François-Xavier Lesage

Clinical stress assessment using a visual analogue scale

BACKGROUND Clinicians increasingly require short, efficient methods for assessing distress, both in applied research and clinical settings. Most of the available questionnaires are unsuitable for busy clinical settings. The visual analogue scale (VAS) is widely but empirically used to assess perceived stress. AIMS To provide evidence on two of the psychometric properties of the VAS: its discriminative sensitivity (capacity to highlight a difference between groups) and its interconcept validity (the relationship between VAS stress assessment and the assessment of different, but similar concepts). METHODS Employees attending occupational health centres were randomly selected and completed the VAS and also either the Perceived Stress Scale (PSS) or the Hospital Anxiety and Depression Scale (HADS). Analyses of variance were performed to study group effects (age, sex, marital status, parental status, occupational status) on stress scores (PSS and VAS). RESULTS In total, 763 employees participated of whom 501 completed the PSS and 262 the HADS. P-values obtained for the effects of sex, age and occupational status were lower with the VAS than with the PSS. Correlations between the VAS and the anxiety subscale, depression subscale and total score of the HADS were 0.66, 0.45 and 0.65, respectively. Other tools used to assess aspects of psychological distress are known to have similar correlations. CONCLUSIONS Our findings provide evidence that the VAS is at least as discriminating as a questionnaire when it comes to highlighting differences in stress levels between two groups, and the observed correlations with related constructs support its construct validity.

Psychometric properties of the French versions of the Perceived Stress Scale

ObjectivesThis study was conducted to examine the psychometric properties of the French versions of the Perceived Stress Scale (PSS) and to compare the appropriateness of the three versions of this scale (14 items, 10 items, or 4 items) in a sample of workers.Materials and MethodsFive hundred and one workers were randomly selected in several occupational health care centers of the North of France during 2010. Participants completed a questionnaire including demographic variables and the PSS. The psychometric properties of this scale were analyzed: internal consistency, factorial structure, and discriminative sensibility.ResultsFor the PSS-14 and PSS-10, the Exploratory Factor Analysis (EFA) provided a two-factor structure, corresponding to the positively and negatively worded items. Those two factors were significantly correlated (r = 0.43 and 0.50, respectively). For the PSS-4, the EFA yielded a one-factor structure. The reliability was high for all three versions of the PSS (Cronbach’s α values ranged from 0.73 to 0.84). The results concerning the effects of age, gender, marital, parental and occupational statuses showed that the 10-item version had the best discriminative sensibility.ConclusionsThe findings confirmed satisfactory psychometric properties of all the three French versions of the PSS. We recommend the use of the PSS-10 in research settings because of its good psychometric properties.

Burnout Among Occupational Physicians: A Threat to Occupational Health Systems?—A Nationwide Cross-sectional Survey

OBJECTIVES Burnout among occupational health physicians in France was measured in a nationwide cross-sectional survey. The relationships between each dimension of burnout (emotional exhaustion, depersonalization, and feelings of low personal accomplishment) and stress level, identity threat, and job characteristics were analysed. METHODS E-mails were sent out to all occupational physicians working in France by the French Ministry of Labour, inviting them to fill out an online questionnaire. This questionnaire included the Maslach Burnout Inventory, the Perceived Stress Scale, and the Primary Appraisal of Identity scale. Job characteristics were measured with survey-specific questions. RESULTS Of the 5010 occupational physicians who were potentially contacted, 1670 (33%) completed the online questionnaire. The estimated prevalence of burnout was 11.8%, twice as high as in a sample of French general practitioners (5%). The main characteristic of the burnout pattern was feelings of very low personal accomplishment (63.9%). Job characteristics were only weakly correlated with burnout, but stress level and identity threat were correlated with all three dimensions of burnout. The perceived stress was the main risk factor for emotional exhaustion and identity threat for feelings of low personal accomplishment. CONCLUSIONS The health status of occupational physicians is important for both the individual physicians and for the occupational health system. Occupational physicians are unwell, and we probably need to change the way we currently cope with burnout. This is not only a stress-induced syndrome, resulting from high workloads, but a low self-esteem-induced syndrome, too.

Effects of environmental tobacco smoke on respiratory symptoms and pulmonary function.

The aim of this study was to examine the effects of environmental tobacco smoke (ETS) on pulmonary function and respiratory symptoms. During periodic medical examination, 392 French nonsmokers responded to an interviewer-administered questionnaire. Then spirometry was performed to assess pulmonary function. All of the subjects were carefully examined by two occupational physicians. ETS exposure at the workplace was more common than this exposure at home (20% vs. 5%). ETS exposure was significantly associated with forced vital capacity (FVC; −3.16%; 95% CI: −5.67 to −0.64) and forced expiratory volume in 1s (FEV1; −2.90%; 95% CI: −5.59 to −0.23). Abnormal FVC results were significantly increased in exposed subgroup [odds ratio = 2.71 (95% CI: 1.09 to 6.75)]. We did not find any significant dose-response relationship between ETS exposure and lung function results. The effects of ETS exposure on respiratory symptoms and diseases (asthma, wheezing, chronic bronchitis, and dyspnea) were not significant. Thus, this study showed that there was a significant inverse association between exposure to ETS and pulmonary function. Even pulmonary function results inferior to the lower limit of normal may be possible. A stricter legislation against ETS is proposed.

Occupational Risk Factors for COPD: A Case-Control Study.

Objectives The aim of this research was to examine the occupational risk factors for Chronic Obstructive Pulmonary Diseases (COPD) in a range of occupations. Methods Eleven occupations involving different types of exposure were observed in this multicenter case-control study. Controls and cases were matched for sex, age and smoking. Multiple logistic regression analyses were used to estimate odds ratios (ORs). Results A total of 1,519 participants were initially recruited between September 2004 and September 2012. After matching, 547 pairs were obtained. The mean age was 56.3 +/- 10.4 years. Smelter workers were the only ones with an increased risk of COPD in this study (OR = 7.6, p < 0.0001, 95% CI [4.5, 12.9]). Physical activity was protective (OR = 0.7), while living in the city was a risk (OR = 1.6). The main used metals were cast iron, aluminum and alloys. Molds and cores were mainly made from sand and synthetic resins. Machine maintenance (65.2%), molding (49.6%), finishing (41.1%) and casting (41.0%) were the most common activities. Almost all workers (95.1%) cleaned the floors and machines with a brush or compressed air. Conclusions This study demonstrates the importance of occupational factors in the genesis of COPD, especially among smelter workers. As with the fight against smoking-related disease, the removal or substitution of recognized hazardous agents is the best way of preventing the onset of COPD. This is why it is essential to continue research on its occupational risk factors.

Nanoparticules : structures, utilisations et effets sur la santé

Nanotechnology is a scientific domain with a full expansion. Nanomaterials have a big variety of applications in many technological domains. The diffusion, the persistence in atmosphere and the health impacts of nanoparticles are totally different by the bigger particles for the same chemical composition. Studies made, found, cutaneous, pulmonary, cardiovascular and carcinogen toxicities. Properties of nanotubes show that their toxicity may be close to asbestos. Many studies concerning health impacts and environment effects are in course, and the results will be available in a few years. Suspected health impacts on humans and animals justify, in the spirit of precaution, to make all thats possible to reduce the exposure and to protect the health of the exposed people.

Estimation of Annual Incidence of Lung Cancer Associated with Work Place Exposure to Passive Smoking in France

Estimation of Annual Incidence of Lung Cancer Associated with Work Place Exposure to Passive Smoking in France: Shahryar Alipour, et al. Department of Occupational Health, Faculté de Médecine, France—This study attempted to estimate the number of annual new cases of lung cancer from workplace exposure to Environmental Tobacco Smoke (ETS) in France. The number of new lung cancer cases attributable to workplace ETS exposure in France was estimated with regard to the following factors: excess risk of lung cancer from workplace ETS exposure, incidence of lung cancer in non‐exposed non‐smokers, and number of French workers exposed to passive smoking. The excess risk of lung cancer from workplace ETS exposure was estimated as from 0.12 to 0.39 by different references. The French workforce, regularly exposed to ETS in their workplace is about 3.2 millions. The incidence of lung cancer of non‐smokers without exposure to ETS is between 3.7 to 10 per hundred thousand. If these three factors are combined, it is estimated that exposure to workplace passive smoking causes around 14 to 125 new cases of lung cancer each year in France. New lung cancer cases from workplace exposure to ETS represent a few percent of all occupational lung cancers, and a minuscule number in regards to the whole lung cancer annual incidence (14 to 125 for 23,000 lung cancers in France=0.06% to 0.54%)

Évaluation de l’état de santé d’une population d’artisans et de commerçants

Resume But de l’etude Evaluer l’etat de sante d’une population d’artisans et de commercants, et identifier l’existence de maladies liees a leur activite professionnelle. Methode Il s’agit d’une etude descriptive. Les sujets participant a l’etude etaient volontaires. Le bilan comprenait un examen clinique centre sur les organes potentiellement leses par les facteurs d’exposition professionnelle, associe a un questionnaire specifique de chaque profession etudiee. Ce questionnaire etait compose de deux parties : un descriptif professionnel et un chapitre medical. Les examens complementaires prescrits etaient determines en fonction des risques de chaque branche d’activite (explorations fonctionnelles respiratoires, tests allergologiques, radiographie pulmonaire ...). Resultats Mille quarante quatre travailleurs ont ete convoques ; 149 ont participes au bilan. Cent trente-neuf dossiers ont pu etre exploites (53 peintres en bâtiment, 43 coiffeurs et 43 boulangers-pâtissiers). La morbidite generale constatee atteignait 60 %. Elle concernait essentiellement les voies aeriennes, le revetement cutane et l’appareil osteo-articulaire. Les pathologies imputables a l’activite professionnelle concernaient 20 % de la population totale. La moitie des patients furent adresses a leur medecin traitant afin d’effectuer un complement exploratoire, voire une prise en charge therapeutique. Les erreurs liees a l’organisation du travail generaient une exposition deletere parmi 20 % des patients. Discussion Il existe peu de publications traitant specifiquement de l’etat de sante des travailleurs non salaries des professions non agricoles. Les donnees obtenues a l’issue de cette etude sont comparables a celles retrouvees dans la litterature. Cependant, la frequence des maladies diagnostiquees est plus elevee dans d’autres publications. Ce resultat peut s’expliquer notamment par le biais de recrutement que comporte cette etude. Le taux de morbidite eleve et le nombre important de patients necessitant une prise en charge et un suivi medical sont les consequences probables de l’existence de mesures preventives professionnelles insuffisantes ou inadequates.

Health assessment of self-employed hairdressers in France.

Health Assessment of Self‐employed Hairdressers in France: Frederic DESCHAMPS, et al. Occupational Disease Department University Hospital of Reims, France—

The Impact of Work Stressors on Identity Threats and Perceived Stress

This aim of this study was to explore which kinds of working situations are regarded by psychologists as being particularly detrimental to their identity (personal and professional), how these situations are appraised in terms of threat and/or challenge, and what their impact is on perceived stress, work satisfaction, and perceived threat to occupational status. In all, 842 French psychologists answered an open format question requesting them to report a situation that was particularly difficult for them as a person and/or as a psychologist (analyzed by the way of a content analysis), and a questionnaire containing our dependant variables. Four major categories of situations were highlighted. While the first three were positively linked to threat, the “patient relations” category was negatively correlated with it. “Threat to personal identity” mediated the relationship between difficult situations and perceived stress. Situations appraised as being identity-threatening are mostly the same than those found in the stress literature and are stressful because of their impact on personal identity. Moreover, for psychologists, relations to patients, which are at the heart of the profession, seem to be protective regarding stress and identity threats.