[Compensation for occupational diseases after tomodensitometry screening for benign pleuro-pulmonary disease in a multiregional post-occupational medical surveillance program of asbestos-exposed retired workers]. / Déclaration et reconnaissance en maladie professionnelle après dépistage tomodensitométrique de maladies pleuropulmonaires bénignes dans le programme multirégional de surveillance postprofessionnelle de personnes exposées à l'amiante.

BACKGROUND: Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. METHODS: Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. RESULTS: Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. CONCLUSION: A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

[Carcinogenesis of the ethmoidal adenocarcinoma due to wood dust]. / La carcinogenèse de l'adénocarcinome de l'ethmoïde aux poussières de bois.

OBJECTIVES: To recognize the mechanisms and the different oncogenic pathways of ethmoid adenocarcinoma (EADC) in woodworkers. METHODS: A systematic review of the literature and evaluation according to scientific evidences. RESULTS: Wood dust less than 10 microm settles on the external aspects of the ethmoid sinus that is the middle turbinate, the middle meatus and the olfactory cleft. The risk of developing an EADC is important from the first year. It is impossible to know what determines the latency period. Usually, this period exceeds 30 years and only 10% of patients are younger than 50 years of age. Chromosomal instability of the respiratory mucosa appears to be one of the major phases in the oncogenic process. Certain biomolecular and genetic factors are shared with the adenocarcinoma of the colon but they are not activated with the same importance and in the same context suggesting two distinct mechanisms of evolution. The local anatomo-clinical setting in the nasal cavity and carcinogenic substances in the wood dust play a key specific role in the development of EADC. No oncoproteins or immunohistochemistry features were identified in the process suggesting a cascade of genetic or molecular series of events.

Pleural plaques and asbestosis: dose- and time-response relationships based on HRCT data.

Most studies on asbestos-related diseases are based on chest radiographs, and dose-response relationships are still controversial. The aim of this study was to describe the most relevant parameters of asbestos exposure linked to pleural plaques and asbestosis diagnosed by high-resolution computed tomography (HRCT). A large screening programme including systematic HRCT examinations was organised from 2003 to 2005 in France for formerly asbestos-exposed workers. The time since first exposure (TSFE), level, duration and cumulative exposure to asbestos were used in adjusted unconditional logistic regression to model the relationships of the two diseases. Analysis of a population of 5,545 subjects demonstrated that TSFE (p<0.0001) and cumulative exposure (p = 0.02) (or level, depending on the models used), were independently associated with the frequency of pleural plaques. Only cumulative exposure (p<0.0001) or level of exposure (p = 0.02) were significantly associated with asbestosis. All trend tests were significant for these parameters. To date and to our knowledge, this study is the largest programme based on HRCT for the screening of asbestos-exposed subjects. Both time-response and dose-response relationships were demonstrated for pleural plaques, while only dose-response relationships were demonstrated for asbestosis. These parameters must be included in the definition of high-risk populations for HRCT-based screening programmes.

Is ethmoidal adenocarcinoma screening in employees exposed to wood dust justified?

INTRODUCTION: Since 1995, the means which are used for the follow-up of wood-workers in France are obsolete. Based on experts' opinions, they have never been assessed as effective in the detection of adenocarcinoma of the ethmoid sinus. OBJECTIVE: Collecting the data present in the literature to justify the necessity and the means of a screening protocol that would help detect ethmoidal adenocarcinoma among the wood worker population. METHOD: This is a review of the literature from three data bases: the National Library of Medicine, the French National Institute for Research and Security and the French National Centre for Scientific Research. Only English and French articles were reviewed and they were classified in four categories according to proof tools purposed by the French High Authority for Health. RESULTS: There is a direct statistical relationship between the amount of wood dust and the development of ethmoidal adenocarcinoma, but threshold doses cannot actually be calculated. The relative risk is high starting the first year of exposure and the exposed population is well recognized. Despite the means presently available for follow-up, this lesion is always diagnosed at an advanced stage. Survival rates at 5-years would increase if the tumour were to be detected at stages T1 or T2. The CT scan is not suited for this aim because of its low sensibility in separating soft tissue contrast. On the other hand, the MRI allows the detection of small nasal or sino-nasal tumours with intact osseous boundaries with a 98% sensibility. However, the data from experimental models and healthy human volunteers show that wood-dust settles over the olfactory cleft and the adjacent mucosa. Moreover in the large majority of cases the implantation pedicle of these tumours is coming from within these areas. Therefore, nasal fibroscopic examination represents the best tool to detect adenocarcinoma of the ethmoid sinuses at its earlier stages. It is well tolerated and its cost is low. CONCLUSION: A screening of ethmoidal adenocarcinoma seems to be possible with simple means in specific population. An early detection could improve the prognosis of this lesion.

Computed tomography findings in urban transportation workers with low cumulative asbestos exposure.

OBJECTIVE: To assess the frequency of computed tomography (CT) scan pleural and interstitial changes in a population of urban transportation workers with low cumulative exposure to asbestos, and to measure inter-reader agreement. DESIGN: A total of 269 male volunteers (mean age 54.0 +/- 2.3 years, mean estimated cumulative exposure index 1.7 +/- 2.3 fibres/ml-years), underwent a CT scan which was read independently by three experienced readers, with further consensus reading in case of pleural or parenchymal abnormalities. Inter-reader agreement was assessed by means of Kappa statistic. RESULTS: On consensus reading, four subjects had interstitial opacities, three had diffuse pleural thickening and 26 (9.7%) had pleural plaques that were unilateral in 65% of cases and < or =2 mm thick in 54% of cases. No correlation was observed between pleural plaques and latency, duration of exposure or cumulative exposure. The inter-reader agreement for the detection of pleural abnormalities was fair. CONCLUSION: In this relatively young population with low cumulative exposure to asbestos, the prevalence of pleural abnormalities was low. These abnormalities were very limited in thickness and extent, leading to marked inter-reader variability and making it difficult to assess their relationship to asbestos exposure.

Health consequences of the first Persian Gulf War on French troops.

Since 1993, many studies on the health of Persian Gulf War Veterans (PGWV) have been undertaken. These studies have concluded that there has been an increased mortality due to external causes, no excess of recognized diseases, and no effect on PGWV children. When compared with the non-deployed, PGWV have reported a higher frequency of infertility as well as different symptoms, but a specific Gulf War syndrome was not identified. In October 2000, the French government asked an independent working group to analyse the scientific literature on PGWV health. The group concluded that an exhaustive study of French PGWV was to be undertaken. The objectives of this study were to describe the exposures of PGWV in the operations theatre, to report on the symptoms and diseases that occurred in PGWV and their children during and after the military campaign, and to explore the possibility of a Gulf War syndrome. This exhaustive cross-sectional study, which included all civilians and troops who served in the Gulf from August 1990 to July 1991, began in January 2002. Data were collected by postal self-administered questionnaires. A standardized clinical evaluation was performed by 27 clinics of occupational diseases and nine military hospitals. Symptoms and diseases which appeared after the campaign are described. To date, among 20,261 PGWV, 5,666 participated in the study (28%). The most frequent symptoms described since the return from the Gulf were headaches (83%), neurological or psychological symptoms, and back pain. Apart from well-known symptoms associations (respiratory, neurocognitive, psychological and musculo-skeletal syndromes), no other cluster was highlighted by our analysis.

Professional and medical outcomes for French train drivers after "person under train" accidents: three year follow up study.

AIMS: To investigate psychiatric disorders, somatic health, and professional effects in French train drivers having experienced a "person under train" accident, and somatic health and professional effects. METHODS: A total of 202 train drivers were evaluated several times: immediately after the event, three months later, and one, two, and three years later. These drivers were compared with 186 train drivers not exposed to that psychotraumatic shock. The evaluations relied primarily on the GHQ-28 and MINI questionnaires. RESULTS: In the exposed group, at the first evaluation, the prevalence of post-traumatic stress was 4%; scores > or =5 on the GHQ-28 were significantly higher than in the non-exposed group (32% versus 6%), for both the overall result and three sub-scores (somatic symptoms, anxiety and sleep, and psychosocial functioning). All these differences disappeared within a year. Vulnerability factors concerned prior traumas, acute and lasting life events, and the particular occupational situation where the driver is not accompanied but drives the train away alone in the aftermath of the accident. Over 95% of subjects had no short, medium, or long term impairment of their occupational fitness. CONCLUSIONS: Most of the psycho-behavioural disorders were observed in the immediate aftermath of the accident and disappeared within a year. The driver's occupational future does not seem to be affected by the "person under train" accident. Consideration of a traumatic accident as a job related risk and close psychological support of drivers after an accident probably increase the subject's ability to recover from the event.

Healthy worker effect and changes in respiratory symptoms and lung function in hairdressing apprentices.

AIMS: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. METHODS: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). RESULTS: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25-75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. CONCLUSIONS: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

[Radiodermatitis in interventional radiology (hand dose measurement, screening and compensation)]. / Radiodermites en radiologie interventionnelle (doses reçues aux mains, dépistage et réparation).

It is to be feared that the expansion of interventional radiology could lead to the reappearance of chronic radiodermatitis. Only a few studies mention the doses received by the hands, however these radiation doses are always high. Whereas clinical examinations lead to a belated diagnosis, capillary microscopy, a quick and non invasive test, enables to detect vascular injuries at the subclinical stage. Radiological protection is currently based on leaded gloves and on the reduction of exposure duration. Compensation for chronic radiodermatitis depends on the practitioner's status. In spite of a better evaluation of the overall irradiation, hand exposure remains a cause for concern. Capillary microscopy can provide appropriate medical surveillance.

Computerized equipment for the delivery of inhaled doses of solid particles in specific bronchial challenge.

An apparatus to generate solid particles was tested for use in diagnosing occupational asthma. This equipment measures the inhaled dose of dry particles during specific inhalation challenge. It includes an aerosol generator, a cyclone type particle size selector, and an inhalation chamber to which a patient breathing at tidal volume can be connected for the test. It is fully controlled by a standard personal computer in automatic mode, acting on the flow rate and the aerosol generator to maintain the concentration at a fixed value, usually 3 mg/m3. The dose of aerosol delivered to the patient was calculated from the aerosol concentration, and the inhaled volume was calculated by integration of the corresponding signals. The coefficient of variation for this measurement was estimated to be 12%. The mass median aerodynamic diameter (MMAD) of aerosol inside the inhalation chamber was measured for three substances: lactose, wheat flour, and buckwheat flour. The MMAD of the aerosol inside the chamber was also estimated from the particle size distribution of the raw powder. The relative difference between the measured MMAD and the calculated value was less than 15%. The corresponding relative difference between the measured geometrical SD and the calculated value was found to be less than 26%.

[Recent advances in environmental toxicology]. / Nouvelles données sur les toxiques de l'environnement.

Among the sanitary effects of environmental chemicals, 3 examples illustrate the complexity of the issues to be solved: 1. endocrine disrupters, xenobiotics which interfere with hormonal systems, could increase the risk of reproductive and developmental disturbances and explain the rising incidence of hormone-dependent cancers; 2. multiple chemical sensitivity due to odorous chemicals has severe social consequences and warrants further research; 3. the reappearance of well-known poisoning cases and the emergent new toxic diseases due to substitutive products for solvents, cooling agents and spray propellants banned for ecological purpose, demonstrate the need for surveillance programmes of industrial and household products.

Quantification of the dose of inhaled flour: relation with nonspecific bronchial and immunological reactivities.

The aim of this study was to investigate the relationship between specific bronchial reactivity and respective nonspecific bronchial and immunological reactivities. Twenty-one patients underwent bronchial challenges with lactose and flour. The aerosol of particles was generated by a computer-controlled aerosolizer. Specific bronchial challenge results were expressed as the provocative dose of flour (PDf) that caused a 20% or 15% decrease in the forced expiratory volume in one second (FEV1). For each subject, the decrease in FEV1 observed during the challenge with flour was compared with the calculated lower limit of the 99.7% confidence interval for the lactose challenge. The subjects also underwent a nonspecific challenge with methacholine and a measurement of the specific immunoglobulin E against wheat. The inhalation of lactose did not significantly affect FEV1. Nine subjects had high reactivity to wheat flour with a PDf20 <400 microg. Five subjects had intermediate reactivity: FEV1 fell by <20% but by significantly more than that in the test with lactose. For 7 subjects, there was no significant change in FEVI for inhaled doses of flour over 1390 microg. The results for specific bronchial challenge were significantly correlated with those for the methacholine test (p<0.02). Positive skin tests and specific immunoglobulin E against wheat were observed more frequently in the high reactivity group. Specific bronchial challenge can be performed safely to establish precise dose-response curves. The provocative dose of flour causing a 20% decrease in forced expiratory volume in one second is useful for evaluating the degree of specific reactivity but is not suitable in cases of intermediate reactivity in which comparison with the lactose test is necessary. Specific reactivity is probably a function of immunological and nonspecific bronchial reactivities.

Reticulocytes and solvents: an epidemiological study.

OBJECTIVES: The aim of the study was to look for a rise in reticulocyte levels in workers exposed to various solvents, in comparison to non exposed control subjects. METHODS: A cohort of exposed workers was selected on the criterion of exposure to solvents, among employees regularly attending the Centre of Occupational Medicine of Molsheim (France) during the second trimester of 1995. Controls were selected over the same period from the voluntary blood donors of the Transfusion Centre of Strasbourg (France). Complete blood counts and flow cytometric reticulocyte counts were determined in all blood samples. RESULTS: Analysis of the haematological parameters displaying significant differences revealed the existence of higher levels of circulating reticulocytes and lymphocytes in workers exposed to solvents than in control subjects. These variations did not appear to depend on the intensity or length of exposure. CONCLUSIONS: This study demonstrates the occurrence of an increase in circulating reticulocytes in relation to occupational exposure to solvents, without as yet providing sufficient information to allow elucidation of the underlying mechanism. An increase in total circulating lymphocytes was observed in the same group of exposed workers. The concomitant rise in absolute values of these two elements of the blood counts is to our knowledge described here for the first time in an epidemiological study.

[Arterial hypertension and socioeconomic status in a representative population of French railway drivers]. / Hypertension artérielle statut social et environnement dans une population de conducteurs de trains français.

UNLABELLED: High blood pressure (HDP) is known as a cardiovascular risk factor depending both on environmental and socio-economic factors. METHODS: From October 1993 to october 1994 a cross sectional study was carried out among 1,855 French railway drivers (FRD) representative of the 17,432 males FRD, aged 25 to 54 years. Age, weight, height, hip and waist, smoking, living area, type of train they drove (goods, suburban, TGV, inter-city trains), their grade (3 grades) were recorded. HBP corresponds to systolic blood pressure (BP) 160 mmHg or diastolic BP > or = 95 mmHg or to normal BP under antihypertensive medication. The analysis was carried out according to 2 age classes: 20-36/37-54 years. RESULTS: In our sample 8.5% of FRD suffered from HBP, 3.5% in the younger class, and 13.5% in the other one. Using univariate analysis, among the oldest, subjects with lower grades suffered more often from HBP (19%). Paris area was more often related to HBP for the 20-36 years (6.7%). This was the case for the oldest living in Paris area (19.7%), and the North East (15.2%). Subjects with central obesity (19.9 vs 6%), and hyperlipidemic FRD (20.9 vs 10.9%) were more often related to HBP in the 35-54 years group Whatever the type of train they drove no difference was found. In multivariate analysis, (stepwise logistic regression BMDP LR) independent HBP factors are: age OR 3.4 IC 1.9-5.9 (20-36 vs 37-54), central obesity OR 1.7 IC 1.1-2.6, tobacco consumption OR 2.1 IC 1.2-3.5 (smokers vs non smokers), ex-smokers: OR 2.3 IC 1.3-3.9 (Ex-smokers vs non smokers), living area (all regions vs South East in the Mediterranean border). Nevertheless, grades and type of train they drove were not independent factors. CONCLUSION: These results show the determining part played by environmental factors: age, central obesity, living area and tobacco consumption in the determinism of HBP in professional background: these factors can account for the difference observed in professional factor (grade).

Occupational exposure to solvents and hairy cell leukaemia.

OBJECTIVES: The role of occupational exposures in hairy cell leukaemia was investigated through a multicentre, hospital based, case-control study. This paper analyses the role of exposure to solvents other than benzene in hairy cell leukaemia. METHODS: The study included 226 male cases and 425 matched controls, exposure to solvents was evaluated by expert case by case review of the detailed data on occupational exposures generated by specific interviews. Also, exposure to solvents was evaluated with an independently constructed job exposure matrix (JEM). RESULTS: No association was found between hairy cell leukaemia and previous employment in a job exposed to solvents (odds ratio (OR) 0.9 95% confidence interval (95% CI) 0.6 to 1.3). ORs for the main occupational tasks exposed to solvents were around 1 and did not increase with the frequency or the duration of the tasks. No specific type of paint or glue was found to be significantly associated with hairy cell leukaemia. No association was found with exposure to solvents, taken as a whole, with either expert assessments or the JEM. No association was found with aromatic, chlorinated, or oxygenated subgroups of solvents. The ORs did not increase with the average intensity of exposure assessed by the experts, with the frequency of use, or with the duration of exposure. Finally, no association was found with non-occupational exposure to solvents. CONCLUSIONS: The study did not show any association between exposure to solvents and hairy cell leukaemia.

[Occupational asthma caused by buckwheat flour]. / Asthme professionnel à la farine de sarrasin.

Buckwheat flour, mainly used for pancakes, may induce asthma following inhalation and anaphylactic reactions following ingestion. These allergic reactions are mediated by specific IgE and may be confirmed by skin test and radio-allergo-sorbent test. The occupational asthma of a patient working in pancake restaurant was confirmed by specific challenge test with a computerised device to generate particles. A very small amount of buckwheat flour (10 micrograms) induced an immediate fall of the FEV1 to 56% of the initial value. No bronchial reaction was observed with lactose nor with wheat flour. Specific bronchial challenge identifies the allergen responsible for asthma, measures the level of sensitization and thus can prevent the occupational exposure.

Consequences of occupational asthma on employment and financial status: a follow-up study.

The aim of this study was to describe changes in employment and income following a diagnosis of occupational asthma, and to determine what factors might affect these changes. Two hundred and nine patients with occupational asthma were reviewed on average 3.1 yrs after the diagnosis had been made. They were contacted by telephone or were sent a self-administered questionnaire by post. Multiple logistic regression models were constructed to determine which variables were associated with loss of employment after the diagnosis. At the time of review, 44% of patients had left their previous job and 25% were currently unemployed. Remarkably, 32% remained exposed to the offending agents in the same job. Forty six percent of the patients had suffered a reduction of income (84% of those who had left their employer versus 19% of those still employed in the same company (p < 0.001)). Claims for compensation, size of the company, level of education, and age at the time of diagnosis were significantly associated with a risk for becoming unemployed or having a new employer after the diagnosis of occupational asthma. Occupational asthma results in severe socioeconomic consequences. The French compensation system for occupational asthma should be revised, as the criteria currently used to determine compensation for this disease largely underestimate the social and occupational damages.

Hairy cell leukaemia and occupational exposure to benzene.

OBJECTIVES: The role of occupational exposures in hairy cell leukaemia (HCL) was investigated through a multicentre, hospital based, case-control study. This paper analyses the role of exposure to benzene in HCL. METHODS: A population of 226 male cases of HCL and 425 matched controls were included in the study. Benzene exposure was evaluated by expert review of the detailed data on occupational exposures generated by case-control interviews. RESULTS: No association was found between HCL and employment in a job exposed to benzene (odds ratio (OR) 0.9 (95% confidence interval (95% CI) 0.6-1.3)). The sample included 125 subjects, 34 cases (15%), and 91 controls (21%) who had been exposed to benzene, as individually assessed by the experts, for at least one hour a month during one of their jobs. Benzene exposure was not associated with a risk of HCL (OR 0.8 (0.5-1.2)). No trend towards an increase in OR was detected for increasing exposures, the percentage of work time involving exposure to > 1 ppm, or the duration of exposure. No findings suggested a particular risk period, when the OR associated with the time since first or last exposure, or since the end of exposure, were examined. CONCLUSIONS: In conclusion, with the low exposures prevalent in the sample, the study did not show any association between benzene exposure and HCL.

Hairy cell leukaemia, occupation, and smoking.

The roles of farm practices, occupational exposures to organic solvents, and ionizing radiation in the risk of hairy cell leukaemia (HCL) were examined in a French hospital-based multicentre case-control study including 291 cases (229 men and 62 women) and 541 controls (425 men and 116 women). No positive association was observed with occupations involving exposure to organic solvents or with self-declared exposures to solvents, but a significant association with self-reported exposure to petrol or diesel was found for men (OR = 1.5 CI95% [1.0-2.1]). No association with ionizing radiation was detected. Agriculture employment gave an odds ratio of 1.7 (CI95% [1.1-2.4]) for men and 2.7 (CI95% [1.1-6.7]) for women. Among men, the association seems to affect farmers rather than agricultural workers. Self-declared exposure to pesticides or bovine cattle breeding was related to HCL risk in both genders. Finally, a significant negative association with smoking was observed in men, with an inverse exposure-risk relationship odds ratios of 0.6, 0.5 and 0.2, respectively, for cumulative consumptions of < 10, 10-23 and > or = 24 pack-years), contrasting with an odds ratios clearly > 1 in women.