Marie-Pascale Lehucher-Michel

Occupational Allergic Contact Dermatitis and Asthma due to a Single Low Molecular Weight Agent

Received Aug 1, 2007; Accepted Sep 18, 2008 Published online in J-ST AGE Dec 5, 2008 Correspondence to: M.P. Lehucher-Michel, Hôpital Timone Adultes, Consultation de Pathologie Professionnelle, Service de Médecine et Santé au travail, 264 rue St Pierre, 13385 Marseille cedex 05, France (e-mail: marie-pascale.lehucher@ap-hm.fr) Occupational Allergic Contact Dermatitis and Asthma due to a Single Low Molecular Weight Agent

Organizational factors impacting job strain and mental quality of life in emergency and critical care units

OBJECTIVES This study measures the association between hospital staffs job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. MATERIAL AND METHODS This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. RESULTS Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employers efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. CONCLUSIONS If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented.

Syndrome de burnout : un « vrai » facteur de risque cardiovasculaire

The burnout syndrome is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment in individuals professionally involved with others. The burnout syndrome is poorly recognized, particularly in France, as a distinct nosology from adaptation troubles, stress, depression, or anxiety. Several tools quantifying burnout and emotional exhaustion exist, the most spread is the questionnaire called Maslach Burnout Inventory. The burnout syndrome alters cardiovascular function and its neuroregulation by autonomic nervous system and is associated with: increased sympathetic tone to heart and vessels after mental stress, lowered physiological post-stress vagal rebound to heart, and lowered arterial baroreflex sensitivity. Job strain as burnout syndrome seems to be a real independent cardiovascular risk factor. Oppositely, training to manage emotions could increase vagal tone to heart and should be cardio-protective.

Maladie de Wegener après exposition à la silice : Etude des mécanismes physiopathologiques

Resume La silice cristalline La silice cristalline est un mineral ubiquitaire identifie dans des situations d’exposition professionnelle multiples. C’est un facteur de risque reconnu pour certaines maladies auto-immunes comme la sclerodermie systemique progressive et le syndrome de Caplan-Colinet, ou simplement suggere pour d’autres comme le syndrome de Goujerot-Sjogren primitif, la periarterite noueuse et le lupus erythemateux dissemine. La granulomatose de Wegener Maladie rare, de cause inconnue, la maladie de Wegener est caracterisee par une vascularite granulomateuse atteignant les voies aeriennes superieures et les poumons, associee a une glomerulonephrite. Le role des particules de silice Des etudes ont montre que la silice cristalline pourrait etre impliquee dans la maladie de Wegener. Il semble qu’associees a d’autres facteurs et en particulier a une predisposition genetique, les particules de silice pourraient, apres induction de la formation d’especes radicalaires oxygenees et de cytokines inflammatoires, initier les mecanismes immunopathologiques. Ces derniers se manifesteraient par une exocytose des antigenes myeloperoxydase et proteinase 3 a la surface des polynucleaires neutrophiles.

The relocation of a health care department's. Impact on staff: a Cross-Sectional Survey.

Objective: This survey compares certain quality of work-life factors between a relocated work group and a control group. Methods: A self-administered, cross-sectional survey was conducted 12 months after five departments (304 workers) had been relocated between two public health sites. The survey explored the workers’ psychosocial job characteristics, their perceived health, and psycho-organizational constraints. The results compared both the relocated and control groups by using univariate and then multivariate statistical analyzes. Results: When compared with the control group (n = 272), the relocated group (n = 180) showed a higher prevalence of psychosocial job characteristic “isostrain.” The relocated group showed greater psycho-organizational constraints regarding the organizations favoring communication and team relationships. Conclusions: It seems that staff relocation can provoke a sense of uncertainty and isolation. Perhaps better communication might have reduced this and deter possible negative health outcomes.

Troubles ressentis au bloc opératoire central d’un hôpital de Marseille : quel facteur déclenchant ?

OBJECTIVES In August 2005, a series of complaints, with a strong media coverage, occurred among the staff of the surgery suite of an hospital in Marseilles during a maintenance work period. A study realized during this period of time concluded that the complaints were due to a collective phenomenon provoked by a << self-amplified >> acute discomfort among the staff. No triggering mechanism was identified till then. In order to found a relevant factor that could explain the complaints, we performed a retrospective investigation some time after the events with the aim of reducing the auto-suggestive phenomenon. METHODS Six months after the events, a questionnaire was submitted to each person of the 109 medical and paramedic staff working at central surgery suite during the maintenance work period. Subjects were asked about age, gender, disorder description, medical history, work place and work conditions during the event period. RESULTS The study counted 98 persons with 31 physicians and 67 paramedic staff having replied to the questionnaire. Sixty-nine persons (70,4%) plead showing up symptoms. Multifactorial analysis found that female gender (OR=4,21; IC=1,23-14,38) and perception of particular odours (OR=8,81: IC=2,52-30,78) increased the probability of the occurrence of symptoms. A significant increase (p=0,03) of felt disorders was evidenced among the staff working in the sanitizing room. Disorders were less frequent for persons working in the operating room (p=0,04) and were strongly decreased for smokers (OR=0,25; IC=0,07-0,89). No complaint was recorded six months after the events. PERSPECTIVES Considering the work places and conditions, peracetic acid appears as the most plausible etiologic agent of the reported disorders. As a consequence, hospitals, especially during maintenance work periods, must be sensitized to the involvement of the occupational physician in order to avoid the social and financial cost of such crisis.

Asthme professionnel dans l’industrie de la crevette : une cause peut en cacher une autre

L’asthme professionnel dans l’industrie de la crevette, bien que peu documenté, est une entité classiquement décrite [1]. Les protéines de crevettes ont été identifiées comme étant à l’origine de cet asthme dont le mécanisme serait immunologique [2,3]. Toutefois, d’autres agents présents dans l’environnement professionnel, et notamment des irritants, peuvent être en cause. Nous rapportons deux cas de salariés d’une entreprise de conditionnement de crevettes qui ont présenté une dyspnée asthmatiforme récidivant au travail et pour laquelle deux causes principales peuvent être discutées.

Re: Protein contact dermatitis caused by lime in a pastry chef (Contact Dermatitis 2015: 73: 54-56): LETTER TO THE EDITOR

We read with great interest the case reported by Assarian and Nixon, which presents a pastry chef with protein contact dermatitis caused by lime (1). The article mentioned in the discussion two articles that reported on contact urticaria caused by lime: a lime extract in a shampoo formula (2) and lime flower in herbal beauty masks (3). However, the first article refers explicitly to Tilia, which is commonly called lime tree, but which is not related to lime fruit. Moreover, that article mentions the presence of eugenol, which is absent from lime oils, in the essential oil of Tilia (4). Concerning the second reference, lime flower is not the fruit, so any comparison has limited value. Moreover, there is no information in this article to assure that it is lime. It is not excluded that the article deals with Tilia flower. It therefore seems important to make these clarifications or to not consider these references in the Discussion. This example of divergent, if not erroneous, interpretation highlights the need for correct identification of botanicals. The International Nomenclature of Cosmetic Ingredients (INCI) names, based on the Latin binomial genus and species, are internationally recognized uniform, systematic names used to identify cosmetic product ingredients. Botanicals are also assigned Chemical Abstracts Service (CAS) Registry numbers, which ‘are universally used to provide a unique, unmistakable identifier for chemical substances’ (5). The systematic use of INCI names and CAS numbers would avoid many errors. However, a recent review of topically used herbal medicinal products (6–9) pointed out the problem of the same CAS Registry number being assigned to every extract prepared from a particular plant regardless of chemical composition. They also noted confusion in some INCI names, owing to outdated classifications, confusion with commonly used plant names, or complex genera. The same problems affect the identification of lime extracts. CAS no. 90063-52-8 refers to 17 different extracts/preparations, and CAS no. 8008-26-2 to four (10). Also, lime can refer to a wide variety of species characterized by different chemical compositions (4), but the INCI database mentions only Citrus aurantifolia. Furthermore, the composition of lime fruit can vary during growth (11) and according to storage conditions (12). Essential oil is also subject to variability resulting from the extraction process used, geographical origin, and seasonal variations (13). Correct identification of plant material remains a challenge. In the realm of manufacturing, better standards to guarantee consumer safety and to allow reliable diagnostic assessments are needed (14).

Exposition aux pesticides et sous-groupes de lymphomes non hodgkiniens

RésuméCette étude a évalué l’existence d’un lien entre l’exposition à des pesticides et un sous-groupe de lymphome non hodgkinien (LNH) : lymphomes diffus à grandes cellules B (LDGCB), lymphomes folliculaires (LF), lymphomes indolents non folliculaires et lymphomes T. Cette étude descriptive analytique rétrospective monocentrique conduite durant un an a recueilli par questionnaire les données sur l’exposition à des pesticides de patients traités pour un LNH dans un centre régional de lutte contre le cancer. Sur les 261 patients ayant répondu, 31,4 % ont déclaré être exposés à des pesticides. En conclusion, aucun lien n’est mis en évidence entre une exposition à des pesticides et un sousgroupe de LNH. L’exposition à des herbicides pourrait avoir une influence sur les LDGCB. Des études de plus grande échelle sont nécessaires pour confirmer ces résultats.AbstractThis study evaluated the existence of a link between pesticides exposure and a subgroup of non-Hodgkin lymphoma (NHL) : diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, indolent non-follicular lymphomas and T-cell lymphomas. This descriptive analytic retrospective monocentric study led during one year consisted to collect, by a questionnaire, the data of the pesticides exposure of patients treated for NHL in a regional center of fight against the cancer. Among the 261 patients who responded, 31,4% reported being exposed to pesticides. In conclusion, no link was found between pesticides exposure and a subgroup of NHL. Exposure at herbicides could affect the DLBCL (p=0,07). Larger studies are needed to confirm these results.

Exposition aux animaux et lymphomes non hodgkiniens : analyse pilote de 261 casExposure to animals and non-Hodgkin lymphomas: pilot analysis about 261 cases

This study investigated a possible link between the occupational or domestic exposure to animals and a histological subgroup of non-Hodgkin lymphomas (LNH) (diffuse large B-cell lymphomas [LDGCB], follicular lymphomas [LF], indolent non-follicular LNH [LNHINF] and T-cell LNH). This retrospective, descriptive study was carried out over one year in a regional cancer research center. Data on occupational and domestic exposures to animals, from patients treated for a LNH, was collected via a questionnaire. Among the 261 participants, 73.9% reported they had been exposed to animals, 5% were exposed at work, whereas 72.4% were exposed in a domestic setting. The occupational exposure tended to be more frequent in the subgroup of patients with a LF (P = 0.06). The domestic exposure was less frequent (P = 0.04) in patients with LDGCB (63.0%) than in patients with a small cell LNH B (LF and LNHINF) (76.0%). Although there was no obvious link between occupational or domestic exposure to animals and one of the four histological subgroups of LNH, domestic exposure seemed less common among LDGCB patients. These results need to be confirmed by further studies.