[Occupational medicine in France: the current situation in 2024]. / Médecine du travail en France, état des lieux en 2024.

OCCUPATIONAL MEDICINE IN France : THE CURRENT SITUATION IN 2024. Occupational medicine has evolved since its creation in 1946. Occupational medicine services have become Occupational health services (OHS) and medical examination in nowadays only a part of their missions, which include helping the employers to perform risk assessment, patients to stay at work, and implementing health promotion in the workplaces in order to prevent disabilities. To fulfill those missions, OHS can rely on health specialists (occupational physicians and nurses) but also on a wide range of competencies, from toxicologists to ergonomists, and from psychologists to occupational hygiene specialists, all gathered in multidisciplinary teams, leaded by the occupational physician. Optimizing cooperation between general practitioners and occupational health physicians is still needed to improve the worker journey, to facilitate his ability to return to work and to ameliorate his long-term health follow-up according to his previous occupational exposures.

MÉDECINE DU TRAVAIL EN FRANCE, ÉTAT DES LIEUX EN 2024. La médecine du travail a peu à peu évolué, depuis sa création en 1946. Les services médicaux du travail sont devenus des services de prévention et de santé au travail, et le suivi de santé ne représente désormais qu'une partie de leur activité. L'aide à l'évaluation des risques, le maintien en emploi, les actions de promotion de la santé dans une perspective de prévention de la désinsertion professionnelle ont pris une place grandissante. Cela s'est accompagné d'une évolution des compétences au sein de ces services. Outre la compétence santé représentée par le binôme médecin-infirmier, des ergonomes, psychologues et toxicologues sont désormais présents ; ils interviennent en prévention des risques professionnels et constituent des équipes pluridisciplinaires, animées et coordonnées par le médecin du travail. Une meilleure collaboration entre médecin du travail et médecin traitant reste nécessaire pour améliorer le parcours du travailleur, son maintien en emploi et son suivi de santé au long cours en fonction de ses expositions professionnelles passées.

Assessment of search strategies in Medline to identify studies on the impact of long COVID on workability.

Objectives: Studies on the impact of long COVID on work capacity are increasing but are difficult to locate in bibliographic databases, due to the heterogeneity of the terms used to describe this new condition and its consequences. This study aims to report on the effectiveness of different search strategies to find studies on the impact of long COVID on work participation in PubMed and to create validated search strings. Methods: We searched PubMed for articles published on Long COVID and including information about work. Relevant articles were identified and their reference lists were screened. Occupational health journals were manually scanned to identify articles that could have been missed. A total of 885 articles potentially relevant were collected and 120 were finally included in a gold standard database. Recall, Precision, and Number Needed to Read (NNR) of various keywords or combinations of keywords were assessed. Results: Overall, 123 search-words alone or in combination were tested. The highest Recalls with a single MeSH term or textword were 23 and 90%, respectively. Two different search strings were developed, one optimizing Recall while keeping Precision acceptable (Recall 98.3%, Precision 15.9%, NNR 6.3) and one optimizing Precision while keeping Recall acceptable (Recall 90.8%, Precision 26.1%, NNR 3.8). Conclusions: No single MeSH term allows to find all relevant studies on the impact of long COVID on work ability in PubMed. The use of various MeSH and non-MeSH terms in combination is required to recover such studies without being overwhelmed by irrelevant articles.

Precision and Recall of Search Strategies for Identifying Studies on Work-Related Psychosocial Risk Factors in PubMed.

PURPOSE: This study aims to report on the effectiveness of various search strategies and keywords to find studies on work-related psychosocial risk factors (PRF) in the PubMed bibliographic database. METHODS: We first selected by hand-searching 191articles published on PRF and indexed in PubMed. We extracted 30 relevant MeSH terms and 38 additional textwords. We then searched PubMed combining these 68 keywords and 27 general keywords on work-related factors. Among the 2953 articles published in January 2020, we identified 446 articles concerning exposure to PRF, which were gathered in a Gold Standard database. We then computed the Recall, Precision, and Number Needed to Read of each keyword or combination of keywords. RESULTS: Overall, 189 search-words alone or in combination were tested. The highest Recall with a single MeSH term or textword was 43% and 35%, respectively. Subsequently, we developed two different search strings, one optimizing Recall while keeping Precision acceptable (Recall 98.2%, Precision 5.9%, NNR 16.9) and one optimizing Precision while keeping Recall acceptable (Recall 73.1%, Precision 25.5%, NNR 9.7). CONCLUSIONS: No single MeSH term is available to identify relevant studies on PRF in PubMed. Locating these types of studies requires the use of various MeSH and non-MeSH terms in combination to obtain a satisfactory Recall. Nevertheless, enhancing the Recall of search strategies may lead to lower Precision, and higher NNR, although with a non-linear trend. This factor must be taken into consideration when searching PubMed.

Reliability of citations of medRxiv preprints in articles published on COVID-19 in the world leading medical journals.

INTRODUCTION: Preprints have been widely cited during the COVID-19 pandemics, even in the major medical journals. However, since subsequent publication of preprint is not always mentioned in preprint repositories, some may be inappropriately cited or quoted. Our objectives were to assess the reliability of preprint citations in articles on COVID-19, to the rate of publication of preprints cited in these articles and to compare, if relevant, the content of the preprints to their published version. METHODS: Articles published on COVID in 2020 in the BMJ, The Lancet, the JAMA and the NEJM were manually screened to identify all articles citing at least one preprint from medRxiv. We searched PubMed, Google and Google Scholar to assess if the preprint had been published in a peer-reviewed journal, and when. Published articles were screened to assess if the title, data or conclusions were identical to the preprint version. RESULTS: Among the 205 research articles on COVID published by the four major medical journals in 2020, 60 (29.3%) cited at least one medRxiv preprint. Among the 182 preprints cited, 124 were published in a peer-reviewed journal, with 51 (41.1%) before the citing article was published online and 73 (58.9%) later. There were differences in the title, the data or the conclusion between the preprint cited and the published version for nearly half of them. MedRxiv did not mentioned the publication for 53 (42.7%) of preprints. CONCLUSIONS: More than a quarter of preprints citations were inappropriate since preprints were in fact already published at the time of publication of the citing article, often with a different content. Authors and editors should check the accuracy of the citations and of the quotations of preprints before publishing manuscripts that cite them.

Occupational stressors in healthcare workers in France.

OBJECTIVES: To describe psychosocial constraints and mental health of hospital workers, and to identify the psychosocial constraints significantly associated with mental health difficulties, especially in two groups: caregivers and other hospital workers. METHOD: Data about working conditions and health status collected by the Evrest National observatory in 2018-2019 during occupational health consultation were used. Psychosocial constraints and mental health among caregivers, other hospital workers and non-hospital workers were described. RESULTS: There were 1251 hospital workers (843 caregivers, 408 other hospital workers) and 25 129 other workers. Intensity and working time (time pressure, extra working time, missing or shortening a meal), and ethical dilemmas (not having the means to ensure high-quality work, too rapidly handling a procedure that would require more painstaking care) were significantly more reported by the caregivers than by the other hospital workers (50.8% vs 44.2%, 43.4% vs 32.5%, 47.2% vs 17.2%, 21.4% vs 16.4% and 41.5% vs 29.0% respectively). Prevalence of psychological distress was not significantly higher for caregivers (12.3%) than for other hospital workers (12.4%) but was significantly higher than for other workers (7.3%). For caregivers, factors significantly associated with psychological distress were time pressure (Odds Ratio adjusted on sociodemographic factors (OR) = 2.33 CI95% [1.35-4.04]), "difficulties to reconcile private life and work life" (OR = 2.95 [1.54-5.69]), "work not recognized in the professional setting" (OR = 1.89 [1.08-3.31]) and "fear of losing one's job" (OR = 2.98 [1.53-5.8]). For other hospital workers, they were "difficulties to reconcile private life and work life (OR = 2.76 [1.04-7.30]), "insufficient possibilities of mutual aid" (OR = 2.85 [1.24-6.53] and "not having the means to ensure high-quality work" (OR = 3.42 [1.62-7.21]). CONCLUSION: Factors significantly associated with psychological distress were not the same for caregivers and other hospital workers, nor were they the most frequently reported. Detailed description of the constraints according to group of workers could help to develop a high-priority preventive program regarding psychosocial risk factors.

What face mask for what use in the context of COVID-19 pandemic? The French guidelines.

In the context of the COVID-19 pandemic, wearing a face mask has become usual and ubiquitous, in both hospitals and community. However, the general public is consuming surgical or filtering face piece (FFP) masks irrespective of their specificity, leading to global supply shortage for the most exposed persons, which are healthcare workers. This underlines the urgent need to clarify the indications of the different categories of mask, in order to rationalize their use. The study herein specifies the French position for the rational use of respiratory protective equipment for healthcare workers.

Return-to-work support in cancer patients: Which methodology?

INTRODUCTION: Return to work after cancer is a determinant of patients quality of life. The aims were to describe return-to-work interventions applied in a French University Hospital and to assess its effectiveness in achieving a successful return to work. METHODS: A return-to-work questionnaire was sent to 153 patients who were accompanied by a multidisciplinary return-to-work after cancer consultation. RESULTS: hundred and twenty-one patients answered the return-to-work questionnaire. Analysis of the questionnaire found an overall rate of return to work of 50% two years after the cancer diagnosis. The rate was significantly higher in patients who had received individual psychological support for returning to work (P=0.04) and higher, but not significantly, in patients who had a consultation with the company physician during their period of sick-leave (P=0.08). Participating in support groups and performing the required actions for the recognition of handicapped worker status were not factors associated with return to work. DISCUSSION: An individual psychological support for returning to work and a consultation with the company physician during the period of sick-leave should be systematically recommended for patients suffering from cancer. Participating in support groups and recognition of handicapped worker status should be recommended on a case-by-case basis.

[Return to work for cancer patients]. / Maintien en emploi des patients atteints de cancer.

Return to work is a public health priority which led the French Health Authority to publish recommendations about "return to work and health: prevention of exclusion from work". The aim of this article is to present a literature review of return to work after cancer. Studies about medium-term and long-term effects of cancer are sparse. They suggest worker durable effects. Factors associated with return to work are linked to the patient characteristics, to characteristics of the illness and the treatment, to the workplace and to the help provided to the patient during the return to work process. A specific plan for returning to work in 3 phases (situation comprehension, identification of negative and positive factors for returning to work, implementation of measures concerning the patient, the workplace and the coordination between return to work actors) should be built for each patient, involving the worker, the occupational practitioner, the general and specialist practitioners.

Analysis of Publication Trends in Childhood Obesity Research in PubMed Since 1945.

Background: Childhood obesity (CO) has become a true epidemic and a subject of increasing publications. The aim of this study was to assess if the number of publications in that field increases over time in proportion to the epidemic, and also according to socioeconomic factors. Methods: A PubMed search was carried out to extract articles related to CO published between 1945 and 2017. Data were downloaded from PubMed and processed through a dedicated parser. Socioeconomic data were collected from international organizations. Results: Overall, 36,554 articles were retrieved among 3329 journals, one-third of them being concentrated in 44 journals. The annual growth rate of publications on CO was on average 11.6% per year between 1990 and 2016, whereas the growth rate of articles on pediatrics or of the total articles indexed in MEDLINE was 2.6% and 4.4%, respectively. The most productive countries were the United States (37.80%), the United Kingdom (6.24%), and Italy (4.56%). There was a significant relationship between publications on CO in a country and prevalence of CO in that country (p = 0.002) and between evolution of the number of publications and evolution of the Human Development Index (p = 0.01). Following exponential growth, CO publications reached a plateau in 2013, whereas publications targeted on obesity in infants continue to increase. Conclusions: Research on CO has risen markedly in the last two decades, with a higher growth rate than biomedical research overall, as a result of the worldwide obesity epidemic and also due to specific socioeconomic factors.

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

INTRODUCTION: Guidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer. OBJECTIVE: To evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer. METHODS AND ANALYSIS: This trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities. ETHICS AND DISSEMINATION: This protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER: NCT03562052; Pre-results.

Trends and topics in occupational diseases over the last 60 years from PubMed.

Objectives The purpose of this study was to provide an analysis of scientific production on occupational diseases (OD) during the period 1945-2015 in order to describe publication trends on that topic and identify the major diseases as well as the predominant actors (journals, countries) involved in this field. Methods A PubMed search was carried out to extract articles related to occupational diseases during the period 1 January 1945 to 31 December 2015 using a specific query. Data were downloaded from PubMed in Extensible Markup Language (XML) and processed through a dedicated parser. Results A total of 160 025 articles were retrieved from 7127 journals. One third of these articles were published in 39 journals: the core journals according to Bradford's law. Following exponential growth, OD publications reached a plateau in 2007. The overall dynamics of the OD field are heterogeneous with differences between subfields: psychological diseases emerged in the 1990s while "traditional" OD are less studied nowadays. Despite a sharp decrease in the proportion of publications, the most productive country remains the USA with 14.5% of the OD publications over the period but Scandinavian countries are, proportionally, the most active in research and publication on OD. Conclusions The proportion of publications on OD is decreasing in Medline, except for specific subfields of OD. This is discrepant with the global burden of occupational diseases.

Influence of author's affiliation and funding sources on the results of cohort studies on occupational cancer.

BACKGROUND: Reliability and credibility of research conducted by industry have been questioned, including in the field of occupational health. METHODS: Cohort studies on occupational cancer published between 2000 and 2010 were compared according to their results, their conclusions, their funding, and the affiliation of their authors. RESULTS: Overall, 510 articles were included. Studies published by authors with public affiliation or funded by public grants concluded that their study showed an excess of cancer more frequently (P = 0.01) than studies published by authors with private affiliation or funded by private grants (88% [95%CI = 85-91] vs. 73% [95%CI = 56-88] and 92% [95%CI = 86-97] vs. 71% [95%CI = 57-84], respectively). Discrepancies between statistical results and conclusion occurred more frequently in articles written by authors from the private sector than from the public sector (42% [IC95% = 26-60] vs. 23% [IC95% = 18-26], P = 0.02). CONCLUSIONS: Industry affiliations of authors or industry support of studies are associated with the results of published studies on occupational cancer. The underlying mechanisms warrant further investigation.

Environmental risk factors of systemic sclerosis.

Systemic sclerosis (SSc) has a complex pathogenesis. Although, there is a growing evidence that environmental factors have an impact on alterations and modulation of epigenetic determinants, resulting in SSc onset and progression. A marked correlation has thus been found between SSc onset and occupational exposure to crystalline silica and the following organic solvents: white spirit, aromatic solvents, chlorinated solvents, trichloroethylene, and ketones; the risk associated with high cumulative exposure to silica and organic solvents further appears to be strongly increased in SSc. Altogether, occupational exposure should be systematically checked in all SSc patients at diagnosis, as (1) exposed patients seem to develop more severe forms of SSc and (2) the identification of the occupational agents will allow its interruption, which may lead to potential improvement of SSc outcome. By contrast, based on current published data, there is insufficient evidence that exposure to other chemical agents (including notably pesticides as well as personal care such as silicone and hair dye), physical agents (ionizing radiation, ultraviolet radiation, electric and magnetic fields), and biological agents (infections and diet, foods, and dietary contaminants) is a causative factor of SSc. Further investigations are still warranted to identify other environmental factors that may be associated with SSc onset and progression.

[Advantages of a specialized return to work consultation after cancer]. / Intérêts d'une consultation spécialisée d'aide à la reprise du travail après cancer.

BACKGROUND: To help patients suffering from cancer to return to work, a multidisciplinary medico-psycho-social consultation after cancer was created in Upper Normandy in 2006. AIMS: To describe the organization and the experiences of the consultation. METHODS: The 3 actors of the consultation explained their point of view. Characteristics of the consultants, advises given to them and becoming of the patients were analysed by studying medical observations and questionnaires given to patients. RESULTS: Hundred and fifty patients, principally suffering from breast cancer (64%), consulted for returning to their current job (3/4) or for finding a new job (1/4). The return to work rate was 64% (95% CI=54-73), in a mean time of 7 months after the first "return to work" consultation. Ninety-three percent of the patients found that this consultation was useful. This consultation offers a transition between the hospital and the work environments, it guides patients to the good return to work actors, it gives specific advices about cancer and return to work. It gives specialised advices to workers who usually have not.

Association of occupational exposure with features of systemic sclerosis.

BACKGROUND: Occupational exposure is reported as playing a substantial causative role in systemic sclerosis (SSc). OBJECTIVE: We sought to compare the characteristics of SSc in patients with and without occupational exposure to crystalline silica/solvents. METHODS: In all, 142 patients with SSc were enrolled in this prospective study. An expert committee performed blind evaluation of occupational exposure to crystalline silica/solvents. RESULTS: Patients exposed to crystalline silica more often exhibited: diffuse cutaneous SSc (P = .02), digital ulcers (P = .05), interstitial lung disease (P = .0004), myocardial dysfunction (P = .006), and cancer (P = .06). Patients exposed to solvents more frequently developed: diffuse cutaneous SSc (P = .001), digital ulcers (P = .01), interstitial lung disease (P = .02), myocardial dysfunction (P = .04), and cancer (P = .003); in addition, these patients were more frequently anti-Scl 70 positive and anticentromere negative. Under multivariate analysis, significant factors for SSc associated with exposure to silica/solvents were: male gender (odds ratio 19.31, 95% confidence interval 15.34-69.86), cancer (odds ratio 5.97, 95% confidence interval 1.55-23.01), and digital ulcers (odds ratio 2.42, 95% confidence interval 1.05-5.56). LIMITATIONS: The cohort originated from a single geographic region. CONCLUSION: Occupational exposure to crystalline silica/solvents is correlated with more severe forms of SSc characterized by: diffuse cutaneous involvement, interstitial lung disease, general microangiopathy (digital ulcers and myocardial dysfunction), and association with cancer. Occupational exposure should be systematically checked in all patients with SSc, as exposed patients seem to develop more severe forms of SSc.

Development and evaluation of a new occupational medicine teaching module to advance self-efficacy and knowledge among medical students.

OBJECTIVES: Self-efficacy is defined as a person's beliefs in his or her abilities to successfully complete a task, and has been shown to influence student motivation and academic achievement. The purpose of this study was to evaluate the impact of a new European teaching module in occupational medicine on undergraduate students' self-efficacy and knowledge in the subject matter. METHODS: Pre-, in-between, and posttraining tests were used to assess self-efficacy and knowledge building of 261 third-year medical students on occupational health issues. Determinants of self-efficacy and knowledge were also identified. Repeated measurement data were analyzed with multilevel statistical procedures. RESULTS: The level of self-efficacy and knowledge in occupational medicine increased after the training. Students who frequently attended the lectures scored significantly higher than sporadic attendees. There was no relation between the level of self-efficacy and the final knowledge score. CONCLUSIONS: Teaching with the new occupational medicine module was effective. Lecture attendance is an important determinant of self-efficacy and performance. Self-efficacy was not associated with knowledge score. Encouraging classroom participation may enhance student achievement.

Is the coverage of Google Scholar enough to be used alone for systematic reviews.

BACKGROUND: In searches for clinical trials and systematic reviews, it is said that Google Scholar (GS) should never be used in isolation, but in addition to PubMed, Cochrane, and other trusted sources of information. We therefore performed a study to assess the coverage of GS specifically for the studies included in systematic reviews and evaluate if GS was sensitive enough to be used alone for systematic reviews. METHODS: All the original studies included in 29 systematic reviews published in the Cochrane Database Syst Rev or in the JAMA in 2009 were gathered in a gold standard database. GS was searched for all these studies one by one to assess the percentage of studies which could have been identified by searching only GS. RESULTS: All the 738 original studies included in the gold standard database were retrieved in GS (100%). CONCLUSION: The coverage of GS for the studies included in the systematic reviews is 100%. If the authors of the 29 systematic reviews had used only GS, no reference would have been missed. With some improvement in the research options, to increase its precision, GS could become the leading bibliographic database in medicine and could be used alone for systematic reviews.