Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers.

OBJECTIVES: The aim was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low-radiation helical chest CT scan with chest radiograph for the biennial screening of bronchopulmonary cancer, according to the size of detected nodules. MATERIAL AND METHODS: The screening procedure consisted of biennial chest radiograph and monodetector chest CT scan, given to 972 individuals who had been highly exposed to asbestos. A total of 2555 screening procedures were performed. The study focuses on the 1230 screening procedures for which a 2-year follow-up period was available. RESULTS: Twenty-four cases of bronchopulmonary cancer were diagnosed. CT scan detected 20 cancers, 12 of which had not been detected by chest radiograph. Sensitivity of chest radiograph and CT scan were, respectively, 33% and 83%, lesions measuring over 2 mm in diameter being considered as suspect. The specificity of chest radiograph and CT scan were, respectively, 95% and 78%. Calculation of the differential false positive/true positive (FP/TP) ratio and the receiver operating characteristic curve, performed for both chest radiograph and CT scan, facilitated the determination of the best possible compromise between specificity and sensitivity, according to the diameter threshold applied for considering a nodule as suspect. CONCLUSIONS: Although this study confirms the superior sensitivity of chest CT scan compared with conventional chest radiograph, the associated loss in specificity leads to a recommended diameter of 5 mm as the threshold for considering non-calcified lesions as "suspect", for the surveillance of asbestos-exposed individuals.

A cross-sectional study of the health effects of work schedules on 3212 hospital workers in France: implications for the new French work schedules policy.

This study was designed to investigate the effects of work schedules on the health of hospital workers at the Assistance Publique-Hôpitaux de Paris (AP-HP). Out of 40 hospitals, 17 volunteered to participate in this study. The Standard Shiftwork Index and a questionnaire concerning physicians' work schedules were used. Ten thousand questionnaires were distributed anonymously to hospital workers between March and April 1999. Professional categories comprised head nurses, nurses, nursing auxiliaries, hospital agents, midwives and full time physicians. Departments included internal and geriatric medicine, general paediatrics, orthopaedic and general surgery, operating and emergency rooms, and anaesthesiology and intensive care units. 3250 questionnaires were returned. Demographics for the respondents were: 79.2% female, average age 38.1 +/- 9.1 years old. Eleven work schedules were identified. One fourth of the personnel had fixed morning work schedules. The highest level of job satisfaction was found in personnel working in paediatrics while dissatisfaction was strongest in the gerontology and, emergency room personnel. General Health Questionnaire (GHQ) scores were high for head nurses, operating room nurses and junior doctors as well as for personnel with rotating and flexible shifts. This study will be used to make recommendations concerning the reduction of working time for French hospital workers.

Assessment of bibliographic databases performance in information retrieval for occupational and environmental toxicology.

OBJECTIVE: To determine the efficiency of the major bibliographic databases by assessing the percentage of references among the total literature available that can be retrieved from each database. We also evaluated the best database combinations to carry out an exhaustive search. METHODS: BIOSIS, EMBASE, MEDLINE, NIOSH-TIC, and TOXLINE were searched on two topics: allergy to latex and asbestos and mesothelioma, in the title, abstract, or keywords (textwords). This search was performed for the years 1994 and 1995. All the records were classified by journal and author's name and were verified for each record whether or not it was indexed in each database. Statistical analysis was performed with chi 2 test. RESULTS: 777 articles in 510 issues were found. The efficiency of each database (percentage of articles recovered) and of combinations varied between 11% and 63% for one database and between 42% and 86% for a combination of two databases. The reasons why these differences exist between databases, and within a database, between two different subjects or two different years are reported. CONCLUSION: Firstly, it is not advisable to assert that a bibliography is complete when only one database is searched. Secondly, the efficiency of the databases may be quite different. Finally, it is suggested that the best way to be as exhaustive as possible is to search two or more databases-for example, in EMBASE and TOXLINE, or to a lesser extent EMBASE and MEDLINE. This seems to be the best compromise solution between time consumed for searching and efficiency.

[Vaccination in adults]. / Vaccination de l'adulte.

The vaccinal status of adults is not well known but there are reasons to think it is fair from satisfactory. On the occasion of far away travels or premarital or antenatal special examinations, or systematically, every medical doctor should check his patients' state of immunization, regarding the main infectious hazards. Some situations need special attention: patients suffering from chronic visceral diseases, or elderly; people traveling to endemic countries (the case of diphtheria testifies to the development of new hazards all over the world); people with special leisure activities (such as hunting or fishing), or at risk behaviours (alcohol, tobacco, or some sexual practices). The occupational health physicians have to check the conformity of the vaccinations with the law, and to convince employees and employers to invest in the vaccinal protection for what is not compulsory but medically recommended.

Blood superoxide dismutase and plasma malondialdehyde among workers exposed to asbestos.

Blood superoxide dismutase (SOD) and plasma malondialdehyde (MDA) (an indicator of lipid peroxidation [LPO]) were determined in 97 randomly selected asbestos exposed workers (age range: 25-60 years, mean duration of exposures 19.8 +/- 8.3 years) and in 42 healthy male controls. MDA, SOD, and MDA/SOD ratio in asbestos exposed workers were significantly higher than in controls. Among both the controls and exposed workers neither age nor smoking was related to SOD or MDA levels. SOD was significantly positively correlated with MDA among the exposed workers. Such correlation was not observed among the controls. SOD but not MDA was significantly positively correlated with the duration of exposure to asbestos. Mean levels of SOD or MDA in exposed workers with radiographic signs of lung fibrosis or pleural thickening did not differ significantly from those without such signs. The results confirm the possible involvement of LPO and development of anti-oxidant mechanism(s) of prolonged exposure to asbestos in humans. However, SOD seems not to be the essential anti-asbestos-induced LPO. Relation between these factors and lung fibrosis is still unclear.

Risk of spontaneous abortion among nurses handling antineoplastic drugs.

The purpose of the study was to evaluate the frequency of spontaneous abortion in two groups of women. One group consisted of women regularly involved in the preparation of cancer chemotherapy perfusions and therefore considered to be exposed to cytostatic agents; the other consisted of women not occupationally exposed to such agents. The study was carried out in four French hospitals. Four hundred and sixty-six women were involved; 534 pregnancies were described in which 139 were exposed and 357 were unexposed. The results showed that the frequency of spontaneous abortion was 26% for the exposed pregnancies and 15% in the unexposed ones (odds ratio 2.0). These results do not seem to be due either to the classic risk factors of spontaneous abortion (age, cigarette consumption during pregnancy, pregnancy order) (adjusted odds ratio 1.7) or to possible errors concerning the retrospective evaluation of prior gynecologic and obstetric history.

Respiratory health assessment by questionnaire of 2024 workers involved in man-made mineral fiber production.

A respiratory health questionnaire was administered to the workers producing man-made mineral fibers in three glasswool and two rockwool plants in France, in order to detect adverse effects resulting from fiber exposure. The mean ages of the 2024 male participants ranged from 32 to 41 years. The standardized questionnaire was filled in by the industrial physicians: occupational history, smoking habits, respiratory symptoms (cough, phlegm, dyspnea, asthma), irritative complaints of the upper airways (nasal fossae and sinuses, pharynx and larynx) were all recorded. Multiple unconditional logistic regression was used to test for a relationship between possible explanatory variables and these symptoms. The prevalence of respiratory symptoms (cough, phlegm, dyspnea) was strongly correlated with age and increased markedly among current smokers. Having adjusted for these confounding factors, significantly elevated Odds Ratios (ORs) for cough and phlegm were observed among the workers of one plant (51% of the whole study population) who had been exposed to fibers for a long time. In the same plant, the ORs for complaints of nasal fossae and sinuses increased significantly with the duration of fiber exposure, and one elevated OR was observed for pharyngeal and laryngeal symptoms. These findings were not consistent with the results observed in the four other plants (49% of the study population), since ORs for all these symptoms were either low or not significantly increased according to the duration of fiber exposure. This lack of similarity among plants could be explained either by differences in interviewers, age, seniority and tobacco consumption, or by secular changes in the industrial processes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

[The relevance of chest X-rays and respiratory function tests to the assessment of occupational hazards in asbestos factory workers (author's transl)]. / Expertise de dossiers d'ouvriers d'une filature d'amiante. Place de la radiographie et de l'exploration fonctionnelle (70 cas).

The authors have analyzed the medico-legal records of 70 workers from an asbestos factory, who developed pneumoconiosis, sometimes after prolonged exposure. X-ray films were interpreted (though not without some difficulty) according to the I.L.O. classification criteria. Respiratory function tests included spirometry, gas exchange determination and blood gas measurements. There was a correlation between the duration of occupational exposure and the onset of chest lesions visible on X-ray films (pleural thickening, pulmonary fibrosis and later, pleural calcifications) and a closer correlation between these and the results of the two main respiratory function tests: vital capacity and fractional global and arterio-alveolar CO uptake coefficient (DuaCO). It appeared, however, that lung function impairment sometimes preceded radiological abnormalities, and this should be taken into consideration when assessing the financial compensation due to workers exposed to asbestos.

[Comparison of data of respiratory function tests and pulmonary radiology images. Apropos of 106 subjects exposed to asbestos]. / Comparaison entre les données de l'exploration fonctionnelle respiratoire et les images radiologiques pulmonaires. A propos de 106 sujets exposés a l'amiante.

We have compared X-ray and lung function data in 106 asbestos workers with diverse, yet most often prolonged and important, exposure times. Based on the international B.I.T. classification, we have found a significant link between VC and type, density, opacity extent and presence of pleural thickening. The same relationship is found with alveolo-arterial ductance. On the whole, however, it is difficult to determine lung function condition with X-ray. Thus, certain criteria concerning function should be considered as well as radiography.