Permanent unfitness for work and mental disorders: a multicentric cross-sectional study of 2,788 unfit employees

In France, Mental Disorders (MD) are the second most common medical cause of unfitness-for-work notices. The main objective is to describe the MD causing permanent medically unfitness at the workstation. A cross-sectional multicenter survey was conducted among employees followed by 323 physicians from occupational health services of the South of France in 2017. The MD responsible for unfitness for the job were coded according to the ICD-10 nomenclature and their occupational origin was estimated by each physician. On 359,966 employees screened, 2,788 were unfitted. Among the 2,779 unfitness cases which were analysed, 985 were unfitted for MD. The incidence rate of unfitness for MD was 2.78 unfit per 1,000 employees followed. Representing 36.8% (985 cases) of all grounds for unfitness, MD were estimated to be work-related in 614 (63.6%) of cases. The main MD were 449 (45.6%) cases of major depressive episodes, 227 (23.0%) anxiety disorders and 131 (13.3%) recurrent depressive disorders. Their occupational origin was mentioned in 296 (67.3%), 168 (74.7%), 62 (49.6%) cases and the link with a Burnout (BO) in 166 (38.3%), 61 (27.9%) and 41 (34.2%) cases respectively among 364 all pathologies reported to a BO. Unfitness for MD was more common among women (ORa = 1.79 95% CI [1.50-2.13]), working in trade, transport, accommodation and catering (ORa = 1.47 95% CI [1.04-2.09]) and increase with age (ORa = 4.24 95% CI [2.73-6.60] for over 55). Major depressive episodes represent the MD most frequently responsible for unfitness and the most related to occupational origin.

Guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology

This research letter provides guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology.

Factors associated with internal contamination of nurses by antineoplastic drugs based on biomonitoring data from a previous study

Internal contamination of healthcare professionals by antineoplastic drugs (ADs) remains a current occupational health issue, particularly because these compounds are classified as dangerous to handle by the NIOSH. In order to improve preventive actions, a study of the factors associated with this internal contamination was conducted among nursing staff in health care institutions. This study is a statistical analysis of metadata from a cross-sectional observational study conducted among nurses in two French hospitals. The internal contamination of each nurse was assessed in a previous study and was defined by whether or not at least one studied AD was detected in at least one urine sample. Three urine samples and a self-questionnaire were collected for each participant. Analysis of five ADs (cyclophosphamide, ifosfamide, metabolite of 5-fluorouracil, methotrexate, doxorubicin) were performed by liquid chromatography coupled to tandem mass spectrometry. A multivariate stepwise descending regression model was used to determine factors associated with internal contamination by coupling data from a self-questionnaire with internal contamination data. A total of 74 nurses participated to the study and 68 were included for this work: 39 nurses with and 29 without detectable internal ADs contamination. Two protective factors of internal contamination could be identified: a high "glove wearing score" (OR: 0.957; 95%CI: 0.93-0.98; p < 0.01) and a high "total number of years handling ADs and/or caring for patients treated with ADs" (OR: 0.797; 95%CI: 0.67-0.91; p < 0.01). In addition, three factors contributing to internal contamination were identified, namely "feeling sufficiently informed about tasks exposing to ADs" (OR: 9.585; 95%CI: 2.23-57.05; p < 0.01), "disposal of a waste bin containing equipment used for administration of the ADs studied" (OR: 8.04; 95%CI: 1.87-46.08; p < 0.01) and "changing sheets and/or making bed of a patient treated by one of the ADs studied" (OR: 10.479; 95%CI: 1.43-133.30; p < 0.05). Thus, the use of gloves when handling ADs directly or indirectly and the contaminating nature of certain tasks should be taken into account when (1) implementing preventive actions in health care services and (2) training and informing exposed staff. Further studies would be desirable to confirm these results and extend them to other professional categories.

Permanent Unfitness for Work and Musculoskeletal Diseases: A Multicentric Cross-sectional Study of 2788 Unfit Employees

OBJECTIVE

To describe the various musculoskeletal diseases resulting in work-related permanent unfitness for work. Methods: In 2017, a multicenter cross-sectional employee survey in the South of France was conducted by 323 occupational physicians. Results: Of the 359,966 employees monitored, 2788 had permanent unfitness for work. This number included 1078 for musculoskeletal diseases, which was more frequent in women (odds ratio, 1.42; confidence interval, 1.20 to 1.68) and showed an increase in women older than 55 years (odds ratio, 6.42; confidence interval, 4.4 to 6.60). Back disorder was the most common work-related disorder reported (n = 488 [45.4%]), with soft tissue conditions being (n = 237 [22.0%]). Arthropathy (n = 157 [14.6%]) had occupational origins in 282 (44.3%), 169 (26.6%), and 55 (8.6%) cases, respectively. Conclusions: Musculoskeletal disability prevention should be encouraged to avoid resultant employment attrition.

Job retention for people with bipolar disorder: A qualitative analysis

At least half of people with bipolar disorder, whose global prevalence is greater than 1% of the general population, do not have a stable occupation. The objective of this study is to identify the factors perceived by bipolar people as having an impact on retention in employment. Semi-directed individual interviews were offered to subjects with bipolar disorder, of working age, who had been seen by three different hospital departments in the south of France. These people had to be medically stable and have at least one occupational experience. Each interview was recorded and transcribed manually and then analyzed according to a thematic classification of verbatims. Nineteen people participated in the interviews. Three major themes identified were classified into intrinsic (working routine and working environment) and extrinsic (external aids) factors for the bipolar person. The majority believe that working regular hours is a balancing factor. For everyone, night work and stress factors can lead to relapses. All stressed the need to destigmatize the disease. Most believe that it is necessary to develop employment support organizations specific to mental illnesses. This research helps to inform people with bipolar disorder about the occupational factors that help balance their condition. Personalized multidisciplinary care pathways involving occupational medicine must be developed in order to promote the balance of the disease and job retention.

Dépistage du personnel de santé exposé au SARS-CoV-2

Introduction

Dans le cadre de la pandémie mondiale au SARS-CoV-2, les personnels de santé (PS) sont professionnellement exposés à ce virus. Dans ce contexte, cette étude présente les données de surveillance de 5704 travailleurs d’un centre hospitalier, exposés au SARS-CoV-2.

Matériel et méthode

Les PS symptomatiques, les cas contacts et ceux présentant une forte anxiété ont été testés du 17/03/20 au 20/04/2020. Le diagnostic de COVID-19 a été réalisé par RT-PCR après prélèvement nasopharyngé.

Résultats

Au cours de cette période, 30,4 % (1735/5704) des PS ont bénéficié de 3057 écouvillons nasaux. Parmi ceux-ci, 8,0 % (138/1735) étaient infectés par le SRAS-CoV-2. Parmi les PS positifs au SARS-CoV-2, 21,7 % étaient asymptomatiques. Chez les PS symptomatiques, 8,1 % (77/952) des tests RT-PCR effectués étaient positifs ; chez les PS, cas contact, sans symptôme, 2,3 % (23/1010) des tests étaient positifs (p < 0,001) ; chez les PS, anxieux, asymptomatiques, 0,3 % (2/687) des tests étaient positifs. Les premiers étaient plus à risque d’être positifs que ces derniers (p < 0,001). Dans les unités COVID et les unités non-COVID, le nombre de personnes infectées par le SARS-CoV-2 était respectivement de 5,8 % (13/223) et 8,2 % (125/1512) (p = 0,2). Les catégories professionnelles les plus souvent infectées par le SARS-CoV2 étaient les infirmières (30,0 % ; 40/138), les internes/médecins (21,0 % ; 29/138) et les aides-soignants (10,9 % ; 15/138). Parmi les médecins, la majorité étaient des internes (70,0 % ; 20/29). Les travailleurs de plus de 50 ans étaient moins susceptibles d’être positifs au SARS-CoV-2 (3,8 % ; 14/373) que les autres travailleurs plus jeunes (9,1 % ; 124/1362) (p < 0,001). Aucun cas grave de COVID-19 n’a été signalé dans notre population au cours de cette période.

Conclusion

Parmi les PS positifs détectés, 21,7 % (25/115) étaient asymptomatiques. Ces données soulignent l’importance du dépistage systématique des cas contacts même asymptomatiques et de l’utilisation d’équipements de protection individuelle pour éviter la transmission. Le pourcentage des cas positifs diminuait à mesure que l’âge augmentait, en particulier après l’âge de 45 ans. Les personnels de plus de 45 ans, étant plus expérimentées et se sentant plus à risque, ont pu être mieux protégées ou affectées à des services moins à risque ou confinés à domicile. Les PS travaillant dans des unités COVID-19 n’étaient pas plus souvent infectés que ceux travaillant dans des unités non-COVID-19, probablement parce qu’ils étaient plus conscients des dangers et des risques associés au SARS-CoV-2, qu’ils disposaient de plus d’équipements de protection individuelle, qu’ils les portaient de manière plus stricte et qu’ils étaient mieux informés et formés.

Cancer survivors' efforts to facilitate return to work

This study assesses individual factors that influence return to work (RTW) and in particular on the cancer survivors' ability to prepare his/her job resumption. A self-administered questionnaire was completed by 105 cancer survivors after at least 4 weeks after the time of their RTW. Various methods of returning to work were compared between occupational and medical characteristics with multivariate statistical tests. Regular contact by a cancer survivor with the company during sick leave is associated with RTW within 1 year of diagnosis (ORaj = 5.78). Optional pre-reinstatement visit with the occupational physician is associated with the absence of employee activity's change (ORaj = 2.30). The cancer survivors who during treatment period ask for an adaption of treatment are more likely to have a change in working conditions (ORaj = 14.5). The adaptation to recovery conditions appears to be associated with survivors' effort to RTW. It should be confirmed with new studies.

[Qualitative study on young hospital physicians: They remain satisfied…]

INTRODUCTION

Prevalence of depression, suicidal ideation and burnout are higher among physicians than in general population. Young physicians seem more concerned and the beginning of career seems to be a period of greater risks for hospital practitioners. While this may be the case, in France, few studies have specifically evaluated the quality of the working conditions of this population. The objective of this study is to identify stress factors related to the organization of work and to social relationships at work, as they are perceived by the young hospital physicians.

METHODS

A qualitative study through semi-structured interviews was conducted with hospital practitioners with less than 10 years of practice. Manual analysis of the interviews was carried out by three interviewers and supplemented by a computerized lexical analysis.

RESULTS

Eighteen physicians were interviewed. Five categories of psychosocial and organizational factors have been identified. Teamwork and communication are generally associated with positive feelings. The pace of work, professional status, organizational factors and material conditions are considered unsatisfactory. Young physicians, however, are satisfied with the content of their work, particularly because of scientific emulation and skills development.

CONCLUSION

The results of this study should help to better target prevention actions in order to improve the working conditions of young doctors. It seems a priority to reduce their workload or to regulate their working time, to offer greater stability to their work and to provide them with better material work conditions.

The quality of life and the future of young adults with Asperger syndrome

Purpose: This pilot study describes the socio-professional development and quality of life of young adults with Asperger syndrome in France.Methods: Those young adults, between 18 and 30 years old, receiving care in a child psychiatry department for autistic spectrum disorder, were requested to respond to the Ad Hoc, World Health Organization Quality Of Life - Bref and Copenhagen psychosocial questionnaires regarding their socio-professional background and feelings about their future.Results: Of the 79 eligible subjects, 24 were selected to participate in our study. Their average age at the time of the pilot study was 22.2 years (standard deviation 3.4 years), and their average age when they were diagnosed was 17.5 years (standard deviation 3.7 years.). There were 54% who reported a psychiatric comorbidity anxiety disorder. Half stated they had completed secondary school and benefitted from being professionally employed. During this study, only six were employed, while the others remained financially dependent on their parents. The group's quality of life self-assessment scores were significantly lower compared to the French general population in overall psychology (43.6 versus 68.7) and social relationships (48.9 versus 76.5). However, the study's participants perceived work as an important means to their personal development. Hence, in order to cope with their difficulties, they hoped to benefit from customized support adapted to their autistic disorder and for their workplace colleagues to be better informed about Asperger syndrome.Conclusions: Our results are in line with international data. Additional studies need to be done in order to determine socio-professional integration factors and, in particular, the integration of potential contributions by occupational health departments with those social and medical teams supporting these young adults.Implications for rehabilitationYoung adults with Asperger syndrome benefit from the support of their family in determining their professional goals.Support may be required to enhance social and communicative abilities to help integration.Employees would benefit from information on the syndrome and how best to support.

Radiation protection for surgeons and anesthetists: practices and knowledge before and after training

The use of radiological activity in the operating room (OR) and a regulatory decrease of the eye lens dose warrant an assessment of how medical staff are protected from radiation. This study aims to evaluate practices and knowledge in radiation protection (RP) for OR doctors before and after training. A descriptive study of surgeons and anesthetists in a French public hospital center was conducted in 2016. An ad hoc questionnaire concerning occupational practices and knowledge about RP was distributed before and one month after RP training. Among 103 doctors attending the training, 90 answered the questionnaire before the training. Results showed a lack of knowledge and good practice in RP. Most of the participants (86.7%) had never been trained in RP and recognized insufficient knowledge. Most of them (92.2%) wore a lead apron, 50.0% a thyroid-shield, 5.6% lead glasses, 53.3% a passive dosimeter and 17.8% an electronic dosimeter. None of them benefitted from collective protective equipment such as a ceiling suspended screen. The questionnaire following the training was completed by only 35 doctors. A comparison before and after training results showed an improvement in knowledge (scores of correct responses: 5.5/16 before and 9.5/16 after training) but not in RP good practices (scores of correct responses: 3.2/7 before and 3.3/7 after training). One training session appears to be insufficient to improve the application of the safety rules when x-rays are used. Communication needs to be improved regarding RP among anesthetists and surgeons, such as training renewal, workstation analysis in OR related to x-ray use and occupational medical follow-up. Otherwise, radiological risks in OR need to be given better consideration, such as radio-induced cataract risk. It is necessary to encourage the use of dosimeters and protective equipment and to strengthen access to lead glasses and collective protective equipment, such as ceiling suspended screens. All these recommendations ensure the received dose is reduced to as low as is reasonably achievable.

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

OBJECTIVES

This study measures the association between hospital staff's 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 employer's 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.

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.

[Lexical analysis on the quality of work life of hospital psychiatrists]

PURPOSE

A qualitative study was conducted in 2013 with hospital psychiatrists working in two psychiatric hospitals of different regions in order to document the quality of work life of public hospital psychiatrists.

METHOD

Semi-guided interviews were conducted with psychiatrists using an interview guide. Physicians were randomized according to health institution, age, gender and adult or paediatric psychiatry speciality. Data were analysed with the Alceste software and interpreted.

RESULTS

Sixteen psychiatrists were interviewed. Four themes, composed of sub-themes, were highlighted. The first them concerned medical and social patient care, with the child's social and family environment, structural constraints and interactions with the care network. The second them concerned quality of care with the training of healthcare workers and the relational dimension. The third them concerned working in the public hospital system with the role of the "physician-administrator", loss of the meaning of work and job satisfaction. The last theme refers to the specificity of working in psychiatry with forensic aspects and violence issues.

CONCLUSION

This study suggests that psychiatrists are globally satisfied with their jobs. The main factors to be improved are working time organization to allow more time to listen to the patient, interprofessional exchanges and paramedical staff training. These data should be assessed by means of a quantitative study.

[Occupational noise induced hearing loss acknowledgement: Opinions of a regional occupational disease commission]

CONTEXT

In France, occupational noise-induced hearing loss is compensated by the "Régime Général" of the French Social Security according to the system of the tables of occupational diseases. If administrative and/or exposure criteria are lacking, the regional occupational disease commission (CRRMP) is seized to pronounce an opinion - favourable or not - on the direct link between occupational activity and the deafness.

OBJECTIVE

This study aimed at determining the decisive factors in this opinion.

METHODS

An exhaustive retrospective investigation analysed conclusions of CRRMP of the region Provence-Alpes-Côte d'Azur-Corsica related to the noise-induced hearing loss declarations emitted anonymously between January 1st, 2005 and December 31st, 2007. Favourable and unfavourable opinions were listed then cross-examined against the sociodemographics data of the employees, areas of expertise of the physicians at the origin of the initial medical certificate, grounds for submission to the commission, the occupational physician's opinion on the occupational origin, the results of the engineering consultant's investigation, the audiogram of the first observation of injury and those made in period of noise exposure.

RESULTS

One hundred and twenty conclusions were analyzed. Claimants, typically male, 59-year-old on average, mainly came from the sectors of the metal industry (46.7%), transportation (20.8%) and building and civil engineering works (15.8%). All in all, 57.5% of the declarations were refused. These refusals were mainly connected to an opinion unfavourable, unexploitable or absent in the occupational physician, an overrun of the care period when it lasted 5 years and more and the absence of hearing deficit during the exposure.

PERSPECTIVES

The results of our study lead to recommend the implementation of a certificate of noise exposure and the realization of an audiogram at the end of exposure to reduce the number of badly informed files and bring an answer more adapted to the demands of occupational noise-induced hearing loss acknowledgements.

Use of imaging in the follow-up of workers exposed to lung carcinogens: practices in occupational medicine and its determinants

We studied occupational physicians' (OPs) practices of referrals for imaging of workers occupationally exposed to lung/pleural carcinogens and the factors associated with them. This cross-sectional telephone survey of 379 OPs practicing in Southeastern France showed that 81% of them referred exposed patients for chest radiographs, 33.5% for computed tomography (CT), and 16.1% for neither. Making no referral was positively associated with believing cancer risks are lower in one's own geographic sector than elsewhere and negatively associated with keeping employee risk records up-to-date. Referrals for CT were positively associated with work at in-house occupational health services (OHS), and completing employee exposure histories often/always. Both the OHS type and factors that may shape OPs' awareness of cancer risks in their sector appear to influence imaging referral practices. Occupational physicians would benefit from guidelines clarifying benefits and risks associated with imaging in such patients. An effort to harmonize regulatory provisions and guidelines also appears necessary.

Links between private habits, psychological stress and brain cancer: a case-control pilot study in France

Numerous studies have increasingly suggested that medical history and lifestyle factors could be involved in the increase of cancer risk in adults. The issue whether psychological factors can influence the development of cancer has been discussed for many years. In the field of brain cancer, psychological stress has not so far been investigated. We conducted a French case-control pilot study with 122 adult incident cases and 122 controls free of any cancer diagnosis, matched for age and gender, to investigate links between malignant primitive brain tumours (MPBT) and medical history, private habits and psychological stress. Data were collected through self-administered questionnaires, and person-to-person interviews. To complete the psychological stress assessment, 100-mm visual analog scales were used. After adjustment for confounders, we found no significant effect of head trauma, aspartame, tobacco or alcohol consumption, place (rural or urban) of residence, sociodemographic data, and experience of psychological stress at work/home. Our results showed a significant association between MPBT risk and major life events over the past 5 years before diagnosis (OR = 1.90, 95% CI 1.13-3.20), family histories of cancer (OR = 1.90, 95% CI 1.12-3.22), fresh vegetable and fruit intake (OR = 0.29, 95% CI 0.09-0.95), and skipped meals several times per week (OR = 0.35, 95% CI 0.16-0.77). The present study suggests the role of genetic factors in glioma risk, and also suggests that an acute and sudden psychological stress might influence MPBT appearance. Additional large clinical studies are needed to confirm these findings.

Occupational physicians' attitudes and practices in relation to occupational cancer prevention: a qualitative study in southeastern France

We conducted a qualitative survey of 20 occupational physicians (OPs) in southeastern France in 2008 to study their attitudes and practices regarding the prevention of occupational cancers. Occupational physicians' practices regarding occupational cancers centered mainly on prevention. Numerous difficulties impeded these activities: attitudes that minimized the carcinogenic risks by employers and employees, the absence or inadequacy of mandatory risk assessment to identify health hazards, and difficulties in obtaining individual exposure forms, which employers are supposed to complete to identify employees exposed to carcinogens. Other problems were related to the resources available to OPs and the constraints on their time. Finally, some OPs reported that they lacked self-efficacy. The results of this study suggested the need to strengthen OPs' initial training, draft and adopt good practice guidelines for various aspects of their practices, and improve collaborations between OPs and other professionals specialized in the prevention of occupational risks.

Occupational and environmental risk factors for brain cancer: a pilot case-control study in France

INTRODUCTION

The increased incidence of malignant primary brain tumors (MPBT) reported in several studies could be due to environmental factors. To estimate the chemical and physical risk factors of these tumors in southeastern France, a pilot case-control study that included all new MPBT cases diagnosed in 2005 in the main brain cancer treatment centers in the western section of the Provence-Alpes-Côte d'Azur (PACA) region.

MATERIAL AND METHODS

Age-, sex-, and hospital-matched controls were selected from the neurosurgery department of the same hospital. An occupational physician, using a standardized questionnaire, collected information on suspected risk factors of MPBT in a face-to-face interview at the hospital of all case and control subjects. Data collected included jobs held, various exposures throughout working life, and leisure time activities.

RESULTS

The study included 122 cases and 122 controls. No particular job was identified as a major risk factor for brain cancer. Risk was significantly higher among those who used glue (OR=17.58, 95% CI 1.75 - 176.62) during leisure activities and significantly lower among those residing near cellular telephone towers (OR=0.49, 95% CI 0.26 - 0.92).

DISCUSSION

Several new hypotheses about the effects of cellular telephone towers and chemical exposure merit further analytic studies.

Persistent cognitive functioning deficits in operating rooms: two cases

BACKGROUND

To date, chronic toxic encephalopathy (CTE) has never been described in operating room personnel.

CASE REPORT

We report two cases of anaesthetists who developed this pathology. They have both used anaesthetic gases for many years in paediatric surgery. Air conditioning was deficient during three years in operating rooms and atmospheric anaesthetics concentration was high (N(2)O mean concentration: 311 ppm, peak levels 1,600 ppm; halogenated: 16 ppm, peak levels: 1,600 ppm).

CLINICAL SYMPTOMS

Mood troubles and non-specific neuropsychic deficits gradually evolved until they had to stop working. Neuropsychological assessment showed important deficits in attention, executive functioning, short-term memory and visuo-spatial organization. Blood tests, VEPs, MRI, neuroSPECT and cardiovascular exams were normal. Troubles had slowly improved after cessation of exposure and sequels still remain.

CONCLUSION

These CTE cases seem to be the consequence of a long-term exposure to important levels of anaesthetic gases, and particularly nitrous oxide. It points out the importance of preventive measures in operating rooms, where occupational hazards are varied.

Assessment of Antioxidative Activity of Lipid- and Water-Soluble Vitamins in Human Whole Blood. Comparative Analysis Between a Biological Test and Chemical Methods

Assessment of the antioxidant activity of vitamins and other compounds is of interest in the understanding of their in vivo effects. In this study, we have investigated the activity of several lipid and water-soluble vitamins in human whole blood. Measurements were carried out using a biological test that enables the evaluation of both red blood cells and plasma resistance against free radical activity induced by 2,2'-azobis (2-amidinopropane)hydrochloride (AAPH). Antioxidant activity of vitamins has been determined by using the biological test versus chemical methods (chemiluminescence, DMPD radical). We have observed strong antioxidant potentials for vitamins B6 and B9 with biological tests, but not with chemical methods. At 10 μM, the vitamin B9 efficiency in inhibiting radical-induced red blood cell hemolysis was almost three times higher than vitamin C efficiency and two times higher than α-tocopherol efficiency. Antioxidant activity was not observed for vitamins B1 or B2, nor for retinol. The weak activity of β-carotene still remains to be investigated particularly in relation to oxygen pressure. Our study demonstrated that the biological test is more useful than the chemical methods employed in this instance, for the evaluation of antioxidant capacity of lipophilic and putatively biologically active compounds.

Maladie de Wegener après exposition à la silice

CRYSTALLINE SILICA: Crystalline silica is an abundant mineral found in multiple occupational exposures. It is a recognised occupational risk factor for some systemic auto-immune diseases such as progressive systemic scleroderma and Caplan-Colinet's syndrome, or just suspected in Goujerot-Sjögren's syndrome, periarteritis nodosa and systemic lupus erythematosus. WEGENER'S GRANULOMATOSIS: A rare disease of unknown of unknown aetiology, the disease is characterised by granulomatous vasculitis affecting the upper respiratory tracks, lungs and kidneys, associated with glomerulonephropathy. THE ROLE OF SILICA PARTICLES: Studies have shown that crystalline silica may be implied in Wegener's disease. Associated with other factors, notably with a genetic predisposal, silica particles might, through the release of reactive oxygen radicals and inflammatory cytokines, trigger-off immunopathological mechanisms. The latter would be manifested by exocytosis of the proteinase 3 and myeloperoxidase antigens on the surface of the polynuclear neutrophils.

[Suspicious pigmented skin lesions. Screening campaign by occupational physicians in the Provence-Alpes-Côte d'Azur region]

OBJECTIVE

Cutaneous melanoma prevention has become a public health issue. The incidence of this cancer has been steadily growing for 50 years, and the related death ratio is not decreasing. Today, the surgical resection of a thin lesion is the only validated curative treatment. The early detection of melanoma represents a major line in the management of such tumours.

METHODS

Occupational physicians of the PACA area were invited to participate in a campaign for the screening of pigmented suspect cutaneous lesions for 2 years. Voluntary physicians were trained to use the ABCDEF diagnostic criterion. Lesions were detected during regular yearly consultations (1998/1999) and the data concerning the development and care of these lesions was collected during consultations over the following year (1999/2000).

RESULTS

Two hundred and fifty occupational physicians of the PACA area participated in the campaign. Two pre-cancerous lesions and 10 cancers (5 melanoma and 5 pigmented basocellular carcinoma) were found among the 487 suspect lesions detected. Each melanoma had a Breslow score of less than 0.9 mm and were of good or even excellent prognosis.

CONCLUSION

The cutaneous examination, although rapid, during the occupational medicine consultations, is an effective means of detecting the early onset tumoral lesions which, at that stage may potentially be cured. The ABCDEF criterion is a useful diagnostic tool and should be taught to the all the medical and paramedical staff.

Assessment of lifestyle effects on the overall antioxidant capacity of healthy subjects

Oxidative damage is increasingly recognized as playing an important role in the pathogenesis of several diseases such as cancer and cardiovascular diseases. Using a biologic test based on whole blood resistance to free-radical aggression, we sought to evaluate lifestyle factors that may contribute to the normal variability of the overall antioxidant status. We assessed this global antiradical defense capacity in 88 men and 96 women in relation to information on lifestyle obtained by questionnaire. In our relatively young, healthy population, we found a weak negative relation between male sex or aging and the resistance to oxidant stress. Among the factors studied, nonsmoking, vitamin and/or mineral supplementation, and regular physical activity were closely associated with an increased overall antioxidant capacity. Conversely, the antioxidant potential was negatively related to tobacco smoking; psychologic stress; alcohol consumption; moderate vegetable, low fruit, and low fish consumption; and, to a lesser extent, high natural ultraviolet light exposure. Thus, we were able to determine "unhealthy" and "healthy" lifestyle patterns that truly contributed to the variation of individual antioxidant capacity. We conclude that lifestyle determinants of cancer and cardiovascular risks were associated with a decreased overall antioxidant status as dynamically measured by means of a biologic test. Thus, the evaluation of the total human resistance against free-radical aggression, taking into account nutritional habits, lifestyle, and environmental factors, may be useful in preventive medicine as a precocious diagnosis to identify healthy subjects who are at risk for free-radical-mediated diseases.

[Oxidative stress and human disease. Current knowledge and perspectives for prevention]

DYNAMIC BALANCE: The antibiotic status of the human organism results from the dynamic balance between the antioxidant system and the production of reactive oxygen species. Oxidative stress occurs when this balance shifts in favor of pro-oxidants as can occur in several disease situations. ROS: Part of the oxygen used by cells is transformed into toxic metabolites, reactive oxygen species (ROS), which can be the cause or consequence of tissue and molecular disorders. Some of the most prominent diseases linked with oxidative stress include atherosclerosis, cancer, allergy, neurodegenerative diseases, Parkinson's disease. PERSPECTIVES FOR PREVENTION: Actions designed to prevent the environmental cause, such as eviction of a exposure to toxins or a change in eating habits, can be an effective means of reducing the lesions induced. Study of total antioxidant potential could be quite useful for detecting and monitoring environmental damage and for clinical follow-up. It could also help in determining, for each individual, the negative or positive development of a therapy on the anti-free radical action. Treatments must be personalized according to the tested response.

Dyshidrotic eczema and occupation: a descriptive study

Dyshidrotic eczema (DE) is a chronic and/or recurrent vesicular eczema of the palmar sides of the hands and sometimes the soles of the feet. The major aetiologies to be considered are atopic DE, contact DE, systemic contact DE and DE due to fungal or microbial allergy. To clarify the role of occupational contact allergens, 59 workers with DE were examined to determine whether they had atopy, environmental contact sensitization and/or contact allergy coupled with work activity. For all, patch testing was carried out using the European standard series and the material brought in by the patients. No significant difference was found between the rate (42.4%) of history of atopy among the 59 workers with DE and that (30.6%) observed among 160 workers with other forms of hand eczema (HE). Positive patch test reactions were found in 72.8% of dyshidrotic patients. A relationship to occupational activity was strong for 18 (30.5%) of them but this rate was significantly lower than that (55%) observed among the 160 with other types of eczema. Results of the present study showed that contact sensitization is as much involved in workers with DE as in workers with other form of HE, even though the relationship to work is significantly less frequent for DE. It also suggests that atopic histories are no more involved in DE than in other forms of HE.

[Natural latex allergy. Primary and secondary prevention in work environment]

AT RISK GROUPS: The incidence of latex hypersensitivity of latex hypersensitivity has increased over the last decade. The main at-risk groups for developing latex allergy are: health care workers and employees working in latex industries, patients with atopic diathesis and subjects with repeated surgical procedures during childhood. SENSITIZATION: The use of cornstarch powder gloves can sensitize healthy subjects and exacerbate symptoms of allergic patients as the powder spreads the latex allergens into the environment.

PRACTICAL ATTITUDE

We propose here some practical recommendations for prevention, both for the general population and for allergic subjects.

Effect of smoking on micronucleated epithelial cells in smears from the uterine cervix

A pilot study was conducted to determine whether any relationship exists between micronucleated cell rates of female uterine cervical epithelium and current smoking status. Cervical uterine cells obtained from 118 pre-menopausal females, seen between September 1994 and June 1995 at the Occupational Medecine Interprofessional Association (AIMT), were tested for micronucleated cells by the micronucleus assay. Of the 68 subjects taken from this population that provided a least a 1000 analysed cells, 36 were non-smokers and 32 were smokers. Age distributions were different between smokers and non-smokers but results showed that age had no effect on micronucleated cell levels. Micronucleated cervical cell rates reached 0.66% in non-smokers and 1.11% in smokers: these two levels were not statistically different. No association was noted between number of cigarettes smoked and micronucleated cell levels. Results suggested that consuming 5-20 cigarettes per day was not enough to show a smoking effect on cervical micronucleated cells. A test with a greater number of female subjects would be necessary to confirm this.

Micronuclei kinetics of exfoliated urothelial cells

Micronuclei observed in exfoliated cells result from DNA-damage of basal epithelium's cells by mutagens. Exfoliated urothelial cells can be collected by non-invasive procedure and may be used as target site to identify genotoxic effects of chemicals. Kinetic studies are important for any biomarker, especially those in which tissue differentiation and maturation processes will heavily influence the time between induction of damage and collection of damaged cells for analysis. This manuscript details the result of a longitudinal study of micronuclei induction in cells isolated from urine samples of 4 healthy women over 6 consecutive days. Three of them were former smokers. Results suggested that micronucleated cell rates were not influenced neither by the day nor by the time of sampling.

Protective effects of alpha-hederin, chlorophyllin and ascorbic acid towards the induction of micronuclei by doxorubicin in cultured human lymphocytes

The influence of alpha-hederin (a saponin isolated from Hedera helix), chlorophyllin, the sodium-copper salt of chlorophyll, and ascorbic acid (vitamin C) on the direct clastogenicity of doxorubicin (Adriamycin) was investigated in vitro in human lymphocytes for the induction of micronuclei. In order to determine a possible mechanism of action responsible for the antimutagenic activity, treatments were performed for the three substances at different times of the culture (pre-treatment, simultaneous and post-treatment). Alpha-hederin (1.3 x 10(-2), 0.13, 1.3 and 13 nmol/ml) and chlorophyllin (0.14, 1.4 and 14 nmol/ml) were found to exert an antimutagenic effect against the clastogenicity of doxorubicin (1.5 x 10(-2) nmol/ml) in all treatments at all concentrations. Ascorbic acid (10 nmol/ml) was effective in reducing the micronucleus levels only in the simultaneous treatment, when it was previously incubated with doxorubicin for 2 h at 37 degrees C before being introduced into the culture. Our results suggested a desmutagenic effect for alpha-hederin, chlorophyllin and ascorbic acid. Chlorophyllin acted also through a bio-antimutagenic mechanism and alpha-hederin seemed to induce metabolic enzymes, which inactivated doxorubicin. Preliminary studies showed that the effective antimutagenic concentrations of alpha-hederin, chlorophyllin and ascorbic acid had no clastogenic or aneugenic effects in human lymphocytes. No cytotoxicity was observed for the three antimutagenic agents either.

The micronucleus assay in human exfoliated urothelial cells: effect of smoking

Micronucleated cell rates were examined in exfoliated urothelial cells of 73 healthy donors not occupationally exposed to mutagens or aneugens. Micronucleated cell levels averaged 0.54 +/- 0.68% in the entire population: they reached 1.09% in smokers, 0.95% in ex-smokers and 0.24% in non-smokers. Among variation factors evaluated during this study, only smoking had a significant effect on micronucleated cell rates (P = 0.007) whereas age and sex had no effect (P = 0.101 and P = 0.918). No significant difference was observed between micronucleated cell rates of smokers and ex-smokers, suggesting that smoking could generate clones of basal micronucleated cells in urothelial tissues.