Main Causal Agents of Occupational Asthma in France, Reported to the National Network for Occupational Disease Vigilance and Prevention (RNV3P) 2001-2018

OBJECTIVES

The definition of work-related Asthma (WRA) has changed in recent years and new etiologies and agents have been identified. The aim of this study is to describe the main causal agents of WRA in France in the period 2001-2018 in the main work sectors.

METHODS

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)], Data between 2001 and 2018 with at least a probable or certain association with one occupational agent, were included.

RESULTS

Work sectors with more cases OF WRA included personal service activities (10.6%), food industry (10.2%) and healthcare activities (7.6%). WRA cases were most frequently related to flour (10%), quaternary ammoniums compounds (5.3%), isocyanates (5.1%) and cleaning products (4.8%).

CONCLUSION

Occupational exposure to specific agents capable of causing WRA is still present, and four agents represent more than 25% of the cases. Actions to prevent respiratory exposure are still relevant.

Evolution of Global Health and Psychosocial Factors among Hospital Workers during First Year of SARS-CoV-2 Pandemic: A Longitudinal Study

OBJECTIVES

To assess trends in overall health (mental and physical) and psychosocial factors in a population of workers (both healthcare and non-healthcare) in a French teaching hospital during the first year of the SARS-CoV-2 pandemic in France.

METHODS

A validated version of the SATIN questionnaire with adapted scoring was used to collect data on health and impacts of work stressors. This questionnaire was sent to all workers at the hospital in T1 (July-August 2020) and T2 (July-August 2021) and self-administered online.

RESULTS

A total of 1313 participants who completed the questionnaire at T1 and 826 at T2 were included. Overall, 568 workers completed the questionnaire at T1 and T2. We found a deterioration in overall health and especially stress and mental health in hospital workers and healthcare workers (HCWs), with a negative impact of the workload and work environment.

CONCLUSIONS

The SARS-CoV-2 pandemic impacted negatively the mental health, work stressors, and psychosocial perceptions of both HCW and non-HCW in a French hospital. The study confirms that hospital workers are an important target.

[Continued breastfeeding upon return to work: a qualitative study at the Brest University Hospital]

The objective of this qualitative study was to highlight the facilitating measures and difficulties encountered in continuing breastfeeding when returning to work at the Brest Regional University Hospital. The eleven mothers interviewed were able to take advantage of the solidarity in the care services to carry out their project, but simple institutional measures are still possible to facilitate this conciliation.

Occupational Exposures and Esophageal Cancer: Prog Study

Esophageal cancer is the sixth most common cause of cancer death worldwide. In France, Brittany is one of the regions most seriously affected. This increased incidence is usually linked to high rates of alcohol overconsumption and smoking, established risk factors for esophageal cancer, but the region has special occupational exposures. We aim to describe the occupational exposures of patients with esophageal cancer. Between June and October 2020, we conducted a monocentric descriptive study in a French Teaching Hospital and identified 37 eligible patients. We gathered data through a systematic individual interview for each participant and by an analysis of their medical file. We were able to include 36 patients; most were men (n = 27, 75.0%) and smokers (n = 25, 69.4%), 21 (58.3%) presented an adenocarcinoma esophageal cancer, 13 (36.1%) a squamous cell cancer, and 2 other types. On occupational exposure, patients declared respectively high exposure by manipulating asbestos materials for 11 (30.6%) patients, regularly in contact with benzene by handling fuel in 7 cases (19.4%), chlorinated solvents in 4 cases (11.1%), pesticides in 4 cases, and ionizing radiation exposure in 3 patients (8.3%). Our findings support the creation of a large-scale study to explore the impact of occupational exposures, particularly exposure to asbestos and hydrocarbons.

[Smoking, vaping among hospital staff during the Covid-19 pandemic: Appraisal of the "tobacco-free hospital, campus" campaign in Brest]

INTRODUCTION

In the framework of a "tobacco-free hospital and campus" campaign, we conducted a study on the prevalence of smoking and vaping among a university hospital (CHRU) staff. The study took place in late 2020 (from 1 September to 15 December), and involved self-assessment of the impact of the covid-19 pandemic on smoking.

MATERIAL AND METHOD

A cross-sectional study was carried out using an online questionnaire, which was distributed by email and QR code posting and included socio-professional details as well as data on participants' smoking and vaping.

RESULTS

There were 782 responses, representing a participation rate of 13.5%. The sample included 73.3% women and 22.7% men; 28.9% nurses, 24.9% medical staff, 3.6% nursing assistants and 42.6% other professional categories. The overall smoking rate was 13%. Sixty-two (7.9%) participants vaped; 37 (5%) vaped exclusively, 25 (3.2%) combined smoking and vaping. Men smoked more than women: 23.7% vs. 9.4% (P < 0.01). Medical staff smoked and vaped less than other categories; 6.2% vs 14.8% (P < 0.01) and 4.1% vs 9.1% respectively (P=0.02). Doctors were more often non-smokers: OR=2.71 (95% CI: 1.14-6.46). Among smokers, 25% said they had increased their cigarette consumption during the covid-19 pandemic, frequently as a means of combating stress or fatigue.

CONCLUSION

This study showed a lower smoking rate than in the literature, possibly due to the high participation of physicians. Ours were the initial estimates of vaping among hospital staff.

Health impact of work stressors and psychosocial perceptions among French hospital workers during the COVID-19 outbreak: a cross-sectional survey

OBJECTIVE

To compare global health, mental health impact of work stressors and psychosocial perception of healthcare workers (HCWs) and non-HCWs in a hospital after the first peak of the COVID-19 outbreak in France.

METHODS

A validated version of the SATIN (Santé Au Travail Inrs université Nancy 2)questionnaire with adapted scoring was used to collect data on health and impact of work stressors. This questionnaire was sent to all workers at a hospital in July 2020 and was self-administered online. In a multinomial regression model, we included HCW status, age, gender and front-line worker status as covariates.

RESULTS

Data from a total of 1405 participants were included. We found that being an HCW, male and front-line worker was a risk factor for negative perception of work demand (OR 7.35, 95% CI 4.2 to 11.47; OR 2.55, 95% CI 1.11 to 5.89; OR 1.78, 95% CI 1.04 to 3.06). Being an HCW was a predictive factor for stress (OR 1.47, 95% CI 1.04 to 2.08), poor global health (OR 1.71, 95% CI 1.14 to 2.55) and negative perception of work activity environment (OR 1.9, 95% CI 1.3 to 2.8).

CONCLUSION

We have shown that all HCWs suffered from some health impact shortly after the first peak of the COVID-19 outbreak. We underline some stressors with high impact, including work demand, work abilities and organisational context, and emphasise the need for risk management.

[Impact of the Covid-19 pandemic on the health of nurses in a university hospital]

In a university hospital in Brittany, health monitoring of the staff was set up at the beginning of the Covid-19 pandemic. The first results of the studies carried out in this context showed that nurses showed a greater deterioration of their physical health than other professionals. However, thanks to psychological balancing measures, nurses did not appear to be more affected in terms of psychological health and well-being at work than the other hospital workers.

Seafarers' mental health in the COVID-19 era: lost at sea?

Seafarers are exposed to several physical and psychosocial stressors. Recent studies highlighted specific disorders as fatigue, boredom and diseases as depression. Seafarers are also commonly exposed to post-traumatic stress disorder (piracy, accidents, threats). Coronavirus disease 2019 (COVID-19) impacts seafarers with an estimated 400,000 of whom are stranded on vessels around the world, with extended time on board, repatriation's difficulties and the financial concerns of the unexpectedly unemployed. International Maritime Organization has established the Seafarer Crisis Action Team to help them. In France, in last 10 months a dedicated call centre received 142 calls from 32 seafarers for psychological phone consultations mostly linked to this era. With the increase of duration of the COVID-19 crisis, psychological health care, repatriations and financial solutions are needed for seafarers.

Sexually transmitted infections in seafarers: 2020's perspectives based on a literature review from 2000-2020

BACKGROUND

Seafarers are a special population. The issue of sexually transmitted diseases among seafarers is as old as navigation itself, and is a public health issue and a matter of concern for seafarers themselves. The purpose of this article is to review the literature on sexually transmitted infections (STIs) in professional seafarers in the 21st century, with a view to guiding maritime physicians in their practice.

MATERIALS AND METHODS

This is a Medline® and Scopus® literature review covering publications between 01/01/2000 and 31/12/2019. Out of the 224 articles, 26 were selected.

RESULTS

This review showed that at the beginning of the 21st century, attention has been focused mainly on human immunodeficiency virus (HIV). Few seroprevalence data were available. Between 10% and 91% of seafarers had been tested for STIs. Several risk behaviours were identified: out of 4022 seafarers surveyed, 34.3% said they had several sexual partners; out of 3722 seafarers surveyed, 19.5% engaged with sex workers; out of 3493 seafarers surveyed, 63.3% did not always use condoms, while 58.0% were aware of the relevance of this protection. There was a lot of misunderstanding about STIs: 28.3% of seafarers believed that a healthy-looking person could not be HIV-positive.

CONCLUSIONS

The main pathology studied was HIV. Many seafarers had no specific training and only learned about STIs and HIV through media such as television. Maritime doctors could use new technologies to disseminate the right information on STI prevention.

Medical unfitness for work at sea: causes and incidence rate over a 12-year period in France

Background

The purposes of the study were first to determine the incidence rate of medical unfitness for work at sea among French seafarers, second to identify the conditions (diseases or accidents) causing such incapacity so as to set up prevention measures where possible and third to ascertain whether there were any overrepresentations of diseases according to category of unfit seafarers (fishers, merchant seafarers, shellfish farmers and professional sailors).

Methods

An exhaustive, observational, descriptive, retrospective epidemiological and nosological study was carried out based on the medical coding of files stored in the Aesculapius® national database, which registers all medical data regarding seafarers presenting at the French seafarers’ health services. The increasing rate of permanent medical unfitness for work at sea was calculated in relation to the annual number of registered seafarers. A 12-year span was chosen in an attempt to ascertain the different sociodemographic categories associated with incapacity.

Results

In all, 2392 seafarers were declared unfit for work at sea. This represents a permanent medical unfitness for work at sea incidence rate of below 1% for all French seafarers examined for medical fitness between 2005 and 2016.

The average age of the population of unfit seafarers was 48. The average time spent at sea before being declared unfit for work at sea was 15.5 years. Sixty-seven percent of the seafarers declared unfit had been working in the fishing sector.

The main reasons for deciding permanent unfitness for work at sea were: rheumatological conditions associated specifically with the spine; injuries relating to accidents or other external causes, mostly affecting the upper limbs; mental and behavioural disorders, including mood disorders and particularly addictions; and diseases of the circulatory system, namely coronopathies. The incidence rate of medical unfitness for work at sea was seen to increase between 2005 and 2016, but a decrease due to the dilution effect was noted in 2015.

Conclusions

Permanent unfitness seldom occurs among French professional seafarers. Prevention measures must be focused on musculoskeletal disorders, psychiatric affections and coronary conditions as well as on combatting maritime accidents, especially in the professional fishing sector, where such affections and accidents are overrepresented.

Temporary and permanent unfitness of occupational divers. Brest Cohort 2002-2019 from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P)

BACKGROUND

In France, the monitoring of professional divers is regulated. Several learned societies (French Occupational Medicine Society, French Hyperbaric Medicine Society and French Maritime Medicine Society) have issued follow-up recommendations for professional divers, including medical follow-up. Medical decisions could be temporary unfitness for diving, temporary fitness with monitoring, a restriction of fitness, or permanent unfitness. The aim of study was to point out the causes of unfitness in our centre.

MATERIALS AND METHODS

The divers' files were selected from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Only files with a special medical decision were selected, between 2002 and 2019.

RESULTS

Three hundred and ninety-six professional divers are followed-up in our centre and 1371 medical decisions were delivered. There were 29 (7.3%) divers with a special medical decision, during 42 (3.1%) medical visit. Twelve (3.0%) had a permanent unfitness. The leading cause of unfitness was pulmonary diseases: emphysema (3), chronic obstructive pulmonary disorder (2), asthma (2). Sixteen (4.0%) divers had temporary unfitness. The leading causes were cardiovascular (4 times) and neurological (6 times). Twelve (3.0%) divers had had at least one decompression sickness.

CONCLUSIONS

Judgments of permanent unfitness for diving were rare (3.0% of divers), but were because of life-threatening disease. Medical follow-up of occupational divers was justified to decrease the risk of fatal event during occupational dives.

[COVID-19: what protection for hospital staff?]

In France, several caregivers have died of COVID-19. Certain pathologies or treatments were correlated with more severe forms. What measures have been put in place to protect the health of hospital caregivers who are particularly exposed?

Quality of life among district hospital nurses with multisite musculoskeletal symptoms in Vietnam

Background

Nurses are one of the population groups with the highest prevalence of musculoskeletal disorders (MSDs). At many sites, musculoskeletal symptoms (MS) represent a major health‐care burden, adversely affecting nurses' quality of life and giving rise to mental health issues.

Objectives

This study measured the prevalence of multi‐body‐site (two or more anatomical sites) musculoskeletal symptoms (MMS), and the association between MMS, a number of demographic and work characteristics, psychological distress, and the quality of life among district hospital nurses.

Material and Methods

A cross‐sectional study was performed with 1179 nurses in Haiphong City using three questionnaires: the Modified Nordic; Quality of Life Enjoyment and Satisfaction Short Form (Q‐LES‐Q‐SF); and the Kessler Psychological Distress Questionnaire (K6).

Results

Women have a higher MMS prevalence than men (57.1% in women vs 37.6% in men, P < .001). Having a higher number of anatomical sites of MS appears to be associated with a worse quality of life among nurses. Linear regression analysis found a number of other factors negatively associated with the nurses' quality of life: gender (female), age (50‐60 years old vs 19‐29 years old), and psychological distress.

Conclusions

This study shows a high prevalence of MMS and the relationship between, on the one hand, MMS, gender, age, as well as psychological distress and, on the other hand, the quality of life among nurses in Vietnam. Further in‐depth studies are needed to investigate the causal relationships between these indicators.

[Better screening for work-related cancers: The experience of Brest University Hospital Occupational Disease Center inpatient service]

INTRODUCTION

An in-patient clinical service has been set up in March 2016 in the Occupational Diseases Center of Brest University Hospital, France, to seek for work-relatedness of diseases in patients hospitalized into the oncology and hematology departments. We present here data after two years of existence.

METHODS

All cases of cancers or malignant hematological diseases (ICD-10 codes C00 to C97 and D37 to D48) seen between March 1, 2016, and March 1, 2018, have been identified. We present sociodemographic data, occupational exposures, occupation, business sector, and tobacco consumption. The causation level between the disease and each of the occupational exposures has been rated as strong, intermediate, weak or null by the occupational medicine specialist of the Occupational Diseases Center.

RESULTS

Among the 196 patients encountered, there are 127 work-related diseases and 82 of these had one occupational exposure rated as strong or intermediate. The most frequent occupational hazards were asbestos (48 cases) and ionizing radiation (23 cases). The most frequent business sectors were metallurgy, mechanical engineering, and agriculture. Lung cancer was the most frequently reported disease (49 cases).

DISCUSSION

. We identified well-known couples with occupational exposures and diseases, such as asbestos and lung cancer. We also identified a link between pesticides and leukemias. This in-patient clinical service is helpful to identify work-related exposures and in helping patients to get compensated.

Prevalence of problem gambling in an employed population in Brittany, France

Some employees may have recourse to gambling, notably as an adaptive strategy. Although many studies have been performed on specific occupational groups (i.e. gambling industry, transportation or teaching), none have been conducted with workers followed-up by Occupational Health Services (OHS). Our aim was to evaluate the prevalence of problem gambling in an employed population and its links with work. We performed a cross-sectional study between November 2016 and April 2017, in an OHS in France. We evaluated the prevalence of gambling using the Lie or Bet questionnaire and the Canadian Problem Gambling Index. Among the 410 employees included, 138 (33.7%) had gambled in the previous year, 12 (2.9%) considered their gambling experience to be work-related, 13 (3.2%) were identified as problem gamblers. The influence of colleagues and the workplace hierarchy and ease of access to gambling (in tobacco shops, bars…) could be risk factors. Screening for gambling behavior could be offered by occupational health services, using the Lie or Bet, especially for employees exposed to readily available gambling opportunities at their workplace.

Don't forget about seafarer's boredom

BACKGROUND

The question we asked was whether it is worthwhile screening for seafarers who are prone to boredom, and whose mental health might deteriorate on board because of the particular character of life at sea.

MATERIALS AND METHODS

We used the Farmer and Sundberg Boredom Proneness Scale (BPS), validated in French, as well as the Zigmond and Snaith Hospital Anxiety and Depression Scale (HADS). The survey was voluntary and responses were collected by means of questionnaires which were returned by post.

RESULTS

Eighty seafarers (40 officers and 40 crew) as well as 63 office staff from the same shipping company were included in the survey. We found a significant difference between officers and operational personnel: average score of 8.4 ± 5 (median = 7) for officers and 10.2 ± 4.8 (median = 10) for operational personnel. 21% of the officers have scores greater than or equal to 12 compared with 41% of the crew. There is a significant correlation between the BPS and HADS test scores, in terms of depression, for the office staff and the seafarers taken as a whole; this correlation being highly significant among officers (r = +0.85), but only marginally significant among crew members (r = +0.54).

CONCLUSIONS

The BPS may be useful in screening for seafarers prone to boredom and depression for their fitness for embarkation.

Evolution of the respiratory function of professional divers over 15 years

BACKGROUND

The study was aimed at assessing changes in respiratory function after 15 years of profes- sional diving, among scientific divers.

MATERIALS AND METHODS

A retrospective study was performed on divers who underwent an initial visit and a visit 15 years later at the same medical centre, among divers who had a scientific activity (monitoring the coastline, fauna and flora). Pulmonary function tests were performed in the same laboratory with the same operating standards and using a Jaeger MasterBody plethysmograph. Each subject acted as his or her own control. The data were analysed by Student's t-test and Spearman's correlation coefficient.

RESULTS

Twenty-six divers were included. Changes over 15 years included: a decrease in the forced expired volume in 1 second/functional vital capacity (FEV1/FVC) ratio (-6 for absolute value, p < 0.01; and -5% for theoretical value, p = 0.02); a decrease in forced expiratory flow (FEF)25% (-1.1 for absolute value, p < 0.01; and -21% for theoretical value, p < 0.01); a decrease in transfer factor for carbon monoxide (TLCO) (-0.7 for absolute value, p = 0.04); and an increase in vital capacity (VC) (+8% for theoretical value, p = 0.03). A significant correlation was found between the consumption of tobacco in packs per year (PY) and the variations in VC (r = 0.89; p < 0.01) and the variations in the theoretical FEV1 (r = 0.76; p = 0.03). There was a significant relationship between the number of dives and the variations in the percentage of the theoretical FEV1/FVC ratio (r = -0.42; p = 0.04). The same relationship was found for the average of dive duration (r = -0.59; p < 0.01) Conclusions: With increasing length of diving activities service, the pulmonary function displays a trend toward both a decrease in TLCO and a decrease in FEF25%.

LUCSO-1-French pilot study of LUng Cancer Screening with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens: study protocol

INTRODUCTION

Guidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.

OBJECTIVE

To evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.

METHODS AND ANALYSIS

This trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.

ETHICS AND DISSEMINATION

This protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

TRIAL REGISTRATION NUMBER

NCT03562052; Pre-results.

Infectious diseases affecting occupational divers: review of 2017 literature

BACKGROUND

Occupational divers are prone to many health risks. For instance, they can get infections. We reviewed the infectious diseases in occupational divers.

MATERIALS AND METHODS

This is a literature review which went on up to 31.12.2017. The research was carried out on Medline and Scopus databases, in French and English languages.

RESULTS

Fifteen papers report cases of infections in occupational divers. They are mainly skin infections, but also ear-nose-throat and ophthalmological infections.

DISCUSSION AND CONCLUSIONS

According to data collected, infections among occupational divers are quite scarce. These diseases are not specific to the workplace, and are comparable with data on recreational diving. Prevention is mainly based on hygiene and equipment maintenance.

[Smoking among hospital staff and the impact of the November, No Smoking Month campaign on this population]

INTRODUCTION

Smoking cessation is a public health priority. Several prevention campaigns exist, including this one of the "month without tobacco", made in November in France. Healthcare workers have an important role to play in stopping smoking, while many of the healthcare workers are themselves smokers. The purpose of this article is to study the prevalence of tobacco consumption among hospital staff and to evaluate its effects.

MATERIAL AND METHOD

It is a transversal study, carried out among the 734 agents of a French hospital, between December 2016 and January 2017, by anonymous self-questionnaires. The study included all hospital employees, whether they were caregivers or not.

RESULTS

The participation rate was 35%, of whom 193 (75.7%) were health care workers, 46 (17.6%) were administrative and 17 (6.7%) were working in technical services. There were 31% smokers and 26% forming smokers. There were no significant differences in smoking by age, or socio-occupational category. During this campaign, 66.7% of smokers had plans to quit, and 29% tried to quit.

CONCLUSION

The prevalence of smoking in this hospital was comparable to that of the general population, and among the highest in hospital in the literature. The campaign of the month without tobacco has influenced the consumption of smokers. Other studies need to analyze how to handle this population.

[Asbestos in the National Navy: Employment-exposure matrix]

INTRODUCTION

The odd risk ratio for an asbestos-related disease is 6.9 for National Defense personnel and 94% of the victims who are compensated belong to the French Navy. While employment-exposure matrices exist for the civilian environment, none are available to the military. Our work consists of the creation of the first employment-exposure matrix in the French Navy, in order to optimize post-occupational medical surveillance.

METHOD

We conducted a bibliographic search for asbestos in naval repair, naval embarking and foreign navies. From databases such as Medline, Pubmed, we used the following keywords "Navy", "Asbestos", "Shypyard" and "Military" and we have extended ourselves to the registers of existing theses on the subject.

RESULTS

Epidemiological and bibliographic data confirm the increased risk in the French Navy. Three variables are important in the proposal of this employment-exposure matrix: employment, year of arming the ship and duration of embarkation. There is a major risk for personnel whose work is in direct contact with asbestos, in particular machine personnel, irrespective of their duration of exposure. For embarked personnel who do not have direct contact with asbestos in their jobs, the increase in risk depends essentially on the ship's year of arming and the presence of asbestos, whether or not on board, as well as the duration of exposure of seafarers.

CONCLUSION

These results allow us to recommend a classification of the risk in accordance with the recommendations of the French Health Authority and to propose an adequate post-professional follow-up for the personnel of the Navy.

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.

Can a transgender person be an occupational diver? Demonstration from a case report

This is the first case report about a transgender professional diver. The purpose of this article is to show the professional adaptations to help him to continue occupational dive and to raise the question of the impact on diving risks of hormonal treatment in this case. He was a 39-year-old man when he began his transition. He had worked as a diver for 9 years before his transition. When he changed to look like a woman, there were a few difficulties in continuing his professional activity. The main difficulty was that he looked like a woman while working with men. Modesty was a crucial issue in the enterprise. There were other problems such as the organisation of premises, the physical workload and the interaction between treatments and diving. There is a lack of a law to guide the employer. French legislation does not address the issue of transsexuals for this profession. The medical recommendations do not specify contraindications or adaptations for diving safely. Because of his transition, he lost muscle mass. The occupational physician helped to adjust his activity: decreasing the weight of his diving suit, creating a female-like locker room etc. Finally, the question of the risk of decompression illness arose. Legal hormonal medication seems not to significantly increase the risk of decompression illness, but this diver was taking illicit treatment to speed up the transition. The occupational physician recommended taking the legal hormonal medication.