Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P).

BACKGROUND: Occupational contact urticaria (OCU) is an occupational contact dermatitis that can cause serious health consequences and disability at work. OBJECTIVES: To describe OCU and its temporal trends by the main causal agents and activity sectors in a nationwide scheme in France. METHODS: Using data from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P), we described OCU reported during the period 2001-10 and analysed the temporal trends of OCU and OCU attributed to the most frequent agents over the study period. Trends analyses were supported by reporting odds ratios using a logistic regression model with reference to 2001, or with time as a continuous variable. RESULTS: During the study period, 251 cases of OCU were reported in RNV3P, half of which were due to natural rubber latex, in particular in the health and social work activity sector (HSW). The number of these cases declined significantly over the study period (19% per year), and particularly after 2006. Conversely, the other causes of OCU did not decrease. CONCLUSIONS: Using surveillance data from a French national network, this study has found that there was a significant decline in OCU due to natural rubber latex, particularly in the HSW, when powdered latex gloves were banned from French hospitals. Our results show the effectiveness of this preventive measure, and suggest that this practice should be extended to other sectors.

Occupational allergic contact dermatitis and major allergens in France: temporal trends for the period 2001-2010.

BACKGROUND: Occupational allergic contact dermatitis (OACD) is one of the most common occupational skin diseases in developed countries, but data about its temporal trends in incidence remain sparse. OBJECTIVES: The aim of this study is to describe OACD trends in terms of industrial activities and main causal agents in France over the period 2001-2010. MATERIALS AND METHODS: Data were collected from the French National Network of Occupational Disease Vigilance and Prevention (RNV3P, Réseau National de Vigilance et de Prévention des Pathologies Professionnelles). All OACD considered probably or certainly associated with an occupational exposure were included in the study. Trends were examined (i) on annual crude numbers of OACD and (ii) on reported odds ratios of OACD calculated using logistic regression models. RESULTS: Overall, 3738 cases of OACD were reported and the mean age of OACD cases was 35 years, 52% being women. The most frequent occupations were hairdressers, health care workers, cleaning staff and masons. The total number of OACD cases remained stable over the study period, but increases in OACD related to isothiazolinones (P = 0·002), epoxy resins (P = 0·012) and fragrances (P = 0·005) were observed. Conversely, decreases were noted for cement compounds (P = 0·002) and plant products (P = 0·031). These trends highlight specific sectors and exposures at risk of OACD. CONCLUSIONS: Trends in OACD depend on the nature of exposure. Observed decreases were consistent with prevention measures taken during the study period, and the increases observed serve to highlight those areas where preventative efforts need to be made to reduce skin allergies in the workplace.

Do young adults with childhood asthma avoid occupational exposures at first hire?

Information on the healthy worker hire effect in relation to asthma is scant. We aimed to assess whether and how childhood asthma-related characteristics (before hire) relate to occupational exposures at first hire. Analyses were conducted in 298 children examined at the first survey of the Epidemiological Study on the Genetics and Environment of Asthma (1991-1995), who reported a training period or a job at follow-up in 2003-2007 (aged 17-29 yrs; 53% males). Exposure likelihood to dust, gases and/or fumes in their first occupation was estimated by the ALOHA job exposure matrix. Asthma before the first occupation and two asthma classifications for severity (Global Initiative for Asthma 2002 guidelines) and symptoms were defined by questionnaire. In their first job, 47% of subjects were exposed. After adjustment (age, sex and education), pre-hire onset asthmatics (59%) were nonsignificantly less likely to be exposed (OR 0.67, 95% CI 0.41-1.11). Associations were stronger when considering those with severe asthma or high symptom score in childhood (OR 0.27 (95% CI 0.11-0.63) and OR 0.49 (95% CI 0.25-0.99), respectively). The association was observed in those who completed a university degree (OR 0.55, 95% CI 0.29-1.04) but not in the others (OR 0.98, 95% CI 0.44-2.22), with consistent results for all asthma characteristics. Results suggest a healthy worker hire effect in subjects with more severe or more symptomatic asthma in childhood. Education may modulate self-selection.

Under-estimation of self-reported occupational exposure by questionnaire in hospital workers.

OBJECTIVES: The aim of the study was to determine whether self-reported occupational exposure to cleaning/disinfecting agents in hospital workers is accurate, in comparison to expert assessment, taken to be the gold standard. METHODS: In the Epidemiological Study of the Genetics and Environment of Asthma (EGEA), participants were interviewed on occupation with a specific questionnaire for hospital workers regarding tasks and cleaning/disinfecting agents. Two estimates of exposure were available: self-report and expert assessment. The expert assessment involved a standardised procedure to estimate intensity, frequency and probability of exposure for each job. The present analysis focused on eight exposures: formaldehyde, glutaraldehyde, bleach/chlorine, alcohol, quaternary ammonium components, ammonia, sprays and latex gloves. Agreement and differences between self-reported and expert estimates were studied by kappa and phi coefficients and McNemar tests, respectively. RESULTS: In the survey of 1571 adults, 176 ever hospital workers (327 occupations) with both self-reported and expert exposure assessments were studied. An underestimation of self-reported exposure was observed especially for formaldehyde (26.5% vs 32.7%, p=0.01), ammonia (7.4% vs 18.8%, p<0.0001), alcohol (64.9% vs 93.0%, p<0.0001) and quaternary ammonium components (16.6% vs 70.9%, p<0.0001), compared to expert assessment. CONCLUSION: Occupational exposure to disinfecting/cleaning agents is common and high in hospitals. A large underestimation of self-reported exposure and a lack of knowledge of product components was observed. Our results show the relevance of expert assessment in epidemiological studies to limit measurement bias. This work underlines the need for health education programmes on the occupational risks induced by these types of products.

[Compensation for occupational respiratory diseases in France]. / Réparation des maladies respiratoires professionnelles en France.

Respiratory physicians must be aware of the administrative procedures for the compensation of occupational diseases in order to advise their patients. These procedures for declaration, recognition and compensation are dependent on the patient's social insurance. However, the general principles of this insurance coverage are similar. They are based on a "mixed" system: 1) a presumed cause, when the disease appears on a government list published in the national record (Journal Officiel), and if all administrative and exposure criteria described in that list are met, 2) a case-by-case opinion, with certain limitations, if the presumed cause does not apply. However, these procedures do not apply to self employed workers who do not benefit from occupational disease social insurance. Furthermore, patients with asbestos-related diseases receive additional compensation, the criteria for which are reviewed here: compensation funds and anticipated retirement.

HD-16: a new quality of life instrument specifically designed for insomnia.

BACKGROUND AND PURPOSE: To design a new quality of life (QoL) instrument specifically for insomnia. PATIENTS AND METHODS: Based on severe insomniacs' interviews, we have built a new quality of life scale that has been tested in one group of 240 severe insomniacs, in one group of 422 mild insomniacs and in one group of 391 good sleepers. Ten steps led to the construction of a specific QoL scale. RESULTS: Five dimensions have been validated as both relevant and independent from each other. Sixteen items out of the 43 initially tested were retained and significantly different within the groups in each dimension. Based on the 16 items selected, we called the scale Hotel Dieu 16 (HD-16). We have therefore verified the score's specificity (correlation score of +0.36) and the reliability of the scale (Cronbach coefficient alpha=0.78). CONCLUSION: HD-16 may be used as a focused instrument to better assess an insomniac's quality of life.

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.

Respiratory symptoms and bronchial reactivity among pig and dairy farmers.

OBJECTIVES: This study assessed the prevalence of respiratory manifestations among French pig and dairy farmers and determined the relationship between bronchial reactivity and respiratory manifestations. METHODS: The pig farmers included 102 men working more than half-time inside swine confinement buildings. There were 51 male dairy farmers and 81 male referents. The demographic characteristics of the three groups were similar except for more smokers among the referents. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after a methacholine challenge (cumulative doses 80, 240, and 560 micrograms). Airborne dust, ammonia, and carbon dioxide were measured inside 28 swine confinement buildings. RESULTS: The pig farmers were exposed to a total dust level of 2.41 mg.m-3. The respirable particle concentration was low. The pig and dairy farmers had a significantly higher prevalence of cough and morning phlegm than the referents. Before the methacholine challenge, the dairy farmers had nonsignificantly lower mean lung function values than the other groups. Among the subjects with no history of asthma, nonspecific bronchial hyperreactivity was significantly higher among the pig and dairy farmers than among the referents. There was a fall in the forced expiratory volume in 1 s (FEV 1.0) that was greater than 10% in 6.7% of the referents, 17.9% of the swine workers, and 35.6% of the dairy farmers. This result was unchanged after adjustment for the initial FEV1.0. CONCLUSIONS: The prevalence of respiratory symptoms was significantly higher among the pig farmers without base-line lung function impairment. However, both the pig and the dairy farmers had increased bronchial reactivity.

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%.

[Human Pasteurella multocida infections. Value of serological diagnosis]. / Les infections humaines à Pasteurella multocida. Intérêt du diagnostic sérologique.

In five human cases of Pasteurella multocida infection, high titres of specific antibodies were found by indirect haemagglutination (capsular antigens) and agglutination (somatic antigens). The specificity of the antibodies fitted with the serotypes of the isolated strains (three A 3 and two A 7). Subsequent changes in antibody titres in human beings were similar to those observed in animals. The risk of this animal-acquired infection being probably underestimated in medical practice, the usefulness of these tests in human beings is discussed.

[Risk factors for tumors of the bladder. Epidemiological study of 701 patients in Ile-de-France]. / Facteurs de risque des tumeurs de vessie. Etude épidémiologique chez 701 sujets en Ile-de-France. Groupe Cancers Vessie de PETRI.

The authors present the results of an investigation conducted, under the aegis of the PETRI association, on 701 patients living in the Paris region who, over a 1-year period, had asked the medical advisers of the Social Security Sickness Benefits department to dispense them from paying their portion of the cost of treatment on the ground that they had cancer of the bladder*. The purposes of the investigation were to obtain accurate data concerning the role played by tobacco and alcohol abuse in bladder cancer and to look for possible occupational exposures. The smoking and drinking habits of 636 patients could be analyzed: 89 percent of the men were, or had been, smokers with an average consumption of 33 packs per annum, and with a frequent overconsumption of alcoholic drinks. The professional cursus of 665 patients (31 percent active, 64 percent retired) could be established. The study confirmed that tobacco smoking and alcohol abuse, as well as certain occupational factors, play a role in the development of bladder cancer. Some professional sectors, such as the plastic industry or the hide and leather work, were better represented among these patients than would have been expected from their distribution in the active population. Surveillance of the population exposed by industrial doctors, and follow-up of people who have retired from some sectors of activity are as essential as anti-smoking campaigns.

[Specific bronchial provocation test with solid aerosols. Quantification of results]. / Test de provocation bronchique spécifique avec aérosols solides. Quantification des résultats.

OBJECTIVES: To determine 1) the level of specific bronchial reactivity by challenge with flour and 2) the criteria of positivity using a new method for the expression of the results. METHOD: Thirty-eight asthmatic subjects, occupationally exposed to wheat flour, performed a challenge with lactose then with flour. The instantaneous measurement of the concentration and of the inspiratory airflow were used to calculate the inhaled dose and to establish the dose-response relationships. The results were given 1) by the dose of flour provoking a 20% fall in FEV1 (PDf20), 2) by the comparison of the variation of the FEV1 during the challenge with flour to the distribution of the values observed during the challenge with lactose (inferior limit of the confidence interval at 99.7%). RESULTS: The variations of the FEV1 were not significantly related to the inhaled dose of lactose. The specific bronchial reactivity to flour was a continuous data and three groups were distinguished: 1) subjects (n = 15) with high bronchial reactivity had a fall of FEV1 of more than 20% 2) subjects (n = 13) without significant variation of the FEV1 for doses higher than 1,400 micrograms by comparison to the distribution of the values of the lactose test 3) subjects (n = 10) with a significant fall of FEV1 by comparison to the distribution of the values of the lactose test but lower than 20%. For this group with moderate reactivity, the flow of the inhaled dose may be determinant for the bronchial response. CONCLUSIONS: PDf 20 measures the specific bronchial reactivity. However, if the fall in FEV1 is lower than 20%, the specific challenge with flour may be compared to the challenge with lactose to detect the subjects with moderate reactivity. Our results confirmed the role of the inhaled dose and suggested the role of the dose rate in the outset of bronchial obstruction among asthmatic subjects.

[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.

[Human granulocytic ehrlichiosis in Europe]. / L'ehrlichiose granulocytique humaine en Europe.

Human granulocytic ehrlichiosis is an emerging infectious disease, which is transmitted by the tick Ixodes ricinus in Europe, like other diseases: Lyme disease, tick-borne encephalitis, babesiosis... This tick lives in the forest and its hematophagic activity ranges from April to October. Flu and febrile symptoms ten days after tick bite should suggest diagnosing the disease. Disease evolution is generally favorable, even if serious complications may occur. Leukopenia, thrombocytopenia, and elevated serum transaminases are common laboratory findings. Complementary assays useful for the diagnosis are: blood smear, indirect immunofluorescence, and polymerase chain reaction. Biological diagnostic criteria are more and more accurate, with the evolution of knowledge and technique. Tetracycline treatment generally leads to clinical and biological recovery. Informing physicians and occupationally exposed people should reinforce current prevention measures against tick bites.

[Claim, recognition, compensation of occupational respiratory diseases]. / Déclaration, reconnaissance, indemnisation des maladies respiratoires professionnelles.

Many occupations involve an environment that may provoke lung diseases. This should be kept in mind whenever lung disease is diagnosed for detection of an occupational factor requires steps toward prevention, and compensation may be due the patient. Counselling the patient on the administrative steps to be taken often requires the advice of the occupational physician, the consultant physician or specialised services in order to maintain the rights of the patient.