghien cUu nhieu hdn khoa ngoai. Cd 12,6%
nhan vien y t l bj hat hdi, xd mOi, ehay nude mat khi t i l p xiic vdi bdng hoa, ehd, meo...(tien cdn dj Cmg, bang 1). Mdt sd ft (5,0%) da dupe c h i n doan bj benh suydn tU nhd; 15,1% da tUhg di gdp bae sTvi bj benh me day (bang 1). 24,3% nhan vien y te da tUng bj cham tay nhung chi cd 20,1% ho di gdp bac sT. Thdi gian trung binh cOa mdt ddt cham tay trong khoang vai ngay den 1 tuan ehiem da sd (bang 1)
Tl le hien mac
Tl Id hidn mac bdnh cham tay la 7,8% (bang 1). Tt Id hidn mac nay thap hdn cac nghien cliu tUdng tU eiia liber va d n g sU thUC hidn vdo ndm 2012 Id 21%
[2, 3]; ciia Van Der Meer vd cdng sU ndm 2013 la 12% [13]. So sanh vdi cae 6d tdi tUdng tu dUdc thuc hien tai cae nUde trong eiing khu vUe nhuTrung Qudc (18,3% d i l u dudng bj cham tay [10]; 12,9% bac sTbj bdnh Cham tay [11]), Nhdt Ban (53,3% dieu dUdng bj elidm tay [7]; 25,1% bae sT[6]) va Thd Nhj K^ (47,5%
^ l u dudng bj chdm tay [5]) thi v i n thap hdn nhieu, tuy nhien ede nghien eUu tU cac nude ehdu A dupc thuc hien tren ddi tUdng hoae Id d i l u dUdng hodc Id bac sT chU khdng quan sat ca 2 ddi tUdng cCing mdt liie. Tl Id hien mae trong nghidn cUu ndy t h i p cd t h i do phan ldn nhan vien y te khoa ngoai khong tham gia vao nghidn eijfU (mat m l u ) . Hode eung d the nhan vien y te d kien thUc de dU phdng benh ndy ndn tl Id bdnh nay t h i p .
Cham tay va gidi tinh
Trong nghien eiiU nay chiing tdi tim t h i y mdi lien quan g i i ^ eham tay va gidi tfnh (bang 2). Dieu nay khac vdi d e nghien eiiU ciia d e tae gia khac trong khu vuc chdu A nhu: cQa tae gia Lan va d n g sU thUC hidn tai Dai Loan vdi p=0,8 [4]; eOa tde gia Smith yd cpng su ttiuc hien tai Tmng Qudc [11] vdi p=0,6; eOa tac gia Sato vd d n g sU dUOc thUC hien tai Nhdt Ban vdi p=0,57 [6].
Y HOC THUC HANH (950) - S6 2/2015
Mdt nghien eOu ciia tae gia ilber va d n g sU dUpe thuc hien tai Dan Maeh ndm 2012 [3] lai cho thay nhan vien y te nam bj eham tay nhieu hdn so vdi nhanj/idn y te nu" (p<0,boi). S u khac biet nay d the do ddi tUdng nghien cUu khac nhau. Tac gia Smith nghidn eUu tren ddi tUdng Id bae sT, tae gia Lan nghien eUu trdn ddi tUdng la d i l u dudng, edn tae gia liber nghien eUu tren ddi tUdng la nhdn vidn y t l bao gdm bac sT, <^lu dudng, trd ly d i l u dudng va ky thudt vien sinh hpc. Nhu vay, mdi lien quan giiJra gidi tinh va bdnh chdm tay khdng hang i^nh qua eae nghien cdu.
Tien d n benh the tang di lAig
Benh d lien quan vdi tien d n benh the tang dj Ung. Mac dii khdng ed mdi lien quan vdi bdnh suydn nhung lai cd mdi lidn quan manh vdi tien cdn bi di Ung (0R= 3,3; p=0,02; KTC 95% tU 1,2 - 9,2) vd tieri d n bj m l day (0R= 3,6; p=0,01; KTC95% tU 1,3 - 9,7) (bang 2). Dieu nay cung tUdng t u nhu k i t qua nghidn eliU cOa Smith va edng su dUde thUc hien tai Han Qude vdo nam 2006 (tren ddi tupng nghien cUu la sinh vien i^eu dudng): bdnh chdm tay cd lien quan d i n tien cdn dj Ung eiia sinh vien (OR=4,2; KTC 95%:
1,5 - 12,8; p =0,0083) [8]. Ngoai ra, tae gia Smith eung d nghidn cUu tUdng tU tai Do, ket qua cho t h i y chdm tay cd lidn quan vdi tien can noi cac mang dj Ung (previous allergic rash) vdi OR=5,5; p=0,0038, KTC 95%: 1.9-19,2 [9]; tai Tmng Qudc tren ddi tupng Id d i l u dudng vdi OR=4,6; p=0,0096; KTC95%: 1 4 - 15,0 [10].
Ben canh cac nghien cUu ciia Smith, cdn cd nghidn ciiu ciia Ozyazicioglu va cdng su tai Tho NhT K^ cung cho kdt qua tUdng t u la benh chdm tay cd lien quan vdi tiln edn dj Ung (p<0,01) [5]. Tai Ba Lan ndm 2006, tae gia Szepietowski vd edng sU khi khao sat benh eham tay d eae dieu dudng da nhan thay rang benh eham tay ed lidn quan d i n t i l n cdn vidm mui dj Ung (p<0,0001) [12]. Va gan day nhat, nam 2013 tac gia Ilber vd cpng su cung tim ra sU lien quan giQa ca ff\a di Ung t h i tang vd bdnh eham tay (p<0,001)[2].
KiT LUAN
Nghien eUu nay eho thay tl Id hien mac benh chdm tay cfla nhan vien y t l tai thanh phd Hd Chf Minh ndm 2013 la 7,8%. Dang lam sang thudng g^p nhat la dang mun nude. Bdnh ed lien quan d i n tien d n dj Ung, m l day,
TAI LI^U THAM KHAO
1. Elston M. D., yyimed D. D., Watsky K. L., Schwarzenberger K. (2002) "Hand Dermatitis". J Am Acad Dermatol, 47 (2), 29-\-9.
2. Ibler K.S., Jemec G. B., Flyvholm M. A., Diepgen T.
L., Jensen A., Agner T. (2012) "Hand Eczema:
Prevalence And Risk Factors Of Hand Eczema In A Population Of 2274 Healthcare Wort<ers". Contact Demnatitis, 67 (4), 200-7.
3. Ibler S. K., Jemec G. B., Agner T. (2012)
"Exposures Related To Hand Eczema: A Study Of Healthcare Workers". Contact Demnatitis, 66 (5), 247-53.
4. Lan C. C , Tu H. P., Lee C. H., Wu 0. S., Ko Y. C , Yu H. S., Lu Y. W., Li W. C . Chen G. S. (2011) "Hand Demiatitis Among IJniversity Hospital Nursing Staff With Or Wfithout Atopic Eczema: Assessment Of Risk Factors".
Contact Dermatitis, 64 (2), 73-9.
5. OzyazUcUoglu N., Surenler Semra, TanaiVerdi Gulbu (2010) "Hand Dermatitis Among Paediatrie Hurses". Joumal Of Clinical Nursing, 19,1597-1603.
6. Sato K., Kusaka Y., Suganuma N., Nagasawa S., Deguchi Y. (2004) "Occupational Allergy In Medical Doctors". Joumal Of Occupational Health, 46 (2), 165-70.
7. SmiUi R. D., Adach! Y., MlhashI M., Kawano S., Ishitake T. (2006) "Hand Demiatitis Risk Factors Among Clinical Nurses In Japan". Clin Nurs Res, 15 (3), 197-208.
8. Smith R. D., Choe M. A., Jeong J. S., An G. J., Chae Y. R., Jeon M. Y. (2006) "Hand Derrtiatitis Among Korean Nursing Students". Int J Nurs Pract, 12(3), 160-5.
9. Smith R. D., Smyth W.. Leggat P. A., Wang R. S.
(2005) "Prevalence Of Hand Dermatitis Anong Hospital Nurses Working In A Tropical Environment'. Aust J Adv Nurs, 22 (3), 28-32.
10. Smith R. D., Wei N., Kang L., Wang R. S. (2004)
"Wortt Environment And Hand Dermatitis /\mong Nurses In A Chinese Teaching Hospital". Environ Health Prev Med, 9(4), 181-4.
THim TRANG NGUON LUC Y HOC C6 TRUYEN TAI TRAM Y TE XA VA CU SOf HANH NGHE Y HOC CO TRUYEN TIT N H A N 0 TJNH HA TiNH, THliA THIEN HUE VA BJNH DjNH
HOANG THj HOA L t , PHAM VU K H A N H Cifc Quan / y Y, Dupc co truyin Bg Y te
D A T VA'N D ^
Hien nay, YHCT da dupe hdn 120 nude tren the gidi, k l d eac nude phat triln siK dung de eham sde sUc khde nhan dan.
ChSm sde sUe khde ban dau bang YHCT tai edng ddng da va dang Id van de dupe nganh y t l nude ta ehd h-png phat triln ti!/ Idu. Dang, Nha nUdc va Bd Y te quan tam chi dao triln khai viec xay dung vd eflng
d mang ludi YHCT tuyin cd sd, tuy nhien t^ Id tram y te xa phudng ed hoat ddng YHCT, eung nhu t j Id kham chu'a bdnh bang YHCT tai TYT trong k i t qua tdng ket Chinh saeh Qude gia ve y dUde hpe d tmyln edn chiem t j Id thap, cd sd hanh' nghe YHCT t u nhan tai mdt sd dja phUdng e h i ^ thuc su phat huy vai trd trong eham sde va bao vd sUc khde nhan dan.
De t i l p tuc djnh hudng cac chfnh saeh, ehien ludc
