Opportunities for Making Every Contact Count approaches in workplaces

There is now evidence that widespread adoption of the Making Every Contact Count (MECC) approach developed in the United Kingdom can have a significant impact on health. Even though there are important reasons explaining why such an approach is scarcely applied in workplaces, MECC might be of interest in some specific cases, such as healthcare settings or large companies. It could be considered, organized and evaluated in such workplaces.

Comparison of Machine Learning Methods in the Study of Cancer Survivors' Return to Work: An Example of Breast Cancer Survivors with Work-Related Factors in the CONSTANCES Cohort

PURPOSE

Machine learning (ML) methods showed a higher accuracy in identifying individuals without cancer who were unable to return to work (RTW) compared to the classical methods (e.g. logistic regression models). We therefore aim to discuss the value of these methods in relation to RTW for cancer survivors.

METHODS

Breast cancer (BC) survivors who were working at diagnosis within the CONSTANCES cohort were included in the study. RTW was assessed five years after the BC diagnosis (early retirement was considered as non-RTW). Age and occupation at diagnosis, and physical occupational job exposures assessed using the Job Exposure Matrix, JEM-CONSTANCES, were evaluated as predictors of RTW five years after BC diagnosis. The following four ML methods were used: (i) k-nearest neighbors; (ii) random forest; (iii) neural network; and (iv) elastic net.

RESULTS

The training sample included 683 BC survivors (RTW: 85.7%), and the test sample 171 (RTW: 85.4%). The elastic net method had the best results despite low sensitivity (accuracy = 76.6%; sensitivity = 31.7%; specificity = 90.8%), and the random forest model was the most accurate (= 79.5%) but also the least sensitive (= 14.3%).

CONCLUSION

This study takes a first step towards opening up new possibilities for identifying the occupational determinants of cancer survivors' RTW. Further work, including a larger sample size, and more predictor variables, is now needed.

Source apportionment of PM2.5 oxidative potential in an East Mediterranean site

This study aimed to evaluate the oxidative potential (OP) of PM2.5 collected for almost a year in an urban area of the East Mediterranean. Two acellular assays, based on ascorbic acid (AA) and dithiothreitol (DTT) depletion, were used to measure the OP. The results showed that the mean volume normalized OP-AAv value was 0.64 ± 0.29 nmol·min-1·m-3 and the mean OP-DTTv was 0.49 ± 0.26 nmol·min-1·m-3. Several approaches were adopted in this work to study the relationship between the species in PM2.5 (carbonaceous matter, water-soluble ions, major and trace elements, and organic compounds) or their sources and OP values. Spearman correlations revealed strong correlations of OP-AAv with carbonaceous subfractions as well as organic compounds while OP-DTTv seemed to be more correlated with elements emitted from different anthropogenic activities. Furthermore, a multiple linear regression method was used to estimate the contribution of PM2.5 sources, determined by a source-receptor model (Positive Matrix Factorization), to the OP values. The results showed that the sources that highly contribute to the PM2.5 mass (crustal dust and ammonium sulfate) were not the major sources contributing to the values of OP. Instead, 69 % of OP-AAv and 62 % of OP-DTTv values were explained by three local anthropogenic sources: Heavy Fuel Oil (HFO) combustion from a power plant, biomass burning, and road traffic emissions. As for the seasonal variations, higher OP-AAv values were observed during winter compared to summer, while OP-DTTv did not show any significant differences between the two seasons. The contribution of biomass burning during winter was 33 and 34 times higher compared to summer for OP-AAv and OP-DTTv, respectively. On the other hand, higher contributions were observed for HFO combustion during summer.

Comparison Between Musculoskeletal Pain and Gender-Specific, Non-gendered Job-Exposure Matrix and Self-reported Exposures in CONSTANCES

PURPOSE

Musculoskeletal disorders (MSDs) are common worldwide and gender differences exist in terms of prevalence and disability. MSDs are a leading cause of sick leave and physical work exposures. To assess the association between physical exposures assessed by the gender-specific CONSTANCES Job-Exposure Matrix (JEM) and musculoskeletal pain in six areas: neck pain, shoulder pain, elbow/arm pain, hand/wrist pain, low back pain, knee/leg pain; and to compare the results with those obtained using the non-gendered CONSTANCES JEM and with individual self-report exposures.

METHODS

We included 48,736 male and 63,326 female workers from the CONSTANCES cohort (France). The association between 27 physical exposures and musculoskeletal self-reported pain in six body areas was assessed using logistic regression. We conducted the analysis with three types of exposures: (1) individual self-reported exposures; (2) gender-specific CONSTANCES JEM; (3) non-gendered CONSTANCES JEM, and adjusted for age and Body Mass Index (BMI). Analyses were stratified by gender.

RESULTS

The associations to the gender-specific and non-gendered JEM were similar. The odds ratios using individual self-reported exposures were comparable to the JEM-based associations, with the exceptions of the exposures 'change tasks', 'rest eyes' and 'reach behind'. In some comparisons, there were differences in the direction and/or significance of effects between genders (regardless of whether the JEM used was gender-specific or not).

CONCLUSION

The gender-specific and non-gendered JEMs gave similar results, hence, developing physical work exposures JEMs that are gender-specific may not be essential. However, when predicting musculoskeletal pain, it seems relevant to stratify the analysis by gender.

Development and evaluation of the gender-specific CONSTANCES job exposure matrix for physical risk factors in France

OBJECTIVES

This study aimed to construct and evaluate a gender-specific job exposure matrix (JEM) for 27 physical work exposures, based on self-report.

METHODS

We constructed a JEM using questionnaire data on current physical exposures from 29 381 male and 35 900 female asymptomatic workers aged 18-69 years in the French CONSTANCES cohort study. We excluded workers with musculoskeletal pain to reduce potential reporting bias. We grouped 27 self-reported physical exposures using the French national job codes and stratified by gender. We compared individual and group-based exposures using the performance indicators Cohen's kappa (κ), sensitivity, specificity, and area under the receiver operating curve (AUC).

RESULTS

JEM validation showed fair-to-moderate agreement (κ 0.21-0.60) for most physical exposures for both genders except for 'reach behind' (poor), 'bend neck' (poor), 'finger pinch' (poor), standing' (good), 'use computer screen' (good), and 'use keyboard or scanner' (good). We found the highest AUC for 'standing' (men 0.85/ women 0.87), 'kneel/squat' (men 0.80/women 0.81), 'use computer screen' (men/women 0.81), and 'use keyboard or scanner' (men 0.82/ women 0.84). The AUC was <0.60 for only three exposures: 'bend neck' (men 0.58/women 0.57), 'finger pinch' (men 0.56/ women 0.55), and 'reach behind' (men 0.54/ women 0.51).

CONCLUSION

The constructed JEM validation measures were comparable for men and women for all exposures. Further research will examine the predictive ability of this gender-specific JEM for musculoskeletal disorders and the relevance of gender-stratification in this process, knowing accuracy of each exposure.

Comprehensive chemical characterization of PM2.5 in the large East Mediterranean-Middle East city of Beirut, Lebanon

The chemical composition of PM_2.5 at two sites in Lebanon, a country in the East Mediterranean - Middle East region, is investigated in the spring and summer seasons. The average PM_2.5 concentrations were of (29 ± 16) µg/m³ for Beirut urban site and (32 ± 14) µg/m³ for Beirut suburban site. This study showed that the geographic location of the East Mediterranean region, such as its proximity to the Mediterranean Sea and the dust storm intrusion are a significant contributor to the high PM levels from natural sources, which cannot be mitigated, rendering the PM_2.5 WHO annual Air Quality guideline unattainable due to high natural background, which also applies to the entire Middle East region. Turkey and Eastern Europe are the dominant origin of air masses throughout our sampling days, suggesting the long-range transport as an important potential contributor to the high observed concentrations of V, Ni, and sulfate in this region most probably in other East Mediterranean countries than Lebanon too. Main local sources determined through the chemical speciation including organics are road transport, resuspension of dust and diesel private generators. A health risk assessment of airborne metals was performed and the carcinogenic risk for all the metals exceeded by 42 (adults) and 14 (children) times the acceptable risk level (10^-6) at both sites. Vanadium was the predominant carcinogenic metal, emphasizing the need to replace energy production with cleaner energy on a regional level and highlighting the severe impact of air pollution on the health of inhabitants in this region's main cities.

Comparing physical work exposures between men and women: findings from 65 281 workers in France

OBJECTIVES

Musculoskeletal disorders (MSDs) are a leading cause of disability and sick leave among workers. Although MSDs are associated with physical exposures, there are gender differences in the prevalence and related disability. This study aimed to compare self-reported physical work exposures by gender for people within the same occupational group.

METHODS

We used cross-sectional data from 65 281 asymptomatic workers aged 18-69 years from the CONSTANCES cohort study (France). We compared 27 physical exposures between men and women in the same occupational groups ('Profession et Categorie Sociale' group) using Mann-Whitney U tests.

RESULTS

Men and women performing the same job often reported different levels of exposure. 38 of 365 occupational groups had a gender difference in reported exposure for 10 or more of 27 physical exposures, with men reporting higher exposures in 79% of these jobs. Women reported higher exposures in nursing and other healthcare professions. The probability that a random man had an exposure value higher than a random woman varied widely, from 8% to 92%, and was highly dependent on occupational groups and the specific exposure.

CONCLUSIONS

Men and women working in the same jobs reported different physical exposures for some jobs and some exposures. Further research should further define and explore these reported differences to improve prevention and research.

Source apportionment of PM2.5 using organic/inorganic markers and emission inventory evaluation in the East Mediterranean-Middle East city of Beirut

Source contributions to PM_2.5 concentrations were evaluated in Greater Beirut (Lebanon), a typical East Mediterranean-Middle East (EMME) city, using Positive Matrix Factorization with two approaches. The first approach included only inorganic species (PMF-trad) and the other approach added organic markers (PMF-org). PMF-org identified 4 additional sources, and large discrepancies in contributions were observed for some major sources found in both approaches, highlighting the importance of including organic markers. The traffic factor was underestimated in PMF-trad by 2 to 7 folds. Moreover, results showed that this city is prone to high desert dust concentrations originating from uncontrollable dust storm events, like all cities in the Middle East. A PM_2.5 mitigation plan taking into account the potency of the identified sources was developed. Sources like diesel generators or traffic presented smaller contributions in term of mass compared to desert dust, however the health impact of the latter is relatively small and actions should target sources with the highest potency. Local emission inventories in the EMME region are scarce and studies typically rely on global emission inventories for local air quality management plans, but these inventories significantly underestimate Beirut's road transport emissions by more than an order of magnitude.

Association between prolonged exposure to long working hours and stroke subtypes in the CONSTANCES cohort

BACKGROUND

Though there is increasing evidence on the effect of long working hours (LWH) and stroke, few studies have distinguished stroke subtypes. We examined the associations between LWH and ischaemic or haemorrhagic stroke after adjusting for cardiovascular risk factors.

METHODS

From a national population-based cohort CONSTANCES, baseline questionnaires and initial health examinations were used to retrieve sociodemographic and cardiovascular risk factors from 2012 to 2018. LWH were defined as self-reported working time≥10 hours daily for at least 50 days per year. Incident cases of stroke were collected using International Classification of Disease codes recorded in the National Health Data System. Associations between LWH and stroke were investigated using multinomial models adjusted for cardiovascular risk factors.

RESULTS

Among the 160 751 participants who were free from stroke at baseline, exposure to LWH≥10 years was reported by 20 723 participants, and 190 incident cases of stroke were identified, including 134 ischaemic and 56 haemorrhagic. Exposure to LWH was associated with an elevated odds of ischaemic stroke (OR=1.61 (1.04-2.49)) and haemorrhagic stroke (OR=2.50 (1.38-4.53)) in unadjusted models. In adjusted multivariable models, only the LWH association with haemorrhagic stroke remained significant (aOR=1.92 (1.01-3.09)).

CONCLUSIONS

LWH were associated with stroke, though it remained significant for haemorrhagic stroke only after adjustments. Differences in direct and indirect biological pathways and lack of power in the ischaemic subgroup may explain these results and further studies on the impact of mediating and effect measure modifying factors are needed. Nevertheless, policies that attenuate effects of both LWH and cardiovascular risks factor are warranted.

Teleworking and Musculoskeletal Disorders: A Systematic Review

Teleworking has spread drastically during the COVID-19 pandemic, but its effect on musculo-skeletal disorders (MSD) remains unclear. We aimed to make a qualitative systematic review on the effect of teleworking on MSD. Following the PRISMA guidelines, several databases were searched using strings based on MSD and teleworking keywords. A two-step selection process was used to select relevant studies and a risk of bias assessment was made. Relevant variables were extracted from the articles included, with a focus on study design, population, definition of MSD, confounding factors, and main results. Of 205 studies identified, 25 were included in the final selection. Most studies used validated questionnaires to assess MSD, six considered confounders extensively, and seven had a control group. The most reported MSD were lower back and neck pain. Some studies found increased prevalence or pain intensity, while others did not. Risk of bias was high, with only 5 studies with low/probably low risk of bias. Conflicting results on the effect of teleworking on MSD were found, though an increase in MSD related to organizational and ergonomic factors seems to emerge. Future studies should focus on longitudinal approaches and consider ergonomic and work organization factors as well as socio-economic status.

Interventions on Well-being, Occupational Health, and Aging of Healthcare Workers: A Scoping Review of Systematic Reviews

Introduction

With recent higher awareness of the necessity of improving healthcare workers' well-being, we aimed to overview systematic reviews dealing with interventions on well-being, occupational health, and aging of healthcare workers.

Methods

From three databases (PubMed, Embase, and Web of Science), a scoping review of systematic reviews was carried out to determine current knowledge on interventions focused on the well-being or aging of healthcare workers. Only systematic reviews were considered, with appropriate extraction and quality evaluation.

Results

Of the total of 445 references identified, 10 systematic reviews were included, mostly published since 2019. Nurses were the most frequent targets of interventions, and mental health was the main outcome described. The overall level of quality was also heterogenous, with high to low-quality reviews.

Conclusions

Workers' mental health well-being was the major outcome targeted by intervention, with varying level of evidence. Further studies are needed with integrative approaches on global health and life course perspectives, with a focus on the plurality of settings, worker types, and women.

Cardiac Arrest Management in the Workplace: Improving but Not Enough?

The aim was to describe out-of-hospital cardiac arrest (OHCA) occurring in the workplace of a large emergency network, and compare the evolution of their management in the last 15 years. A retrospective study based on data from the Northern Alps Emergency Network compared characteristics of OHCA between cases in and out the workplace, and between cases occurring from January 2004 to December 2010 and from January 2011 to December 2017. Among the 15,320 OHCA cases included, 320 occurred in the workplace (2.1%). They were more often in younger men, and happened more frequently in an area with access to public defibrillation, had more often a shockable rhythm, had a cardiopulmonary resuscitation started by a bystander more frequently, and had a better outcome. Cardiopulmonary resuscitation started by a bystander was the only chain of survival link that improved for cases occurring after December 2010. Workplace OHCA seems to be managed more effectively than others; however, only a slight survival improvement was observed, suggesting that progress is still needed.

Correction: Abou-Elnour et al. Investigation of the Optical Properties for Quaternary Se60-xGe35Ga5Sbx (x = 0, 5, and 10) Chalcogenide Glass. Materials 2022, 15, 6403

The authors would like to make a correction in a recently published paper [...].

Comparison of different estimators of SARS-CoV-2 pandemic activity on geographical and temporal levels

Background

Studies began investigating occupational exposures as a source of contamination to SARS-CoV-2, yet few considered the variation in SARS-Cov2 pandemic activity for these exposures. Several indicators were built to assess SARS-Cov2 activity though they usually serve a specific purpose and have limitations. The aim was to compare qualitatively different estimators of the SARS-CoV-2 pandemic activity and to create an estimator of pandemic activity level based on daily hospital admissions for job-exposure matrices (JEM) usage.

Methods

From publicly available French databases, we retrieved all data from March 19, 2020 (first day available) to March 25, 2021 (day of data collection) on four different estimators: percentage of intensive care bed occupied, reproductive number, tests' positive rate and number positive tests. An indicator based on new daily hospital admissions was created for a COVID JEM. Due to the heterogeneity of the estimators, a qualitative comparison was carried out.

Results

During the study period, three major outbreaks took place. Though the number of positive tests was the first indicator to worsen during the 2nd outbreak, it failed to identify variation during the outbreak. Though each indicators behaved differently during the study period, the indicator based on new daily hospital admissions and the positive rate seemed to be the closest to one another.

Conclusion

This study highlights the heterogeneity of the indicators used during the first and second SARS-Cov2 outbreaks in France. An indicator based on new daily hospital admissions seems to be a good candidate for estimating SARS-CoV-2 epidemic activity for COVID JEMs and is easily available in countries where usual indicators are not commonly accessible.

Association between COVID-19 infection and work exposure assessed by the Mat-O-Covid job exposure matrix in the CONSTANCES cohort

OBJECTIVES

The COVID-19 pandemic has brought to light a new occupational health threat. We aimed to evaluate the association between COVID-19 infection and work exposure to SARS-CoV-2 assessed by a job-exposure matrix (JEM), in a large population cohort. We also estimated the population-attributable fraction among exposed subjects.

METHODS

We used the SAPRIS-SERO sample of the CONSTANCES cohort, limited to subjects actively working, and with a job code available and a questionnaire on extra work activities. The following outcomes were assessed: COVID-19 diagnosis was made by a physician; a seropositivity to the ELISA-S test ('serology strict') and ELISA-S test intermediate with positive ELISA-NP or a positive neutralising antibodies SN ('serology large'). Job exposure was assessed using Mat-O-Covid, an expert-based JEM with an Index used as a continuous variable and a threshold at 13/1000.

RESULTS

The sample included 18 999 subjects with 389 different jobs, 47.7% were men with a mean age of 46.2 years (±9.2 years). The Mat-O-Covid index taken as a continuous variable or with a threshold greater than 13/1000 was associated with all the outcomes in bivariable and multivariable logistic models. ORs were between 1.30 and 1.58, and proportion of COVID-19 attributable to work among exposed participants was between 20% and 40%.

DISCUSSION

Using the Mat-O-Covid JEM applied to a large population, we found a significant association between work exposure to SARS-CoV-2 and COVID-19 infection, though the estimation of attributable fraction among exposed people remained low to moderate. Further studies during other exposed periods and with other methods are necessary.

Investigation of the Optical Properties for Quaternary Se60-xGe35Ga5Sbx (x = 0, 5, and 10) Chalcogenide Glass

A quenching technique was used to prepare the chalcogenide system of the Se60−xGe35Ga5Sbx (x = 0, 5, and 10 at. %), which was deposited as thin films onto glass substrates using a thermal evaporation technique. X-ray diffraction patterns were used for structure examination of the fabricated compositions, which exposes the amorphous nature of the deposited samples. Meanwhile, the chemical compositions of the prepared samples were evaluated and calculated via the energy-dispersive X-ray spectroscopy (EDX), which was in agreement with the measured compositional element percentages of the prepared samples. Based on the optical reflectance R and transmittance T spectra from the recorded spectrophotometric data ranging from 350 to 2500 nm, the influence of the Sb element on the Se60−xGe35Ga5Sbx thin films’ optical properties was studied. The film thickness and the refractive index were calculated via Swanepoel’s technique from optical transmittance data. It has been observed that the films’ refractive index increases with increasing x value over the spectral range. The refractive index data were used to evaluate the dielectric constants and estimate dispersion parameters Eo and Ed using the Wemple−DiDomenico model. The optical energy gap Egopt was calculated for the tested compositions. The result of the optical absorption analysis shows the presence of allowed direct and indirect transitions.

Factors associated with limitations in daily life and at work in a population with shoulder pain

Background

Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain.

Methods

A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation.

Results

The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively).

Conclusions

The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.

Impact psychologique de la crise sanitaire COVID-19 sur les soignants d’une unité temporaire de réanimation hors les murs : étude observationnelle monocentrique et contrôlée

Contexte

La crise sanitaire engendrée par la COVID-19 a eu un impact majeur sur le système de soin et les soignants. L’attention à porter aux professionnels du soin est indispensable, et passe par l’identification des facteurs de risques pour leur santé psychique. Dans les unités de soins intensifs (USI) la crise sanitaire a induit un stress professionnel important du fait de l’afflux de patients, de l’exposition au virus et du manque de connaissance de ce virus. L’étude présentée a pour objectif d’évaluer et comparer l’impact psychosocial de la crise COVID-19 sur les soignants exerçant dans une USI standard versus une USI ad hoc gérée par les anesthésistes en salle de réveil ou salle d’opération, dans le même hôpital universitaire.

Méthode

L’étude est une enquête transversale composée de questionnaires validés (HADS, Brief COPE, CBI et PCLS), de question sociodémographiques et d’un questionnaire ad hoc sur les caractéristiques professionnelles, soumis ç l’ensemble des professionnels travaillant dans les deux USI d’un hôpital Universitaire Français, d’avril à mai 2020. Une régression logistique a été réalisée pour identifier les facteurs de risques indépendants de l’anxiété, la dépression, le burnout et l’état de stress post traumatique (ESPT) ; avec une valeur significative pour un p < 0,05.

Résultats

Le taux de réponse était de 76 % (66/84) et 84 % (142/168), respectivement dans les USI ad hoc et standard. L’anxiété est statistiquement plus fréquente dans l’unité ad hoc que la standard 3,01 IC 95 % [1,24 ; 7,29] p 0,014). Il n’y a pas de différence significative entre les ICU concernant les incidences de la dépression, le burnout et l’ESPT. L’analyse multivariée révèle que le genre féminin et le travail en USI ad hoc était des facteurs de risque d’anxiété. Le genre féminin et l’usage de psychotrope étaient liée à la dépression. Le burnout était lié au sentiment de protection et à l’usage de psychotrope. Aucun facteur de risque significatif n’a été identifié pour l’ESPT.

Conclusion

L’évaluation de l’impact psychosocial sur les professionnels travaillant en USI classique ou ad hoc dans le même hôpital révèle des facteurs de risque spécifiques pour l’anxiété, le burnout et la dépression. Ces informations doivent être prise en compte dans l’adaptation des structures de soin pour de futures organisations de crise.

Chemical profiles of PM2.5 emitted from various anthropogenic sources of the Eastern Mediterranean: Cooking, wood burning, and diesel generators

The chemical profiles of PM_2.5 emitted from a non-road diesel generator, wood burning and cooking activities including chicken and beef charcoal grilling and general cooking activities were determined. The characterization included the carbonaceous fraction (OC/EC), water-soluble ions, elements, and organic species comprising n-alkanes, polycyclic aromatic hydrocarbons, carboxylic acids, levoglucosan, dioxins, furans, and dioxin-like polychlorinated biphenyls. The main component in the PM_2.5 from the different sources was carbonaceous matter with a mass contribution to PM_2.5 of 49% for cooking activities, 53% for wood burning, 66% for beef grilling, 72% for chicken grilling, and 74% for diesel generator with different OC/EC concentration ratios. The analysis of organic compounds contents using diagnostic ratios and indexes showed differences between the sources and revealed specific source markers. The water-soluble ions had the highest contribution in the cooking activities profile with 17% of PM_2.5 and the least in the chicken grilling profile (1.1%). Additionally, 29 analyzed elements were identified, and their contribution varied with the sources (ranging from 1% to 11% of PM_2.5). These findings could be used to differentiate these sources and could assist in the use of source apportionment methods.

Association between reported work in cold environments and stroke occurrence in the CONSTANCES cohort: a prospective study

OBJECTIVE

Cold environments are a potential risk factor for stroke. The aim of this study was to investigate the association between performing work tasks in cold environments and the occurrence of a first stroke event.

METHODS

From the French population-based cohort CONSTANCES ('Cohorte des consultants des Centres d'examens de santé' in French), we collected data from baseline questionnaires along with medical interviews on cardiovascular risk factors and reported exposure to cold temperatures (<10°C) at work. Exposures were categorised as rare (<2 hours/day), often (≥2 and <4 hours/day) and almost always (≥4 hours/day). Incidence of stroke was retrieved from the French National Health database. Bivariate and multivariable logistic regression models were used to assess the association between working in cold environments and the incidence of stroke. Stratified analyses on stroke types were also conducted.

RESULTS

There were 160 782 participants and 224 strokes (168 ischaemic and 76 haemorrhagic) included in our study. No significant increase in stroke was found for working in cold environments; the adjusted OR for often or almost always exposed was 1.14 (95% CI 0.46 to 2.84).

CONCLUSIONS

This study did not reveal a significant excess risk of stroke for occupational exposures to low temperatures. Further studies are needed to better assess the effect of preventive measures and very low temperature on occurrence of cardiovascular diseases.

Job-Exposure Matrix: A Useful Tool for Incorporating Workplace Exposure Data Into Population Health Research and Practice

Workplace exposures to physical, chemical, and psychosocial factors account for a large burden of chronic diseases. Obtaining useful estimates of current and past workplace exposures is challenging, particularly in large general population studies. Job-exposure matrices (JEMs) are a useful tool for exposure assessment, particularly when no individual level exposure data are available. A JEM provides a cross-tabulation of job titles (sometimes combined with industry) and estimated exposures to workers carrying out these jobs during different time periods. The major limitation of JEMs is that they do not account for individual variation in exposures within the same job. This limitation is offset by the advantages of low cost, wide applicability, lack of bias from self-reporting, and the ability to estimate exposures based on job titles when no other exposure data exist. There is growing use of JEMs in research examining the role of workplace exposures in the development of chronic diseases, and interest in their application to public health practice. This paper provides a scoping review of JEM use, some examples of JEMs, and brief guidance for the application of JEMs in epidemiological research. In conclusion, JEMs provide a useful tool for researchers and public health practitioners to estimate occupational exposures in large scale epidemiological studies relevant to many health conditions.

223 Development of Online Surgical Skills Education

Introduction

Online teaching rapidly emerged as a viable alternative to traditional face-to-face education. However, how to teach surgical skills in the online environment has not been established nor evaluated yet.

Method

An international one-day online surgical skills course consisting of lectures, pre-recorded virtual workshops, live demonstrations, and surgical skills teaching in breakout rooms was organised. Simultaneously, a traditional face-to-face surgical skills teaching was held and used as benchmark. Skills development assessed by trained demonstrators and self-reported competency scores were compared between the online and face-to-face event.

Results

In total, 553 participants from 20 different countries attended the online course, 64 were trained in breakout rooms with a 1:5 demonstrator to candidate ratio whilst the remaining candidates participated in didactic skills development sessions. In a separate face-to-face course 20 candidates were trained with traditional methods. Post course competency ratings by demonstrators in suturing, tendon repair and vascular anastomosis were not significantly different between students receiving online breakout room or face-to-face teaching (ps&gt;0.05). The development of the same skills to “articulation” were not different between formats (ps&gt;0.05). Post course self-rated competency scores improved for all technical skills (p&lt;0.001). Small group sessions, both online and face-to-face, received higher satisfaction ratings compared to large group sessions in terms of clarity of instructions, answers to questions and demonstrator feedback.

Conclusions

Online teaching of surgical skills for early training years is an appropriate alternative to face-to-face teaching with the ability to define clear learning objectives, effectively teach surgical skills and achieve similar learning outcomes.

868 The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube

Introduction

Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage.

Presentation of case

A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding.

Discussion

The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed.

Conclusions

Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

593 Colonic Perforation Following Major Burns: A Systematic Review

Introduction

Major burns complicated by stress ulceration and perforation of the stomach or duodenum is a recognised clinical phenomenon. Colonic perforation in burns patients is seemingly uncommon, and the overall incidence, clinical signs/diagnosis of perforation, intervention required, and mortality is incompletely described in the literature.

Method

We performed a systematic review of the literature on severe burns resulting in colonic perforation during admission. Relevant studies from January 1975 to June 2020 were retrieved from MEDLINE and EMBASE databases. Patient demographics, total body surface area (TBSA), site of colonic perforation, management and overall outcome were extracted. We present a case series of five major burns patients who had colonic perforations in our Specialist Burns Centre.

Results

We identified 54 studies, of which nine (two case series and seven case reports) met the inclusion criteria. In most cases, the TBSA associated with a colonic perforation was ≥ 30% (10/16 patients, 63%) and the abdomen was involved in 9/16 patients (56%). Perforations mainly affected the right colon (12/16 patients, 75%), usually occurring after the second week of admission (13/16 patients, 81%). Right-sided colonic perforations were associated with an increased mortality rate compared to left-sided perforations (42% vs 25%).

Conclusions

The current literature, mainly limited to case series and case reports, confirms that colonic perforations in burns patients are rare. The resulting perforation is related to the systemic effect of burn injuries including sepsis and gastrointestinal stasis. We have identified patients who are at higher risk of developing colonic perforations in order to prompt early diagnosis and intervention.

1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning

Aim

Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally.

Method

The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe.

Results

Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally.

Conclusions

The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.

Matrice emplois-exposition pour le SARS-CoV-2 (COVID-19) : création de « Mat-O-Covid », validité et perspectives

L’évaluation de l’exposition est difficile pour le chercheur du domaine des risques professionnels. L’objectif du travail est de développer et de valider une matrice emplois-exposition (MEE) pour l’exposition professionnelle au SARS-CoV-2 appelée « Mat-O-Covid ». Grâce à un groupe d’expert français, la matrice a été développée pour tous les travailleurs sur la profession et les catégories socioprofessionnelles de 2003 (avec une passerelle de transcodage vers la Classification internationale type des professions de 2008) et un focus sur le secteur de soin et médicosocial. La moyenne des codages des experts a été utilisée comme estimation pour l’exposition « sujets » (collègues et/ou public) et « patients » pour le focus secteurs sanitaires, ainsi que la probabilité de prévention pour chaque. Les corrélations intraclasses ont été considérées comme bonnes à excellentes, sauf pour la prévention en santé. Comparées à la matrice américaine O*Net, l’évaluation a été considérée comme satisfaisante. En conclusion, une MEE « Mat-O-Covid » fournissant une probabilité d’exposition professionnelle au SARS-CoV-2 aura des implications pour la recherche et en santé publique, sous réserve de connaître ses limites et de poursuivre sa validation.

A Protocol for the Use of Case Reports/Studies and Case Series in Systematic Reviews for Clinical Toxicology

Introduction: Systematic reviews are routinely used to synthesize current science and evaluate the evidential strength and quality of resulting recommendations. For specific events, such as rare acute poisonings or preliminary reports of new drugs, we posit that case reports/studies and case series (human subjects research with no control group) may provide important evidence for systematic reviews. Our aim, therefore, is to present a protocol that uses rigorous selection criteria, to distinguish high quality case reports/studies and case series for inclusion in systematic reviews.

Methods: This protocol will adapt the existing Navigation Guide methodology for specific inclusion of case studies. The usual procedure for systematic reviews will be followed. Case reports/studies and case series will be specified in the search strategy and included in separate sections. Data from these sources will be extracted and where possible, quantitatively synthesized. Criteria for integrating cases reports/studies and case series into the overall body of evidence are that these studies will need to be well-documented, scientifically rigorous, and follow ethical practices. The instructions and standards for evaluating risk of bias will be based on the Navigation Guide. The risk of bias, quality of evidence and the strength of recommendations will be assessed by two independent review teams that are blinded to each other.

Conclusion: This is a protocol specified for systematic reviews that use case reports/studies and case series to evaluate the quality of evidence and strength of recommendations in disciplines like clinical toxicology, where case reports/studies are the norm.

Acting on the potentially reversible causes of traumatic cardiac arrest: Possible but not sufficient

INTRODUCTION

Traumatic cardiac arrest (TCA) guidelines emphasize specific actions that aim to treat the potential reversible causes of the arrest. The aim of this study was to measure the impact of these recommendations on specific rescue measures carried out in the field, and their influence on short-term outcomes in the resuscitation of TCA patients.

METHODS

We conducted a retrospective study of all TCA patients treated in two emergency medical units, which are part of the Northern Alps Emergency Network, from January 2004 to December 2017. We categorised cases into three periods: pre-guidelines (from January 2004 to December 2007), during guidelines (from January 2008 to December 2011), and post-guidelines (from January 2012 to December 2017). Local guidelines, a physician education programme, and specific training were set up during the post-guidelines period to increase adherence to recommendations. Utstein variables, and specific rescue measures were collected: advanced airway management, fluid administration, pelvic stabilisation or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at day 30 with good neurological status (cerebral performance category scores 1 & 2) in each period, considering the pre-guidelines period as the reference.

RESULTS

There were 287 resuscitation attempts in the TCA cases included, and 279 specific interventions were identified with a significant increase in the number of fluid expansions (+16%), bilateral thoracostomies (+75%), and pelvic stabilisations (+25%) from the pre- to post-guidelines periods. However, no improvement in survival over time was found.

CONCLUSION

Reversible measures were applied but to a varying degree, and may not adequately capture pre-hospital performance on overall TCA survival.

PM2.5 characterization of primary and secondary organic aerosols in two urban-industrial areas in the East Mediterranean

Primary and secondary organic aerosols in PM_2.5 were investigated over a one-year campaign at Zouk Mikael and Fiaa, Lebanon. The n-alkanes concentrations were quite similar at both sites (26-29 ng/m³) and mainly explained by anthropogenic emissions rather than natural ones. The concentrations of total Polycyclic Aromatic Hydrocarbons (PAHs) were nearly three times higher at Zouk Mikael (2.56 ng/m³) compared to Fiaa (0.95 ng/m³), especially for indeno[1,2,3-c,d]pyrene linked to the presence of the power plant. A characteristic indeno[1,2,3-c,d]pyrene/(indeno[1,2,3-c,d]pyrene + benzo[g,h,i]perylene) ratio in the range 0.8-1.0 was determined for heavy fuel oil combustion from the power plant. Fatty acids and hopanes were also investigated and were assigned to cooking activities and vehicular emissions respectively. Phthalates were identified for the first time in Lebanon with high concentrations at Zouk and Fiaa (106.88 and 97.68 ng/m³ respectively). Moreover, the biogenic secondary aerosols revealed higher concentrations in summer. The total terpene concentration varied between 131 ng/m³ at Zouk Mikael in winter to 469 ng/m³ at Fiaa in summer. Additionnally, the concentrations of the dicarboxylic acids especially for adipic and phthalic acids were more influenced by anthropogenic sources.The analysis of molecular markers and diagnostic ratios indicated that the sites were strongly affected by anthropogenic sources such as waste open burning, diesel private generators, cooking activities, road transport, power plant, and industrial emissions. Moreover, results showed different pattern during winter and summer seasons. Whereas, higher concentrations of biogenic markers were clearly encountered during the summer period.

Usefulness of a job-exposure matrix 'MADE' as a decision tool for compensation of work-related musculoskeletal disorders

We aimed to assess the predictivity of the biomechanical job-exposure matrix 'MADE' using compensation data from the National Health Insurance for work-related disorders. Data were obtained from 2013 to 2015, area under curves (AUC), sensitivity, specificity and predictive values were calculated using compensation results as reference. We collected 163 128 cases data. AUC ranged from 0.64 for shoulders disorder to 0.82 for knee disorders. If two thresholds were considered, 28.7% of the sample fit under or over those. The matrix showed a fair predictivity. Such matrix cannot replace expertise but might be a tool used for improving compensation process.

Association between physical limitations and working life exposure to carrying heavy loads assessed using a job-exposure matrix: CONSTANCES cohort

INTRODUCTION

Decline in physical performance with age varies among workers. We studied the association between lifetime exposure to carrying heavy loads and limitations in climbing stairs.

METHODS

We used data from the French CONSTANCES study. A biomechanical Job-Exposure Matrix (JEM) was combined with lifetime job histories to build a cumulative exposure score, and compared with reported limitations in climbing stairs using robust Poisson models, stratified by sex and educational level.

RESULTS

Of the 26,255 subjects, 618 men and 1,080 women reported difficulties in climbing stairs; this outcome was associated with cumulative exposure to carrying heavy loads: adjusted PR= 2.17 (1.75-2.73) for men, 1.50 (1.30-1.74) for women. The association was primarily seen among less educated subjects.

CONCLUSION

Cumulative work exposure to carrying heavy loads across the working life was associated with physical limitations in climbing stairs among the less educated in both genders.

Enhancement of lipid productivity from a promising oleaginous fungus

Oleaginous fungi have recently gained increasing attention among different microorganisms due to their ability for lipid production for the preparation of biofuel. In the present study, a locally isolated fungus E45, identified genetically as Aspergillus sp. strain EM2018, was found to produce 25.2% of the total lipids content of its dry cell weight (DCW). Optimization of culture conditions was performed and lipid accumula­tion increased by about 2.4 fold (from 25.2% to 60.1% of DCW) when the fungus was grown for seven days in the potato dextrose (50 g/L) liquid medium at pH 5.0, incubation temperature at 30 ºC and inoculum size of 2 × 106 spore/mL. Supplementation of the medium with yeast extract and NaNO3 at a concentration of 0.05% as organic and inorganic nitrogen sources, respectively, increased lipid production (53.3% lipid/dry biomass). Gas chromatography analysis of fungal lipids revealed the presence of saturated (mainly palmitic acid C16:0 (33%) and lignoceric acid C24:0 (15%)) and unsaturated fatty acids in different proportions (mainly linoleic acid C18:2 (24.4%), oleica cid C18:1 (14%) and arachidonic C20:4 (7.4%). These findings suggest this new oleaginous fungus as a promising feedstock for various industrial applications and for the preparation of biodiesel.

Production of Glucoamylase, α-amylase and Cellulase by Aspergillus oryzae F-923 Cultivated on Wheat Bran under Solid State Fermentation

Filamentous fungi have been widely utilized in production of enzymes which have many industrial applications. In this study, twenty five local fungal isolates, belonging to Aspergillus sp., Trichoderma sp. and Penicillium sp., were screened under solid state fermentation conditions (SSF) for the production of α-amylase, glucoamylase and cellulase. Asperigillus oryzae F-923, cultivated on wheat bran, was the most promising isolate for production of the target enzymes under this study. Physical parameters of moisture content, pH, temperature and incubation time, optimized were 1:2(w/v), 5.5, 28°C and 72 hr, respectively. The production of enzymes was enhanced when ammonium sulfate was supplemented as a nitrogen source to wheat bran. The production of α-amylase and glucoamylase was also enhanced when 10% (w/w) soluble starch was added as a carbon source to wheat bran. However xylose supplementation at 10% (w/w) was observed to be best for cellulase production. Tap water was found to be efficient for enzymes' extraction from the fermentation medium. Three successive extractions were needed to obtain the produced enzymes from the fermented substrate. Characterization of the produced enzymes revealed that, the optimum temperature for α-amylase and glucoamylase was 60°C, while 50°C was the optimum temperature for cellulase activity. Isopropanol 1:1(v/v) was proved to be more suitable for partial purification of enzymes. Following partial purification of enzymes of glucoamylase, α-amylase and cellulase increased to 10.8, 11.8 and 11.4 folds, respectively.

Cumulative Exposure to Long Working Hours and Occurrence of Ischemic Heart Disease: Evidence From the CONSTANCES Cohort at Inception

Background

Long‐working hours (LWH) are a probable risk factor for ischemic heart diseases (IHD); however, no previous study has considered duration of exposure to LWH when addressing this topic. We aimed to determine the association between cumulative exposure to LWH and IHD while accounting for relevant confounders.

Methods and Results

In this retrospective study, we included all baseline participants from the French population‐based cohort CONSTANCES. Part‐time employees and those who reported a cardiac event in the 5 years before LWH exposure were excluded. From self‐administered questionnaires and clinical examinations, we obtained participants’ age, sex, body mass index, occupational status, smoking habits, high blood pressure, diabetes mellitus, familial history of cardiovascular disease, dyslipidemia, exposure to LWH, and its duration. We defined LWH as working for >10 hours daily for at least 50 days per year. The main outcome was reported history of IHD, ie, myocardial infarction or angina pectoris, during a clinical examination. Of 137 854 included participants, 69 774 were men. There were 1875 cases (1.36%) of IHD, and exposure to LWH was reported by 42 462 subjects (30.8%) among whom 14 474 (10.50%) reported exposure for at least 10 years. Overall, exposure to LWH for ≥10 years was associated with an increased risk of IHD, adjusted odds ratio (aOR) 1.24 (1.08–1.43), P=0.0021. In stratified analyses, this effect was not observed in women, but was significant amongst men, aOR 1.28 (1.11–1.48), P=0.0008.

Conclusions

This large population‐based study supports an association between cumulative exposure to LWH and IHD in men. Future research should consider relevant strategies for reducing LWH exposure and duration.