[Continued breastfeeding upon return to work: a qualitative study at the Brest University Hospital]. / Poursuite de l'allaitement à la reprise du travail : étude qualitative au CHRU de Brest.

The objective of this qualitative study was to highlight the facilitating measures and difficulties encountered in continuing breastfeeding when returning to work at the Brest Regional University Hospital. The eleven mothers interviewed were able to take advantage of the solidarity in the care services to carry out their project, but simple institutional measures are still possible to facilitate this conciliation.

[Impact of the Covid-19 pandemic on the health of nurses in a university hospital]. / Impact de la pandémie de Covid-19 sur la santé des infirmiers d'un CHU.

In a university hospital in Brittany, health monitoring of the staff was set up at the beginning of the Covid-19 pandemic. The first results of the studies carried out in this context showed that nurses showed a greater deterioration of their physical health than other professionals. However, thanks to psychological balancing measures, nurses did not appear to be more affected in terms of psychological health and well-being at work than the other hospital workers.

Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study Carried Out During the 2012 AG2R Transatlantic Boat Race.

OBJECTIVES: The primary objective of this study was to identify skin disorders encountered in a population of sport sailors. Unlike merchant mariners and fishermen, there is sparse literature on this maritime population. Secondary objectives were to uncover on-board conditions that may contribute to dermatological problems in this population. METHODS: We conducted a prospective study during the 2012 AG2R transatlantic race. Sixteen two-man crews participated in this race, all using the same model of sailboat (Bénéteau Figaro 2). Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival, 22 to 24 days later. RESULTS: Twenty-eight of 32 skippers (88%) participated in departure data collection, and 18 (56%) completed data collection on arrival. The average age of sailors was 34 years (SD = 8). Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival. Furthermore, several new skin problems were found postrace: skin scaling, skin erosions on the buttocks, dyshidrosis, thermal burns, and sunburns. The use of protective gear and sunscreen was common, but on-board hygiene was poor with infrequent bathing and clothing changes. CONCLUSIONS: Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors.

Dysbaric osteonecrosis in professional divers: two case reports.

AIM: Dysbaric osteonecrosis (DON) is an avascular bone necrosis seen in divers and compressed-air workers. It continues to be a significant occupational hazard that has important medical and social consequences for professional divers. The prevalence of DON varied between 0% and 70.6% in professional divers in the literature. This paper seeks to describe the distribution of the lesions, the diagnosis and the prognosis of individuals affected by DON referred to a French occupational disease center. METHOD: We led a retrospective study by searching for cases of DON in the medical files of divers seen in our occupational disease center between 2001 and 2014. 332 professional divers consulted in our center between 2001 and 2014.Clinical, radiological and pathological data were collected to report about the cases. RESULTS: We report two cases of DON in divers. The first case is a left femoral head lesion in a 38-year-old man who underwent a total hip arthroplasty. Histopathological examination of the native femoral head confirmed the diagnosis of DON. The second case of DON concerns the humeral heads in a 52-year-old man. The treatment was conservative in this second case. In both cases the patients have been declared definitely medically unfit to dive and were financially compensated. Conclusion: The prognosis of DON raises the question of the ability among employees whose rehabilitation is difficult.

Occupational accidents among attendants inside hyperbaric chambers in France.

INTRODUCTION: The purpose of the study was to assess the number of accidents among staff employed in the operation of hyperbaric chambers in France. MATERIALS AND METHODS: A retrospective study using a questionnaire was carried out on occupational accidents in France between 2005 and 2011. RESULTS: 12 (46%) centres participated in the study, representing 73 subjects. The mean age was 43.5 years (SD=9.73). They had worked in hyperbaric chambers for 9.8 years on average (SD=7.7). The average number of hyperbaric sessions was 198.3 per subject (SD=174.25), for a total of 8.072 hyperbaric sessions; 27% of the subjects reported that they had at least one accident during the study period. In all, 30 accidents were reported: 3 blood exposures, 4 accidents related to patient handling, 20 hyperbaric accidents; 3 other accidents. Of the hyperbaric accidents, 2 (10%) involved decompression sicknesses with cutaneous symptoms, 3 (15%) decompression illness (DCI), 14 (70%) ear traumatisms, 1 (5%) dental accident. The incidences were 372 per 100,000 sessions in hyperbaric chambers (SHC) for all accidents, 248 per 100,000 SHC for hyperbaric accidents and 173 per 100,000 SHC for ENT barotraumas. CONCLUSION: The accidents involving staff operating hyperbaric chambers were mainly ear traumatisms..

Breastfeeding and return to work at a teaching hospital.

In France, return to work represents a break in the continuation of breastfeeding, especially for caregivers. The objective of this study was to describe the breastfeeding practices of hospital workers. From 378 respondents, the prevalence of breastfeeding was found to be 69 % when leaving the maternity ward, 36.5 % when returning to work, and 20.1 % at 6 months. The average duration of breastfeeding was 23.3 weeks. In total, 44 % of breastfeeding women said they stopped breastfeeding because of their work: workload, irregular hours, no breastfeeding room, and fatigue.

Occupational asthma and occupational rhinitis: the united airways disease model revisited.

OBJECTIVES: Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions. METHODS: Data on incident cases of OA (2008-2010) were collected through the French national occupational disease surveillance and prevention network, using a standardised form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma. RESULTS: Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01). CONCLUSIONS: These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitisers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents.

COVID-19 on board a cruise ship: medical management.

BACKGROUND: First, this analysis was conducted to study a coronavirus disease 2019 (COVID-19) cluster dynamic on a cruise ship in order to allow the ship physician to anticipate the duration and importance of the contaminations. Secondly, the author tries to find out if the closed environment on board allows specific conclusions about epidemic dynamics and preventative measures. MATERIALS AND METHODS: From a personal epidemiological compendium done by himself on board the author analysed different epidemic curves identified on board other ships and compared them to the epidemiologic data from the different COVID-19 contamination waves in France since 2020. All crew members were submitted to polymerase chain reaction tests on D2, D5, D8 and D15 and symptomatic cases were tested on on-board devices in the meantime. An excel file called "Log Covid" allowed for daily reporting to the ship-owner on the epidemic dynamics and the prospects on the end of crises in order to anticipate the resumption of the business in the best conditions. The jobs on board, age and geographic origin of the contaminated people were analysed, as well as their vaccination status. RESULTS: Out of a total of 118 crew members, 61 (52%) sailors were contaminated in 8 days. The symptoms were benign (pharyngitis, headaches, feverish state); no serious form of illness were reported. The passengers were repatriated to France at the earliest stage. The epidemic phase occurred in a 15-day window. The first 8 days corresponded to the ascending phase, then a faster phase of epidemic decrease of 7 days. Similarities emerged between the epidemic dynamics of this virus and other contaminations on cruise ships and epidemic phases on land in spite of important differences in numbers. CONCLUSIONS: This study can allow a ship's doctor to better understand the viral dynamics in case of a COVID- 19 cluster and to anticipate the exit of the crisis. Repeated tests during the active phase of the epidemic are necessary in case of a large cluster to know where to place oneself on a typical epidemic curve. Isolation and barrier measures advised by the ship's doctor remain the only weapons that can limit its magnitude.

Occupational Contact Dermatitis Caused by Artichokes.

Introduction: Few cases of skin diseases caused by exposure to artichokes have been published. Artichokes contain sesquiterpene lactones, which are known to be sensitizing. Irritant contact dermatitis (ICD) has also been diagnosed. To our knowledge, no protein contact dermatitis (PCD) has yet been reported to be induced by artichoke. Objectives: The aim of this study was to identify the different types of contact dermatitis that may be due to occupational exposure to artichokes and the professions concerned. Materials and Methods: We conducted a descriptive study, retrieving data from the French national database of occupational diseases for the period of 2001 to 2018. Results: Fifty-six cases were retrieved, and 10 cases were included in this study after data analysis and reading the clinical reports: 7 allergic contact dermatitis (ACD), 2 PCD, and 1 ICD caused by artichokes. Patients were farmers (4), agri-food workers (3), market gardener (1), cashier (1), and store employee (1). Conclusions: This is the first series of occupational contact dermatitis that can be induced by artichokes. Exposure to artichokes can lead to ICD, ACD, PCD, and perhaps contact urticaria. The sesquiterpene lactone mix patch test is not always sufficient to confirm an ACD by artichokes. Irritant contact dermatitis can be associated with ACD from artichokes or evolve on its own.

Does Decreased Diffusing Capacity of the Lungs for Carbon Monoxide Constitute a Risk of Decompression Sickness in Occupational Divers?

Long-term alterations of pulmonary function (mainly decreased airway conductance and capacity of the lungs to diffuse carbon monoxide (DLCO)) have been described after hyperbaric exposures. However, whether these alterations convey a higher risk for divers' safety has never been investigated before. The purpose of the present pilot study was to assess whether decreased DLCO is associated with modifications of the physiological response to diving. In this case-control observational study, 15 "fit-to-dive" occupational divers were split into two groups according to their DLCO measurements compared to references values, either normal (control) or reduced (DLCO group). After a standardized 20 m/40 min dive in a sea water pool, the peak-flow, vascular gas emboli (VGE) grade, micro-circulatory reactivity, inflammatory biomarkers, thrombotic factors, and plasmatic aldosterone concentration were assessed at different times post-dive. Although VGE were recorded in all divers, no cases of decompression sickness (DCS) occurred. Compared to the control, the latency to VGE peak was increased in the DLCO group (60 vs. 30 min) along with a higher maximal VGE grade (p < 0.0001). P-selectin was higher in the DLCO group, both pre- and post-dive. The plasmatic aldosterone concentration was significantly decreased in the control group (-30.4 ± 24.6%) but not in the DLCO group. Apart from a state of hypocoagulability in all divers, other measured parameters remained unchanged. Our results suggest that divers with decreased DLCO might have a higher risk of DCS. Further studies are required to confirm these preliminary results.

Occupational dermatitis in workers exposed to detergents, disinfectants, and antiseptics.

Anti-infective prevention has led to a significant use of disinfectants, detergents, and antiseptics in various areas of activities. Most of these products are skin irritants and allergens, which can cause skin disorders in exposed workers. The authors conducted a descriptive and retrospective study on occupational dermatitis diagnosed at an occupational dermatology hospital consultation service, targeting exposed workers in the health, food, and cleaning industries. These included 20.9% (61 of 291) of the patients seen at this consultation. An occupational origin was proven for 50 of these 61 patients. The most frequent dermatoses were irritant contact dermatitis (42%) and allergic contact dermatitis (26.3%). The main allergens were disinfectants and antiseptics (26.3%), especially quaternary ammoniums, aldehydes, and nickel. Patients exposed to disinfectants, detergents, and antiseptics in the workplace represent an important part (about 1 of 5) of occupational dermatology consultations, although factors may be contributory. Prevention and knowledge are necessary for this increasing issue.

Bed bugs on ship: a French review.

BACKGROUND: Linked to the increase in international travel and development of insecticide resistance, a resurgence of bed bug infestation has been observed since the 2000's and become now a worldwide public health problem. Passenger ships as part of the tourism industry are traditionally infested by bed bugs, but the whole maritime world is now concerned. MATERIALS AND METHODS: We conducted a short questionnaire-survey among the 22 doctors of the French seafarers' health services to assess the level of this phenomenon in the occupational maritime environment. RESULTS: Twenty seven per cent of the doctors reported that a patient shared to them a bed bug infestation on board. In that case, all declared that the infestation impacted the patient's life on board. Eighteen per cent responded that a shipowner had already sought their support in face of a bed bug infestation. Lastly, 27% considered that bed bug infestation is an increasing problem. CONCLUSIONS: Bed bugs infestation on board has a major impact on the seafarers and passengers, and significant economic consequences. Preventive measures need to be implemented to limit the risks of dissemination. It is essential to inform and educate seafarers on best practice.

Occupational asthma, rhinitis and contact urticaria in a salmon-processing worker.

We report a case of occupational allergy to salmon combining allergic asthma, allergic rhinitis and allergic contact urticaria in a 59-year-old salmon-processing worker. Parvalbumin is the most common allergen, but indeed sensitisation to tropomyosin, preservatives and spices could occur.

Hearing Impairment in French Merchant Seafarers: Retrospective Study on Data from 8308 Audiometric Tests.

Background: A high level of occupational noise exposure has been noted in the fishing sector. Yet, less is known regarding other navigation groups, such as merchant seafarers, since a French study in the 1980s. This study assesses hearing impairment (HI) in a French merchant seafarers' population. Methods: We collected data of all audiograms performed in 2018 and 2019 for French merchant seafarers. For each seafarer, hearing ability was measured in both ears using pure-tone audiometry at the following frequencies: 0.5, 1, 2, 3, 4, 6, and 8 kHz. Hearing threshold levels (HTLs), or the intensity of sound below which no sound is detected, were measured in decibels Sound Pressure Level (dB SPL) at each frequency and recorded in 5 dB increments. For HI, we used the validated definition of the American Speech−Language−Hearing Association (ASHA). Results: We were able to include statistical analysis results of 8308 audiograms. In a multiple logistic regression adjusted for age, experience, and class of navigation, we found that experience of more than 14 years Odds Ratio OR 1.28 (CI 95% 1.07−1.53), age 31−40 OR 2.2 (CI 95% 1.4−3.4), and >40 years OR 14, 3 (IC 95% 9.7−21) and marine engineers OR 1.26 (IC 95% 1.01−1.57) were still risk factors for HI. Conclusion: In 2018, Marine engineers were still the workers' group with a higher risk of HI in merchant seafarers but, notch at 4 Hz, specific of noise-induced hearing loss, has improved. They have an HI close to the definition of socioacousis and mean deficit differences with deck and services' merchant seafarers improved. Our results could be interpreted as a limitation of occupational noise exposure impact in a merchant seafarers' population, needing an improvement in prevention measures and also encouraged to continue to improve onboard working conditions.

Occupational Exposures and Esophageal Cancer: Prog Study.

Esophageal cancer is the sixth most common cause of cancer death worldwide. In France, Brittany is one of the regions most seriously affected. This increased incidence is usually linked to high rates of alcohol overconsumption and smoking, established risk factors for esophageal cancer, but the region has special occupational exposures. We aim to describe the occupational exposures of patients with esophageal cancer. Between June and October 2020, we conducted a monocentric descriptive study in a French Teaching Hospital and identified 37 eligible patients. We gathered data through a systematic individual interview for each participant and by an analysis of their medical file. We were able to include 36 patients; most were men (n = 27, 75.0%) and smokers (n = 25, 69.4%), 21 (58.3%) presented an adenocarcinoma esophageal cancer, 13 (36.1%) a squamous cell cancer, and 2 other types. On occupational exposure, patients declared respectively high exposure by manipulating asbestos materials for 11 (30.6%) patients, regularly in contact with benzene by handling fuel in 7 cases (19.4%), chlorinated solvents in 4 cases (11.1%), pesticides in 4 cases, and ionizing radiation exposure in 3 patients (8.3%). Our findings support the creation of a large-scale study to explore the impact of occupational exposures, particularly exposure to asbestos and hydrocarbons.

Evolution of Global Health and Psychosocial Factors among Hospital Workers during First Year of SARS-CoV-2 Pandemic: A Longitudinal Study.

OBJECTIVES: To assess trends in overall health (mental and physical) and psychosocial factors in a population of workers (both healthcare and non-healthcare) in a French teaching hospital during the first year of the SARS-CoV-2 pandemic in France. METHODS: A validated version of the SATIN questionnaire with adapted scoring was used to collect data on health and impacts of work stressors. This questionnaire was sent to all workers at the hospital in T1 (July-August 2020) and T2 (July-August 2021) and self-administered online. RESULTS: A total of 1313 participants who completed the questionnaire at T1 and 826 at T2 were included. Overall, 568 workers completed the questionnaire at T1 and T2. We found a deterioration in overall health and especially stress and mental health in hospital workers and healthcare workers (HCWs), with a negative impact of the workload and work environment. CONCLUSIONS: The SARS-CoV-2 pandemic impacted negatively the mental health, work stressors, and psychosocial perceptions of both HCW and non-HCW in a French hospital. The study confirms that hospital workers are an important target.