Takotsubo syndrome in a teen health centre.

BACKGROUND: Takotsubo syndrome is also referred to as stress cardiomyopathy and typically occurs in females aged 55 years and older. This demographic represents a significant part of the healthcare workforce and they have over recent decades experienced increasing levels of violence from patients and clients. AIMS: Our study describes a Takotsubo syndrome that occurred following an incident of physical and verbal aggression at work in a teen health centre. CASE REPORT: We report the case of a 56-year-old female community educator who suffered chest pain 48 h after suffering an aggressive incident at work. She had no history of cardiovascular disease. During hospitalization she was investigated with an electrocardiogram, echocardiography, coronary angiography, left ventriculography and a cardiac magnetic resonance imaging. Examinations confirmed the diagnosis of Takotsubo cardiomyopathy. This was deemed to be a work-related accident. With the help of her occupational physician, the patient was able to return to work with work adjustments. CONCLUSIONS: Increasing levels of violent behaviours towards staff in the health care sector underscores the need for measures in the workplace to help prevent precipitation of this syndrome in workers.

Radiation protection for surgeons and anesthetists: practices and knowledge before and after training.

The use of radiological activity in the operating room (OR) and a regulatory decrease of the eye lens dose warrant an assessment of how medical staff are protected from radiation. This study aims to evaluate practices and knowledge in radiation protection (RP) for OR doctors before and after training. A descriptive study of surgeons and anesthetists in a French public hospital center was conducted in 2016. An ad hoc questionnaire concerning occupational practices and knowledge about RP was distributed before and one month after RP training. Among 103 doctors attending the training, 90 answered the questionnaire before the training. Results showed a lack of knowledge and good practice in RP. Most of the participants (86.7%) had never been trained in RP and recognized insufficient knowledge. Most of them (92.2%) wore a lead apron, 50.0% a thyroid-shield, 5.6% lead glasses, 53.3% a passive dosimeter and 17.8% an electronic dosimeter. None of them benefitted from collective protective equipment such as a ceiling suspended screen. The questionnaire following the training was completed by only 35 doctors. A comparison before and after training results showed an improvement in knowledge (scores of correct responses: 5.5/16 before and 9.5/16 after training) but not in RP good practices (scores of correct responses: 3.2/7 before and 3.3/7 after training). One training session appears to be insufficient to improve the application of the safety rules when x-rays are used. Communication needs to be improved regarding RP among anesthetists and surgeons, such as training renewal, workstation analysis in OR related to x-ray use and occupational medical follow-up. Otherwise, radiological risks in OR need to be given better consideration, such as radio-induced cataract risk. It is necessary to encourage the use of dosimeters and protective equipment and to strengthen access to lead glasses and collective protective equipment, such as ceiling suspended screens. All these recommendations ensure the received dose is reduced to as low as is reasonably achievable.

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

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

[Occupational physicians and occupational cancers: attitudes, opinions, practices. A qualitative study in South Eastern France]. / Médecins du travail et cancers professionnels : attitudes, opinions et pratiques. Une recherche qualitative dans le Sud-Est de la France.

BACKGROUND: A qualitative study was conducted in 2008 of occupational physicians (OPs) in south-eastern France to document their attitudes, opinions and practices on prevention and screening of occupational cancers. This was done to provide elements to prepare the questionnaire of a quantitative study in 2009. METHODS: Semi-structured interviews were conducted using a structured interview guide with 20 OPs. The data collected were subjected to an analysis of thematic content type. RESULTS: The analysis revealed that OPs face many difficulties when preventing occupational cancers. For most of OPs, these difficulties appeared related to "external factors": lack of involvement of employers and minimization of risks by employers and employees. Lack of time, overload and, for some OPs, perceived lack of independence towards employers, were also mentioned as barriers to cancer prevention. This study also suggested hypotheses related to OPs themselves (internal factors): perceived lack of effectiveness and, trend to minimize the risks of occupational cancer in their geographical area. Finally, the results suggest a significant heterogeneity of OPs' practices regarding occupational cancer screening. CONCLUSION: These results raise several hypotheses that will be addressed further in the quantitative survey. They warn about the difficulties of a profession that seems to encounter a demographic and identity crisis.

[Occupational exposure and systemic sclerosis. Literature review and result of a self-reported questionnaire]. / Evaluation de l'exposition toxique professionnelle de patients atteints de sclérodermie systémique. Revue de la littérature et résultat d'un auto-questionnaire.

Systemic sclerosis (scleroderma) is a rare auto immune disease. Its physiopathology, based on various mechanisms, involves a predisposing genetic background and some exogenous factors. Among them, the role of toxic products is highly suggested according to several case-control studies. The aim of this study is to review the literature concerning occupational exposure associated with scleroderma. This review is completed by the results of a self-reported questionnaire on occupational exposures sent to 82 scleroderma patients followed in Marseille. Scleroderma associated with silica exposure should be declared as occupational disease. Moreover, the role of other toxic agents such as solvents is highly suspected and scleroderma occurring in case of high exposure should also be declared. Our study performed in Marseilles showed a occupational exposure in 10% of cases (five patients having an occupational exposure that could be involved in the genesis of the disease). One had an occupational silica exposure and was declared as occupational silica disease. Other cases had various toxic exposures including solvents and two were declared as disease of occupational nature. Occupational exposure (labour and leisure) must be searched for when faced with a scleroderma patient for two reasons: the possible declaration of an occupational disease and a better knowledge on toxics involved in scleroderma.

Micronuclei kinetics of exfoliated urothelial cells.

Micronuclei observed in exfoliated cells result from DNA-damage of basal epithelium's cells by mutagens. Exfoliated urothelial cells can be collected by non-invasive procedure and may be used as target site to identify genotoxic effects of chemicals. Kinetic studies are important for any biomarker, especially those in which tissue differentiation and maturation processes will heavily influence the time between induction of damage and collection of damaged cells for analysis. This manuscript details the result of a longitudinal study of micronuclei induction in cells isolated from urine samples of 4 healthy women over 6 consecutive days. Three of them were former smokers. Results suggested that micronucleated cell rates were not influenced neither by the day nor by the time of sampling.

[Natural latex allergy. Primary and secondary prevention in work environment]. / Allergie au latex naturel. Prévention primaire et secondaire en milieu de travail.

UNLABELLED: AT RISK GROUPS: The incidence of latex hypersensitivity of latex hypersensitivity has increased over the last decade. The main at-risk groups for developing latex allergy are: health care workers and employees working in latex industries, patients with atopic diathesis and subjects with repeated surgical procedures during childhood. SENSITIZATION: The use of cornstarch powder gloves can sensitize healthy subjects and exacerbate symptoms of allergic patients as the powder spreads the latex allergens into the environment. PRACTICAL ATTITUDE: We propose here some practical recommendations for prevention, both for the general population and for allergic subjects.

[Oxidative stress and human disease. Current knowledge and perspectives for prevention]. / Stress oxydant et pathologies humaines. Bilan et perspectives préventives.

DYNAMIC BALANCE: The antibiotic status of the human organism results from the dynamic balance between the antioxidant system and the production of reactive oxygen species. Oxidative stress occurs when this balance shifts in favor of pro-oxidants as can occur in several disease situations. ROS: Part of the oxygen used by cells is transformed into toxic metabolites, reactive oxygen species (ROS), which can be the cause or consequence of tissue and molecular disorders. Some of the most prominent diseases linked with oxidative stress include atherosclerosis, cancer, allergy, neurodegenerative diseases, Parkinson's disease. PERSPECTIVES FOR PREVENTION: Actions designed to prevent the environmental cause, such as eviction of a exposure to toxins or a change in eating habits, can be an effective means of reducing the lesions induced. Study of total antioxidant potential could be quite useful for detecting and monitoring environmental damage and for clinical follow-up. It could also help in determining, for each individual, the negative or positive development of a therapy on the anti-free radical action. Treatments must be personalized according to the tested response.

[Suspicious pigmented skin lesions. Screening campaign by occupational physicians in the Provence-Alpes-Côte d'Azur region]. / Lésions cutanées pigmentées suspectes. Campagne de dépistage par les médecins du travail de la région Provence-Alpes-Côte d'Azur.

OBJECTIVE: Cutaneous melanoma prevention has become a public health issue. The incidence of this cancer has been steadily growing for 50 years, and the related death ratio is not decreasing. Today, the surgical resection of a thin lesion is the only validated curative treatment. The early detection of melanoma represents a major line in the management of such tumours. METHODS: Occupational physicians of the PACA area were invited to participate in a campaign for the screening of pigmented suspect cutaneous lesions for 2 years. Voluntary physicians were trained to use the ABCDEF diagnostic criterion. Lesions were detected during regular yearly consultations (1998/1999) and the data concerning the development and care of these lesions was collected during consultations over the following year (1999/2000). RESULTS: Two hundred and fifty occupational physicians of the PACA area participated in the campaign. Two pre-cancerous lesions and 10 cancers (5 melanoma and 5 pigmented basocellular carcinoma) were found among the 487 suspect lesions detected. Each melanoma had a Breslow score of less than 0.9 mm and were of good or even excellent prognosis. CONCLUSION: The cutaneous examination, although rapid, during the occupational medicine consultations, is an effective means of detecting the early onset tumoral lesions which, at that stage may potentially be cured. The ABCDEF criterion is a useful diagnostic tool and should be taught to the all the medical and paramedical staff.

[The ban on smoking in public places (Decree No. 2006-1386 of 15th November 2006): Impact over 12 months on smoking status of hospital nurses]. / Interdiction de fumer dans les lieux affectés à un usage collectif (décret no 2006-1386 du 15 novembre 2006) : impact à 12 mois sur le statut tabagique chez des infirmiers hospitaliers.

INTRODUCTION: In France, the decree No. 2006-1386 banned smoking in public places such as hospitals. The aim of our study was to describe the impact of the legislation on the smoking status of hospital nurses. METHODS: A descriptive study was undertaken in a university hospital of Marseilles, under the responsibility of the occupational medicine service. Between April and June 2008, a questionnaire was distributed to the nurses who had been working for more than one year. The following data were collected: demographic information, smoking status, behaviour and attitudes regarding smoking addiction, knowledge regarding existing preventive measures. RESULTS: Sixty-four percent of 715 eligible subjects responded; thirty percents reported themselves as current smokers, 25 % as ex-smokers and 45 % as non-smokers. Among the smokers, 68 % said that they had decreased their tobacco consumption during their working hours and 28 % their overall daily consumption. Among ex-smokers, 20 % declared that they were in the process of quitting. CONCLUSIONS: The nurses had decreased their tobacco consumption at work and these positive results should be confirmed over a long-term perspective. The preventive role of the occupational physician could be reinforced.

Dyshidrotic eczema and occupation: a descriptive study.

Dyshidrotic eczema (DE) is a chronic and/or recurrent vesicular eczema of the palmar sides of the hands and sometimes the soles of the feet. The major aetiologies to be considered are atopic DE, contact DE, systemic contact DE and DE due to fungal or microbial allergy. To clarify the role of occupational contact allergens, 59 workers with DE were examined to determine whether they had atopy, environmental contact sensitization and/or contact allergy coupled with work activity. For all, patch testing was carried out using the European standard series and the material brought in by the patients. No significant difference was found between the rate (42.4%) of history of atopy among the 59 workers with DE and that (30.6%) observed among 160 workers with other forms of hand eczema (HE). Positive patch test reactions were found in 72.8% of dyshidrotic patients. A relationship to occupational activity was strong for 18 (30.5%) of them but this rate was significantly lower than that (55%) observed among the 160 with other types of eczema. Results of the present study showed that contact sensitization is as much involved in workers with DE as in workers with other form of HE, even though the relationship to work is significantly less frequent for DE. It also suggests that atopic histories are no more involved in DE than in other forms of HE.

Protective effects of alpha-hederin, chlorophyllin and ascorbic acid towards the induction of micronuclei by doxorubicin in cultured human lymphocytes.

The influence of alpha-hederin (a saponin isolated from Hedera helix), chlorophyllin, the sodium-copper salt of chlorophyll, and ascorbic acid (vitamin C) on the direct clastogenicity of doxorubicin (Adriamycin) was investigated in vitro in human lymphocytes for the induction of micronuclei. In order to determine a possible mechanism of action responsible for the antimutagenic activity, treatments were performed for the three substances at different times of the culture (pre-treatment, simultaneous and post-treatment). Alpha-hederin (1.3 x 10(-2), 0.13, 1.3 and 13 nmol/ml) and chlorophyllin (0.14, 1.4 and 14 nmol/ml) were found to exert an antimutagenic effect against the clastogenicity of doxorubicin (1.5 x 10(-2) nmol/ml) in all treatments at all concentrations. Ascorbic acid (10 nmol/ml) was effective in reducing the micronucleus levels only in the simultaneous treatment, when it was previously incubated with doxorubicin for 2 h at 37 degrees C before being introduced into the culture. Our results suggested a desmutagenic effect for alpha-hederin, chlorophyllin and ascorbic acid. Chlorophyllin acted also through a bio-antimutagenic mechanism and alpha-hederin seemed to induce metabolic enzymes, which inactivated doxorubicin. Preliminary studies showed that the effective antimutagenic concentrations of alpha-hederin, chlorophyllin and ascorbic acid had no clastogenic or aneugenic effects in human lymphocytes. No cytotoxicity was observed for the three antimutagenic agents either.

Effect of smoking on micronucleated epithelial cells in smears from the uterine cervix.

A pilot study was conducted to determine whether any relationship exists between micronucleated cell rates of female uterine cervical epithelium and current smoking status. Cervical uterine cells obtained from 118 pre-menopausal females, seen between September 1994 and June 1995 at the Occupational Medecine Interprofessional Association (AIMT), were tested for micronucleated cells by the micronucleus assay. Of the 68 subjects taken from this population that provided a least a 1000 analysed cells, 36 were non-smokers and 32 were smokers. Age distributions were different between smokers and non-smokers but results showed that age had no effect on micronucleated cell levels. Micronucleated cervical cell rates reached 0.66% in non-smokers and 1.11% in smokers: these two levels were not statistically different. No association was noted between number of cigarettes smoked and micronucleated cell levels. Results suggested that consuming 5-20 cigarettes per day was not enough to show a smoking effect on cervical micronucleated cells. A test with a greater number of female subjects would be necessary to confirm this.

The micronucleus assay in human exfoliated urothelial cells: effect of smoking.

Micronucleated cell rates were examined in exfoliated urothelial cells of 73 healthy donors not occupationally exposed to mutagens or aneugens. Micronucleated cell levels averaged 0.54 +/- 0.68% in the entire population: they reached 1.09% in smokers, 0.95% in ex-smokers and 0.24% in non-smokers. Among variation factors evaluated during this study, only smoking had a significant effect on micronucleated cell rates (P = 0.007) whereas age and sex had no effect (P = 0.101 and P = 0.918). No significant difference was observed between micronucleated cell rates of smokers and ex-smokers, suggesting that smoking could generate clones of basal micronucleated cells in urothelial tissues.