Alain Bergeret

Work-related road accidents in France

A descriptive analysis of all victims of road accidents recorded by the police in 1997 was carried out, distinguishing accidents occurring in the course of work, while commuting and for private reasons. The analysis concerned 105,816 drivers from 14 to 64 years of age; among these, 9.9% were injured during the course of work and 18.6% while commuting. The gender-ratio was maximal for accidents during the course of work (SR = 5.5) and minimal while commuting (2.1). Accidents in the course of work were generally less serious than the two other types aforementioned. Compared with the incidence rates for labourers, those of self-employed trades and services (SETS) and those of employees and executives were higher for accidents incurred during the course of work and lower for those incurred during commuting. Professional drivers had the highest risk during the course of work. Accidents while working were most serious for SETS and professional drivers. Although it was impossible to take into account the mileage travelled, this study points out the real share of work-related road accidents and shows the need to develop and adapt prevention to the groups at risk that we have identified.

Cancer mortality in a synthetic spinning plant in Besançon, France.

Objectives: To assess the mortality of a cohort of workers in a synthetic textile spinning plant and to evaluate the relationship between mortality from lung, liver and bladder cancer and the processes or the products used. Methods: The study population consisted of male workers present for at least 6 months in the plant from 1968 to 1984. The cohort was followed until 1999. Vital status and the causes of death were determined by consulting national registries. The population of the Franche-Comté region was used for comparison. In total, 17 groups of exposure were assessed by the industrial hygienist, based on the consensus of an expert group that determined the exposure levels of each job to selected occupational hazards. Each worker was assigned to one or several groups, according to his occupational history. Confounding factors could not be assessed. Standardised mortality ratios (SMR) and 95% bilateral confidence intervals were calculated based on an assumed Poisson distribution of the number of cases to compare the plant mortality and the population mortality. Internal analyses were performed with Cox models in order to assess the risks of death related to the various exposures. Results: In the whole cohort, mortality from all malignant neoplasms was lower than expected, but this was not significant. All the estimated SMRs were lower than or close to 1. The “hot -line fitters” (RR = 2.13; n = 9; 1.06 to 4.29) and the “fibre-drawing workers” (RR = 1.83; n = 20;1.09 to 3.07) experienced a statistically significant excess in mortality from lung cancer. A slightly elevated but not significant risk of death related to lung cancer (RR = 1.5; n = 41; 0.8 to 2.7) was observed in the groups with the highest exposure to mineral fibres. A statistically significant increase in cancer deaths was observed for workers with high exposure to dust (higher intensity: RR = 1.42; n = 79; 1.06 to 1.89). Conclusion: Some findings, mainly of lung cancer, justify further exploration in other plants in this industry,

Job Restrictions for Healthcare Workers with Musculoskeletal Disorders: Consequences from the Superior’s Viewpoint

Objective Many workers suffer from musculoskeletal disorders. In France, occupational physicians are able to set job aptitude restrictions obliging employers to adapt the worker’s job. The present study explored the impact of job restriction from the point of view of the employees’ supervisors. Methods A qualitative study was conducted in 3 public hospitals. 12 focus groups were organized, involving 61 charge nurses and head nurses supervising 1 or more workers restricted for heavy lifting or repetitive movements. Discussions were recorded for qualitative thematic analysis. Results Charge and head nurses complained that aptitude restrictions were insufficiently precise, could not be respected and failed to mention residual capability. A context of personnel cuts, absenteeism and productivity demands entailed a need for polyvalence and reorganization threatening the permanence of adapted jobs. Job restrictions had several negative consequences for the charge and head nurses, including overwork, increased conflict, and feelings of isolation and organizational injustice. Conclusion Protecting the individual interests of workers with health issues may infringe on the interests of their supervisors and colleagues, whose perception of organizational justice may go some way to explaining the support or rejection they show toward restricted workers. This paradox should be explicitly explored and discussed.

Long-term effectiveness of an educational and physical intervention for preventing low-back pain recurrence: a randomized controlled trial

OBJECTIVE Low-back pain (LBP) is a common and recurrent condition, but the evidence is scarce about effective strategies to prevent recurrence and disability in the longer term. This study investigated the effect of a light exercise program, initiated in the workplace and continued at home, in reducing recurrence of LBP episodes among healthcare workers. METHODS A total of 353 healthcare workers from ten hospitals were enrolled in a randomized controlled trial (RCT) and were randomized to the intervention or control groups, the latter of which received usual care. The intervention comprised three steps: (i) a 2-hour education session, (ii) five weekly 90-minutes exercise training sessions in the workplace, and (iii) a home-based self-managed exercise program. The main outcome was recurrence of LBP with sick-leave at 24-months follow-up. RESULTS At two-year follow-up, 35 workers (24%) in the intervention group and 31 workers (21%) in the control group had at least one LBP recurrence with sick leave. No effect was observed between groups [odds ratio (OR) 1.22, 95% confidence interval (95% CI) 0.67-2.23, P=0.516]. The intervention was effective in reducing fear avoidance with a mean reduction of -3.6 (95% CI -4.8- -2.4) points on the fear-avoidance beliefs questionnaire score for physical activity (FABQ-P) in the intervention group compared with -1.3 (95% CI -2.2- -0.3) points in the control group (P<0.05). It was also effective in improving muscle endurance with a mean increase of 13.9 (95% CI 3.3-24.5) minutes on the Sorensen test in the intervention group compared with -8.3 (95% CI-17.5-0.9) minutes in the control group (P<0.05). Healthcare utilization was reduced in the intervention group for painkillers, medical visits, imaging and outpatient physiotherapy. CONCLUSION It was not possible to conclude about the effectiveness of a light exercise program to reduce LBP recurrence episodes in the long-term in healthcare workers. However, it was effective to improve muscle endurance, and to reduce fear-avoidance beliefs and healthcare utilization. Further studies are necessary in order to identify effective interventions to reduce LBP recurrence and related sick-leaves.

Facteurs de risques professionnels du cancer de l’ovaire. Revue de la littératureProfessional risk factors associated with the cancer of the ovary. Literature review

The aim of this work was to review the available literature on occupational risk factors associated with ovarian cancer. A PubMed search was performed using an algorithm with the following search terms: ovary, ovarian, exposure, work, occupation. Relevant articles were selected through assessment of titles and abstracts as well as through the reference lists of related articles. A total of 54 studies were selected for this review, including 17 studies on asbestos exposure and risk of ovarian cancer and, 16 studies on other occupational factors (5 cohort studies and 11 case control studies). An increased risk of ovarian cancer has been reported for several occupations (teachers, administration employees, nurses, religious workers) and various industrial sectors (biomedical research, telephony industry, hairdresser and beautician, printing factories) with inconsistent results. Moreover, in many of these studies, individual risk factors of ovarian cancers were not considered. Despite methodological limitations of published studies, a significantly increased risk for ovarian cancer associated with asbestos exposure have been consistently reported.

Perception of the A/H1N1 influenza pandemic and acceptance of influenza vaccination by Université Claude Bernard Lyon 1 staff: A descriptive study

We assessed the perception and attitudes of university staff, including medical school and other science specialties, toward the 2009 A/H1N1 influenza pandemic and influenza vaccination program. A cross-sectional online survey was conducted among 4,529 university personnel on October 19–20, 2009. Seven hundred (15%) employees participated in the study. Only 18% were willing to be vaccinated, men more than women (29% versus 9%, P < 0.001), and professors/researchers more than administrative/technical staff (30% vs. 6%, P < 0.001). Intention to be vaccinated was insufficient. Additional efforts are needed to improve information dissemination among university staff. Medical university personnel should receive more information to increase vaccine coverage and protect them as well as patients.

Tumeurs rares et pathologies professionnelles

Le caractere exceptionnel d’un cancer peut parfois faciliter l’identification de facteurs professionnels. Citons par exemple l’etude d’agregats de cancers comme l’angiosarcome hepatique, un cancer rare survenant chez des sujets exposes au monochlorure de vinyle ou le caractere specifique de l’association entre un type de cancer et une profession comme pour le cancer de l’ethmoide chez les menuisiers. En revanche, lorsque le cancer considere est une localisation particuliere ou un sous-type histologique d’un cancer frequent, les donnees publiees ne sont pas toujours suffisamment detaillees pour identifier des facteurs professionnels de ce cancer rare. Ainsi, des facteurs professionnels concernant des cancers a cellules renales sont actuellement discutes mais les publications ne detaillent pas toujours les types histologiques concernes alors que seulement certains d’entre eux sont des tumeurs rares.

Étude sur les liens entre santé au travail et secteur spécialisé en alcoologie

Resume Objectifs Les expertises collectives de l’Inserm (2001 et 2003) sur les effets sur la sante et les effets sociaux de l’alcoolisation excessive ont permis d’etablir des recommandations pour les pratiques professionnelles tant au niveau du reperage que de la prise en charge des sujets en difficultes avec l’alcool. Les medecins generalistes et les medecins du travail occupent des postes-cles pour faciliter les bilans de consommations et aider l’orientation des personnes vers les Centres de cure ambulatoire en alcoologie (CCAA). L’etude epidemiologique nationale faite par l’Inserm et l’Anpaa aupres des CCAA vise a analyser la contribution des medecins du travail a l’orientation des patients et les caracteristiques des personnes adressees au secteur specialise en alcoologie. La comparaison de ces patients avec les personnes adressees par les medecins generalistes ou apres depistage de l’alcoolemie routiere permet d’analyser differentes conditions de reperage des situations a risque vis-a-vis de l’alcool. Methode Les CCAA de l’Anpaa ont accueilli, pour l’annee 2002, 22 169 consultants dont pres de la moitie ont une activite professionnelle (48 %). Un questionnaire individuel propose lors des premiers entretiens contient les caracteristiques socio-demographiques, l’origine et les raisons de la demarche, les consommations de psychotropes licites ou illicites et les difficultes rencontrees. Trois groupes sont compares suivant l’origine de la demarche : medecine du travail, medecine generale et route. Resultats En 2002, 2, 2 % des consultants actifs des CCAA sont adresses par la medecine du travail (n = 229) et 20,6 % par l’alcoolemie routiere (n = 2170). Les consultants adresses par la medecine du travail sont plus âges, plus nombreux a exercer la profession d’employes mais moins nombreux dans les autres categories socio-professionnelles. Les difficultes rencontrees sont plus anciennes et concernent surtout le travail. La consommation d’alcool est majoritairement quotidienne dans le sous-groupe de la medecine du travail. Par ailleurs, 8,8 % des consultants de CCAA en activite sont adresses par les medecins generalistes (n = 916). Les consultants adresses par la medecine du travail sont plus âges. Ils comptent plus d’hommes. Ils sont plus nombreux a exercer la profession d’employes ou ouvriers mais moins nombreux dans les autres categories socio-professionnelles. Pres de 4 sur 10 disent rencontrer des difficultes dans leur travail, c’est leur principal probleme, alors que ceux qui viennent par l’intermediaire des generalistes notent la sante et les relations familiales comme principales difficultes. Les difficultes sont aussi anciennes. Il n’y a pas de difference de mode d’alcoolisation entre les deux sous-groupes et il y a autant de fumeurs. Conclusion Les deux groupes venant de la medecine du travail et de la medecine generale apparaissent proches sur les plans sanitaire et comportemental, illustrant la filiere de la sante au travail vers le medecin traitant en cas d’alcoolisation excessive. La difference avec le recrutement du au depistage de l’alcoolemie routiere est nette et montre la necessite de la complementarite des demarches de reperage et d’orientation pour des groupes de personnes aux caracteristiques et besoins aussi differents.