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

OBJECTIVES

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

METHODS

Data were collected from the French national network of occupational health surveillance and prevention [Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)], Data between 2001 and 2018 with at least a probable or certain association with one occupational agent, were included.

RESULTS

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

CONCLUSION

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

[Protection of caregivers in a university hospital at the time of Covid-19: Between overprotection and underprotection or between abandonment and weakening of the vital forces?]

During the first months of the Sars-Cov-2 pandemic, French caregivers faced difficult situations, organizational changes, and rapidly changing recommendations. The occupational physicians of the hospital staff had to accompany the caregivers, both to answer their questions, both to better prevent the risks to their health in connection with the pandemic. Recommendations were quickly issued by the Société française de médecine du travail (French Society of Occupational Medicine). In our CHU, an evaluation of exposures was made by department. Occupational physicians advised agents and the institution to limit the risks to the health of agents. However, faced with the uncertainties linked to ignorance of the virus, how can we play both the role of protection of each agent, and that of a doctor registered in a health war? This article revisits from a distance the ethical tensions of the hospital occupational physician and the qualities necessary for the accomplishment of these missions.

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

INTRODUCTION

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

MATERIAL AND METHOD

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

RESULTS

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

CONCLUSION

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

Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community

Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.

[How junior doctors live their work during pregnancy? A qualitative study in France]

INTRODUCTION

During the final part of their medical studies, residents are under a large amount of stress and work overload as reported by a literature review between 2004 and 2014 assessing 33.2% of burn out among them. Pregnancy and motherhood lead to major physical and psychological changes. The purpose of this study was to point out the female residents feeling about the consequences of motherhood and pregnancy during residency.

METHODS

Semi-structured interviews were conducted for this qualitative study. It was based on the Grounded theory and analyzed by a continuous thematization.

RESULTS

Ten interviews were conducted. Data saturation was obtained by the 8th interview. Diversity of medical specialty was sought. Residents expressed their feeling towards the consequences of pregnancy and motherhood during residency. The data analysis highlighted two major themes related to either work (training, industrial relations and job adaptation), or pregnancy and maternity.

CONCLUSION

Becoming a mother during residency represents an additional challenge for residents. It implies adjustment from them and their work teams in order to reduce the negative effect on a professional and personal level.

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

INTRODUCTION

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

MATERIAL AND METHOD

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

RESULTS

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

CONCLUSION

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

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSION

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

[Suffering at work among medical students: qualitative study using semi-structured interviews]

INTRODUCTION

Suffering at work among health professionals is a hot topic. Medical students, doctors of tomorrow, are far from being spared. Prevalence of anxiety and mood disorders range from 20.3 to 69 % for the former and from 12 to 30 % for the latter. The purpose of this article is to determine these factors by qualitative research, according to medical students' points of view.

METHODS

It is a qualitative study using semistructured interviews. The analysis is done according to the Grounded Theory.

RESULTS

12 medical students are interviewed. They expressed difficulties at work and positive factors. Three major themes are identified in selective coding: occupational factors, " study " factors and individual factors. All themes are both a source of well-being and ill-being according to the situations specified in the results.

CONCLUSION

Studying medicine includes positive and negative aspects. Abandonment issues, lack of recognition and insufficient coaching emerge from our study. Screening of suffering at work should be systematic for medical students.

Occupational contact dermatitis from protein in sea products: who is the most affected, the fisherman or the chef?

BACKGROUND

Protein contact dermatitis has frequently been reported in case studies (usually in cases involving contact with seafood products), but there are very few descriptive series. The objectives of this present study were firstly to determine the incidence of protein contact dermatitis among fishermen in France and compare it with data from onshore work involving seafood exposure. Second, to discover what factors could explain any differences. In order to answer these questions we analysed data from the French national occupational disease surveillance and prevention network (RNV3P) and occupational diseases declared to the French National Network for Monitoring and Prevention of Occupational Disease. This retrospective study was done for a 13 year period.

CASE PRESENTATION

Between 2000 and 2012, we only found eight cases of protein contact dermatitis in the French network. There were no cases of protein contact dermatitis in the seafaring population. The eight cases from the French network are essentially allergies to different fish and chefs are the professionals most affected. Atopy is present in half of these cases. In the seafaring population we found several cases of allergic delayed-time contact dermatitis due to bryozoans and to gloves but no protein contact dermatitis.

CONCLUSIONS

Chefs who have to cook seafood are more at risk of occupational protein contact dermatitis than fishermen. We think that skin protection (that is to say glove wearing) is better implemented in the fishing sector than in the catering profession on shore in France.

Occupational factors for mood and anxiety disorders among junior medical doctors

Junior doctors are exposed to multiple occupational risks. The aim of this study was to assess the risk factors and protective factors for mood and anxiety disorders among junior doctors.

MATERIALS AND METHODS

We conducted a cross-sectional study via an anonymous online questionnaire between October 2011 and June 2012. All the junior doctors in our faculty were included. The questionnaire inquired about demographic and health data. It contained four validated scales: the Center for Epidemiologic Studies Depression Scale (CES-D), the Spielberger anxiety questionnaire, the WHO quality of life (WHO - QOL) questionnaire and the Job Content Questionnaire. Finally, it sought to clarify the conditions of professional practice and the interactions between university programmes and junior doctorate students (change of specialty, pregnancy, leave of absence, etc.).

RESULTS

192 juniors doctors participated in the study, 68.2% of whom were women. Out of the group, 13.0% presented a depressive syndrome, while 28.7% presented an anxiety disorder, 32.8% were experiencing Job Strain and 29.7% Iso Strain. The risk factor for anxiety was competition between junior doctors: OR=4.23 (1.06 ‒ 16.82). The protective factors for mood disorders were the help provided by senior physicians and the respect shown by patients: OR=0.21 (0.06-0.74) and 0.20 (0.06-0.75), respectively.

CONCLUSION

This study demonstrated the impact of the relationships with senior physicians and patients on junior doctors' health at work. Consequently, prevention should not be focused uniquely on work organization, but should increase physicians' awareness of the importance of this relationship.

Dysbaric osteonecrosis among professional divers: a literature review

AIM

Dysbaric osteonecrosis (DON) continues to be a significant occupational hazard that has significant medical and social consequences for professional divers. This review aims to evaluate the prevalence and risk factors of DON among professional divers and to summarize the scientific knowledge regarding distribution of the lesions as well as disease prognosis and treatment.

METHOD

A literature review using the Medline database.

RESULTS

The prevalence of DON varies between 0 and 70.6% in professional divers, and its prevalence is highest in Turkey, Hawaii, Korea and Japan but is dependent on activity and medical monitoring. The risk of DON is very low for military divers who strictly obey the decompression rules and who undergo periodic medical examination. DON pre- dominately occurs in the proximal part of the femur and humerus. In a majority of cases, DON will progress despite the absence of further dysbaric exposure.

CONCLUSION

The pathophysiology of the disease is incompletely understood and other etiological factors are perhaps being overlooked.