Job Restrictions for Healthcare Workers with Musculoskeletal Disorders: Consequences from the Superior's Viewpoint.

Objective Many workers suffer from musculoskeletal disorders. In France, occupational physicians are able to set job aptitude restrictions obliging employers to adapt the worker's job. The present study explored the impact of job restriction from the point of view of the employees' supervisors. Methods A qualitative study was conducted in 3 public hospitals. 12 focus groups were organized, involving 61 charge nurses and head nurses supervising 1 or more workers restricted for heavy lifting or repetitive movements. Discussions were recorded for qualitative thematic analysis. Results Charge and head nurses complained that aptitude restrictions were insufficiently precise, could not be respected and failed to mention residual capability. A context of personnel cuts, absenteeism and productivity demands entailed a need for polyvalence and reorganization threatening the permanence of adapted jobs. Job restrictions had several negative consequences for the charge and head nurses, including overwork, increased conflict, and feelings of isolation and organizational injustice. Conclusion Protecting the individual interests of workers with health issues may infringe on the interests of their supervisors and colleagues, whose perception of organizational justice may go some way to explaining the support or rejection they show toward restricted workers. This paradox should be explicitly explored and discussed.

[Renal cell carcinoma and exposure to trichloroethylene: are the French limits of occupational exposure relevant?]. / Cancer du rein et expositions au trichloroéthylène: les valeurs limites d'exposition professionnelle françaises en vigueur sont-elles adaptées ?

BACKGROUND: Several studies have investigated the association between trichloroethylene (TCE) exposure and renal cell cancer (RCC) but findings were inconsistent. The analysis of a case control study has shown an increased risk of RCC among subjects exposed to high cumulative exposure. The aim of this complementary analysis is to assess the relevance of current exposure limits regarding a potential carcinogenic effect of TCE on kidney. METHODS: Eighty-six cases and 316 controls matched for age and gender were included in the study. Successive jobs and working circumstances were described using a detailed occupational questionnaire. An average level of exposure to TCE was attributed to each job-period in turn. The main occupational exposures described in the literature as increasing the risk of RCC were assessed as well as non-occupational factors. A conditional logistic regression was performed to test the association between TCE and RCC risk. Three exposure levels were studied (average exposure during the eight-hour shift): 35ppm, 50ppm and 75ppm. Potential confounding factors identified were taken into account at the threshold limit of 10% (p=0.10) (body mass index [BMI], tobacco smoking, occupational exposures to cutting fluids and to other oils). RESULTS: Adjusted for tobacco smoking and BMI, the odd-ratios associated with exposure to TCE were respectively 1.62 [0.77-3.42], 2.80 [1.12-7.03] and 2.92 [0.85-10.09] at the thresholds of 35ppm, 50ppm and 75ppm. Among subjects exposed to cutting fluids and TCE over 50ppm, the OR adjusted for BMI, tobacco smoking and exposure to other oils was 2.70 [1.02-7.17]. CONCLUSION: Results from the present study as well as those provided in the international literature suggest that current French occupational exposure limits for TCE are too high regarding a possible risk of RCC.

Indicators of long-term return to work after severe traumatic brain injury: A cohort study.

BACKGROUND: Return to work (RTW) is a major objective in the rehabilitation of individuals with severe traumatic brain injury (TBI). Implications for long-term occupational integration (beyond 5 years) have rarely been studied. OBJECTIVE: The objective was to assess long-term RTW and the associated factors after severe TBI. MATERIAL AND METHODS: Retrospective analysis of a cohort of individuals 16 to 60 years old admitted to hospital after severe TBI from 2005 to 2009 and followed prospectively. Medical and occupational data were collected from medical files and by systematic telephone interview to assess outcome at a minimum of 6 years post-trauma. Factors associated with RTW were investigated by multivariable regression analysis, estimating prevalence ratios (PRs) and 95% confidence intervals (CIs). A proportional hazards model was used to study RTW delay, estimating hazard ratios (HRs). RESULTS: Among the 91 individuals included (mean [SD] age 28.5 [11.3] years; 79% male), 63.7% returned to work after a mean of about 20 months, and 57.1% were still working at the time of the survey. Factors significantly associated with RTW on multivariable analysis were higher educational level (adjusted PR, 1.53; 95% CI, 1.15 to 2.03), absence of motor disability (adjusted PR, 1.82; 1.12 to 2.95) and behavioural disorder (adjusted PR, 1.26; 1.01 to 1.60), as well as disabled worker status (adjusted PR, 1.26; 1.01 to 1.60) (likelihood of the multivariate analysis model 53.1). Delayed RTW was associated with health insurance payments (adjusted HR, 0.40; 95% CI, 0.22 to 0.71), motor disability (adjusted HR, 0.34; 0.15 to 0.76), low educational level (adjusted HR, 2.20; 1.06 to 4.56) and moderate disability on the Extended Glasgow Outcome Scale (adjusted HR, 0.49; 0.27 to 0.91) (likelihood of the multivariate analysis model 335.5). CONCLUSION: Individuals with the most severe TBI are able to RTW and remain in work. This study highlights the multiple determinants involved in RTW and the role of socioenvironmental factors.

Optimizing a recycling process of SMC composite waste.

Investigations about the recycling of sheet moulding compounds (SMC) waste as incorporation material for thermoplastic polymer matrix are reported in this paper. A new efficient process is developed in order to strongly increase the reinforcement glass fraction of SMC leading to good mechanical performance of the new thermoplastic compounds. The overall process is composed of two main steps: mechanical and chemical. The second stage is characterised in terms of optimization and capability by means of experimental design and statistical process control techniques for finding the optimal chemical conditions and validating the process.

Road casualties in work-related and private contexts: occupational medical impact. Results from the ESPARR cohort.

BACKGROUND: Road accidents may impact victims' physical and/or mental health and socio-occupational life, notably including return to work. OBJECTIVES: To assess whether the occupational medical consequences sustained by subjects injured in road accidents occurring in a work-related context differ from those associated with private accidents. METHODS: 778 adults who were in work or occupational training at the time of their accident were included. Two groups were distinguished: 354 (45.5%) injured in road accidents occurring in a work-related context (commuting or on duty) and 424 (54.5%) injured in a private accident. The groups were compared on medical and occupational factors assessed on prospective follow-up at 6 months and 1 and 3 years. Multivariate analysis explored for factors associated at 6 months and 1 year with sick leave following the accident and duration of sick leave. RESULTS: There were no significant differences between groups for demographic data apart from a slightly higher injury severity in private accidents (32.5% of private accidents with MAIS3+(Maximum Abbreviated Injury Scale greater or equal to 3) vs. 23.7% for work-related accidents, p = 0.007). Victims of work-related accidents were more often on sick leave (OR = 1.8; 95% CI, 1.1-2.9). Although the length of sick leave is higher for work-related accidents that for private accidents, multivariate analysis showed that the injury severity and the post-traumatic stress disorder (PTSD) are significant factors to explain the time to return to work. There were no significant differences according to occupational impact during follow-up, notably including sick-leave duration, number of victims returning to work within 3 years and number of victims out of work due to incapacity. CONCLUSIONS: In the ESPARR (follow-up study of a road-accident population in the Rhône administrative county: Etude de Suivi d'une Population d'Accidentés de la Route dans le Rhône) cohort, the fact that a road accident occurred in a work-related context did not affect the occupational consequences.

Cancer mortality in a synthetic spinning plant in Besançon, France.

OBJECTIVES: To assess the mortality of a cohort of workers in a synthetic textile spinning plant and to evaluate the relationship between mortality from lung, liver and bladder cancer and the processes or the products used. METHODS: The study population consisted of male workers present for at least 6 months in the plant from 1968 to 1984. The cohort was followed until 1999. Vital status and the causes of death were determined by consulting national registries. The population of the Franche-Comté region was used for comparison. In total, 17 groups of exposure were assessed by the industrial hygienist, based on the consensus of an expert group that determined the exposure levels of each job to selected occupational hazards. Each worker was assigned to one or several groups, according to his occupational history. Confounding factors could not be assessed. Standardised mortality ratios (SMR) and 95% bilateral confidence intervals were calculated based on an assumed Poisson distribution of the number of cases to compare the plant mortality and the population mortality. Internal analyses were performed with Cox models in order to assess the risks of death related to the various exposures. RESULTS: In the whole cohort, mortality from all malignant neoplasms was lower than expected, but this was not significant. All the estimated SMRs were lower than or close to 1. The "hot -line fitters" (RR = 2.13; n = 9; 1.06 to 4.29) and the "fibre-drawing workers" (RR = 1.83; n = 20;1.09 to 3.07) experienced a statistically significant excess in mortality from lung cancer. A slightly elevated but not significant risk of death related to lung cancer (RR = 1.5; n = 41; 0.8 to 2.7) was observed in the groups with the highest exposure to mineral fibres. A statistically significant increase in cancer deaths was observed for workers with high exposure to dust (higher intensity: RR = 1.42; n = 79; 1.06 to 1.89). CONCLUSION: Some findings, mainly of lung cancer, justify further exploration in other plants in this industry.

[Cell Phones and Risk of brain and acoustic nerve tumours: the French INTERPHONE case-control study]. / Téléphone mobile, risque de tumeurs cérébrales et du nerf vestibuloacoustique: l'étude cas-témoins INTERPHONE en France.

BACKGROUND: Use of cell phones has increased dramatically since 1992 when they were first introduced in France. Certain electromagnetic fields (at extremely low frequency) have been recognized as possibly carcinogenic by the International Agency for Research on Cancer. Given the use of radiofrequency technology in cell phones, the rapid increase in the number of cell phones has generated concerns about the existence of a potential health hazard. To evaluate the relationship between the use of cell phones and the development of tumors of the head, a multicentric international study (INTERPHONE), coordinated by the International Agency for Research on Cancer, was carried out in 13 countries. This publication reports the results of the French part of the INTERPHONE study. METHODS: INTERPHONE is a case-control study focused on tumors of the brain and central nervous system: gliomas, meningiomas and neuromas of cranial nerves. Eligible cases were men and women, residents of Paris or Lyon, aged 30-59, newly diagnosed with a first primary tumor between February 2001 and August 2003. The diagnoses were all either histologically confirmed or based upon unequivocal radiological images. Controls were matched for gender, age (+/-5 years) and place of residence. They were randomly drawn from electoral rolls. Detailed information was collected for all subjects during a computer-assisted face-to-face interview. Conditional logistic regression was used to estimate the odds ratio (OR) for an association between the use of cell phones and risk of each type of cancer. RESULTS: Regular cell phone use was not associated with an increased risk of neuroma (OR=0,92; 95% confidence interval=[0.53-1.59]), meningioma (OR=0,74; 95% confidence interval=[0.43-1.28]) or glioma (OR=1.15; 95% confidence interval=[0.65-2.05]). Although these results are not statistically significant, a general tendency was observed for an increased risk of glioma among the heaviest users: long-term users, heavy users, users with the largest numbers of telephones. CONCLUSION: No significant increased risk for glioma, meningioma or neuroma was observed among cell phone users participating in Interphone. The statistical power of the study is limited, however. Our results, suggesting the possibility of an increased risk among the heaviest users, therefore need to be verified in the international INTERPHONE analyses.

Side effects of ranitidine.

Ranitidine was first marketed in 1981; since then many patients have been treated such that much experience has been accumulated on the safety of this histamine H2-receptor antagonist in the treatment of gastroduodenal disease. A wide array of ranitidine-associated side effects has been described, but infrequently. As so much information is now available, the aim of this review is to assess the weight of evidence for a causal link between ranitidine and the reported side effects. Overall, ranitidine is well tolerated. The incidence of general side effects at less than 2% is very similar to placebo. Headaches, tiredness, dizziness and mild gastrointestinal disturbance (e.g. diarrhoea, constipation and nausea) are among the most frequent complaints, but have very seldom resulted in stopping treatment. Cardiovascular side effects are extremely rare and unpredictable with the usual doses of oral ranitidine (at most 1 in 1 million patients). They mostly comprise sinusal bradycardia and atrioventricular blockade, especially after rapid intravenous administration, receding after cessation of the drug. Clinical studies, however, have not shown a significant pharmacological effect of ranitidine on the cardiovascular system via H2-receptors, even though individual sensitivities cannot be ruled out in a few isolated reports. Ranitidine is unlikely to be directly hepatotoxic: a transient change in liver function tests has been noted in only 1 in 100 to 1 in 1000 patients. Several cases of mixed hepatitis have been reported, but very few were fully documented. The incidence of ranitidine-associated acute hepatitis has been estimated to be less than 1 in 100,000 patients. Neuropsychiatric complications may be less common and clinically quite similar to those reported with cimetidine, i.e. confusion, disorientation, hallucinations, delirium. These side effects have occurred especially in critically ill and multiple-therapy patients, or patients with chronic renal or hepatic failure, so that the direct causal link with ranitidine treatment was often difficult to ascertain. Even though an H2-receptor-mediated effect is an attractive hypothesis (since similar complications were noted with other H2-receptor antagonists), other mechanisms have been suggested to play a role, e.g. cholinergic or histaminic effects. The overall incidence of neuropsychiatric complications is probably markedly less than 1%. White cell injury (i.e. agranulocytosis) appears to be the most frequent haematological complication, even though case reports are very few and poorly documented.(ABSTRACT TRUNCATED AT 400 WORDS)

Risk of occupational blood exposure in a cohort of 24,000 hospital healthcare workers: position and environment analysis over three years.

Early and efficient prevention of occupational blood exposure at hospital requires knowledge of exposures and risks according to staff characteristics. Calculation of annual exposure rates and relative rates from personal and occupational data. The overall annual incidence was 3.5 per 100 workers per year; maximum for nurses and midwives (6.5); minimum for cleaners and paramedics (0.6). Exposures affected mainly nurses (57.81% of accidents, 12.12% of cohort) and occurred mostly in the surgical and the medical departments (26.34 and 25.20% of accidents). Men/women and students/physicians rate differences were not significant. Emergency and intensive care staffs had the highest relative rates (4.27 and 3.05) compared with maintenance staff. Nurses and laboratory staff were more exposed than physicians (3.76 and 2.30 times) were. Our results prompt prevention and training to be precisely focused and efficiently devised.

Maternal occupational risk factors for oral clefts. Occupational Exposure and Congenital Malformation Working Group.

OBJECTIVES: This study investigated the role of maternal exposures at work during pregnancy in the occurrence of oral clefts. METHODS: The occupational exposures of 851 women (100 mothers of babies with oral clefts and 751 mothers of healthy referents) who worked during the first trimester of pregnancy were studied. All the women were part of a multicenter European case-referent study conducted using 6 congenital malformation registers between 1989 and 1992. In each center, the mother's occupational history, obtained from an interview, was reviewed by industrial hygienists who were blinded to the subject's status and who assessed the presence of chemicals and the probability of exposure. Odds ratios (OR) were estimated by a multivariate analysis including maternal occupation or occupational exposures during the first trimester of pregnancy and possible confounding factors such as center of recruitment, maternal age, urbanization, socioeconomic status, and country of origin. RESULTS: After adjustment for confounding factors, cleft palate only was significantly associated with maternal occupation in services such as hairdressing [OR 5.1, 95% confidence interval (95% CI) 1.0-26.0] and housekeeping (OR 2.8, 95% CI 1.1-7.2). The analysis suggests that the following occupational exposures are associated with orofacial clefts: aliphatic aldehydes (OR 2.1, 95% CI 0.8-5.9) and glycol ethers (OR 1.7, 95% CI 0.9-3.3) for cleft lip with or without cleft palate and lead compounds (OR 4.0, 95% CI 1.3-12.2), biocides (OR 2.5, 95% CI 1.0-6.0), antineoplastic drugs (OR 5.0, 95% CI 0.8-34.0), trichloroethylene (OR 6.7, 95% CI 0.9-49.7), and aliphatic acids (OR 6.0, 95% CI 1.5-22.8) for cleft palate only. CONCLUSIONS: Due to the limited number of subjects, these results must be interpreted with caution. However, they point out some chemicals already known or suspected as reproductive toxins.

Bladder cancer and occupational exposures.

OBJECTIVES: A hospital-based case-referent study was carried out in Lyon with the purpose of generating hypotheses about the role of occupational exposures to 320 compounds in bladder carcinogenesis. METHODS: Job histories were obtained by questionnaire for 116 cases and 232 reference patients with diseases other than cancer (one referent from the same hospital ward and one from another ward of the same hospital per case); the referents were matched for gender, hospital, age, and nationality. Systematic coding of exposures, with a blind analysis of job histories, was carried out by a team of experts in chemistry and occupational health. RESULTS: Significantly elevated odds ratios were observed for exposure to pyrolysis and combustion products [odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.0-4.0] when the general referents were used and for cutting fluids (OR 2.6, 95% CI 1.2-5.4) when tobacco consumption was adjusted for. The latter was highest among the category consisting of blue-collar and unskilled workers, supervisors, and agricultural workers (OR 4.6 95% CI 2.0-10.6), while the odds ratio for the other category was 0.8 (95% CI 0.3-2.7). An elevated odds ratio for exposure to inks was observed for the women (OR 14.0, 95% CI 1.8-106.5) on the basis of 14 exposed cases, but confounding factors could have been responsible for this result. Odds ratios for several other exposures (rubber: OR 5.7, nitrates: OR 8.2, coke dust: OR 3.5, meat additives: OR 3.8) were also elevated, but not significantly so when based on a small number of exposed cases. CONCLUSION: The observations of this investigation should be tested in future studies, in particular since exposures to agents such as cutting fluids or pyrolysis products are ubiquitous in industrial settings and may present an important public health hazard.

Neutrophil functions in lead-exposed workers.

Neutrophil functions were studied in 38 lead-exposed workers compared to 34 controls. Both groups were matched according to age, sex, drinking and smoking habits, ethnic origin and drug intake. Blood lead levels were found to be seven times higher in exposed workers than in controls. Phagocytosis assayed by chemiluminescence was found to be slightly but not significantly altered in exposed workers. In contrast, chemotaxis using the agarose technique was significantly depressed. These results are in agreement with previous in-vitro findings. A further assessment of clinical consequences is warranted.

[Autoimmune hemolytic anemia during treatment with cyclosporin after liver transplantation]. / Anémie hémolytique auto-immune au cours d'un traitement par la ciclosporine après transplantation hépatique.

Hemolytic anemia was observed in a 36 year-old liver transplant patient. The immunosuppressive regimen included cyclosporine A and prednisolone. Hemolysis appeared a few days after amoxicillin treatment. The presence of anti-D allo-antibodies, auto-antibodies active against erythrocytes, and an immuno-allergic phenomenon against erythrocytic membrane coated by cyclosporine was demonstrated. Increase of daily dose of prednisolone without modification of cyclosporine doses was followed by the disappearance of allo- and auto-sensitization. The role of amoxicillin in promoting these hemolytic phenomenons may be suggested.

[Mortality in the French paper and pulp industry]. / Une étude de mortalité dans l'industrie française du papier et de la pâte à papier.

BACKGROUND: The objective was to describe a possible cancer mortality risk in relation with the occupational exposure within an International study co-ordinated by the International Agency for Research on Cancer. METHODS: An epidemiological cohort study was set up to assess the mortality in four French pulp and paper companies. The four cohorts were followed up from January 1st 1968 to December 31st 1992. The causes of death were ascertained by matching with the national file of causes of death. RESULTS: The full cohort consisted in 5,529 men and 876 women. The total numbers of subjects deceased between 1968 and 1992 were respectively 708 and 34. Causes of death could be traced for 98%. The observed mortality was significantly lower than the expected for all causes of deaths (SMR = 0.86) as well for all deaths by cancer (SMR = 0.87). The analysis by departments showed an excess mortality by cancer of the pancreas in the wood preparation department (SMR = 3.14) as well as in the paper production department (SMR = 2.04). CONCLUSIONS: In absence of any prior hypothesis, it is difficult to assign an occupational origin to these observed excesses. The future results of the international study will enable us to interpret these results more precisely.

[Occupational exposure and malignant hemopathies: a case-control study in Lyon (France)]. / Expositions professionnelles et hémopathies malignes: une enquête cas-témoins réalisée à Lyon (France).

A hospital based case-control study was carried out in Lyon with the aim of assessing the association between haematologic malignancies and occupational exposures to 320 compounds. Job histories were obtained by questionnaire for 118 cases (52 non Hodgkin lymphomas, 48 acute myeloid leukemia, 18 others leukaemias), and 118 controls with diseases other than cancer from the same general hospital; controls were matched for sex, age and nationality. Systematic coding of exposures based on a blind analysis of job histories, was done by a team of experts in chemistry and occupational health. Mantel-Haenszel analysis was performed. Significantly elevated odds-ratio were observed for non Hodgkin lymphomas and exposure to mineral oils (14.86; 2.76-80.0), excavation dusts (3.91; 0.94-15.95), alkali compounds (2.90; 1.09-7.68), inks (2.47; 1.09-5.17). For inks, a dose-response relation was observed. Elevated odds-ratios appeared for acute myeloid leukaemias and arsenic compounds (3.02; 0.90-10.13) and lead compounds (3.70; 1.09-13.44). When regarding industrial activities, two of them are more frequently found: food industries (14 cases/5 controls), public works (12 cases/0 control). When regarding jobs, winding (6 cases/0 control), glass workers (8 cases/1 control) and warehousemen (10 cases and 4 controls) are more often seen among cases.

[Social impact of screening and of medical surveillance on people exposed to asbestos]. / L'impact social du dépistage et de la surveillance médicale chez les personnes exposées à l'amiante.

A medical screening program has collective and individual impact. The collective benefit of medical screening for people exposed to asbestos would be financial (better compensation of occupational diseases related to asbestos). The cost of compensation would be attributed to the special assurance fund for occupational diseases. A medical screening of asbestos diseases would set an example for other Public health problems. It would be important for admission of social damage for the French nation. For individuals, social benefits would be better (compensation during work stop and annuities). But screening can have a negative psychological impact for asymptomatic persons. Persons exposed to asbestos and patients with asbestos diseases are able to quit their job for anticipated retirement. Is it a benefit for patients with mesothelioma or lung cancer? It is a very important benefit for asbestosis. The risk is to change the objective of medical screening into a social screening. The financial and medical benefits of screening for hyaline plaques is very poor. Awarding social damage is important for individuals.

[Quality of life and resumption of social life after heart transplantation]. / Qualité de vie et réinsertion sociale après transplantation cardiaque.

An enquiry by means of a questionnaire was conducted among 48 patients who had received a heart transplant, in order to evaluate their quality of life and their reinsertion into the french society. Health status, physical capacities, daily social and occupational activities and degree of satisfaction are analyzed. Eighty per cent of the patients considered themselves in excellent or good health; their Karnofsky's index, which globally assesses functional capacities, was 1.6, i.e. close to the normal value of 1 and to the results obtained in heart transplant recipients in the USA and in kidney transplant recipients; 61% of non-retired patients had resumed professional or learning activities. There were little changes in leisure activities. Matrimonial happiness was high, although sexual satisfaction was less complete than normally. Ninety-three per cent were satisfied with their life after transplantation.

[Chemical-induced cancers]. / Cancers chimio-induits.

Most chemical carcinogenic agents are industrial. About 4% of all cancers have an occupational origin, but the percentage is higher in exposed populations. Evidence of carcinogenicity is provided by epidemiological studies, animal experiments and other biological sources like experimental mutagenesis. The IARC (International Agency for Research on Cancer) classification and the European Union classification of carcinogenic agents for humans are useful for prevention and regulation. Some cancers are classified as occupational diseases but only a few persons receive compensation given the difficulties of aetiologic diagnosis and the frequent absence of declaration.

[Follow-up after occupational asbestos exposure: terms and devices in foreign]. / Suivi après exposition professionnelle à l'amiante : modalités et dispositifs étrangers.

INTRODUCTION: Diseases, including cancer induced by asbestos, usually occur after many years of latency. The follow-up of employees must therefore continue after the end of their employment (retirement, redundancy, etc.) and such an arrangement has existed in France since 1996. This article reviews the literature on the post-employment monitoring arrangements that exist outside of France, particularly in other European countries, and their characteristics. STATE OF ART: This research has revealed a limited number of national experiences in Germany, Spain, Finland, Italy, Norway, Poland, and Switzerland. The medical protocols generally involve: algorithm decisions, questionnaire, physical examination, chest radiography, CT scan, and/or spirometry. PERSPECTIVES: Internationally, various methods exist to select employees for follow-up and to determine the frequency of subsequent examinations. Unlike Germany, which has a long experience of such medical follow-up, several of these programs are more recent. CONCLUSIONS: Post-occupational medical surveillance of asbestos-related disease is uncommon, monitoring arrangements vary and depend on medical and also on social factors. The French system of post-occupational monitoring can undoubtedly improve but it bears comparison with arrangements in other countries, where these are even present.