Trends in exposures to physically demanding working conditions in France in 2003, 2010 and 2017.

BACKGROUND: To explore trends in social and occupational inequalities in terms of exposures to physically demanding working conditions for French employees. METHODS: Our study assessed data from the French national cross-sectional survey of occupational hazards (SUMER) that was conducted in 2003, 2010 and 2017. Trends in the prevalence of several types of physically demanding working conditions (lifting of heavy loads, awkward postures, vibrations, harmful noise, extreme temperatures, and carcinogenic, mutagenic and reprotoxic agents) were explored. Temporal changes in associations of individual and job characteristics with these factors of hardship at work were examined using multilevel logistic regressions. RESULTS: We estimated that 53.5% of French workers from all industries in the private sector and in public hospitals were exposed to at least one of the adverse physical working conditions considered in 2017. While the prevalence of exposure to severe physical constraints increased between 2003 and 2017 (+4.2 pp), the exposure associated with a hazardous physical environment decreased sharply (-6.3 pp). These observed trends did not occur similarly for all workers. Several inequalities in exposure increased over the period, particularly to the detriment of blue-collar workers. The situation of shift workers deteriorated in terms of the exposure to vibrations and awkward postures. CONCLUSION: Our study indicates that more stringent interventions are needed to reduce the prevalence of pronounced physical constraints that contribute to MSDs. Future prevention strategies, in addition to seeking to achieve a general reduction in exposure to all physically demanding working conditions, should aim to reduce disparities that adversely affect vulnerable populations.

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.

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.

Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France.

BACKGROUND: To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France. METHODS: This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied. RESULTS: Patients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001). CONCLUSION: To our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.

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.

Economic burden of seasonal influenza B in France during winter 2010-2011.

BACKGROUND: In France, 2-15% of the population is affected annually by influenza, which causes significant socioeconomic disruption. Nevertheless, despite its importance for policy makers, few published studies have evaluated the impact of influenza B. Therefore, we assessed the costs associated with influenza B during 2010-2011 in France. METHODS: Cases of lab-confirmed influenza B were analyzed as part of the Influenza B in General Practice Study. Cost calculations were based on micro-costing methods according to the French Health Insurance (FHI) perspective (in Euros, 2011). Costs were compared between age groups using the Kruskal-Wallis test, and when significant, by multiple comparisons based on rank. Moreover, uncertainties were assessed using one-way sensitivity and probabilistic analyses. Overall economic burden was estimated by multiplying cost per patient, flu attack rate, and the French population. RESULTS: A total of 201 patients were included in the study. We found that the mean cost associated with Influenza B was 72€ (SD: 205) per patient: 70€ (SD: 262) for younger children, 50€ (SD: 195) for older children, 126€ (SD: 180) for adults, and 42€ (SD: 18) for elderly. Thus, we observed significantly different costs between the distinct age groups (p<0.0001). Finally, the economic burden of influenza B for the FHI was estimated to be 145 million Euros (95% CI: 88-201). CONCLUSIONS: Our findings highlight the important impact of influenza B and encourage further investigation on policy regarding vaccination strategies in France.

Collective Protection Measures for Occupational Exposure to Carcinogenic Chemicals in France: The Links between Regulations on Chemicals and Effective Implementation.

European directives stipulate that French employers take all available measures to reduce the use of carcinogenic agents. Our study explores the links between regulations on chemicals and the effective implementation of collective protection measures in France to occupational exposure to carcinogenic chemicals. Individual data from the French national cross-sectional survey of occupational hazards, conducted in 2017, were analysed. We investigated whether stricter regulations and longer exposures were associated with a higher level of collective protection using multivariate logistic regressions. In 2017, any collective protection measures were implemented for 35% of occupational situations involving exposure to a carcinogen. A total of 21% of exposure situations benefited from source-based controls (e.g., isolation chamber and local exhaust ventilation) and 26% from general ventilation, for which the effect is limited as collective protection. Our regressions showed that longer exposure durations were associated with more collective protection. Exposure situations to chemicals classified as proven carcinogens by the European Union (category 1A) benefited more from collective protections, which is not the case for products only classified as suspected carcinogens (category 1B). Exposures to products with a Binding Occupational Exposure Limit Value benefited more from source-based controls. Nonetheless, the time spent on the IARC list of carcinogens did not appear to influence the implementation of collective protection measures, except for local exhaust ventilation. At a time when efforts to improve the implementation of protective measures in order to drastically reduce the risks of occupational cancers are still necessary, stricter European and national regulations, but above all, better coordination with the work of the IARC and its classification, are avenues to pursue.

Analyzing the Difficulties of Continuing Physical Activity during the COVID-19 Crisis in France.

Physical activity (PA) and limiting sedentary behavior have been recognized as health-promoting behaviors for many years. Since the COVID-19 pandemic, changes in lifestyle habits have occurred, causing disparities in PA practice. This article aimed to examine the characteristics of French adults who self-reported having difficulties in continuing their exercise practices during the pandemic. Multivariate logistic regressions were used to test whether certain demographic, morphologic, behavioral (sleep, sedentary lifestyle, extent of household chores), and exercise-related variables were significant predictors of experiencing such difficulties, based on data from an online survey of insurance company members. Difficulties in PA practice were found in 57% of the population surveyed. Several factors were identified as predictors of experiencing difficulties, including a high BMI, the type and number of physical activities usually practiced before lockdown, as well as the number of times per week dedicated to PA. For the employed population, specific factors were additionally decisive: sex, time spent in front of screens, and sleeping. Our results will allow public health policy makers and stakeholders in PA and prevention to better target populations in difficulty during periods of disruption, such as that of the pandemic; thus, allowing them to propose structural or organizational solutions for the continuity of PA practice.

Trends in the Control Strategies for Occupational Exposure to Carcinogenic, Mutagenic, and Reprotoxic Chemicals in France (2003-2010).

BACKGROUND: European directives stipulate that French employers take all available measures to reduce the use of carcinogenic, mutagenic, and reprotoxic (CMR) chemicals. Our study explores the trends for the various control measures that are available to employees exposed to CMR agents, at two time points (2003 and 2010). METHODS: Our study assessed data from the 2003 and the 2010 French national cross-sectional survey of occupational hazards (SUMER). The availability of collective protections (source-based controls and general ventilation) and personal protective equipment (PPE) was explored. Trends in the availability of protective measures were studied using multilevel logistic regressions. RESULTS: Exposure situations without any protective measures decreased considerably between 2003 and 2010 (29.9% versus 17.9%, respectively). The increase in the proportion of exposure situations involving source-based controls (e.g. an isolation chamber and local exhaust ventilation) was, however, much less. Multiple regression analysis showed that the protection strategies depended on the job characteristics (e.g. work schedules, the employment contract, and the occupation) as well as the size of the company. There were noticeable changes between 2003 and 2010. For example, differences in protections available between full-time and part-time workers disappeared in the 7-year period, whereas those between executives/managers and other employees increased, as did the gaps between large and small companies. CONCLUSIONS: Although the overall increase in exposure situations involving protective measures masks a number of differences in exposure between employee categories, it is a step in the right direction. Source-based controls appeared to be implemented more for exposures with the longest durations, and PPE was very often combined with collective protections, which is what is currently recommended.

Does adoption of electronic health records improve the quality of care management in France? Results from the French e-SI (PREPS-SIPS) study.

BACKGROUND: Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. OBJECTIVE: The aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France. METHODS: This retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics. RESULTS: The models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology. CONCLUSION: These results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units.

Does adoption of electronic health records improve organizational performances of hospital surgical units? Results from the French e-SI (PREPS-SIPS) study.

BACKGROUND: Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the organizational performances of acute care hospital surgical units throughout France. METHODS: This retrospective study was based on data derived from three national databases for year the 2012: IPAQSS (Indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. National data and methodological support were provided by the French Ministry of Health (DGOS) and the French National Authority for Health (HAS). Multivariate linear models were used to assess four organizational performance indicators: the occupancy rate of surgical inpatient beds, operating room utilization, the activity per surgeon, and the activity per both nurse anesthetist and anesthesiologist which were dependent variables. Several independent variables were taken into account, including the degree of EHR use. RESULTS: The models revealed a significant positive impact of EHR use on operating room utilization and bed occupancy rates for surgical inpatient units. No significant association was found between the activity per surgeon or the activity per nurse anesthetist and anesthesiologist with EHR use. All four organizational performance indicators were impacted by the type of hospital, the geographical region, and the severity of the pathologies. CONCLUSION: We were able to verify the purported potential benefits of EHR use on the organizational performances of surgical units in French hospitals.

Cancer patients' willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network.

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

[Blood transfusions at home or in the hospital? The preferences of cancer patients]. / Administration des transfusions sanguines à l'hôpital ou à domicile ? Le choix des patients atteints de cancer.

Home blood transfusion (HBT) is as safe and effective as hospital transfusion. If HBT can potentially cause anxiety, it can also improve patients' quality of life. The different factors influencing patients' preference for home or hospital are examined on the basis of a prospective study including 139 patients from the comprehensive cancer center of Lyon, and who received transfusions in the hospital outpatient department or at home between 2003 and 2004. A Probit model was used to identify the determinants of the choice of place of transfusion. The intensity of preference for this choice was assessed with the contingent valuation method. Of 139 patients included in the study, 97 chose HBT in the eventuality of a new transfusion. This preference was significantly related to a previous experiment of HBT and to the distance between patient's home and hospital. Mean willingness to pay was 60.9 euro for home and 47.3 euro for hospital transfusion. These results, in favour of HBT, are probably related to the strong involvement of physicians of the blood centre and their active collaboration with a high-level homecare network.

Arachidonic acid differentially affects basal and lipopolysaccharide-induced sPLA(2)-IIA expression in alveolar macrophages through NF-kappaB and PPAR-gamma-dependent pathways.

Secretory type IIA phospholipase A(2) (sPLA(2)-IIA) is a critical enzyme involved in inflammatory diseases. We have previously identified alveolar macrophages (AMs) as the major pulmonary source of lipopolysaccharide (LPS)-induced sPLA(2)-IIA expression in a guinea pig model of acute lung injury (ALI). Here, we examined the role of arachidonic acid (AA) in the regulation of basal and LPS-induced sPLA(2)-IIA expression in AMs. We showed that both AA and its nonmetabolizable analog, 5,8,11,14-eicosatetraynoic acid (ETYA), inhibited sPLA(2)-IIA synthesis in unstimulated AMs. However, only AA inhibited sPLA(2)-IIA expression in LPS-stimulated cells, suggesting that this effect requires metabolic conversion of AA. Indeed, cyclooxygenase inhibitors abolished this down-regulation. Prostaglandins PGE(2), PGA(2), and 15d-PGJ(2) also inhibited the LPS-induced sPLA(2)-IIA expression. Nuclear factor-kappaB (NF-kappaB) was found to regulate sPLA(2)-IIA expression in AMs. Both AA and ETYA inhibited basal activation of NF-kappaB but had no effect on LPS-induced NF-kappaB translocation, suggesting that suppression of sPLA(2)-IIA synthesis by AA in LPS-stimulated cells occurs via a NF-kappaB-independent pathway. 15-Deoxy-Delta(12,14)-PGJ(2) and ciglitazone, which are, respectively, natural and synthetic ligands for peroxisome proliferator-activated receptor-gamma (PPAR-gamma), inhibited LPS-induced sPLA(2)-IIA synthesis, whereas PPAR-alpha ligands were ineffective. Moreover, electrophoretic mobility shift assay showed PPAR activation by AA and PPAR-gamma ligands in LPS-stimulated AMs. Our results suggest that the down-regulation of basal sPLA(2)-IIA expression is unrelated to the metabolic conversion of AA but is dependent on the impairment of NF-kappaB activation. In contrast, the inhibition of LPS-stimulated sPLA(2)-IIA expression is mediated by cyclooxygenase-derived metabolites of AA and involves a PPAR-gamma-dependent pathway. These findings provide new insights for the treatment of ALI.