Central nervous system tumours and occupational ionising radiation exposure: a nested case-control study among the ORICAMs cohort of healthcare workers in France.

OBJECTIVE: This study aimed at investigating the relationship between occupational exposure to external ionising radiation and central nervous system (CNS) tumours mortality in healthcare workers working in France. DESIGN AND SETTING: The Occupational Radiation-Induced Cancer in Medical staff (ORICAMs) nested case-control study was conducted based on the dosimetric records of the national register of occupational dosimetry (Système d'information de la surveillance de l'exposition aux rayonnements ionisants). PARTICIPANTS AND METHODS: 33 CNS tumour deaths occurred between 2002 and 2012 among the ORICAMs cohort composed of 164 015 healthcare workers. Each case was matched to five controls alive at the time of the corresponding case's death, based on sex, year of birth, date of enrolment in the cohort and duration of follow-up. All participants were badge monitored for external radiation exposure, expressed in Hp(10). Conditional logistic regression was used to analyse the dose-response relationship between radiation dose and CNS mortality. RESULTS: Cases were exposed to a mean cumulative career radiation dose of 5.8±13.7 (max: 54.3) millisievert (mSv) compared with 4.1±15.2 (142.2) mSv for controls. No statistically significant association was found between CNS tumour mortality and cumulative whole-body career dose (OR=1.00, 95% CI 0.98 to 1.03), duration of exposure (OR=1.03; 95% CI 0.95 to 1.12) or age at first exposure (OR=0.98; 95% CI 0.91 to 1.06). CONCLUSION: We found no evidence of an association between external radiation exposure and CNS tumour risk in healthcare workers. Limitations of the study include low statistical power and short duration of follow-up.

Radiation protection in a cohort of healthcare workers: knowledge, attitude, practices, feelings and IR-exposure in French hospitals.

The number of healthcare workers occupationally exposed to ionizing radiation (IR) is increasing every year. As health effects from exposure to low doses IR have been reported, radiation protection (RP) in the context of occupational activities is a major concern. This study aims to assess the compliance of healthcare workers with RP policies, according to their registered cumulative dose, profession, and perception of radiation self-exposure and associated risk. Every healthcare worker from one of the participating hospitals in France with at least one dosimetric record for each year 2009, 2014, and 2019 in the SISERI registry was included and invited to complete an online questionnaire including information on the worker's occupational exposure, perception of IR-exposure risk and RP general knowledge. Hp(10) doses were provided by the SISERI system. Multivariate logistic regressions were used. Dosimeter wearing and RP practices compliance were strongly associated with 'feeling of being IR-exposed' (OR = 3.69, CI95% 2.04-6.66; OR = 4.60, CI95% 2.28-9.30, respectively). However, none of these factors was associated with RP training courses attendance. The main reason given for non-compliance is unsuitability or insufficient numbers of RP devices. This study provided useful information for RP policies. Making exposed workers aware of their own IR-exposure seems to be a key element to address in RP training courses. This type of questionnaire should be introduced into larger epidemiological studies. Dosimeter wearing and RP practices compliance are associated to feeling being IR-exposed. RP training courses should reinforce workers' awareness of their exposure to IR.

The impact of COVID-19 lockdown restrictions on the short-term association between in-vehicle particulate pollutants and the respiratory health of Parisian taxi drivers.

OBJECTIVES: This study assessed the short-term associations between in-vehicle ultrafine particles (UFP) and black carbon (BC) concentrations and irritation symptoms and lung parameters of taxi drivers, pre- and post-lockdown. METHODS: As part of PUF-TAXI project, 33 taxi drivers were followed up during two typical working days. In-vehicle UFP and BC were continuously measured by monitoring instruments. Irritation symptoms during the working day were reported via an auto-questionnaire and lung function was assessed by a portable spirometer, pre- and post- work shift. Generalized estimating equations, adjusted for potential confounders, were used to study the association between air pollutants and health outcomes. Effect modification by measurement period (pre- and post-lockdown) was investigated. RESULTS: UFP and BC concentrations inside taxi vehicles decreased significantly post- compared to pre-lockdown. Incidence of nose irritation was positively associated with in-vehicle UFP and BC levels pre-lockdown, when pollutant levels were higher, whereas no significant association was found post-lockdown. The decrease in the FEF25-75% (forced expiratory flow at 25-75% of the forced vital capacity) during the working day was significantly associated with in-taxi UFP levels before but not after lockdown. No association was found with BC. By contrast, incidence of eye irritation was significantly inversely associated with in-vehicle humidity, regardless of pollutant concentrations and the measurement period. CONCLUSIONS: Our findings indicate that an upgrade in in-vehicle air quality could improve respiratory health. This study showed that the magnitude of the incidence of nasal irritation and decrease in lung function depends on UFP concentrations the commuters are exposed to.

Occupational exposure to ionizing radiation in medical staff: trends during the 2009-2019 period in a multicentric study.

OBJECTIVES: Health workers exposed to ionizing radiation account for + 50% of workers exposed to man-made radiation in France. Over the last decade, the use of radiation in medicine has increased due to the introduction of new practices. The EXposition des Professionnels de santE aux RayonnemenTs ioniSants study aims to evaluate and characterize the trends in radiation exposure of health workers in France between 2009 and 2019. METHODS: This retrospective study includes all health workers with at least one dosimetric record in the system for occupational dosimetry registration (Système d'information de la surveillance de l'exposition aux rayonnements ionisants) database for each of the years 2009, 2014, and 2019, in the hospitals included in the study. Individual external doses and socio-professional data were collected. Statistical analyses include descriptions, graphs, and logistic regressions. RESULTS: A total of 1457 workers were included (mean age: 39.8 years, 59% women). The average exposure significantly decreased between 2009 and 2019 (-0.008 mSv/year, p < 0.05). There were large discrepancies in trends according to professions, departments, hospitals, and gender. Over the 10-year study period, radiologic technologists and physicians were the most exposed (0.15 mSv (95%CI 0.14-0.16) and 0.13 mSv (0.06-0.21), respectively), but their exposure tended to decrease. Workers in nuclear medicine departments had the highest radiation exposure (0.36 mSv (0.33-0.39)), which remained stable over time. Thirty-eight percent of recorded doses were nonzero in 2009, decreasing to 20% in 2019. CONCLUSIONS: This study allowed to identify physicians and radiologic technologists in nuclear medicine departments as the most exposed medical workers in France, and to show an overall decrease trend in radiation exposure. This should be instructive for radiation monitoring and safety of exposed medical workers. KEY POINTS: • Radiation exposure of healthcare workers in most medical departments has steadily decreased between 2009 and 2019 in several French hospitals. • The number of zero doses consistently increased during the study period. • Workers in nuclear medicine departments are the most exposed, especially radiologic technologists and physicians.

Changes in air quality in-taxis and in working conditions of taxi drivers pre- and post-lockdown, during the COVID-19 pandemic in the Paris area.

We evaluated the impact of the lockdown restriction measures in the Paris area on the variation of in-vehicle ultrafine particle (UFP) and black carbon (BC) concentrations between the pre- and post-lockdown period and professional drivers' working conditions and practices. The study was conducted with 33 taxi drivers. UFP and BC were measured inside their vehicles with DiSCmini® and microAeth® , respectively, on two typical working days pre- and post-lockdown. Job characteristics were self-reported. Our results showed that post-lockdown, both the number of clients and journey duration significantly decreased. Taxi drivers opened their windows significantly more and reduced the use of air recirculation. UFP decreased significantly by 32% and BC by 31% post-lockdown, with a weaker positive correlation compared to pre-lockdown. The reduction of in-vehicle UFP was due mainly to the reduction of traffic flow and ventilation settings, though the latter probably varied according to traffic conditions. The variation of in-vehicle BC also tended to be related to the decrease in traffic flow post-lockdown. We emphasize the role of traffic emissions on in-vehicle air pollution and that preventive measures such ventilation settings would help to minimize the exposure of professional drivers and passengers to air pollutants.

Short-term association of in-vehicle ultrafine particles and black carbon concentrations with respiratory health in Parisian taxi drivers.

INTRODUCTION: Professional drivers are exposed inside their vehicles to high levels of air pollutants due to the considerable time they spend close to motor vehicle emissions. Little is known about ultrafine particles (UFP) or black carbon (BC) adverse respiratory health effects compared to the regulated pollutants. OBJECTIVES: We aimed to study the short-term associations between UFP and BC concentrations inside vehicles and (1) the onset of mucosal irritation and (2) the acute changes in lung function of Parisian taxi drivers during a working day. METHODS: An epidemiological study was carried out on 50 taxi drivers in Paris. UFP and BC were measured inside their vehicles with DiSCmini® and microAeth®, respectively. On the same day, the frequency and the severity of nose, eye, and throat irritations were self-reported by each participant and a spirometry test was performed before and after the work shift. Multivariate analysis was used to evaluate the associations between in-taxis UFP and BC concentrations and mucosal irritation and lung function, after adjustment for potential confounders. RESULTS: In-taxis UFP concentrations ranged from 17.9 to 37.9 × 103 particles/cm3 and BC concentrations from 2.2 to 3.9 µg/m3, during a mean of 9 ± 2 working hours. Significant dose-response relationships were observed between in-taxis UFP concentrations and both nasal irritation and lung function. The increase of in-taxis UFP (for an interquartile range of 20 × 103 particles/cm3) was associated to an increase in nasal irritation (adjusted OR = 6.27 [95% CI: 1.02 to 38.62]) and to a reduction in forced expiratory flow at 25-75% by -7.44% [95% CI: -12.63 to -2.24], forced expiratory volume in one second by -4.46% [95% CI: -6.99 to -1.93] and forced vital capacity by -3.31% [95% CI: -5.82 to -0.80]. Such associations were not found with BC. Incident throat and eye irritations were not related to in-vehicle particles exposure; however, they were associated with outdoor air quality (estimated by the Atmo index) and in-vehicle humidity, respectively. CONCLUSION: To our knowledge, our study is the first to show a significant association, within a short-period of time, between in and vehicle UFP exposure and acute respiratory effects in professional drivers.

Determinants of ultrafine particles, black carbon, nitrogen dioxide, and carbon monoxide concentrations inside vehicles in the Paris area: PUF-TAXI study.

This study presents real-time concentrations of traffic-related air pollutants during 499 trips conducted by 50 Parisian taxi drivers from PUF-TAXI project. Ultrafine particles (UFP), black carbon (BC), and nitrogen dioxide (NO2 )/carbon monoxide (CO) were measured inside vehicles by Diffusion Size Classifier Miniature® , microAeth® , and Gas-Pro® , respectively, for nine hours. Vehicle/trip data characteristics were collected by questionnaires and on ambient conditions by monitoring stations. The associations between pollutant levels and their potential determinants were analyzed using generalized estimating equation model. Determinants of in-vehicle pollutants levels were identified: (1) ambient factors (meteorology and ambient pollution)-affecting BC, NO2, and CO; (2) vehicle characteristics-affecting all pollutants; and (3) trip-related driving habits-affecting UFP, BC, and CO. We highlight that commuters can, therefore, avoid high in-vehicle air pollutant concentrations mainly by (1) closing windows and activating air-conditioning under air recirculation mode in congested traffic; (2) smooth driving; and (3) maintaining cabin air filters.

Cross-sectional study of in-vehicle exposure to ultrafine particles and black carbon inside Lebanese taxicabs.

Taxi drivers' exposure to traffic-related air pollutants inside their vehicles has been reported in different countries but not yet in Lebanon. Thus, we conducted a cross-sectional study on 20 Lebanese taxi drivers to (1) assess their exposure to ultrafine particles (UFP) and black carbon (BC) inside their vehicles and (2) identify determinants of this exposure. UFP and BC were measured using Diffusion Size Classifier Miniature® and microAeth® Model AE51, respectively, for 5 hours. Data on characteristics of vehicles and trips were collected by face-to-face interviews. Associations between pollutant levels and their determinants were analyzed by multiple linear regression. The mean of UFP count (35.2 ± 17.6 x 103 particles cm-3 ) and BC (5.2 ± 1.9 µg m-3 ) concentrations in-taxis was higher in the morning measurements compared with those in the afternoon measurements. UFP count increased in-taxis by 60% for every 10 minutes spent in blocked traffic and by 84% starting from two trips with smokers compared to trips without smokers. Conversely, UFP count decreased by 30% for every 10 minutes under both air-conditioning and air recirculation mode with windows closed. BC was not affected by any of these factors. Our findings suggest easy ways to reduce UFP exposure inside vehicles for all commuters.

Exposure to traffic air pollutants in taxicabs and acute adverse respiratory effects: A systematic review.

INTRODUCTION: Taxi drivers could be at risk regarding their respiratory health due to their constant exposure to traffic related air pollutants (TRAP) inside their vehicles. Therefore, we aimed to review pollutants exposure inside taxi vehicles and its determinants as well as its acute adverse respiratory effects. METHODS: The literature search was done in Pubmed and in Embase. For additional resources we searched manually articles from the reference lists of the selected papers and from Google Scholar. We included only studies in French or in English language meeting the following eligibility criteria: design: observational and quasi-experimental; study population: taxi drivers or taxi commuters, outcome: pollutants levels in taxicabs and/or acute adverse respiratory effects. Data was extracted using tabulation according to the type of the study (exposure or epidemiological). RESULTS: Out of 1753 articles, 21 studies were included. Exposure studies underlined that TRAP concentrations inside taxicabs were higher than their urban background levels and even exceeded those recorded in buses, in trains and when commuting by active transport modes. Overall, their concentrations varied widely between studies depending on the characteristics of the urban environment and the vehicle fleet of each location. Meteorological parameters and ventilation settings appeared to influence pollutants concentrations inside each vehicle. Otherwise, deficiency in epidemiological studies and inconsistencies in their findings restrain our ability to determine the association between acute respiratory effects and exposure to TRAP inside taxicabs. CONCLUSION: Although studies are heterogeneous, results have shown a high but variable occupational exposure of taxi drivers to TRAP inside their vehicles. However, future researches are required to study short respiratory impact of taxi drivers' exposure to TRAP inside their vehicles.

Pilot study on a new concept of documenting the clinical relevance of patch test results in contact dermatitis patients.

BACKGROUND: Assessment of the clinical relevance of patch test reactions is an essential part of the diagnostic work-up of patients with (occupational) contact dermatitis. However, final diagnostic information, particularly the clinical relevance of allergic patch test reactions, has hitherto been ill-represented in clinical documentation systems (patch test software) and surveillance registries based on these. OBJECTIVES: To develop, implement as a pilot study, and analyse concerning feasibility and contents a new concept of representing the full scope of diagnostic information utilized in the diagnosis of patients with (occupational) contact dermatitis. METHODS: On the basis of a European working group discussion on items to document and catalogue lists to use for this purpose, an online documentation system to collect data was set up, followed by pilot use involving 9 dermatology departments across Europe. RESULTS: Data on 176 patients with suspected occupational hand dermatitis were included; among these, work-relatedness was confirmed in 150, and in 53 non-occupational aetiology was the sole or a contributory cause. Data were further analysed with regard to occupations, product categories, substances (haptens), source of information on which the evaluation was based, and various combinations of these factors, to illustrate the usefulness of the proposed data representation. CONCLUSIONS: An improved method of data collection is presented that more accurately links allergen to exposure and to clinical disease and patient history, and thus better represents clinical relevance. This enables more precise analysis of the causation of contact dermatitis, occupational or non-occupational, and thereby better targeting of prevention. The development of future databases should incorporate the above considerations to record the results of investigation.

Extended documentation for hand dermatitis patients: Pilot study on irritant exposures.

BACKGROUND: Irritant exposure may be a contributory cause or the sole cause of (occupational) hand dermatitis. However, the documentation of irritant exposures in clinical practice is not standardized. OBJECTIVES: To examine the feasibility and usefulness of a form with different items addressing both occupational and non-occupational irritant exposures in a semiquantitative way. METHODS: Between May 2016 and May 2017, successive patients with work-related hand dermatitis, irrespective of aetiology, were examined in 9 specialized European departments. Department-specific investigation was supplemented with the above proforma. The results were recorded by use of an anonymized secured online documentation system in a pilot study. RESULTS: Altogether, 193 patients were included; 114 females and 79 males, with a mean age of 40 years (range 18-68 years). The most common occupational group comprised healthcare workers (n = 35); occupational exposure of the hands to gloves, dusts and water without detergents of >2 hours/day was seen in 54.5%, 24.4% and 24.3% of patients, respectively. Non-occupational exposures rarely exceeded 2 hours/day. CONCLUSIONS: It is hoped that the set of descriptors will offer a basis for (clinical) epidemiological studies assessing the role of irritant exposures in occupational hand dermatitis, and to support a high level of quality and consistency in daily patient care.

Accelerator-free gloves as alternatives in cases of glove allergy in healthcare workers.

BACKGROUND: Accelerators in rubber gloves constitute an important group of contact allergens, particularly in healthcare workers. OBJECTIVES: To assess the efficacy of accelerator-free medical gloves in the secondary prevention of allergic contact dermatitis caused by rubber accelerators in healthcare workers. METHODS: Nine healthcare workers with hand eczema were advised to use accelerator-free rubber gloves after a diagnosis of allergic contact dermatitis caused by rubber accelerators. RESULTS: Switching from conventional medical single-use gloves containing accelerators to accelerator-free medical gloves led to improvement in all cases, and more than two-thirds of the patients were completely free of symptoms. CONCLUSION: The use of accelerator-free medical gloves can be an effective alternative in healthcare workers who are allergic to rubber accelerators.