Brice Loddé

Consumption of addictive substances in mariners

BACKGROUND For many years, studies have confirmed that there is a high prevalence of addiction amongst seafarers. The effect of this is even more serious when one considers their isolated and even hostile living environment presenting risks which require vigilance and rapid reactions. The purpose of this article is to determine the extent of knowledge about addiction among seafarers. MATERIALS AND METHODS This is a review of the literature between 1993 and 2013 with respect to the prevalence of consumption of alcohol, tobacco, cannabis, cocaine, heroin, and other drugs amongst seafarers. Total prevalence was calculated using the virtual population represented by the subjects of each article, when drug consumption definition was the same between articles and when mariners studied were different. RESULTS 63.1% (range 38.4-96.3%) of seafarers smoked tobacco. 14.5% (range 8.8-75%) of seafarers drank alcohol. 3.4% (range 9-45%) had used cannabis during the previous month. Few studies concerned other drugs; 3-10% of seafarers used drugs on board. CONCLUSIONS The prevalence of tobacco and alcohol consumption amongst seafarers was higher than that in the general population. Further studies on the use of drugs at work would be valuable for this population who are subject to significant occupational risk.

Skin infection by Staphylococcus aureus in a fisherman: Difficulty in continuing work on board

BACKGROUND AND AIM The aim of this study was to understand why an infectious skin disease due to colonisation by Staphylococcus aureus methi-S led to disembarkation of a fisherman for treatment and follow-up. MATERIALS AND METHODS While discussing this case we have analysed different reasons why the studied fisherman could not be successfully treated on board. RESULTS A 42-year-old fisherman was first presented with skin lesions while fishing for hake. When the fisherman had developed a fever and exfoliative skin lesions on both hands, the ships captain called the radio-medical centre for the maritime consultation in Toulouse and for the advice on treatment. After 3 days on penicillin, the fever decreased, but the dermatitis became incapacitating. On his return to shore, the fisherman was hospitalised. Bacteriological swabs of the skin lesion showed colonisation with Staphylococcus aureus methi-S with presence of Panton Valentine leukocidin. Seven-day treatment witha follow-up of antibioticotherapy was necessary to resolve the skin eruption and obtain definitive apyrexia. Treatment ashore was advised because of difficulty in continuing manual work on board whilst suffering from significant skin lesions and also due to fear of contagion. CONCLUSIONS Skin infection with Staphylococcus aureus methi-S with presence of Panton Valentine leukocidinis difficult to treat on board because of difficulty in carrying out manual work when hands are affected, and also due to slow improvement of dermatitis even when appropriate treatment is undergone. The maritime environment is also a risk factor for skin abrasion, which can lead to secondary colonisation of pathogenic bacteria.

Asbestos-related lung cancers: A retrospective clinical and pathological study

Exposure to asbestos results in serious risks of developing mesothelioma and lung cancer. The link between asbestos exposure and lung carcinoma is well established. Nevertheless, precise histopathological data are poorly considered when investigating the asbestos-cancer link in a compensatory approach. In the present study, we aim to describe the features of individuals with compensated lung cancer who were referred to an occupational disease center, regarding occupational exposure to asbestos, smoking history and pathological data. We led a retrospective study of compensated ARLC cases seen in our occupational disease center between 2003 and 2013. A total of 146 men were included (mean age at diagnosis, 63.2 years) of whom approximately 90% were heavy current or former smokers (mean value, 30.4 packs/year). The major industries associated with the lung cancer cases were shipbuilding (69.9%), and building construction (7.5%) in this harbor region. The results of the present study showed that lung upper lobe was most prevalent (61.6%) and an excess of adenocarcinoma was found (45.9%), followed by squamous cell carcinoma (38.4%) as well as thoracic sarcomas (2.1%). Neoplasm was not histologically proven in 6.8% of the cases. Subsequent pathology examinations also reclassified 2 tumors as metastases from esophageal and laryngeal origins. In conclusion, smoking prevention should be encouraged in asbestos-exposed workers as reflected by the number of smokers with asbestos-related lung cancer. Thus, histological data should be considered further to evaluate the potent relationship between asbestos exposure and lung malignancy, especially in a compensatory approach.

Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study Carried Out During the 2012 AG2R Transatlantic Boat Race.

OBJECTIVES The primary objective of this study was to identify skin disorders encountered in a population of sport sailors. Unlike merchant mariners and fishermen, there is sparse literature on this maritime population. Secondary objectives were to uncover on-board conditions that may contribute to dermatological problems in this population. METHODS We conducted a prospective study during the 2012 AG2R transatlantic race. Sixteen two-man crews participated in this race, all using the same model of sailboat (Bénéteau Figaro 2). Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival, 22 to 24 days later. RESULTS Twenty-eight of 32 skippers (88%) participated in departure data collection, and 18 (56%) completed data collection on arrival. The average age of sailors was 34 years (SD = 8). Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival. Furthermore, several new skin problems were found postrace: skin scaling, skin erosions on the buttocks, dyshidrosis, thermal burns, and sunburns. The use of protective gear and sunscreen was common, but on-board hygiene was poor with infrequent bathing and clothing changes. CONCLUSIONS Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors.

L’aptitude à la navigation maritime : une véritable évaluation des risques de maladie

Resume But de l’etude L’objectif de l’etude est de souligner l’importance et la difficulte de prononcer une aptitude medicale a la navigation maritime. La particularite de cette situation professionnelle est de mettre les marins et personnels non-marins qui embarquent pour des raisons professionnelles dans des situations ou ils peuvent se trouver pendant plusieurs semaines hors de portee de structures de soins. L’etude decrit l’environnement particulier du monde maritime, la problematique de l’aptitude qui se base, dans les cas qui sont difficiles a trancher, sur l’etude du pronostic a court, moyen et long terme de l’affection en cause. Methode Il s’agit d’evaluer le risque medical avec la meme methodologie applicable dans l’evaluation des risques professionnels : identification des dangers, des dommages, evaluation des risques selon la gravite et l’occurrence, et enfin, prise de decision. L’etude de l’occurrence du risque est menee selon la methodologie de l’ evidence based-medicine (EBM) ou medecine fondee sur les preuves, bien codifiee actuellement. Resultats et discussion La methodologie est developpee a travers un exemple reel. L’etude bibliographique, pilier de la methode EBM, y est detaillee et les resultats discutes. La justification de la prise de decision d’aptitude est donc eclairee avec une evaluation chiffree du pronostic de la maladie en cause, et des dommages potentiels lies au traitement. Conclusion Nous preconisons, dans le cas particulier de l’aptitude a la navigation professionnelle, de coupler la methodologie d’evaluation des risques avec celle de l’ evidence based-medicine afin de justifier de maniere la plus pertinente possible la prise de decision d’aptitude.

436 Risk of workaholism among hospital medical staff: an epidemiological study

Introduction ‘Workaholism’, an addiction to work, is a pathology which has been recognised since the 1970s. It is generally found in around 10% of workers, yet one study on doctors working in a hospital environment demonstrated that 30% suffered from the condition. This study’s objective is to evaluate the prevalence of workaholism among doctors in a university teaching hospital, and to analyse the links to working conditions and the imbalance between effort and reward. Methodology Cross-sectional survey of doctors in a university teaching hospital, using an anonymous online questionnaire via Sphinx Online© software. The questionnaire consisted of general questions, specific questions on psychoactive substances (tobacco, alcohol, cannabis and others), Siegrist’s effort-reward imbalance questionnaire and the Work Addiction Risk Tests (WART) questionnaire. Results were analysed using Excel© and Biostatgv©. Reuslts There were 162 participants, a rate of 30% of relevant personnel. The principal psychoactive substance used by participants was alcohol: 81.3% of subject reported consuming it. An effort-reward imbalance was present in 18% of subjects who participated in the study. The risk of workaholic was identified in 48% of the cohort: 17% were high risk and 31% medium risk. There was a link between workaholism and effort-reward imbalance (p<0,001). Conclusion The frequency of workaholism among doctors is much higher than the general population. From this study the link with work-related stress may help direct primary prevention efforts for this condition.

1156 Voc’s in container, study of health problems in 125 french dockers

Introduction The EOM society published four years ago, a specific questionnaire, FUMEX questionnaire, on health impact of fumigants and other VOC’s in containers. The aims of this study were to evaluate exposure and health impact in dockers. Methods Dockers are interviewed in face to face by a nurse or an occupational physician from Port occupational health centre of Le Havre and Brest from april to September 2015. Questionnaires were analysed by sphinx software. Results 125 questionnaires were included and analysed. Mean age was 35 years, 46% were smokers. More than 80% declared not being exposed to fumigants or VOC’s. Exposures were mostly described for refrigeration technicians (21%), or during port engine driving, handling containers. Symptoms most frequently described were headaches (42%), fatigue (50%), sleeping disorders (33, 6%), and pulmonary irritation (31%). Only 22.4% wore regularly protective equipment. Phosphine is the fumigant mostly mentioned. Discussion Most exposed of port workers seem to be now refrigeration technicians and logistic workers. A lack of knowledge on risk and prevention’s measures is evident and important. The FUMEX questionnaire is too complicated to be relevant for daily prevention in occupational health services. It’s more needed for physicians or in hospital or researchers working with suspicious cases. A shorter and more comprehensible questionnaire was created.

439 Suffering at work among medical students: qualitative study using semi-structured interviews

Introduction Suffering at work among health professionals is a hot topic. Medical students, doctors of tomorrow, are far from being spared. Prevalence of anxiety and mood disorders range from 20.3% to 69% for the former and from 12% to 30% for the latter. The purpose of this article was to determine these factors by qualitative research, according to medical students points of view. Methods It was a qualitative study using semi-structured interviews. The analysis was done according to Grounded Theory. Results 12 medical students were interviewed. They expressed difficulties at work and positive factors. Three major themes were identified in selective coding: occupational factors, ‘study’ factors and individual factors. All themes were both a source of well-being and ill-being according to the situations specified in the results. Conclusion Studying medicine includes positive and negative aspects. Abandonment issues, lack of recognition and insufficient coaching emerge from our study. These results open lines of thought on the ways of improving formation of medical students.

347 Occupational contact dermatitis from protein in sea products: differences between 2 populations

Background Protein contact dermatitis has frequently been reported in case studies (usually in cases involving contact with seafood products), but there are very few descriptive series. Objectives First, to determine the incidence of protein contact dermatitis among fishermen in France and compare it with data from onshore work involving seafood exposure. Second, to discover what factors could explain any differences. Methods/materials/patients We analysed data from the French national occupational disease surveillance and prevention network (RNV3P) and occupational diseases declared to the French National Network for Monitoring and Prevention of Occupational Disease. This retrospective study was done for a 13 year period. Results Between 2000 and 2012, we only found eight cases of protein contact dermatitis in the French network. There were no cases of protein contact dermatitis in the seafaring population. The eight cases from the French network are essentially allergies to different fish and chefs are the professionals most affected. Atopy is present in half of these cases. In the seafaring population we found several cases of eczema due to bryozoans and to gloves but no protein contact dermatitis. Conclusions Chefs who have to cook seafood are more at risk of occupational protein contact dermatitis than fishermen. We think that skin protection (that is to say glove wearing) is better implemented in the fishing sector than in the catering profession on shore in France.

988 Anxiety among health care workers of a teaching hospital

An investigation in psychological suffering in all hospital workers of a teaching hospital has been conducted during one month. Population and methods Our population was composed of 5792 non medical professionals of a teaching universitary hospital. 1738 workers were randomly selected, and answered an online auto-questionnaire, consisting of 4 parts: socio-professional data; JCQ questionnaire (Karasek); HAD questionnaire and working experience scale. Data were collected on Sphinx Online R software and exploited on Excel, using Chi2 statistical test with p<0.05. Results In this study, 822 questionnaires were exploitable, representing 47.3% of the population, and including 81.3% of women. The mean age was 41.8 years old, and workers were 84.3% permanent staff. Job strained staff represented 51.7% of the population, whereas 33.7% of the staff were in active. The overall isostrain was 31.6%. More permanent workers, nurse’s aide and hospital keener were job strained (p<0.05). Depression prevalence was of 8%: men, technical agents and people between 42 and 50 years old had a higher risk of depression, respectively 13%, 15.3% and 13.4% (p<0.05). Anxiety prevalence was of 21.6%: agents before 42 and 50 years old, permanent workers, nurse’s aide, had an increased risk of presenting anxious disorder, respectively 28.2%, 22.9% and 28/3% (p<0.05). Conclusion Anxiety and depression prevalences were important in this study, in a hospital environment, and were higher than in general population. High level of psychological demand partly explained those prevalences.