Fabrice Herin

Work-related asthma in France: recent trends for the period 2001–2009

Objective Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001–2009. Method Data were collected from the French national network of occupational health surveillance and prevention (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. Results Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p=0.007), aldehydes (p=0.01) and latex (p=0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p=0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. Conclusions WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.

Links between nurses' organisational work environment and upper limb musculoskeletal symptoms: independently of effort-reward imbalance! The ORSOSA study.

&NA; The role of psychosocial factors in the development of upper limb musculoskeletal disorders has now been clearly demonstrated. However, only a few studies have analysed the association between the organisational work environment and musculoskeletal disorders in health care workers. The main goal of this study was to test the hypothesis that some specific organisational constraints may be related to upper limb musculoskeletal symptoms experienced by registered nurses, independently of the effort/reward imbalance model and major confounding factors. In 2006, 2194 female registered nurses in 7 French teaching hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded to valid self‐report questionnaires (ERI [effort–reward imbalance], Nordic‐style questionnaire). The organisational work environment was assessed by the self‐rated Nursing Work Index—Extended Organisation scale. Multilevel models were used for analyses. We found that 2 organisational health care constraints: low level of shared values about work between members in the unit and lack of support from the administration were significantly associated with upper limb symptoms, independently of ERI perceptions. This study identified and quantified specific health care organisational factors that have an impact on nurses’ upper limb symptoms, sometimes independently of ERI perception. A prospective study is needed to clarify the causal role of psychosocial and organisational work factors in upper limb injury in nurses. Organisational approaches may be more effective in improving health at work and may also have a longer‐lasting impact than individual approaches. Specific health care organisational factors measured by a new tool (Nursing Work Index—Extended Organisation) have an effect on nurses’ upper limb symptoms, independently of effort–reward imbalance perception.

Predictors of chronic shoulder pain after 5 years in a working population.

Summary Psychological work‐related factors, i.e., decision control, particularly the subject’s perception of their work as monotonous, was a more important predictor of chronic shoulder pain than job demand over a 5‐year follow‐up. ABSTRACT The role of psychosocial and physical factors in the development of shoulder pain has now been clearly demonstrated. However, only a few studies have analyzed these associations over time. The main goal of this study was to evaluate the predictive value of work‐related psychological and mechanical factors on chronic shoulder pain. A total of 12,714 subjects (65% men) born in 1938, 1943, 1948, and 1953 participating in a French prospective longitudinal epidemiological investigation in 1990 to 1995 Enquête Santé Travail Et Vieillissement (ESTEV) were included. Clinical examination was performed by 400 trained occupational physicians. Personal factors and work exposure were assessed by self‐administered questionnaires. Statistical associations between chronic shoulder pain and personal and occupational factors were analyzed using logistic regression modeling. A total of 1706 subjects experienced chronic shoulder pain in 1990, and 2089 experienced chronic shoulder pain in 1995. The incidence of chronic shoulder pain in 1995 was 11% (n = 1355). Forceful effort (odds ratio [OR] = 1.24 95% CI [1.05–1.44], awkward posture (OR = 1.34 95% CI [1.19–1.52]), decision latitude (OR = 1.19 [1.04 to 1.35]), and psychological demand (OR = 1.19 95% CI [1.06–1.32]) in 1990 were significantly associated with chronic shoulder pain in 1995, even after adjustment for personal factors and previous shoulder pain status. Awkward posture (OR = 1.43 [1.25 to 1.63]), psychological demand (OR = 1.24 [1.09 to 1.40]), and decision latitude (OR = 1.21 [1.04 to 1.41] work‐related factors in 1990 were associated with the development of chronic shoulder pain between 1990 and 1995. These results suggest that awkward posture, forceful effort, job demand, and decision control are predictors of chronic shoulder pain at work. Interventions designed to reduce the incidence of chronic shoulder pain must include both mechanical and psychological factors.

Blood pressure and working conditions in hospital nurses and nursing assistants. The ORSOSA study

BACKGROUND Healthcare workers often are unsatisfied with their working conditions despite declaring to like their jobs. Psychosocial constraints in the workplace have increased recently due to changes in work organization. These psychosocial constraints are linked to cardiovascular diseases. AIM To analyze the relationship between blood pressure levels and organizational occupational risk factors in female hospital workers, using a new questionnaire (the Nursing Work Index-Extended Organization [NWI-EO] questionnaire), which quantifies psychological and organizational work factors. METHODS The ORSOSA study is a national, multicentre, cohort study conducted in seven voluntary French university hospitals, including 214 work units with a total of 2307 nurses and 1530 nursing assistants. RESULTS Systolic and diastolic blood pressure appeared to be significantly associated with age (P<0.001) and excess weight (P<0.001). The difference between systolic blood pressure in day-shift and night-shift workers was 2.5mmHg (P<0.001). The NWI-EO dimension most strongly correlated with systolic and diastolic blood pressure was poor team relationships (P<0.01 for both). For a one-point difference in the NWI-EO stress score, systolic blood pressure was higher by a mean of 0.2mmHg. CONCLUSION These results suggest that poor relationships within teams are related to high blood pressure among hospital workers. They add to the evidence that working conditions should be considered and investigated further among other risk factors as a pathway to primary prevention of hypertension and cardiovascular diseases.

Thyroid Function Tests in Persons with Occupational Exposure to Fipronil

BACKGROUND Fipronil represents a chemical class of insecticides acting at the γ-aminobutyric acid receptor in pests. [corrected] Fipronil has been associated with a significant increase in the incidence of thyroid gland tumors concomitant with prolonged exposure to thyroid-stimulating hormone (TSH) in rats. An association between human TSH concentration and thyroid cancer has been also reported. The primary objective of this study was to test the hypothesis that chronic occupational fipronil exposure may be associated with abnormal thyroid function tests. METHODS In 2008, 159 workers of a factory manufacturing fipronil-containing veterinary drugs were assessed. Serum concentrations of TSH, total thyroxine, free thyroxine, fipronil, and fipronil sulfone were measured. RESULTS A positive and significant correlation was observed between serum fipronil or fipronil sulfone levels and duration of fipronil exposure. Serum fipronil sulfone concentration was negatively correlated with TSH concentration in fipronil-exposed workers, but with no significant increase in thyroid function test abnormalities. CONCLUSION This study did not show that chronic fipronil exposure was associated with an increase of thyroid function test abnormalities. But, despite the fact that fipronil exposure in rats has been associated with increased serum TSH, fipronil sulfone concentrations were negatively correlated with serum TSH concentrations in fipronil-exposed workers, raising the possibility that fipronil has a central inhibitory effect on TSH secretion in humans. Close occupational medical surveillance, therefore, appears to be required in factory workers manufacturing fipronil-containing veterinary drugs. Larger epidemiological studies as well as investigations on possible thyroid-disrupting mechanisms of fipronil are also required.

Increased Lung Function Decline in Blue-collar Workers Exposed to Welding Fumes

BACKGROUND There is no consensus at the present time about the effect of welding on lung function decline. This study compared lung function decline between blue-collar workers exposed and not exposed to welding fumes in a French longitudinal cohort of 21,238 subjects aged 37 to 52 years at inclusion. METHODS Medical data, occupation, sector of activity, and spirometry were recorded twice by occupational physicians in 1990 and 1995. A job-exposure matrix was used to identify 503 male blue-collar workers exposed to welding fumes and 709 control subjects and to define the weekly duration of exposure to welding fumes. RESULTS Baseline lung function parameters were higher in workers exposed to welding fumes than in control subjects. After a 5-year follow-up, welding-fume exposure was associated with a nonsignificant decline in FVC (P = .06) and FEV(1) (P = .07) after adjustment for age, pack-years, BMI, and baseline value of the parameter. A significant accelerated decline in FEV(1) (P = .046) was also observed in never smokers exposed to welding fumes. An “exposure-response” relationship was observed between FEV(1) decline and weekly duration of exposure to welding fumes in nonsmokers but not in smokers. CONCLUSIONS Blue-collar workers exposed to welding fumes showed accelerated decline in lung function, which, in nonsmokers, was related to weekly duration of exposure.

Reliability of the Suchey-Brooks method for a French contemporary population

The Suchey-Brooks method is commonly used for pubic symphyseal aging in forensic cases. However, inter-population variability is a problem affected by several factors such as geographical location and secular trends. The aim of our study was to test the reliability of the Suchey-Brooks method on a virtual sample of contemporary French males. We carried out a retrospective study of 680 pubic symphysis from adult males undergoing clinical Multislice Computed Tomography in two hospitals between January 2013 and July 2014 (Toulouse and Tours, France). The reliability of the Suchey-Brooks method was tested by the calculation of inaccuracy and bias between real and estimated ages, and the mean age for each stage and the mean stage for each 10-years age interval were compared. The degree of inaccuracy and bias increased with age and inaccuracy exceeded 20 years for individuals over 65 years of age. The results are consistent with an overestimation of the real age for stages I and II and an underestimation of the real age for stages IV, V and VI. Furthermore, the mean stages of the reference sample were significantly lower for the 14-25 age group and significantly higher for individuals over 35 years old. Age estimation is potentially limited by differential inter-population error rates between geographical locations. Furthermore, the effects of secular trends are also supported by research in European countries showing a reduction in the age of attainment of indicators of biological maturity during the past few decades. The results suggest that the Suchey-Brooks method should be used with caution in France. Our study supports previous findings and in the future, the Suchey-Brooks method could benefit from re-evaluation of the aging standards by the establishment of new virtual reference samples.

Comment on: Systematic Review and Meta-Analysis of Occupational Outcomes After Bariatric Surgery

Dear Editor, We read with great interest the systematic review of Sharples and Cheruvu about occupational outcomes after bariatric surgery [1]. We congratulate the authors for their interesting work. The relationship between obesity and occupation raises a major public health issue. Obesity surgery is very powerful to improve quality of life. The authors pointed out the limited evidence in the literature regarding occupational outcomes following bariatric surgery. They demonstrated that bariatric surgery has a generally positive impact on occupational outcomes. This implies that surgery may have wider economic, social, and psychological benefits over and above its immediate health benefits [1]. We would like to add to authors’ conclusions, since their systematic review only identified ten studies, which compared occupational outcomes before and after surgery, between 2004 and 2015. We have identified 15 more studies [2–16], and we have chosen to include other surgical procedures (open surgeries, adjustable gastric banding, vertical banded gastroplasty) and older articles (from 1977 to 2016), because we cannot ignore the successive evolutions of bariatric surgery and the successive evolutions of work world. All studies published between 1977 and 2000 showed an increase in employment after surgery by 17–29% [2–5]. Furthermore, Peace et al. [6] observed that 36% of the operated patients had better occupational functioning, and Valley et al. [7] observed that 33% of their sample improved their educational or occupational status within the first postoperative year by taking courses, gaining employment, or advancing their occupational status. Crisp et al. [8] found that at 2 years after surgery, 30% of a nonworking sample had taken up a full-time job. Martin et al. [9] found increases in rates of employment in a publicly funded group: approximately 45% of those receiving public assistance could decrease their level of support. All these studies compared employment before and after surgery. Näslund and Agren [10] compared, at 1 year, operated patients to controls (those seeking bariatric surgery). OBES SURG (2017) 27:811–812 DOI 10.1007/s11695-016-2487-3

Occupational exposure to human Mycobacterium bovis infection: A systematic review

Background Mycobacterium bovis (M. bovis) is the main causative agent of bovine zoonotic tuberculosis. The aim of this systematic review is to highlight the occupational exposure to bovine tuberculosis due to M. bovis. Methodology/principal findings A computer based literature search was carried out to identify papers published between January 2006 and March 2017. “PubMed, Cochrane Library and Science Direct” databases were searched systematically. Articles presenting the following properties were included: (i) focusing on M. bovis; (ii) concerning occupational exposure to bovine tuberculosis. A quality assessment was performed after selection of studies. Our search strategy identified a total of 3,264 papers of which 29 studies met the inclusion criteria. Of the 29 articles, 17 were cross-sectional studies (6 were of high quality and scored in the range of 6–7, 11 were of moderate quality and scored in the range 3–5), 10 were case reports, and 2 were reviews. Different occupational fields exposing to the disease were described: livestock sector, particularly in contact with dairy cattle (farmers, veterinaries and assistants, abattoir workers) and working in contact with wildlife (hunters, taxidermists). Conclusions A specific guideline for occupational practitioners taking care of employees exposed to bovine tuberculosis is warranted and should be tailored to level of exposure. This review was intended to be the first step of such a project. Articles were identified from various continents and countries with different socio-economic situations, broadening our understanding of the worldwide situation. Published data on occupational exposure in developed countries are scarce. We had to extrapolate findings from countries with higher prevalence of the disease.