Occupational Risk Factors by Sectors: An Observational Study of 20,000 Workers.

OBJECTIVE: We aimed to assess the prevalence of exposure by sector and the sectors of activity most exposed to each exposure, using routine occupational health data, and to quantify the risk of being exposed. METHOD: Occupational risk factors were assessed by workers followed by the Occupational Health Service of Cher, using self-reported questionnaires. The sectors of activity were grouped into seven sectors, and the risks were grouped into six occupational exposure groups. Comparisons were made using the Chi-squared test and Cramer's V, and the odds ratios were calculated by using logistic regression. RESULTS: We included 19,891 workers. The construction sector had the highest prevalence (p < 0.05 vs. all other sectors) of exposure to physical (76%) and biomechanical factors (82%), as well as chemical risks (75%). Human health and social work was the sector with the highest prevalence of exposure to biological factors (69%), psychosocial factors (90%), and atypical working hours (61%). With workers from administrative and support sectors as the reference, construction workers had more chance of declaring exposure to physical factors (OR = 3.28, 95%CI = 2.89 to 3.72), biomechanical factors (1.82, 1.58 to 2.09), and chemical agents (3.83, 3.38 to 4.33). Workers from the human health and social sectors had more chance of being exposed to biological agents (13.4, 11.9 to 15.2), atypical working hours (1.93, 1.75 to 2.14), and psychosocial factors (2.74, 2.38 to 3.16). CONCLUSION: Psychosocial risk factors were commonly reported in all sectors. Workers in the construction, human health, and social sectors seem to report more exposures than those in other sectors. The analysis of occupational exposures is a necessary basis to build an efficient preventive strategy for occupational health.

Assessment of sick building syndrome using visual analog scales.

BACKGROUND: Despite there is no recommendations for assessing symptoms of sick building syndrome, the use of visual analog scales (VAS) seems attractive and appropriate. We aimed to demonstrate the benefits of using VAS for evaluating subjective symptoms of sick building syndrome. METHOD: We compared an exposed group to a control group with a one-year follow-up. To assess chronology of symptoms, employees were asked to complete four VAS at different times: after vacations (time 1), beginning of the week-beginning of the day (time 2), beginning of the week-end of the day (time 3), and end of the week-end of the day (time 4). Measurements were repeated before and after ventilation work for the exposed group and at the same time in the control group without intervention. Confounding factors were assessed. RESULTS: We included 36 employees (21 in the exposed group and 15 in the control group). Both groups were comparable. Prior to ventilation work, the exposed group had more subjective symptoms than the control group with a chronology of symptoms. After ventilation work, symptoms did not differ between groups, and most symptoms decreased within the exposed group. PRACTICAL IMPLICATION: The use of VAS provided reliable data for assessing sick building syndrome and showed a dose-response relationship between occupational exposure and symptoms.

Burnout in French General Practitioners: A Nationwide Prospective Study.

BACKGROUND: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. METHODS: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. RESULTS: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9-5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15-3.16), working in a suburban area (5.23, 2.18-12.58), and having more than 28 appointments per day (1.95, 1.19-3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93-2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02-1.67 and 1.86, 1.34-2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51-0.83; 0.66, 0.48-0.92; and 0.42, 95%CI 0.23-0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13-0.47), as did group practice for intermediate level of burnout (0.71, 0.51-0.96). CONCLUSION: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

The Forgotten Health-Care Occupations at Risk of Burnout-A Burnout, Job Demand-Control-Support, and Effort-Reward Imbalance Survey.

AIMS: We conducted a cross-sectional study on healthcare workers from the University Hospital in Clermont-Ferrand. They received a self-report questionnaire consisting of the Maslach Burnout Inventory, Job Demand Control Support, Effort-Reward Imbalance model, and questions about ethical conflict in order to investigate on burnout. RESULTS: We included 1774 workers. Overinvestment was the only factor explaining the increase in emotional exhaustion, depersonalization, and the decrease in personal accomplishment. Taking into account the absence of burnout as a reference, overinvestment multiplied the risk of high burnout by 22.0 (5.10 to 94.7). CONCLUSION: Some "forgotten" occupations among healthcare workers are at risk of burnout. Overinvestment was the main factor explaining the increase in the tree dimensions of burnout. Moreover, the two main models of stress at work were highly predictive of burnout.

Burnout Among Hospital Non-Healthcare Staff: Influence of Job Demand-Control-Support, and Effort-Reward Imbalance.

OBJECTIVES: To study the prevalence of burnout among non-health care workers (NHCW), the risk and protective factors and to quantify the risk of burnout. METHOD: We conducted a cross-sectional study on the 3142 NHCW of the University Hospital of Clermont-Ferrand. They received a self-assessment questionnaire. RESULTS: Four hundred thirty seven (13.9%) NHCW completed the questionnaires. More than three quarter (75.4%) of NHCW was in burnout, with one in five (18.7%) having a severe burnout. Job demand was the main factor explaining the increase in exhaustion and overinvestment was the main factor explaining the increase in cynicism. Effort-reward imbalance (ERI) multiplied the risk of severe burnout by 11.2, job strain by 3.32 and isostrain by 3.74. CONCLUSION: NHCW from hospital staff are at high risk of burnout. The two major models of stress at work, the job demand-control-support and the ERI, were highly predictive of burnout, with strong dose-response relationships.

Suicide among physicians and health-care workers: A systematic review and meta-analysis.

BACKGROUND: Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. METHOD: The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* ¼ OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). RESULTS: The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. CONCLUSION: Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

Incidence and Clinical Impact of Anti-TNFα Treatment of Severe Immune Checkpoint Inhibitor-induced Colitis in Advanced Melanoma: The Mecolit Survey.

Immune checkpoint inhibitors (ICI) significantly improve overall survival (OS) in patients with advanced melanoma, but immune-related colitis may occur and warrant anti-tumor necrosis factor α (TNFα) treatment in severe forms. A nationwide, multicenter retrospective survey was conducted to assess both, the real-life incidence of grade 3/4 ICI-induced colitis treated with anti-TNFα, in patients with advanced melanoma, and the consequence of this therapeutic strategy on disease outcome. All patients with advanced melanoma treated with anti-TNFα agents for severe ICI-related colitis in the participating centers were included. Relative incidence was calculated according to the total number of patients treated with ICI in network centers during the period of inclusion. The possible impact of anti-TNFα treatment on disease outcome was evaluated through comparison of objective response rate, progression-free survival, and OS with pivotal literature data. Twenty-seven patients from 13 tertiary referral centers were included. Overall, severe ICI-related colitis treated with anti-TNFα occurred in 1% of patients with advanced melanoma, mostly with ipilimumab. Infliximab was successfully used in all patients but 1, mostly after 1 infusion. OS and progression-free survival of 12 and 3 months, respectively, were observed in these patients, along with an objective response rate of 41% at 12 months. This survey shows a low real-life incidence of severe colitis requiring anti-TNFα. Response rates to immunotherapy and survival data do not appear to significantly differ from those observed in pivotal studies. Severe ICI-induced colitis requiring anti-TNFα treatment appears to be a rare event in advanced melanoma, and infliximab does not seem to adversely affect disease outcome.

Incidence of ill-health related job loss and related social and occupational factors. The "unfit for the job" study: a one-year follow-up study of 51,132 workers.

OBJECTIVE: The analysis of ill-health related job loss may be a relevant indicator for the prioritization of actions in the workplace or in the field of public health, as well as a target for health promotion. The aim of this study was to analyze the medical causes, the incidence, and the characteristics of employees medically unfit to do their job. METHODS: This one-year prospective study included all workers followed by occupational physicians in an occupational health service in the south of France. The incidence of unfitness for work have been grouped according to the main medical causes and analyzed. We performed a multivariate analysis in order to adjust the observed risk of job loss based on the age groups, sex, occupation and the activity sectors. RESULTS: A total of 17 occupational physicians followed up 51,132 workers. The all-cause incidence of being unfit to return to one's job was 7.8‰ (n = 398). The two main causes of being unfit for one's job were musculoskeletal disorders (47.2%, n = 188) and mental ill-health (38.4%, n = 153). Being over 50 years old (Odds ratio (OR) 2.63, confidence interval 95% CI [2.13-3.25]) and being a woman (OR 1.52, 95% CI [1.21-1.91]) were associated with the all-cause unfitness, independent of occupation and activity sector. CONCLUSIONS: Identification of occupational and demographic determinants independently associated with ill-health related job loss may provide significant and cost-effective arguments for health promotion and job loss prevention.

Occupational exposure factors for mental and behavioral disorders at work: The FOREC thesaurus.

BACKGROUND: Mental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) linked with the onset of mental and behavioral disorders. METHODS: The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker's point of view using the FOREC thesaurus. RESULTS: We recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus. CONCLUSIONS: We built the first thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs.

Decreased prevalence of cancer in patients with multiple sclerosis: A case-control study.

BACKGROUND: Studies of cancer prevalence have produced conflicting results concerning the relative risk of overall and specific sub-types of cancer in patients with multiple sclerosis (MS). Contemporary controls and information on tobacco use and alcohol consumption are generally missing from previous studies. OBJECTIVES: To evaluate lifetime cancer prevalence in a large cohort of MS patients relative to appropriate controls. METHODS: We conducted a case-control study, using a postal survey of a cohort of MS patients. Of the 1574 questionnaires sent, 1107 could be used for statistical analysis. Data from 1568 controls were prospectively collected using the same self-administered survey among consecutive out-patients in a single neurology department. Propensity scores matched on age, gender, and history of smoking and alcohol consumption were calculated. RESULTS: Among the MS patients, 7.32% had ever presented with a cancer, whereas 12,63% of the controls had, leading to a bootstrap matched odds ratio (OR) of 0.63; 95% CI 0.57-0.70. Although only exploratory, the use of DMT (immunomodulators or immunosupressants) did not appear to increase this risk (p = 0.42). The disease course also did not affect cancer prevalence. CONCLUSION: MS was associated with a reduced overall cancer risk.

At-risk and intervention thresholds of occupational stress using a visual analogue scale.

BACKGROUND: The visual analogue scale (VAS) is widely used in clinical practice by occupational physicians to assess perceived stress in workers. However, a single cut-off (black-or-white decision) inadequately discriminates between workers with and without stress. We explored an innovative statistical approach to distinguish an at-risk population among stressed workers, and to establish a threshold over which an action is urgently required, via the use of two cut-offs. METHODS: Participants were recruited during annual work medical examinations by a random sample of workers from five occupational health centres. We previously proposed a single cut-off of VAS stress in comparison with the Perceived Stress Scale (PSS14). Similar methodology was used in the current study, along with a gray zone approach. The lower limit of the gray zone supports sensitivity ("at-risk" threshold; interpreted as requiring closer surveillance) and the upper limit supports specificity (i.e. "intervention" threshold-emergency action required). RESULTS: We included 500 workers (49.6% males), aged 40±11 years, with a PSS14 score of 3.8±1.4 and a VAS score of 4.0±2.4. Using a receiver operating characteristic curve and the PSS cut-off score of 7.2, the optimal VAS threshold was 6.8 (sensitivity = 0.89, specificity = 0.87). The lower and upper thresholds of the gray zone were 5 and 8.2, respectively. CONCLUSIONS: We identified two clinically relevant cut-offs on the VAS of stress: a first cut-off of 5.0 for an at-risk population, and a second cut-off of 8.2 over which an action is urgently required. Future investigations into the relationships between this upper threshold and deleterious events are required.

Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis.

BACKGROUND: Creatine is the most widely used supplementation to increase performance in strength; however, the most recent meta-analysis focused specifically on supplementation responses in muscles of the lower limbs without regard to upper limbs. OBJECTIVE: We aimed to systematically review the effect of creatine supplementation on upper limb strength performance. METHODS: We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance measured in exercises shorter than 3 min in duration. The search strategy used the keywords 'creatine', 'supplementation', and 'performance'. Independent variables were age, sex and level of physical activity at baseline, while dependent variables were creatine loading, total dose, duration, time interval between baseline (T0) and the end of the supplementation (T1), and any training during supplementation. We conducted three meta-analyses: at T0 and T1, and on changes between T0 and T1. Each meta-analysis was stratified within upper limb muscle groups. RESULTS: We included 53 studies (563 individuals in the creatine supplementation group and 575 controls). Results did not differ at T0, while, at T1, the effect size (ES) for bench press and chest press were 0.265 (95 % CI 0.132-0.398; p < 0.001) and 0.677 (95 % CI 0.149-1.206; p = 0.012), respectively. Overall, pectoral ES was 0.289 (95 % CI 0.160-0.419; p = 0.000), and global upper limb ES was 0.317 (95 % CI 0.185-0.449; p < 0.001). Meta-analysis of changes between T0 and T1 gave similar results. The meta-regression showed no link with characteristics of population or supplementation, demonstrating the efficacy of creatine independently of all listed conditions. CONCLUSION: Creatine supplementation is effective in upper limb strength performance for exercise with a duration of less than 3  min, independent of population characteristics, training protocols, and supplementary doses or duration.

Psychosocial risks and work suffering / Risques psychosociaux et souffrance au travail

Psychosocial risks and work suffering. The work related mental disorders are one of the main concerns for physicians and for occupational health policy. In addition of the difficulties to take appropriate preventive measures, due to nature and the complexity of this issue, the mental health and its occupational risk factors certainly need some clarification. It's important not to confuse risk factors and adverse consequences. Another key point is the cognitive mediation, and thus its subjective nature, therefore this process is subject to intra and extra variability between the risk factors and health consequences. The aim of this synthesis paper is to shed light on the matter and to bring informations on epidemiological data.

Risques psychosociaux et souffrance au travail. La souffrance au travail est au coeur des préoccupations des médecins mais aussi des politiques de santé au travail. Outre la difficulté à mettre en place des actions de prévention efficaces, liée à la nature et la complexité du problème, le champ de la santé mentale et des facteurs de risque liés à l'environnement professionnel souffre parfois de l'absence de clarté des définitions. Il est important de ne pas confondre les facteurs de risque d'une part, et les conséquences en termes de santé d'autre part. Un autre point clé dans cette problématique est la médiation cognitive, et donc son caractère subjectif par essence, qui a pour conséquence la variabilité intra- et extra-individuelle de la relation entre ces facteurs de risque et les conséquences pour la santé. L'objectif de cette synthèse est donc de tenter d'apporter des éléments de clarification sur l'abord actuel de la problématique des risques psychosociaux et de la souffrance au travail, et de son ampleur d'un point de vue épidémiologique.

Occupational Risk Factors for COPD: A Case-Control Study.

OBJECTIVES: The aim of this research was to examine the occupational risk factors for Chronic Obstructive Pulmonary Diseases (COPD) in a range of occupations. METHODS: Eleven occupations involving different types of exposure were observed in this multicenter case-control study. Controls and cases were matched for sex, age and smoking. Multiple logistic regression analyses were used to estimate odds ratios (ORs). RESULTS: A total of 1,519 participants were initially recruited between September 2004 and September 2012. After matching, 547 pairs were obtained. The mean age was 56.3 +/- 10.4 years. Smelter workers were the only ones with an increased risk of COPD in this study (OR = 7.6, p < 0.0001, 95% CI [4.5, 12.9]). Physical activity was protective (OR = 0.7), while living in the city was a risk (OR = 1.6). The main used metals were cast iron, aluminum and alloys. Molds and cores were mainly made from sand and synthetic resins. Machine maintenance (65.2%), molding (49.6%), finishing (41.1%) and casting (41.0%) were the most common activities. Almost all workers (95.1%) cleaned the floors and machines with a brush or compressed air. CONCLUSIONS: This study demonstrates the importance of occupational factors in the genesis of COPD, especially among smelter workers. As with the fight against smoking-related disease, the removal or substitution of recognized hazardous agents is the best way of preventing the onset of COPD. This is why it is essential to continue research on its occupational risk factors.

Ill Health-Related Job Loss: A One-Year Follow-Up of 54,026 Employees.

INTRODUCTION: The diagnoses of workers being unfit to work may be a relevant health indicator. Therefore, the aim of this study was to analyze the one-year incidence of an unfit to work diagnosis. METHOD: This one-year prospective study included all workers undergoing annual work medical examination from occupational health services in Troyes, France. RESULTS: Twenty-one occupational physicians followed 54,026 employees. The all-cause incidence of being unfit to return to work was 0.772%. The two main causes of being unfit to work were musculoskeletal disorders (61%) and psychopathologies (24%). The relative risk (RR) of being unfit to work, independent of the cause, was higher when employees were aged over 50 years (RR = 2.51), and female (RR = 1.51). CONCLUSIONS: Prospective results from occupational physicians' medical records may provide significant and cost-effective directions to prioritize actions and target health promotion in the workplace.