Parkinson's disease and solvents: Is there a causal link?

We report here on chronic neurological impairment in three car painters with constant occupational exposure to organic solvents. All had a clinical presentation of Parkinson's disease and, in all cases, SPECT DaTscan brain imaging, using 123I-FP-CIT, showed bilateral reduction of tracer uptake in the basal ganglia, evidence of dysfunction at the dopaminergic terminal.

Use of GIS in visualization of work-related health problems.

BACKGROUND: Occupational health and safety (OHS) information is often complex, diverse and unstructured and suffers from a lack of integration which usually precludes any systemic insight of the situation. AIMS: To analyse to what extent the use of geographical information systems (GISs) can help to integrate, analyse and present OHS data in a comprehensive and communicable way relevant for surveillance purposes. METHODS: We first developed a 'macro-approach' (from national to local level), mapping data related to economic activity (denominator of active workers displayed by activity sectors), as well as work-related ill-health (numerators of workers suffering from work-related ill-health). The latter data are composed of compensated occupational diseases on the one hand and work-related diseases investigated by specialized clinics on the other hand. Then, a 'micro-approach' was worked out, integrating at a plant level, using computer-aided drawing, occupational risks data and OHS surveillance data (e.g. use of medication and sickness absence data). RESULTS: At the macro-level, microelectronics companies and workers were mapped at different scales. For the first time, we were able to compare, up to the enterprise level, complementary data showing different pictures of work-related ill-health, allowing a better understanding of OH issues in this sector. At the micro-level, new information arose from the integration of risk assessment data and medical data. CONCLUSIONS: This work illustrates to what extent GIS is a promising tool in the OHS field, and discusses related challenges (technical, ethical, biases and interpretation) and research perspectives.

Primary lung adenocarcinoma: characteristics by smoking habit and sex.

The incidence of adenocarcinoma is increasing, particularly among females. We sought to assess the role of tobacco consumption in clinical presentation according to sex. In this retrospective study, 848 patients diagnosed between 1997 and 2006 at Grenoble University Hospital (Grenoble, France) were stratified into four groups according to smoking habits. Differences between sexes and two contrasting female profiles emerged. Female current smokers were younger than female never-smokers (median 51 versus 69 yrs; p < 0.001), more often had surgery (62.7% versus 39%; p = 0.01) and had a median (95% CI) estimated survival of 26.2 (18.1-49.2) versus 15.1 (12.8-22.2) months (p = 0.002). Both groups had similar survival when taking treatment into account. Among males, smoking did not influence presentation. Male current smokers were older than female current smokers (median 59 yrs; p < 0.001) and fewer had surgery (48.8%; p = 0.015), although the percentage of stage IIIb-IV disease was similar (53% and 46%; nonsignificant) and they had a poorer estimated survival of 14.3 (13.0-18.5) months (p = 0.0024). Males smoked more than females (median 41 versus 30 pack-yrs; p < 0.001). Quitting smoking delayed age at diagnosis by 11 yrs for females (p = 0.0035) and 8 yrs for males (p < 0.001). Our results support the hypothesis that carcinogenesis differs between males and females, and between female smokers and never-smokers.

[Diagnostic difficulties of chronic pulmonary berylliosis in France]. / Difficultés diagnostiques de la bérylliose pulmonaire chronique en France.

INTRODUCTION: The epidemiology of chronic beryllium disease (CBD) in France is poorly understood. The aim of this study was to determine the number of prevalent cases of CBD in France between 2010 and 2014. METHODS: We conducted a national survey using a specific questionnaire distributed by the professional pathology services. RESULTS: In total, 33 CBD cases were reported in France, with a diagnosis established between 1982 and 2014. 85% (28/33) of CBD cases resulted from professional exposure and mostly concerned foundry workers (39%). A definite diagnosis defined by the association of an abnormal beryllium lymphocyte proliferation test and of a granulomatous inflammatory response in the lung, was obtained in 29/33 cases (88%). The other cases were probable CBD, defined by a granulomatous lung disease with a beryllium exposure, but without evidence of beryllium sensitisation. The diagnosis of granulomatous disease was confirmed a mean of 4 years after the end of exposure. The median delay between diagnosis of a granulomatous disease and diagnosis of CBD was 2 years (range 0-38 years). A genetic predisposition was found in 14 of 17 tested patients (82%). CONCLUSION: In this study, we report 33 cases of CBD followed in France between 2010 and 2014. The poor understanding of CBD and the exposure leading to it, the late development after the end of exposure, the complexity of the diagnosis and the similarities with sarcoidosis may explain the small number of cases reported.

[Obese children 10 years later: an observational study]. / Que deviennent 10ans après, les enfants suivis pour surpoids ou obésité ? : étude observationnelle.

INTRODUCTION: Although childhood obesity is a major public health problem, the long-term follow-up of children who are overweight and obese has rarely been studied in France. METHODS: We conducted a single-center observational study of 85 subjects who received medical follow-up for weight problems or obesity in 2001, at which time they were aged between 2 and 17 years. The study followed-up these subjects in 2012, after a mean of 10 years. We separated the study into two time periods. Initial follow-up periods - (A) from the first consultation to the end of individual or group care -and latency periods - (B) from the end of medical care to the year 2012 - were distinguished. A declarative survey based on questionnaires on dietary habits, activity levels, and anthropometric data of children and their parents was conducted in 2012. Two indicators of effectiveness monitoring (α) and post-follow-up (ß) were created. RESULTS: Although 77% of patients had a favorable α indicator, demonstrating the effectiveness of initial management, especially if it was prolonged (>32 months, P=0.007), a re-ascent of the BMI curve after ceasing monitoring occurred in half of the cases (47%) with subjects' BMI significantly correlated with their parents' BMI (P=0.004 for the mother and P=0.02 for the father). CONCLUSION: These observations encourage us to improve the medical follow-up on offer by educating and strengthening the role of parents to achieve a significant and lasting improvement in BMI and weight. In case of medical failure in supporting patients to achieve enough weight loss, the option of bariatric surgery can be considered, even if its recent introduction means that a long-term risk/benefit analysis has yet to be conducted.

Interest of workplace support for returning to work after a traumatic brain injury: a retrospective study.

OBJECTIVE: To analyse usefulness of the SPASE programme, a coordinated facility programme to assist traumatic brain injury (TBI) persons in returning to work and retaining their job in the ordinary work environment. DESIGN: A retrospective study including 100 subjects aged over 18 who had suffered traumatic brain injury (GOS 1 or 2). The criterion for return to work (RTW) success was the ability to return to the job he/she had before the accident or to a new professional activity. RESULTS: Factors associated with RTW success were at short-term (2-3 years): the presence of significant workplace support OR=15.1 [3.7-61.7], the presence of physical disabilities OR=0.32 [0.12-0.87] or serious traumatic brain injury OR=0.22 [0.07-0.66]. At medium-term (over 3 years) these factors were: significant workplace support OR=3.9 [1.3-11.3] and presence of mental illness OR=0.15 [0.03-0.7]. CONCLUSION: This study suggests that a case coordination vocational programme may facilitate the return and maintain to work of TBI persons. It reveals that the workplace support is a key factor for job retention in the medium-term.