[Show abstract][Hide abstract] ABSTRACT: Background
Currently, little data is available about the management of asthma in the working population. The aim of this study was to describe asthma control and severity among workers according to current or previous allergic rhinitis comorbidity.
A network of occupational physicians participated in this pilot study on a voluntary basis. They included a random sample of salaried workers during their systematic occupational medical check-up. All subjects completed a self-administered questionnaire based on the European Community Respiratory Health Survey screening questionnaire, and if they reported any respiratory symptoms including allergic rhinitis, the physician filled in a medical questionnaire. Current asthma control and severity were evaluated according to 2006 Global Initiative for Asthma guidelines.
A total of 110 occupational physicians from two French regions participated. Out of the 6906 employees screened, 3102 identified respiratory symptoms and completed the medical questionnaire and performed spirometry. Overall, 374 were identified as current asthmatics, including 271 (72.5 %) with allergic rhinitis. Among current asthmatics with current allergic rhinitis (n = 95), 68.8 % had partially controlled asthma or uncontrolled asthma, including 51.6 % who received insufficient anti-asthmatic treatment. Partly or no control asthma was not associated with current rhinitis (OR = 1.4; 95 % CI: 0.8-2.7). Current asthmatics with current or previous allergic rhinitis had a significantly lower risk of emergency department visits than current asthmatics without allergic rhinitis (respectively 11.6, 17.1 and 29.1 %; P = 0.002).
Most current asthmatics both with and without allergic rhinitis had uncontrolled asthma, with inappropriate treatment. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.
Preview · Article · Nov 2015 · BMC Pulmonary Medicine
[Show abstract][Hide abstract] ABSTRACT: Pesticides have been associated with Parkinson's disease (PD), but there are few data on important exposure characteristics such as dose-effect relations. It is unknown whether associations depend on clinical PD subtypes.
We examined quantitative aspects of occupational pesticide exposure associated with PD and investigated whether associations were similar across PD subtypes.
As part of a French population-based case-control study including men enrolled in the health insurance plan for farmers and agricultural workers, cases with clinically confirmed PD were identified through antiparkinsonian drug claims. Two controls were matched to each case. Using a comprehensive occupational questionnaire, we computed indicators for different dimensions of exposure (duration, cumulative exposure, intensity). We used conditional logistic regression to compute odds ratios (ORs) and 95% confidence intervals (CI) among exposed male farmers (133 cases, 298 controls). We examined the relation between pesticides and PD subtypes (tremor dominant/non-tremor dominant) using polytomous logistic regression.
There appeared to be a stronger association with intensity than duration of pesticide exposure based on separate models and a synergistic interaction between duration and intensity (p-interaction = 0.04). High intensity exposure to insecticides was positively associated with PD among those with low intensity exposure to fungicides and vice versa, suggesting independent effects. Pesticide exposure in farms specialized in vineyards was associated with PD (OR = 2.56; 95% CI: 1.31, 4.98). The association with intensity of pesticide use was stronger, although not significantly (p-heterogeneity = 0.60), for tremor dominant (p--trend < 0.01) than for non-tremor dominant PD (p--trend = 0.24).
This study helps to better characterize different aspects of pesticide exposure associated with PD, and shows a significant association of pesticides with tremor dominant PD in men, the most typical PD presentation.
Preview · Article · Mar 2015 · Environmental Health Perspectives
[Show abstract][Hide abstract] ABSTRACT: Objective:
To examine the incidence and risk factors for incident thoracic spine pain (TSP) in workers representative of a French region's working population.
In this prospective study, 3,710 workers were assessed in 2002-2005, and 2,332 (62.9%) of them were reassessed in 2007-2010. TSP was assessed by a self-administered Nordic questionnaire at baseline and at followup. At baseline, all participants completed a self-administered questionnaire on personal factors and work exposure. A total of 1,886 subjects (1,124 men and 762 women) without TSP at baseline were eligible for analysis. Associations between incident TSP and risk factors at baseline were analyzed by multivariate logistic regression.
The incidence rate of TSP was 5.2 (95% confidence interval [95% CI] 3.9-6.6) per 100 men and 10.0 (95% CI 7.8-12.1) per 100 women. TSP was often associated with low back pain and neck pain. TSP in men was associated with age (odds ratios [ORs] ranging from 2.6 [95% CI 0.95-7.1] at 30-39 years to 6.0 [95% CI 2.1-17.3] at ≥50 years), being tall (OR 2.2 [95% CI 1.2-3.9]), frequent/sustained trunk bending (OR 3.0 [95% CI 1.5-6.1]), lack of recovery period or change in the task (OR 2.0 [95% CI 1.2-3.6]), and driving vehicles (OR 2.8 [95% CI 1.4-5.5]). Being overweight or obese was associated with lower risk (OR 0.5 [95% CI 0.3-0.96]). TSP in women was associated with high perceived physical workload (OR 1.9 [95% CI 1.1-3.3]), after adjustment for confounding variables.
The risk model of TSP combined personal and work-related organizational and physical factors. Trunk bending appeared to be a strong independent predictor of TSP in this working population.
[Show abstract][Hide abstract] ABSTRACT: Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium-term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium-term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.
No preview · Article · Aug 2014 · Journal of Traumatic Stress
[Show abstract][Hide abstract] ABSTRACT: Introduction:
This study was designed to describe the difficulties of epidemiological follow-up of employees by occupational health services.
This study was based on two transverse studies conducted by the Pays de la Loire musculoskeletal disorders (MSD) surveillance network. Eighty-three occupational health physicians included 3,710 employees between 2002 and 2005 and had to review them between 2007 and 2009. Thirteen of these physicians changed jobs and 7 changed geographical sector in the same occupational health service.
Another 94 physicians were contacted and 85 agreed to participate in the network. The follow-up rate was 43%: 1,044 employees were reviewed by the physician who saw them on inclusion and 567 employees were reviewed by another physician of the network. The other employees were distributed as follows: 25% were lost to follow-up and their occupational status remained unknown; 23% were still employed with an identified occupational health physician but had not attended a medical visit during the follow-up study; 5% had left the occupational health surveillance system. Only 23 employees refused to participate in the follow-up and 105 employees had a physician who refused to participate.
There is therefore a considerable mobility of occupational health physicians, which interfered with follow-up despite their good mobilization and a high percentage of employee are lost to follow-up after having left their jobs. More appropriate systems must be set up to follow populations of employees, such as new collaborations with general practitioners.
[Show abstract][Hide abstract] ABSTRACT: An excessive risk of suicide among agriculture workers has been observed in several studies in France and abroad. Accordingly, French Institute for Public Health Surveillance and Social Insurance in agriculture sector launched collaboration with aim at producing indicators of suicide mortality among agriculture workers population on a regular basis.
No preview · Article · Jun 2014 · Occupational and Environmental Medicine
[Show abstract][Hide abstract] ABSTRACT: Background
Organizational downsizing has become highly common during the global recession of the late 2000s with severe repercussions on employment. We examine whether the severity of the downsizing process is associated with a greater likelihood of depressive symptoms among displaced workers, internally redeployed workers and lay-off survivors.
A cross-sectional survey involving telephone interviews was carried out in France, Hungary, Sweden and the United Kingdom. The study analyzes data from 758 workers affected by medium- and large-scale downsizing, using multiple logistic regression.
Both unemployment and surviving layoffs were significantly associated with depressive symptoms, as compared to reemployment, but the perceived procedural justice of a socially responsible downsizing process considerably mitigated the odds of symptoms. Perception of high versus low justice was assessed along several downsizing dimensions. In the overall sample, chances to have depressive symptoms were significantly reduced if respondents perceived the process as transparent and understandable, fair and unbiased, well planned and democratic; if they trusted the employer’s veracity and agreed with the necessity for downsizing. The burden of symptoms was significantly greater if the process was perceived to be chaotic. We further tested whether perceived justice differently affects the likelihood of depressive symptoms among distinct groups of workers. Findings were that the odds of symptoms largely followed the same patterns of effects across all groups of workers. Redeploying and supporting surplus employees through the career change process–rather than forcing them to become unemployed–makes a substantial difference as to whether they will suffer from depressive symptoms.
While depressive symptoms affect both unemployed and survivors, a just and socially responsible downsizing process is important for the emotional health of workers.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The aim of the study was to assess both personal and occupational risk factors for non-specific neck disorder (ND) in a representative working population characterized by various levels of exposure to work-related constraints. ND during the preceding 7 days was assessed in 3,710 workers surveyed by 83 occupational physicians between 2002 and 2005. Personal risk factors and work exposure were assessed by a standardized examination and a self-administered questionnaire. Associations between ND and personal and occupational factors were analyzed using logistic regression modeling separately in men and in women.
The personal risk factors for ND were age (OR for 1-year increment 1.02, 95% CI 1.01 to 1.03 in men and 1.03 [1.01-1.04] in women) and previous history of arthritis disease (OR 2.39 [1.17-4.91] in men and 3.95 [1.92-8.12] in women). The risk of ND increased with previous history or upper limb musculoskeletal disorders in men (OR 1.58 [1.17-2.13]) and decreased with BMI in women (OR for 1-kg/m(2) increment 0.96, [0.93-0.99]). The work-related risk factors of ND were sustained or repeated arm abduction (OR 2.08 [1.35-3.21] in men and 2.22 [1.27-3.86] in women) and neck flexion (OR 1.64 [1.26-2.12] in women). Work pace dependent on customers (OR 1.42 [1.10-1.83]) and psychological demand of the task (OR 1.49 [1.15-1.92]) increased the risk of ND in men. Work pace dependent on quantified targets (OR 1.37 [1.05-1.79]) and low supervisor support (OR 1.68 [1.30-2.17]) increased the risk of ND in women. This study highlighted the multifactorial nature of ND.
No preview · Article · Feb 2014 · Journal of Occupational Health
[Show abstract][Hide abstract] ABSTRACT: To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos exposure in France including non-occupational exposure.
A population-based case-control study including 437 incident cases and 874 controls was conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a conditional logistic regression.
A clear dose-response relationship was observed between occupational asbestos exposure and pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs 67.0 (99% CI 25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI 74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI -33.5% to 73.5%) in men and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was 87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women.
Our study suggests that the overall ARp in women is largely driven by non-occupational asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence. Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the observed difference in ARp between men and women.
[Show abstract][Hide abstract] ABSTRACT: Mesothelioma is a rare disease less than 0.3% of cancers in France, very aggressive and resistant to the majority of conventional therapies. Asbestos exposure is nearly the only recognized cause of mesothelioma in men observed in 80% of case. In 1990, the projections based on mortality predicted a raise of incidence in mesothelioma for the next three decades. Nowadays, the diagnosis of this cancer is based on pathology, but the histological presentation frequently heterogeneous, is responsible for numerous pitfalls and major problems of early detection toward effective therapy. Facing such a diagnostic, epidemiological and medico-legal context, a national and international multidisciplinary network has been progressively set up in order to answer to epidemiological survey, translational or academic research questions. Moreover, in response to the action of the French Cancer Program (action 23.1) a network of pathologists was organized for expert pathological second opinion using a standardized procedure of certification for mesothelioma diagnosis. We describe the network organization and show the results during this last 15years period of time from 1998-2013. These results show the major impact on patient's management, and confirm the interest of this second opinion to provide accuracy of epidemiological data, quality of medico-legal acknowledgement and accuracy of clinical diagnostic for the benefit of patients. We also show the impact of these collaborative efforts for creating a high quality clinicobiological, epidemiological and therapeutic data collection for improvement of the knowledge of this dramatic disease.
Full-text · Article · Feb 2014 · Annales de Pathologie
[Show abstract][Hide abstract] ABSTRACT: Purpose of the study We aimed to assess whether the risk factors for severe shoulder pain, especially exposure to biomechanical and psychosocial occupational factors, were still relevant after a 12-year follow-up, even after retirement. Method All men participating in the ARPEGE ancillary study of the Gazel cohort (followed up since 1989) and who answered the 1994 or 1995 general Gazel self-administered questionnaire were included. Psychosocial factors were collected in 1995 from a preliminary version of the Karasek questionnaire on job demand and decision latitude. The biomechanical factor of interest was "elevation more than 90 of load-bearing arm" (abduction and load). The association between these factors and the incidence or persistence of severe shoulder pain (≥ 4/8 on a numerical scale) between 1994-95 and 2006 was studied as a function of the presence of physical factors, psychosocial factors or both, also taking into account having retired before 2001. Results In 2006, when most of the subjects had retired, 1482 men and 1132 women answered the questionnaire. None of the psychosocial factors studied were significantly associated with shoulder pain in those who did not have pain in 1994-95, unlike the biomechanical factor, studied in men only. Among workers with severe shoulder pain in 1994-95, the only work-related factor possibly associated with the persistence of severe shoulder pain in 2006 in multivariate analysis was having retired before 2001 (Odds ratio = 0.49, CI 95% = 0.23-1.04). Conclusion In the long term, only the biomechanical factor has been shown to be associated with the onset of severe shoulder pain in men in 2006 (no woman was exposed). None of the psychosocial dimensions studied have remained significantly associated with shoulder pain at the end of the follow-up, after taking into account biomechanical and personal factors.
No preview · Article · Nov 2013 · Archives des Maladies Professionnelles et de l Environnement