A. Leroyer

Blood and urinary levels of metals and metalloids in the general adult population of Northern France: The IMEPOGE study, 2008–2010

BACKGROUND The assessment of human chemical risks related to occupational or environmental exposure to pollutants requires the use of both accurate exposure indicators and reference values. The objective of this study was to evaluate the blood and urinary levels of various metals and metalloids in a sample of adults aged 20-59 years of the general population of Northern France, a formerly heavily industrialised area that retains some industrial activity. METHODS A cross-sectional study was conducted between 2008 and 2010, enrolling 2000 residents of Northern France. The quota method was used to guarantee the representativeness of the participants on a sex, age, social category and smoking status basis, according to the census done by the French National Institute of Statistics and Economic Studies. The levels of 14 metals: aluminium (Al), antimony (Sb), total arsenic (As), beryllium (Be), cadmium (Cd), cobalt (Co), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), thallium (Tl), vanadium (V) and zinc (Zn) were quantified by ICP-MS in urine and blood samples. RESULTS A total of 982 men and 1018 women participated, allowing the analysis of 1992 blood and 1910 urine samples. Some metal(loid)s were detected in over 99% of the blood (Cd, Co, Mn, Ni, Pb) and urine (As, Co, Pb, Zn) samples and the remaining metals in 84-99% of the samples, with the exception of blood V (19%), blood Be (57%) and urine Be (58%). Mean blood levels of Pb and Zn were significantly higher in men, and Mn, Co and Cr in women. In urine, mean Pb, Tl and Sb concentrations were significantly higher in men, and Al and Co in women. Current smokers had significantly higher mean levels of blood Cd and Pb and lower blood Co, Mn and Hg. In urine (adjusted on urinary creatinine), the smokers had higher mean levels of Cd, Pb, V and Zn and lower mean levels of As, Co, and Hg. Overall, the mean urinary levels of most metal(loid)s found in the general population of Northern France were higher than those found in the French national survey for the same period except for urinary V. Mean blood lead level was markedly less than that of the French national population. CONCLUSION This first biomonitoring survey of a large number of metal(loid)s in the general population of Northern France provides useful information on exposure levels to toxic elements and highlights the specificity of the regional environment. These data could be used, in complement to the national human biomonitoring reference values, for the interpretation of biomonitoring results.

Neck, shoulder, and hand and wrist pain among administrative employees: relation to work-time organization and psychosocial factors at work.

Objective: We sought to analyze the associations between work-time organization, psychosocial factors at work, and musculoskeletal pain of the neck, shoulders, and wrists and hands among administrative employees. Methods: We analyzed the pain felt in a population of 762 employees during the 7 days before the survey at any of the three sites studied (multiple logistic regression). Results: We found no associations between work-time organization and neck or shoulder pain. Wrist and hand pain increased with irregular schedule (odds ratio “OR” = 2.01; 95% confidence interval “95% CI” = 1.19–3.41) and lack of advance (at least 8 days) notice of schedule (OR = 1.90; 95% CI = 1.03–3.50). Of the psychosocial factors, only high psychological demand was associated with a significant increase in the prevalence of pain, in the neck and the shoulders (respectively: OR = 1.86, 95% CI = 1.23–2.82; OR = 1.88, 95% CI = 1.17–3.03). Conclusion: Prevention by improved psychosocial constraints at work must continue.

Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of northern France: the IMEPOGE Study, 2008-2010.

ABSTRACT There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma–mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3–19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

Return to work after treatment for breast cancer: single-center experience in a cohort of 273 patients

An increasing number of patients are treated for breast cancer during professional life. A meta-analysis published in February 2009 found that breast cancer survivors were more unemployed than healthy control participants (35.6% versus 31.7%, pooled RR, 1.28; 95% confidence interval: 1.11–1.49) [1]. We report a retrospective study that assesses both medical and socioprofessional factors impacting on the likelihood of patients to return to work after treatment. Between 1 January 2004 and 31 December 2005, a cohort of 1067 patients who were <60 years of age and had been surgically treated in our institution received a questionnaire with medical, sociodemographic and professional items. An answer was obtained in 586 cases. After excluding in situ carcinomas, local relapses, bilateral tumors and patients without professional activity before treatment, 273 patients were assessable. All the clinical files of these patients were reviewed. We studied return to work qualitatively (by univariate and then by multivariate logistic regression) and quantitatively, by measuring time to return to work (by logrank and then by multivariate Cox model). Overall, 79.8% of the patients returned to work after a median delay of 11.5 months. In the multivariate analysis, the factors affecting the return to work were age (P < 0.0001), particularly patients >55 years returning to work in 58% of cases versus more than 80% in younger ones, educational level (P < 0.001), colleague support (P < 0.001), chemotherapy (P < 0.05), lymphedema (P < 0.01), and the physical (P = 0.01) and psychological (P < 0.01) professional constraints of the job. Local pain with ankylosis of the shoulder was significant only in the univariate analysis (P < 0.0001). The factors affecting time to return to work were similar. We showed there was no significant difference observed according to type of surgery, tumorectomy versus mastectomy, sentinel lymph node versus axillary clearance, radiation therapy or not, and hormonotherapy or not. It is important to interpret this study in the context of the French social model. Our return to work rate is similar to that of previous publications [2, 3], whereas the length of sick leave is much longer as compared with English and North American studies [4]. As in previous publications, age is one of the main factors correlated with a lower rate of return to work [2, 3, 5]. The only clinical factor negatively correlated with the return to work is chemotherapy. This treatment also delays the return to work: 14.3 versus 7.2 months for patients who did not receive letters to the editor Annals of Oncology

Prospective evaluation of the impact of a change in the organization of work on perceived stress and health in assembly-line workers in an automobile plant

Background Although the competitive climate of the automobile industry is modifying the organization of work in French plants, the health consequences of these changes have not been investigated. The objective of this study was to determine the health impact on employees of an automobile manufacturing plant in northern France of a change to a “Total Quality Management“ type of organization. Methods This before-and-after study concerned 80 factory employees. The health impact of their work was measured before the change and then 4 and 12 months after the reorganization began, with a French version of the Job Content Questionnaire, which assesses stress at work, a self-rated health scale, and the rate of infirmary visits. Paired comparisons were used to assess before-and-after changes. Results Scores for psychological and physical demands increased significantly at 4 and 12 months after the organizational changes began, while the self-rated health score diminished significantly during both follow-ups. Decision latitude and social support scores remained unchanged during follow-up, and the number of subjects under stress in the study group (high psychological demands and low decision latitude) did not increase significantly. Finally, the rate of infirmary visits increased significantly during the study period. Conclusion These results show that employees’reaction to these organizational modifications differed according to the scale studied and that their overall perceptions were more complex than expected in view of the changes that occurred.

Influence Of Delta-Aminolevulinic Acid Dehydratase Gene Polymorphism on Selected Lead Exposure Biomarkers in a Cohort of Ex-Smelter Workers

Lead (Pb) body burden and toxicity may be influenced by genetic polymorphisms. The aim of this study was to investigate the influence of G177C delta-aminolevulinic acid dehydratase (ALAD) polymorphism (rs1800435) on selected Pb exposure biomarkers in a population of workers highly exposed to this metal in the past. A cross-sectional survey was conducted between 2007 and 2009 within the cohort of ex-employees of a smelter in the north of France that closed down in 2003. A questionnaire was completed by each participant and blood samples enabled determination of Pb levels and ALAD polymorphism. Five parameters estimating the Pb body burden and its variations were studied: last blood lead level (BLL) during activity, cumulative blood Pb index, BLL at the time of the study, and absolute and percent changes in BLL after cessation of metal exposure. Multiple regression models were used to evaluate links between ALAD polymorphism and the selected Pb exposure biomarkers. Two hundred and four men were included. At the time of inclusion, the median age was 53.5 yr. The median duration of Pb exposure was 25 yr and the median latency since end of exposure was 5.6 yr. The frequency of ALAD-2 allele was 9.3%, with 34 subjects being heterozygous (ALAD1-2) and 2 homozygous (ALAD2-2). According to genotype, there was no significant difference for any of the five selected Pb exposure biomarkers. These results lend support to the notion that ALAD polymorphism exerts no marked impact on Pb body burden.

A case study on co-exposure to a mixture of organic solvents in a Tunisian adhesive-producing company.

Objectivesto assess environmental and biological monitoring of exposure to organic solvents in a glue-manufacturing company in Sfax, Tunisia.MethodsExposure of volunteer workers, in the solvented glue-work-stations, in the control laboratory and in the storage rooms of the finished products, was assessed through indoor-air and urine measurements. Informed consent of the workers was obtained.Results and discussionThe exposure indexes were found with high values in the solvented workshop as well as in the control laboratory and were respectively, 8.40 and 3.12. These indexes were also correlated with hexane and toluene indoor air concentrations. As to urine, the obtained results for the 2,5-hexandione and hippuric acid, metabolites of hexane and toluene, respectively, were in accord with the indoor-air measurements, with an average of 0.46 mg/l and 1240 mg/g of creatinine.ConclusionThis study assessed for the first time biological exposure to organic solvents used in Tunisian adhesive industries. Although values are likely to underestimate true exposure levels, some figures exceed European and American occupational exposure guidelines.

Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study

Objectives Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs. Method We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April–August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates. Results Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%). Conclusions Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk.