Jean-Dominique Dewitte

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.

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.

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.

Maritime environment health risks related to pathogenic microorganisms in seawater

Background: Numerous studies show that seawater is the ecological niche of many microorganisms. Some microorganisms are pathogenic to humans. The purpose of this paper is to describe the biological agents and pathologies mentioned in the literature. Materials and methods: This is a review of the literature from the Medline database.

Health effects of hyperbaric exposure on chamber attendants: a literature review

BACKGROUND Inside attendants working in hyperbaric chambers are exposed to risks related to the hyperbaric environment, handling and care. The aim of this study is to review the literature focusing on the impact of this activity on health. MATERIALS AND METHODS This is a literature review using the Medline database. RESULTS Eight articles studied decompression illness (DCI). The incidence of DCI ranged from 0 to 37 per 100,000 sessions in hyperbaric chambers (SHC). The incidence of injuries ranged from 0 to 412 per 100,000 SHC. The most prevalent cause of accidental death was fire: 77 deaths (patients and attendants) between 1923 and 1996. Dysbaric osteonecrosis has been reported in one study only. CONCLUSIONS Inside attendants face risks in the chamber, even if serious health effects seems rare compared to the total number of SHC.

The framework of clinical occupational medicine to provide new insight for workaholism

There is no single agreed definition of workaholism. Most interventions proposed for people suffering from workaholism target individuals. There is a paucity of descriptions of workplace risk factors. Our study examines case reports of patients suffering from workaholism with a focus on the role of the workplace. We describe case reports from patients of the Occupational Disease Centre in Brest, France between 2013 and 2016. Consultations were conducted within the framework of clinical occupational medicine with a focus on real work situations. Diagnoses of workaholism were made according to Goodman’s criteria. The situations of four patients are reported. Three of these suffered from workaholism: a 41 yr-old sales representative, a 51 yr-old nurse in progressive care and a 30 yr-old saleswoman. The last case report concerns the situation of a 41 yr-old team leader who was first suspected to have workaholism, but later diagnosed with a bipolar disorder. Bipolar disorders and other addictive behaviours should be assessed. An exclusive variable remuneration and work organization that could induce confusion between the working and personal environment both constitute risk factors. Some patients were ambivalent to their condition and willing to go on working despite ill-health issues. These elements could be integrated into further research on workaholism.

Asbestos-related lung cancers are rarely associated with ALK, ROS1 and RET rearrangements

Lung cancer remains the main cause of cancer death. In addition to smoking, exposure to occupational carcinogens constitutes a major risk for lung cancer. Among occupational cancers, asbestos-related ones are the most frequent, accounting for about 5–7% of lung cancers. A better understanding of the molecular pathways implicated in the progression of cancer has greatly improved the therapeutic management of patients with advanced lung cancers, especially nonsmall cell lung cancer (NSCLC) of the adenocarcinoma subtype. Indeed, several therapies targeting the epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK)/ROS1 pathways are now approved to treat patients with advanced EGFR-mutated or ALK/ROS1-rearranged NSCLC, respectively. While EGFR and ALK alterations are mainly encountered in NSCLC of nonsmokers, other biomarkers are more frequent in smoking patients, such as KRAS mutations, and are of prognostic interest. Nevertheless, the frequencies of the different biomarkers analysed daily for the therapeutic management of patients with NSCLC are rarely reported in occupational lung cancers, including asbestos-related ones. ALK, ROS1 and RET rearrangements can also be diagnosed in asbestos-related lung cancers http://ow.ly/rFpb30hV5Wt

Why is occupational photocontact allergic dermatitis caused by ketoprofen rarely reported in the literature

Damien-Thibaud Maurel1,2, Quentin Durand-Moreau1,2 , Richard Pougnet1,2, Jean-Dominique Dewitte1,2, Anne-Marie Roguedas-Contios3, Lynda Bensefa-Colas4,5 and Brice Loddé1,2 1Laboratoire ORPHY, Université de Bretagne Occidentale, CS 93837 – 29238, Brest Cedex 3, France, 2Service de Santé au Travail et Maladies liées à l’environnement, CHRU Morvan, 29609 Brest Cedex, France, 3Service de dermato-allergologie et vénéréologie, CHRU Morvan, 29609 Brest Cedex, France, 4Occupational Diseases Department, University Hospital of Centre of Paris COCHIN, AP-HP, 75014 Paris, France and 5Laboratoire Santé Publique et Environnement, Paris Descartes University, Sorbonne Paris Cité, EA 4064 Paris, France

Lung Cancer in an Orthoprosthetist Using Vermiculite

Occupational exposure to certain substances would cause cancer. Herein, we report on a case of a 58-year-old former orthoprostethist who died from a lung adenocarcinoma. He had a 3 pack-year history of smoking and a single exposure to asbestos during his professional career. Between 1979 and 2010, he used vermiculite plaques daily to build medical prostheses, using no personal protective equipment. Contamination of vermiculite with amphibole asbestos has been described in Libby, Montana. Expert opinion on this case has raised the hypothesis of the use of this kind of vermiculite during this period and the occupational etiology of this cancer. It seems important to point out the possibility of vermiculite-related lung cancers in unusual occupations in order to better document such cases in the future.