Work-related road traffic accidents: emergence of new modes of personal journey - analysis based on data from a register of road traffic accidents in France.

INTRODUCTION: According to the 2018-2019 People Mobility Survey, work-related journeys (commuting and on-duty journeys) account for approximately 25% of all journeys. The use of non-motorised (nm) and motorised (m) personal mobility devices (PMDs) has steadily increased since their introduction into the French market in the last decade. OBJECTIVE: This study aimed to describe the characteristics of work-related road accidents and their evolution since the introduction of new PMDs in France and the increase in the use of scooters. MATERIALS AND METHODS: This was a retrospective, cross-sectional study using data from the Rhône Road Trauma Registry. Data were collected from 2015 to 2020. We included the data for the victims aged 18-70 years who were injured in work-related road accidents. RESULTS: We identified 11 296 individuals aged 18-70 years who experienced work-related road accidents. An injury report was provided for a total of 11 277 patients. A total of 546 passengers and 78 drivers of other motorised vehicles (buses/trams, construction equipment and tractors) were excluded from the analysis. Seven patients died at the time of the accident and seven died after hospitalisation. Of the 10 653 (94.4%) victims, there were pedestrians (5.1%) or riders of bicycles (16.9%), scooters (3.8%), other PMDs (roller blades, skateboards, monowheels, gyropods and hoverboards; 0.4%) and motorised two wheelers (21.4%), or drivers of car (45.3%), and truck (1.5%). More than half of the scooter riders and 80% of other PMD riders were men. More than 60% of other PMD riders and 53% of scooter riders were under 34 years of age. Most scooter road accidents occurred during commuting (95.6%). 65% of the scooter accidents and 50% of other PMD accidents did not have opponents. Overall, one-quarter of the victims experienced accidents without opponents. Most scooter riders had injuries to their upper limbs (59.2%), lower limbs (46.8%), face (21.2%) or head (17.9%). DISCUSSION: This original study on work-related road accidents allowed us to characterise the increase in work-related road accidents associated with new modes of travel, particularly scooters. The results observed for users of scooters and other PMDs in this study were generally consistent with those found in the scientific literature. Despite limited data, the results suggest that accidents involving scooters or other PMDs are of low severity. CONCLUSION: Many head injuries could be prevented with more widespread use of helmets, among scooter and other PMD users and bicycle users.

[The impact of lockdown on mental health in PhD students, a cohort study in a French university]. / Impact du confinement sur la santé mentale des doctorants, une étude de cohorte dans une université française.

INTRODUCTION: Few studies are available on the health status of doctoral students. This position at the border between university studies and a professional activity presents specific risk factors, especially in terms of psychosocial constraints. The lockdowns implemented worldwide to control the COVID-19 pandemic are potentially worsening factors. METHODS: At Lyon 1 University, a systematic medical follow-up of first year PhD students had been set up by the occupational health service in 2019. In the context of the lockdown during the COVID-19 pandemic, a telephonic interview was proposed to the same PhD students in order to assess the impact of the lockdown on working conditions and health and to provide possible assistance. During this interview, a standardized questionnaire was used to collect information about the conditions during the lockdown, doctoral work during this period and the consequences on research progress, as well as possible financial difficulties due to the lockdown. In addition, questions were asked about the perceived general health conditions and consultation with a health practitioner during this period. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety. Questions on lifestyle during lockdown, changes in diet during the period, weight change, and changes in the quantity and quality of their sleep were also asked. Comparisons of perceived health status, the prevalence of anxiety and depression symptoms at baseline and during the follow-up survey were made by MacNemar Chi2 tests, as the data were repeated ones. The students were informed orally and in writing that their data would be entered anonymously into a computer and that they could have access to their data in accordance with the General Data Protection Regulation (GDPR). They were all informed by e-mail about the study results at the end of the study. The data collection process was registered with the National Institute for Health Data (INDS) and with the university's register under reference no. 2020/002 by the university's data protection officer in compliance with the French data protection laws (CNIL). The protocol was approved by the ethics committee of the Lyon University College of General Medicine (notification number: 2020-10-29-02). RESULTS: Of the 161 PhD students initially interviewed, 149 underwent a second interview. In total, 89.2% of the students assessed their health as good or very good. Regarding the answers to the GAD-7 questionnaire, 8.1% had a score equal to or higher than 10, corresponding to moderate to severe anxiety. Regarding the answers to PHQ-9, 19.6% of the PhD students had a score equal to or higher than 9 corresponding to moderate to severe depressive syndromes. The prevalence of an anxiety disorder was significantly associated with the absence of an outside private access in the place of residence during lockdown (75% vs. 37%), an increase in coffee consumption (33% vs. 5%), an increase in the quantity of food consumed (50% vs. 12%), weight gain (50% vs. 19%) and a deterioration in sleep quality (75% vs. 28%). The prevalence of a depressive symptom was significantly associated with lockdown in an urban area (89% vs. 70%), the occurrence of financial difficulties (7% vs. 1%), the consultation of a health professional during the period (34% vs. 15%), smoking cessation (14% vs. 1%), changes in the quantity (31% vs. 9%) and deterioration (59% vs. 25%) of the quality of sleep, and diet changes (66% vs. 43%). GAD-7 scores were unchanged for 90% of participants between the two surveys, but they were higher for 6.8% of doctoral students and lower for 2.7 % (P=0.1). A deterioration of the PHQ-9 scores, i.e. higher scores in the second survey compared to the first, was observed for 15.5% of the PhD students while an improvement of the scores was observed for 1.4% (P=0.0001). DISCUSSION: A number of studies have been published on the impact of lockdown on mental health, but few of them focused specifically on PhD students and even fewer were prospective studies. Their results are therefore difficult to compare with ours; they generally show GAD-7 and PHQ-9 scores that are similar to those of our population, or even higher. The impact of lockdown on the mental health of doctoral students highlighted in our study therefore justifies an appropriate follow-up of this population, particularly in the case of former psychiatric disorders.

Outcome of the Compensation Process Initiated by an Occupational and Environmental Diseases Center.

BACKGROUND: Regional Centers for Occupational and Environmental Pathologies (CRPPE) are responsible for identifying possible occupational etiologies of pathologies. When an occupational origin is determined, an Initial Medical Certificate (IMC) is given to the patient to allow him to initiate a procedure for recognition as an occupational disease (OD) by his health insurance organization. OBJECTIVES: The main aim of this study was to investigate the outcome of occupational disease claims in patients who received an IMC delivered by the CRPPE of Lyon. METHODS: A telephone interview was systematically conducted with patients who consulted the CRPPE for a claim for occupational disease recognition between 07/2020 and 06/2021, about six months after the consultation. It was conducted by a physician using a standardized questionnaire. RESULTS: Out of 128 patients eligible for this study, 98 were included. Diseases of the respiratory system (34.7%) and cancers (28.6%) were the most common pathologies in our population. A process of OD compensation was initiated by 86 patients (87.8%). At the time of the study, the outcome was favorable for 63 patients (73.3%). Moreover, 18 patients (18.4%) wished for additional help from the CRPPE to carry out the procedures. Nine patients requested a new consultation, including five who still needed to complete the process. CONCLUSION: This study shows the benefit of a consultation by occupational disease consultants. However, difficulties still need to be solved in these procedures. Thus, the systematic follow-up of patients shows its advantages. The provision of support to carry out the process seems necessary.

Testicular germ cell tumour risk by occupation and industry: a French case-control study - TESTIS.

OBJECTIVE: Testicular germ cell tumours (TGCT) are the most common cancer in men of working age and its incidence has increased notably over the past 40 years. Several occupations have been identified as potentially associated with TGCT risk. The aim of this study was to further explore the relationship between occupations, industries and TGCT risk in men aged 18-45 years. METHODS: The TESTIS study is a multicenter case-control study conducted between January 2015 and April 2018 in 20 of 23 university hospital centers in metropolitan France. A total of 454 TGCT cases and 670 controls were included. Full job histories were collected. Occupations were coded according to the International Standard Classification of Occupation 1968 version (ISCO-1968) and industry according to the 1999 version of Nomenclature d'Activités Française (NAF-1999). For each job held, ORs and 95% CIs were estimated using conditional logistic regression. RESULTS: A positive association was observed between TGCT and occupation as agricultural, animal husbandry worker (ISCO: 6-2; OR 1.71; 95% CI (1.02 to 2.82)), as well as salesman (ISCO: 4-51; OR 1.84; 95% CI (1.20 to 2.82)). An increased risk was further observed among electrical fitters and related, electrical and electronics workers employed for 2 years or more (ISCO: 8-5; OR≥2 years 1.83; 95% CI (1.01 to 3.32)). Analyses by industry supported these findings. CONCLUSIONS: Our findings suggest that agricultural, electrical and electronics workers, and salesmen workers experience an increased risk of TGCT. Further research is needed to identify the agents or chemicals in these high-risk occupations which are relevant in the TGCT development. TRIAL REGISTRATION NUMBER: NCT02109926.

Recognition of COVID-19 with occupational origin: a comparison between European countries.

OBJECTIVES: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. METHODS: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. RESULTS: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. CONCLUSIONS: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

Role of the occupational disease consultant in the multidisciplinary discussion of interstitial lung diseases.

BACKGROUND: Diffuse interstitial lung diseases (ILD) constitute a heterogeneous group of conditions with complex etiological diagnoses requiring a multidisciplinary approach. Much is still unknown about them, particularly their relationship with occupational exposures. The primary objective of this study was to investigate the distribution of occupational exposures according to type of ILD. The secondary objectives were to estimate the proportion of ILDs possibly related to occupational exposure and to evaluate the added value of the participation of an occupational disease consultant in ILD multidisciplinary discussions (MDD). METHODS: From May to December 2020, all consecutive patients with ILD whose cases were reviewed during a MDD in a referral centre for ILD were prospectively offered a consultation with an occupational disease consultant. RESULTS: Of the 156 patients with ILD whose cases were reviewed in MDD during the study period, 141 patients attended an occupational exposure consultation. Occupational exposure was identified in 97 patients. Occupational exposure to asbestos was found in 12/31 (38.7%) patients with idiopathic pulmonary fibrosis (IPF) and in 9/18 (50.0%) patients with unclassifiable fibrosis. Occupational exposure to metal dust was found in 13/31 (41.9%) patients with IPFs and 10/18 (55.6%) patients with unclassifiable fibrosis. Silica exposure was found in 12/50 (24.0%) patients with autoimmune ILD. The link between occupational exposure and ILD was confirmed for 41 patients after the specialist occupational consultation. The occupational origin had not been considered (n = 9) or had been excluded or neglected (n = 4) by the MDD before the specialised consultation. A total of 24 (17%) patients were advised to apply for occupational disease compensation, including 22 (15.6%) following the consultation. In addition, a diagnosis different from the one proposed by the MDD was proposed for 18/141 (12.8%) patients. CONCLUSIONS: In our study, we found a high prevalence of occupational respiratory exposure with a potential causal link in patients with ILD. We suggest that a systematic specialised consultation in occupational medicine could be beneficial in the ILD diagnostic approach.

Domestic use of pesticides during early periods of development and risk of testicular germ cell tumors in adulthood: a French nationwide case-control study.

BACKGROUND: Testicular germ cell tumours (TGCT) are the most frequent cancers in young men in developed countries and their incidence rate has doubled worldwide over the past 40 years. Early life exposures to pesticides are suspected to increase TGCT risk. Our research aimed at estimating adult TGCT risk associated with parental domestic use of pesticides during early periods of child development. METHODS: We conducted a case-control study of 304 TGCT cases, aged 18-45 years old, recruited in 20 French university hospitals, and 274 controls frequency-matched on hospital and birth year. Participants' mothers provided information on their domestic use of pesticides from 1 year before start of pregnancy to 1 year after their son's birth, for gardening activities, treatment of indoor plants, pets, wood and mold, and pest control. Odds ratios (OR) for TGCT (overall and by histological subtype) and 95% confidence intervals (CI) were estimated using conditional logistic regression. RESULTS: Prevalence of reported domestic use of pesticides was 77.3% for insecticides, 15.9% for fungicides and 12.1% for herbicides. While no association was found for any use of insecticides (OR = 1.27, CI = 0.80-2.01) or herbicides (OR = 1.15, CI = 0.67-2.00), elevated risks of TGCT overall (OR = 1.73, CI = 1.04-2.87) and non-seminoma subtype (OR = 2.44, CI = 1.26-4.74) were observed for any use of fungicides. When specific purposes were examined, using fungicides and/or insecticides for woodwork (OR = 2.35, CI = 1.06-5.20) and using insecticides on cats and dogs (OR = 1.95, CI = 1.12-3.40) were associated with increased risk of non-seminoma subtype. We found no association for seminoma subtype. CONCLUSIONS: Although recall bias may partially explain the elevated ORs, our study provides some evidence of a positive association between domestic use of pesticides during early periods of development, particularly fungicides and risk of adult TGCT and non-seminoma. Given the common domestic use of pesticides in France, further research on TGCT risk is warranted.

Inequalities in the control of the occupational exposure in France to carcinogenic, mutagenic and reprotoxic chemicals.

Background: Our study examined the social disparities that exist in the implementation of protection measures for occupational exposure to carcinogenic, mutagenic and reprotoxic agents in France, and its aim was to identify which types of employees/jobs require priority action. Methods: We analyzed data from the 2010 French national cross-sectional survey of occupational hazards. The availability of the various collective and individual protections was explored. The associations of job and company characteristics with protective measures were studied by multilevel regressions. Results: Effective collective protection measures were implemented in 25% of the exposure situations. Managers and intellectual professionals, who accumulated lower CMR exposure prevalences, durations, and intensities than blue-collar workers, benefited the most from effective collective protections. The availability of effective collective protection measures was not influenced by the size of the company. The presence of a Committee for health, safety, and work conditions, as well as intervention of occupational health and safety officers in the past 12 months were associated with a lower exposure intensity, but not with the implementation of more protection measures. Longer exposure durations were associated with more effective collective protection. Conclusion: Substantial discrepancies were observed in exposure levels and protection measures as a function of the characteristics of employees' jobs and the companies that they work for. The main priority in regard to prevention should be a focus on unskilled workers, since their collective protection still appears to be insufficient, while their exposure lengths and intensities were the most substantial.

Occupation and risk of female breast cancer: A case-control study in Morocco.

BACKGROUND: Breast cancer is the most frequent cancer among Moroccan women. Environmental and occupational factors may play a role in breast cancer etiology. This study aimed to investigate the association between occupation, industry, and breast cancer risk among Moroccan women. METHODS: A total of 300 breast cancer cases and 300 controls (matched by age and area of residence) were included in this study. Full occupational history was collected, with a detailed description of each job held for at least 6 months. Occupations were coded according to the International Standard Classification of Occupations (ISCO 08) and the Moroccan Analytical Classification of Professions (2001). Industries were coded according to the Statistical Classification of Economic Activities in the European Community (2008). Odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounders were estimated by using conditional logistic regression. RESULTS: An overall decreased risk of breast cancer was observed among women doing only household work (OR = 0.32; 95% CI = 0.18-0.55). An increased risk of breast cancer was observed among women in agricultural occupations, particularly those employed as agricultural laborers (ISCO 08 code: 921; OR = 2.91; 95% CI = 1.51-5.60) and the risk increased with duration of employment (P trend = .01). Analyses by industry corroborated these findings. CONCLUSIONS: Our findings suggest that occupational exposures may be associated with increased risk of breast cancer among female agricultural workers in this population. Further investigations, with advanced methods of occupational exposure assessment, are warranted to clarify the role of chemicals involved in this high-risk occupation and to suggest preventive actions and screening.

Systematic screening for occupations and occupational exposures in head and neck squamous cell carcinoma patients.

PURPOSE: The importance of occupational exposures in patients with head and neck squamous cell carcinomas (HNSCC) has received little attention. METHODS: In a single-center study, we prospectively characterized occupational exposures in 154 HNSCC cancer patients in a systematic occupational consultation and examined the association between most frequent exposures, HNSCC stage and localization. RESULTS: Patients occupied a mean of 3.3 different positions during their working life. The prevalence of asbestos, the most frequent exposure (46 patients; 29.9%) was higher than in the French population > 50 years. Other frequent exposures were solvents (n = 26; 16.9%) and silica (n = 19; 12.3%). For 37 patients (24%) a possible link was identified between occupational exposures and HNSCC. Duration of asbestos exposure was significantly higher (p = 0.04) in patients with hypopharyngeal and laryngeal cancer compared to other localizations. CONCLUSIONS: Occupational exposures are frequent in patients with HNSCC and should receive increased attention by physicians.

Do regulations protect workers from occupational exposures to carcinogenic, mutagenic and reprotoxic (CMR) agents in France?

OBJECTIVE: This article explores the impact of regulations on the implementation of collective protections in France to occupational exposure to carcinogenic, mutagenic and reprotoxic (CMR) agents. METHODS: Individual data from the French national cross-sectional survey of occupational hazards conducted in 2010 were analysed. We investigated whether stricter regulations and longer exposures were associated with higher level of collective protection using multivariate logistic regressions. RESULTS: General ventilation, for which effect is limited as collective protection for CMR products, was present in 19% of situations involving CMR agents while isolation chambers, the most effective form of protection, were only very rarely implemented. Multilevel logistic regressions show that exposure situations to products classified as category 1 or 2 by the European Union do not have a higher probability of benefiting from a collective protection measures. Exposures to products with a Binding Occupational Exposure Limit Value selectively benefited from a better level of protection. Exposures to agents entered on the International Agency for Research on Cancer (IARC) list of proven or probable carcinogens benefited more from effective collective protections than products suspected to be carcinogens but not yet classified by IARC. CONCLUSIONS: These results suggest that the dissemination of evaluations of carcinogens by the IARC translate into improved protective measures even though the IARC classification has no mandatory impact on regulations.

Occupational exposures and cancer: a review of agents and relative risk estimates.

OBJECTIVES: The contribution of occupational exposures to the cancer burden can be estimated using population-attributable fractions, which is of great importance for policy making. This paper reviews occupational carcinogens, and presents the most relevant risk relations to cancer in high-income countries using France as an example, to provide a framework for national estimation of cancer burden attributable to occupational exposure. METHODS: Occupational exposures that should be included in cancer burden studies were evaluated using multiple criteria: classified as carcinogenic or probably carcinogenic by the International Agency for Research on Cancer (IARC) Monographs volumes 1-114, being a primary occupational exposure, historical and current presence of the exposure in France and the availability of exposure and risk relation data. Relative risk estimates were obtained from published systematic reviews and from the IARC Monographs. RESULTS: Of the 118 group 1 and 75 group 2A carcinogens, 37 exposures and 73 exposure-cancer site pairs were relevant. Lung cancer was associated with the most occupational carcinogenic exposures (namely, 18), followed by bladder cancer and non-Hodgkin's lymphoma. Ionising radiation was associated with the highest number of cancer sites (namely, 20), followed by asbestos and working in the rubber manufacturing industry. Asbestos, bis(chloromethyl)ether, nickel and wood dust had the strongest effect on cancer, with relative risks above 5. CONCLUSIONS: A large number of occupational exposures continues to impact the burden of cancer in high-income countries such as France. Information on types of exposures, affected jobs, industries and cancer sites affected is key for prioritising policy and prevention initiatives.

Varied exposure to carcinogenic, mutagenic, and reprotoxic (CMR) chemicals in occupational settings in France.

PURPOSE: To explore varied exposure to carcinogenic, mutagenic, and reprotoxic chemicals (CMR) for French employees. METHODS: Our study assessed data from the French national cross-sectional survey of occupational risks (SUMER) that was conducted in 2010 in a national representative sample of employees. We selected 28 CMR agents that were classified by the International Agency for Research on Cancer or European Union as being known or presumed to have CMR potential in humans. The association of individual and job characteristics with exposure prevalence, duration, and intensity of the CMR agents during a 1-week period was examined using multilevel logistic regression analysis. RESULTS: Overall, 10.4% of employees in 2010 were exposed to one or more CMR agents at their workplace, and 3.4% were subjected to multiple CMR exposures. Blue-collar workers, night-shift workers and workers with short-term employment contracts experienced higher exposure prevalence (p < 0.01) and intensity (p < 0.05). Blue-collar workers and shift workers experienced also longer exposure duration (p < 0.001). Conversely, managers, workers of large companies, and women were less exposed to CMR agents (p < 0.001). The presence of a Committee for Health, Safety, and Working Conditions, and intervention by Occupational Health and Safety officers were significantly associated with reduced exposure intensities (p < 0.001 and p < 0.05). Establishment of European CMR regulations and the existence of an applicable substitution principle reduced the exposure duration (p < 0.001) and intensity (p < 0.05). CONCLUSIONS: Our results point out disparities in CMR exposure and identify high-priority targets for prevention measures to help reducing social health discrepancies.

Trends in occupational disparities for exposure to carcinogenic, mutagenic and reprotoxic chemicals in France 2003-10.

Background: To explore trends in social and occupational inequalities in terms of exposure to carcinogenic, mutagenic and reprotoxic chemicals (CMR) for French employees. Our study assessed data from the French national cross-sectional survey of occupational hazards (SUMER) that was conducted in 2003 and 2010. We included all of the 27 CMR agents that were classified by the International Agency for Research on Cancer or European Union regulations as being known or presumed to have CMR potential in humans. Trends in prevalence and degree of exposure were examined using multilevel logistic regression analysis. The number of employees exposed to CMR agents decreased by 17.5% between 2003 and 2010. The only CMR entities for which exposure rates increased are not considered to be proven CMRs according to the European Union regulations. With the exception of apprentices, there was an overall decrease in exposure prevalence for all employees. This decrease occurred, however, to different extents. The decrease in the risk of exposure to CMR agents was much greater for those on permanent contracts, managers, and in enterprises with more than 500 employees. Nonetheless, in situations where there was potential for exposure, companies with fewer than 10 employees were in fact able to decrease the degree of risk more than the others. Our results confirm the relevance of reinforcing regulatory restrictions for CMR products, while also indicating that monitoring of trends in disparities will allow public health policy makers to better evaluate progress made toward reducing disparities that affect vulnerable populations.

[Motivations and obstacles to occupational disease claims in lung cancer patients: an exploratory psychosocial study]. / Moteurs et freins à la reconnaissance en maladie professionnelle des patients atteints de cancers bronchiques : une étude psychosociale.

PURPOSE: The proportion of lung cancers with an occupational origin has been estimated to be between 10 and 20%. They are largely under-reported, as 60% are not compensated as occupational disease. Although most patients are not familiar with the process of compensation, other factors could explain this under-reporting. The aim of this study was to identify psychosocial factors that could impact patients with occupational lung cancer to claim for compensation. METHODS: We conducted a case study involving semi-structured interviews with eight lung cancer patients enrolled in a cohort designed to systematically screen occupational exposures and propose claims for compensation to work-related cancer patients. RESULTS: Seven interviewed patients were familiar with occupational cancers, but most of them did not believe that past exposure could be related to their current disease. Patients associated compensation claims with a long and complex procedure for an abstract purpose. Several patients expressed a certain attachment to their employers. CONCLUSION: Interviewed patients often considered compensation claims to be a grievance procedure against the employers whom they did not consider to be responsible for their disease. Lung cancer is itself an obstacle to compensation considering the aggressive treatments and related adverse events, the poor medium-term prognosis and the predominant role of smoking in the etiology of the disease. Patients mentioned the financial compensation and the role of healthcare professionals as key elements to motivate them to claim for compensation.

Studying the impact of early life exposures to pesticides on the risk of testicular germ cell tumors during adulthood (TESTIS project): study protocol.

BACKGROUND: The incidence of testicular germ cell tumors (TGCT), the most common cancer in men aged 15 to 45 years, has doubled over the last 30 years in developed countries. Reasons remain unclear but a role of environmental factors, especially during critical periods of development, is strongly suspected. Reliable data on environmental exposure during this critical time period are sparse. Little is known on whether it could be a combined effect of early and later-life exposures. METHODS/DESIGN: Our research aims to study the association between TGCT risk and pesticide exposures (domestic, occupational and environmental) during critical time periods of development and combined early and later-life exposures. The study design, developed during a 2-year pilot study, is a multicenter case-control study of 500 cases (ascertained through histology) and 1000 fertile/fecund controls recruited through 21 French 'Centres d'Etude et de Conservation des Œufs et de Sperme humain' (CECOS). Trained professional interviewers interview the subjects and their mothers by phone. Using a geographic information system developed and tested for application in this study design, environmental pesticides exposure assessment is based on life-time residential history. Occupational pesticides exposures are assessed by an industrial hygienist based on parents' occupations and tasks. Exposures during the prenatal period, early childhood and puberty are focused. A blood sample is collected from each participant to assess genetic polymorphisms known to be associated with TGCT risk, as well as to explore gene-environment interactions. DISCUSSION: The results of our study will contribute to better understanding the causes of TGCT and the rapid increase of its incidence. We explore the effect of combined early and later-life pesticides exposure from multiple sources, as well as potential gene-environment interactions that have until now been rarely studied for TGCT. Our design allows future pooled studies and the bio-bank allows additional genetic or toxicological analyses.

Evolution of work conditions for employees driving for work in France based on data from the 2003, 2010 and 2017 SUMER surveys (Surveillance Médicale des expositions aux risques Professionnels).

INTRODUCTION: The occupational road-accident risk on public roads and the work conditions for professional driving is still an important issue in occupational health despite lower road-accident rates. This study presents the evolution over time of the work-related constraints for these employees based on the Sumer surveys carried out in 2003, 2010 and 2017. METHOD: Data from the 2010 and 2017 surveys were restricted to match the scope of the 2003 survey in order to enable prevalence data to be compared in equivalent populations. The main variable of interest was "driving (car, truck, bus, and other vehicles) on public thoroughfares" for work (during the last week of work: yes/no). Work time characteristics, work rhythm, autonomy and scope for initiative, collective work group, standards and evaluations variables were completed by the occupational health physicians. A self-administered questionnaire was also provided to employees and contained the Job Content Questionnaire, which assesses decision latitude, social support and psychological demands, the reward scale of Siegrist questionnaire, the hostile behaviour with inspired questions for Leymann, sick leave and work accidents during the past 12 months and job satisfaction. Finally, prevention in the workplace was also completed by the occupational health physicians. RESULTS: About 25% of employees in France were exposed to work-related driving in 2017, which was stable in comparison with 2003 and 2010. However, the population was older and there were more females, more often from the clerical staff/middle manager category and working in companies with fewer than 10 employees. Employees exposed to work-related driving were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. CONCLUSIONS: The percentage of employees exposed to occupational road accident risk, i.e., exposure to work-related driving, remained stable at about 25% in 2017 compared with previous surveys. These employees were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. PRACTICAL APPLICATIONS: Prevention campaigns on work-related road accident risk should be provided to all employees in all companies since all jobs can be concerned.

The risk of road traffic crashes for occupational drivers: A responsibility study with comparison to the general population.

BACKGROUND: Road accidents are the leading type of work-related fatalities, but the impact of work-related travel on overall traffic safety has been scarcely studied. OBJECTIVE: The main objective of the present study was to assess drivers' relative road accident risk between work-related and personal journeys. METHODS: A responsible/non-responsible case-control study was performed on a sample of 7,051 road accidents in France from the VOIESUR project. Logistic regression determined odds-ratios according to work-related versus personal travel, and identified risk factors for responsibility, specific to each of the two sub-groups. RESULTS: Drivers traveling on duty or commuting home were significantly less often responsible for accidents than drivers on personal journeys: OR = 0.75 [0.63; 0.89] and 0.65 [0.53; 0.80] respectively. Responsibility was significantly more frequent in commuting to versus from work: OR = 1.38 [1.06; 1.78]. Among on-duty drivers, professional passenger-transport drivers had the lowest risk of responsibility (OR = 0.25 [0.11; 0.58]), while those on temporary or work/study contracts and professional light goods vehicle drivers had the highest risk (OR = 11.64 [2.15; 62.94] and OR = 29.83 [5.19; 171.38] respectively). When driving under the influence of alcohol, risk of responsibility was higher in commuting home than in personal journeys. CONCLUSION: On-duty drivers showed lower risk of responsibility for an accident than other drivers. However, on-duty drivers on temporary or work/study contracts, who are usually not subject to specific regulations, showed higher risk, and should be the subject of particular attention regarding occupational risk prevention.

Gingiva squamous-cell carcinoma in a non-smoking patient with occupational exposure to solvent siphoning using mouth: case report and literature review.

Background: While overall head and neck cancer incidence decreases due to reduced tobacco and alcohol consumption, the incidence of HPV negative oral cavity squamous cell carcinoma (SCC) is raising in several industrialized countries, especially in non-smoking and non-drinking patients. Case presentation: We document a case of gingiva SCC in a 56 years old never-smoker patient reporting low alcohol consumption and unusual occupational solvent exposure. The HPV-negative lesion was surgically removed in 2018, and the patient remains in complete remission 4 years after recurrent surgery in 2019. In 2021, the patient was referred to the occupational cancer consultation. The patient worked as screen printer for 18 years. He reported mouth siphoning every 2-3 days to transfer organic solvents (mainly aromatic hydrocarbons and ketones) from containers into smaller recipients, with regular passage of solvents into his mouth. Conclusion: According to the literature, the frequency of solvent siphoning using mouth is likely to be underestimated. While our review did not find studies reporting longterm consequences to the oral cavity of mouth siphoning, current evidence supports a positive association of upper aero digestive tract SCC with occupational exposures to organic solvents and printing processes. In absence of major extraprofessional factors, the HPV-negative gingiva SCC of this patient might be attributable to the regular occupational oral solvent exposure. While the available evidence remains limited to formally establish a causal relationship, clinicians should investigate this hazardous work practice in patients with OSCC and history of solvent exposures.