The prevalence, determinants, and consequences of post-COVID in healthcare workers: A cross-sectional survey.

Data on post-coronavirus disease (COVID) in healthcare workers (HCWs) are scarce. We aimed to assess prevalence, determinants, and consequences of post-COVID in HCWs. In fall 2022, we performed a cross-sectional survey in a tertiary care hospital with a web-based questionnaire sent to HCWs. Post-COVID was defined as persistent/new symptoms 3 months after acute COVID. Propensity score weighting was performed to assess the impact of post-COVID on return-to-work. 1062 HCWs completed the questionnaire, 713 (68%) reported at least one COVID, and 109 (10%) met the definition for post-COVID, with workplace contamination reported in 51 (47%). On multivariable analysis, risk factors for post-COVID were female gender (p = 0.047), ≥50 years (p = 0.007), immunosuppression (p = 0.004), ≥2 COVID episodes (p = 0.003), and ≥5 symptoms during acute COVID (p = 0.005). Initial sick leave was prescribed for 94 HCWs (86% post-COVID), for a median duration of 7 [7-9] days, and extended for 23. On return-to-work, 91 (84%) had residual symptoms, primarily asthenia/fatigue (72%) and cognitive impairment (25%). Cognitive impairment at return-to-work was associated with post-COVID. Ten HCWs (9%) received a medical diagnosis of post-COVID, 8 consulted the occupational physician, and four required work adaptation. Post-COVID affected 10% of HCWs. Long-term consequences included repeated sick leaves and residual symptoms on return-to-work.

Relationships between asbestos exposure and pleural plaques: dose and time effects using fractional polynomials.

OBJECTIVE: The aim of this study was to confirm the relationship between several parameters of exposure to asbestos and pleural plaques (PP) using data from a large cohort of retired workers occupationally exposed to asbestos in France. METHOD: A large screening programme, including high-resolution CT (HRCT) examinations at inclusion and two other HRCT campaigns, was organised from 2003 to 2016 in four regions of France for voluntary, formerly asbestos-exposed workers. Exposure to asbestos has been evaluated by industrial hygienists based on the complete work history. The time since first exposure, the time since last exposure, Cumulative Exposure Index and maximum level of exposure to asbestos, were used in logistic regression using fractional polynomials to model the relationship with PP. RESULTS: The study included 5392 subjects with at least one HRCT available. There was a significant non-linear effect of time since first exposure, time since last exposure and Cumulative Exposure Index to asbestos on the presence of PP. The risk of PP increased with increasing Cumulative Exposure Index to asbestos adjusted for time since first exposure, age and smoking status. Models also show that PP odds rise with increasing time since first exposure adjusted for cumulative index exposure, age and smoking status. PP odds decrease when time since last exposure increases. CONCLUSION: The study provides new data on the link between asbestos exposure and the presence of PP using fractional polynomials with non-linear relationships for time exposure parameters and asbestos exposure parameters.

Quality of life in retired workers with past exposure to asbestos.

BACKGROUND: Asbestos causes cancer and non-cancerous lung and pleural diseases and can also have a negative psychological impact but little is known about its effect on health-related quality of life. OBJECTIVES: The aim of this study is to describe the health-related quality of life (HRQoL) of retired men with a history of occupational exposure to asbestos and examine factors linked with low HRQoL. METHODS: Retired male workers of the French Asbestos-Related Disease Cohort (ARDCO) completed self-questionnaires that included SF-36v2 and HAD scales, questions about their perception of asbestos (perceived dangers and level of exposure, expectations to fall ill, or knowing someone who is) and their respiratory symptoms. Asbestos exposure was assessed by industrial hygienists. A perceived risk score was created using factorial analysis. Multivariable regressions were performed for all SF-36 subscales. RESULTS: A total of 1266 of 2075 questionnaires (61%) were returned complete and included in analysis. After adjustment for potential confounders, an increase in perceived risk score resulted in a decrease in physical component summary score (PCS), up to 10.7 points (p = 0.048) and in mental component summary score (MCS) (p = 0.044). Presence of respiratory symptoms was also associated with significantly decreased PCS and MCS (p < 0.001). Poor HRQoL was linked to higher perceived risk score with p ≤ 0.01 for all SF-36 dimensions. Asbestos exposure assessed by an expert was not associated with any outcome. CONCLUSIONS: All dimensions of HRQoL appear to be affected by the perceived risk of incurring asbestos-related disease and respiratory symptoms.

Effects of different amosite preparations on macrophages, lung damages, and autoimmunity.

The underlying mechanisms of asbestos-related autoimmunity are poorly understood. As the size, surface reactivity, and free radical activity of asbestos particles are considered crucial regarding the health effects, this study aims to compare the effects of exposure to pristine amosite (pAmo) or milled amosite (mAmo) particles on lung damage, autoimmunity, and macrophage phenotype. Four months after lung exposure to 0.1 mg of amosite, BAL levels of lactate dehydrogenase, protein, free DNA, CCL2, TGF-ß1, TIMP-1, and immunoglobulin A of pAmo-exposed C57Bl/6 mice were increased when compared to fluids from control- and mAmo-exposed mice. Effects in pAmo-exposed mice were associated with lung fibrosis and autoimmunity including anti-double-strand DNA autoantibody production. mAmo or pAmo at 20 µg/cm2 induced a pro-inflammatory phenotype characterized by a significant increase in TNFα and IL-6 secretion on human monocyte-derived macrophages (MDMs). mAmo and pAmo exposure induced a decrease in the efferocytosis capacities of MDMs, whereas macrophage abilities to phagocyte fluorescent beads were unchanged when compared to control MDMs. mAmo induced IL-6 secretion and reduced the percentage of MDMs expressing MHCII and CD86 markers involved in antigen and T-lymphocyte stimulation. By contrast, pAmo but not mAmo activated the NLRP3 inflammasome, as evaluated through quantification of caspase-1 activity and IL-1ß secretion. Our results demonstrated that long-term exposure to pAmo may induce significant lung damage and autoimmune effects, probably through an alteration of macrophage phenotype, supporting in vivo the higher toxicity of entire amosite (pAmo) with respect to grinded amosite. However, considering their impact on efferocytosis and co-stimulation markers, mAmo effects should not be neglected. KEY MESSAGES: Lung fibrosis and autoimmunity induced by amosite particles depend on their physicochemical characteristics (size and surface) Inhalation exposure of mice to pristine amosite fibers is associated with lung fibrosis and autoimmunity Anti-dsDNA antibody is a marker of autoimmunity in mice exposed to pristine amosite fibers Activation of lung mucosa-associated lymphoid tissue, characterized by IgA production, after exposure to pristine amosite fibers Pristine and milled amosite particle exposure reduced the efferocytosis capacity of human-derived macrophages.

Household Use of Green Cleaning Products, Disinfecting Wipes, and Asthma Control Among Adults.

BACKGROUND: The use of household disinfectants and cleaning products (HDCPs) may negatively impact asthma control, but studies remain scarce. Moreover, no study considered green products or wipes, increasingly used during home cleaning. OBJECTIVE: To assess the associations between the use of HDCPs, including disinfecting wipes and green products, and asthma control based on data from the French Web-based NutriNet-Santé cohort. METHODS: Using a standardized questionnaire (2018), we assessed asthma control (never asthma: reference; controlled: Asthma Control Test ≥ 20; uncontrolled: Asthma Control Test < 20) and the use of HDCPs, including 2 types of products (irritants and green products) and 2 application modes (sprays and disinfecting wipes). Cross-sectional associations of the frequency of weekly use of HDCPs at home with asthma control, adjusted for sex, age, smoking status, body mass index, and educational level were assessed by multinomial logistic regressions. RESULTS: Analyses were performed on 37,043 adults (mean age 47 y; 75% women; 62% with a weekly use of at least 1 HDCP). Strong associations were observed between weekly use of HDCPs and uncontrolled asthma. In particular, an almost daily use (4-7 d/wk) of irritants (odds ratio [OR] 2.81; 95% confidence interval [95% CI] 1.97-4.00) and green products (OR 2.40; 95% CI 1.70-3.39) as well as sprays (OR 2.69; 95% CI 1.97-3.68) and disinfecting wipes (OR 3.51; 95% CI 2.31-5.33) was associated with uncontrolled asthma. When not co-used with irritants and sprays, associations remained statistically significant for both disinfecting wipes and green products. CONCLUSIONS: Weekly use of HDCPs, including green products or wipes, was associated with uncontrolled asthma and should be considered by health practitioners in order to improve asthma control.

Influenza vaccine coverage among healthcare workers: A cluster analysis from a cross-sectional survey.

OBJECTIVES: Influenza vaccination is recommended for healthcare workers (HCWs). However, in a 1500-bed tertiary care university hospital in France, influenza vaccine coverage among HCWs was 23% in 2017. PATIENTS AND METHODS: We performed a cross-sectional study between 05/09/2018 and 25/09/2018 among HCWs, randomly selected independent of their vaccination status, to estimate influenza vaccination coverage rate during the 2017-2018 season, and explore factors influencing vaccination, using a questionnaire. Multivariable regression analysis to assess factors associated with vaccine uptake and hierarchical clustering on principal components to identify HCW profiles regarding factors influencing vaccine uptake, were performed after multiple imputation. RESULTS: 977 HCWs were included (68% participation rate), primarily females (84%), nurses (38%) of 18-39 years old. Influenza vaccination coverage rate reached 33[30-36]%. Frequent vaccination (aOR 39.27[21.52-74.51]) and personal/family medical history of influenza (aOR 3.33[1.16-10.02]) were independently associated with vaccination. In HCWs' patterns of influenza vaccination status, three clusters were identified: 1) (n = 438) mostly vaccinated (70%); 2) (n = 507) most unvaccinated (97%); and 3) (n = 32) unvaccinated HCWs lacking knowledge on influenza and influenza vaccine. Among the 148 (15%) HCWs reluctant to receive the vaccine the following year, 23 (16%) received it for the 2017-2018 season, while 125 (84%) did not, mostly stating they had doubts about the vaccine (82%). CONCLUSION: This work identifies determinants of vaccine uptake and highlights HCWs profiles associated with factors influencing vaccination and a subgroup of HCWs flexible about having the vaccine during the upcoming seasonal campaign. This result opens up perspectives toward improved vaccination coverage among HCWs.

Pleural Plaques and the Role of Exposure to Mineral Particles in the Asbestos Post-exposure Survey.

BACKGROUND: Previous studies have inconsistently reported associations between refractory ceramic fibers (RCFs) or mineral wool fibers (MWFs) and the presence of pleural plaques. All these studies were based on chest radiographs, known to be associated with a poor sensitivity for the diagnosis of pleural plaques. RESEARCH QUESTION: Does the risk of pleural plaques increase with cumulative exposure to RCFs, MWFs, and silica? If the risk does increase, do these dose-response relationships depend on the co-exposure to asbestos or, conversely, are the dose-response relationships for asbestos modified by co-exposure to RCFs, MWFs, and silica? STUDY DESIGN AND METHODS: Volunteer workers were invited to participate in a CT scan screening program for asbestos-related diseases in France. Asbestos exposure was assessed by industrial hygienists, and exposure to RCFs, MWFs, and silica was determined by using job-exposure matrices. A cumulative exposure index (CEI) was then calculated for each subject and separately for each of the four mineral particle exposures. All available CT scans were submitted to randomized double reading by a panel of radiologists. RESULTS: In this cohort of 5,457 subjects, significant dose-response relationships were determined after adjustment for asbestos exposure between CEI to RCF or MWF and the risk of PPs (ORs of 1.29 [95% CI, 1.00-1.67] and 1.84 [95% CI, 1.49-2.27] for the highest CEI quartile, respectively). Significant interactions were found between asbestos on one hand and MWF or RCF on the other. INTERPRETATION: This study suggests the existence of a significant association between exposure to RCFs and MWFs and the presence of pleural plaques in a large population previously exposed to asbestos and screened by using CT scans.

Maternal occupational exposure to organic solvents and intrauterine growth in the ELFE cohort.

BACKGROUND: In developed countries, about 15% of women are occupationally exposed to solvents. Associations between this maternal occupational exposure and intrauterine fetal growth are inconsistent, but almost no existing study has investigated this relation by solvent family (oxygenated, petroleum, and chlorinated), although they may affect fetal growth differently. OBJECTIVES: To investigate the relations between maternal occupational solvent exposure, by solvent family, and the risk of neonates born small for gestational age (SGA), or with low birthweight, or with small head circumference (HC). METHODS: Among the 18,040 women enrolled in the Elfe rather than included in the Elfe birth cohort, we included 13,026 women who worked during pregnancy (72% of the cohort). Information about maternal occupations and industrial activities during pregnancy was collected by questionnaire at the maternity ward, and completed at 2-month when necessary. Using Matgéné job-exposure matrices, we assessed maternal occupational exposure to solvents. Logistic and multiple linear regressions were used to assess the association between maternal occupational solvent exposure and SGA status, birth weight, and HC. Analyses were conducted for exposure during pregnancy and also stratified by the trimester that pregnancy leave began. RESULTS: We observed a higher risk of SGA newborns among mothers occupationally exposed during pregnancy to petroleum solvents (ORadjusted = 1.26; 95%CI: 1.01 to 1.57). Among women working until the third trimester of pregnancy, we observed a higher risk of SGA newborns to those occupationally exposed to oxygenated solvents (ORadjusted = 1.75; 95%CI: 1.11 to 2.75), a significantly lower birthweight for infants of mothers exposed to petroleum solvents (ßadjusted = -47.37 g; -89.33 to -5.42), and a lower HC among newborns of those occupationally exposed to oxygenated solvents (ßadjusted = -0.28; -0.49 to -0.07) and to chlorinated solvents (ßadjusted = -0.29; -0.53 to -0.05). DISCUSSION: Our results suggest that maternal occupational solvent exposure may influence fetal growth, especially exposure into the third trimester of pregnancy.

Co-exposures to physical and psychosocial work factors increase the occurrence of workplace injuries among French care workers.

Objective: The aim of this study was to analyze the effect of co-exposures to physical and psychosocial factors (PSF) regarding the incidence of workplace injuries (WI) among care workers. Additional objective was to identify the work factors associated with the co-exposure combinations leading to the highest rates of WI. Methods: The study sample consisted of 4,418 care workers participating to the French Working Conditions Survey both in 2013 and 2016. WI were assessed during the 4-year follow-up by matching the databases of the National Health Insurance Funds' compensation system. We assessed exposure for physical factors and PSF using factorial analyses and hierarchical clustering. We implemented a Poisson regression model with the WI incidence as the outcome and the clusters as independent variables of interest. Logistic regression model allowed identifying the work factors that predicted co-exposure combinations with a WI rate > 40%. Results: WI were highly related to both physical and psychosocial exposures. With low exposure to one or the other, there was no increased risk of WI. Physical factors and PSF potentiated each other and their co-exposure significantly increased the risk of WI, with model predicted rates per 1,000 persons-year for those most exposed to physical risk of 14.6 [4.5-24.8] with low PSF and 38.0 [29.8-46.3] with high PSF. Work factors that predicted co-exposure combinations with a rate > 40 WI% were: working as nursing assistant or hospital services officer, lack of predictability and flexibility of schedules, overtime, controlled schedules, work-family imbalance and insufficient preventive measures. Conclusions: Our findings highlight the need to take into account psychosocial factors in addition of only considering physical factors when analyzing WI occurrence, as usually done. Prevention actions must be taken to reduce both physical and psychosocial exposure. These results provide keys points for the prevention of WI among care workers.

Occupational Exposures to Irritants and Sensitizers, Asthma and Asthma Control in the Nutrinet-Santé Cohort.

BACKGROUND: The role of chronic occupational exposures to irritants in asthma remains not well-defined. Few studies have examined their associations with asthma and its control. OBJECTIVE: To study the associations of occupational exposures with asthma and its control, with specific interest for irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS: Analyses included 4,469 adults (3,792 with neither asthma nor respiratory symptoms, 677 with current asthma; 75.9% women, mean age 54 years) of a case-control study (2018) from the French NutriNet-Santé cohort. Current asthma was defined by ever asthma with symptoms, medication or asthma attacks in the past 12 months, adult-onset asthma by age at first asthma attack older than 16 years, and uncontrolled asthma was defined by an Asthma Control Test score less than 20. Ever/current exposures were assessed with the Occupational Asthma-specific Job Exposure Matrix. Associations were evaluated by multinomial logistic regressions adjusted for sex, age, smoking status, and body mass index. RESULTS: Ever exposures to sensitizers (high molecular weight [HMW]: OR 1.53, 95% CI 1.18-2.00; and low molecular weight [LMW]: OR 1.42; 95% CI 1.09-1.87), irritants (OR 1.32; 95% CI 1.03-1.68), and DCPs (OR 1.43; 95% CI 1.10-1.85) were associated with current adult-onset asthma. Significant associations between ever exposures and uncontrolled adult-onset asthma were observed for high molecular weight (OR 2.69; 95% CI 1.52-4.78) and low molecular weight (OR 2.27; 95% CI 1.24-4.37) sensitizers, irritants (OR 2.32; 95% CI 1.36-3.95), and DCPs (OR 2.59; 95% CI 1.48-4.54). Results were similar for current exposures, with higher ORs. No association was observed with solvents. CONCLUSIONS: Occupational exposures to both sensitizers and irritants were associated with current adult-onset asthma and uncontrolled asthma. Irritant and sensitizing agents should be carefully considered in asthma management.

Cost-Effectiveness of an Organized Lung Cancer Screening Program for Asbestos-Exposed Subjects.

Background: The National Lung Screening Trial (NLST) and NELSON study opened the debate on the relevance of lung cancer (LC) screening in subjects exposed to occupational respiratory carcinogens. This analysis reported the incremental cost-effectiveness ratios (ICER) of an organized LC screening program for an asbestos-exposed population. Methods: Using Markov modelization, individuals with asbestos exposure were either monitored without intervention or annual low-dose thoracic computed-tomography (LDTCT) scan LC screening. LC incidence came from a prospective observational cohort of subjects with occupational asbestos exposure. The intervention parameters were those of the NLST study. Utilities and LC-management costs came from published reports. A sensitivity analysis evaluated different screening strategies. Results: The respective quality-adjusted life year (QALY) gain, supplementary costs and ICER [95% confidence interval] were: 0.040 [0.010-0.065] QALY, 6900 [3700-11,800] € and 170,000 [75,000-645,000] €/QALY for all asbestos-exposed subjects; and 0.144 [0.071-0.216] QALY, 13,000 [5700-26,800] € and 90,000 [35,000-276,000] €/QALY for smokers with high exposure. When screening was based on biennial LDTCT scans, the ICER was 45,000 [95% CI: 15,000-116,000] €/QALY. Conclusions: Compared to the usual ICER thresholds, biennial LDTCT scan LC screening for smokers with high occupational exposure to asbestos is acceptable and preferable to annual scans.

Pleural plaques and risk of lung cancer in workers formerly occupationally exposed to asbestos: extension of follow-up.

BACKGROUND: Occupational asbestos exposure is associated with pleural plaques (PP), a benign disease often seen as a marker of past exposure to asbestos and lung cancer. The association between these two diseases has not been formally proved, the aim of this study was to evaluate this association in the asbestos-related disease cohort (ARDCO) cohort. METHODS: ARDCO is a French multicentric cohort including workers formerly occupationally exposed to asbestos from 2003 to 2005. CT scan was performed to diagnose PP with double reading and lung cancer (incidence and mortality) was followed through health insurance data and death certificates. Cox models were used to estimate the association between PP and lung cancer adjusting for occupational asbestos exposure (represented by cumulative exposure index, time since first exposure and time since last exposure) and smoking status. RESULTS: A total of 176 cases (of 5050 subjects) and 88 deaths (of 4938 subjects) of lung cancer were recorded. Smoking status was identified as an effect modifier. Lung cancer incidence and mortality were significantly associated with PP only in non-smokers, respectively, HR=3.13 (95% CI 1.04 to 9.35) and HR=16.83 (95% CI 1.87 to 151.24) after adjustment for age, occupational asbestos exposure and smoking status. CONCLUSIONS: ARDCO study was the first to study this association considering equal asbestos exposure, and more specifically, our study is the first to test smoking as an effect modifier, so comparison with scientific literature is difficult. Our results seem to consolidate the hypothesis that PP may be an independent risk factor for lung cancer but they must be interpreted with caution.

Delay between COVID-19 complete vaccination and SARS-CoV-2 infection among healthcare workers.

OBJECTIVES: Healthcare workers (HCWs), at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccination, which became mandatory for them on September 15th, 2021 in France. In November they were confronted to the fifth COVID-19 wave despite excellent vaccine coverage. We aimed to estimate the incidence of SARS-CoV-2 infection after complete vaccination among HCWs with different vaccination schemes, and its determinants. METHODS: We enrolled all HCWs in the university hospital of Rennes, France who had received complete vaccination (two doses of COVID-19 vaccine). The delay from last vaccination dose to SARS-CoV-2 infection was computed.Fitted mixed Cox survival model with a random effect applied to exposure risk periods to account for epidemic variation was used to estimate the determinants of SARS-CoV-2 infection after complete vaccination. RESULTS: Of the 6674 (82%) HCWs who received complete vaccination (36% BNT162b2, 29% mRNA-1273, and 34% mixed with ChAdOx1 nCoV-19) and were prospectively followed-up for a median of 7.0 [6.3-8.0] months, 160 (2.4%) tested positive for SARS-CoV-2 by RT-PCR. Incidence density of SARS-CoV-2 infection after complete vaccination was 3.39 [2.89-3.96] infections per 1000 person-month. Median time from vaccine completion to SARS-CoV-2 infection was 5.5 [3.2-6.6] months. Using fitted mixed Cox regression with the delay as a time-dependent variable and random effect applied to exposure risk periods, age (P < 0.001) was independently associated with the incidence of SARS-CoV-2 infection. Vaccine schemes were not associated with SARS-CoV-2 infection (P = 0.068). A period effect was significantly associated with the incidence of SARS-CoV-2 infection (P < 0.001). CONCLUSIONS: In this real-world study, incidence of SARS-CoV-2 infection increases with time in fully vaccinated HCWs with no differences according to the vaccination scheme. The short delay between complete vaccination and incident SARS-CoV-2 infection highlights the need for sustained barrier measures even in fully vaccinated HCWs.

Head and neck cancer and asbestos exposure.

OBJECTIVES: The aim of this study was to analyse, within a French cohort of workers previously occupationally exposed to asbestos, incidence and mortality from various sites of head and neck cancers (larynx excluded) and to examine the potential link of these cancers with pleural plaques. METHODS: A 10-year follow-up study was conducted in the 13 481 male subjects included in the cohort between October 2003 and December 2005. Asbestos exposure was assessed by industrial hygienist analysis of a standardised questionnaire. The final cumulative exposure index (CEI; in equivalent fibres.years/mL) for each subject was calculated as the sum of each employment period's four-level CEI. The number of head and neck cancers recorded by the National Health Insurance fund was collected in order to conduct an incidence study. Complementary analysis was restricted to men who had performed at least one chest CT scan (N=4804). A mortality study was also conducted. We used a Cox model with age as the time axis variable adjusted for smoking, time since first exposure, CEI of exposure to asbestos and pleural plaques on CT scans. RESULTS: We reported a significant dose-response relationship between CEI of exposure to asbestos and head and neck cancers after exclusion of laryngeal cancers, in the mortality study (HR 1.03, 95% CI (1.01 to 1.06) for an increase of 10 f.years/mL) and a close to significant dose-response relationship in the incidence study (HR 1.02, 95% CI (1.00 to 1.04) for an increase of 10 f.years/mL). No statistically significant association between pleural plaques and head and neck cancer incidence was observed. CONCLUSIONS: This large-scale study suggests a relationship between asbestos exposure and head and neck cancers, after exclusion of laryngeal cancers, regardless of whether associated pleural plaques were present.

Endoscopic follow-up of low-grade precancerous bronchial lesions in high-risk patients: long-term results of the SELEPREBB randomised multicentre trial.

BACKGROUND: 3-9% of low-grade preinvasive bronchial lesions progress to cancer. This study assessed the usefulness of an intensive bronchoscopy surveillance strategy in patients with bronchial lesions up to moderate squamous dysplasia. METHODS: SELEPREBB (ClinicalTrials.gov NCT00213603) was a randomised study conducted in 17 French centres. After baseline lung computed tomography (CT) and autofluorescence bronchoscopy (AFB) to exclude lung cancer and bronchial severe squamous dysplasia or carcinoma in situ (CIS), patients were assigned to standard surveillance (arm A) with CT and AFB at 36 months or to intensive surveillance (arm B) with AFB every 6 months. Further long-term data were obtained with a median follow-up of 4.7 years. RESULTS: 364 patients were randomised (A: 180, B: 184). 27 patients developed invasive lung cancer and two developed persistent CIS during the study, with no difference between arms (OR 0.63, 95% CI 0.20-1.96, p=0.42). Mild or moderate dysplasia at baseline bronchoscopy was a significant lung cancer risk factor both at 3 years (8 of 74 patients, OR 6.9, 95% CI 2.5-18.9, p<0.001) and at maximum follow-up (16 of 74 patients, OR 5.9, 95% CI 2.9-12.0, p<0.001). Smoking cessation was significantly associated with clearance of bronchial dysplasia on follow-up (OR 0.12, 95% CI 0.01-0.66, p=0.005) and with a reduced risk of lung cancer at 5 years (OR 0.15, 95% CI 0.003-0.99, p=0.04). CONCLUSION: Patients with mild or moderate dysplasia are at very high risk for lung cancer at 5 years, with smoking cessation significantly reducing the risk. Whereas intensive bronchoscopy surveillance does not improve patient outcomes, the identification of bronchial dysplasia using initial bronchoscopy maybe useful for risk stratification strategies in lung cancer screening programmes.

Deep Learning for the Automatic Quantification of Pleural Plaques in Asbestos-Exposed Subjects.

OBJECTIVE: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos. METHODS: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques. RESULTS: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years. CONCLUSIONS: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy.

Risk factors for SARS-CoV-2 infection among health care workers.

BACKGROUND: Health care workers (HCWs) are on the front line for COVID-19. Better knowledge of risk factors for SARS-CoV-2 infection is crucial for their protection. We aimed to identify these risk factors with a focus on care activities. METHODS: We conducted a seroprevalence survey among HCWs in a French referral hospital. Data on COVID-19 exposures, care activities, and protective equipment were collected on a standardized questionnaire. Multivariate logistic regressions were used to assess risk factors for SARS-CoV-2 IgG adjusted on potential confounding. FINDINGS: Among the 3,234 HCWs enrolled, the prevalence of SARS-CoV-2 IgG was 3.8%. Risk factors included contact with relatives or HCWs with COVID-19 (odds ratio [OR] 2.20 [1.40-3.45] and 2.16 [1.46-3.18], respectively), but not contact with COVID-19 patients. In multivariate analyses, suboptimal use of protective equipment during nasopharyngeal sampling (OR 3.46 [1.15-10.40]), mobilisation of patients in bed (OR 3.30 [1.51-7.25]), clinical examination (OR 2.51 [1.16-5.43]), and eye examination (OR 2.90 [1.01-8.35]) were associated with SARS-CoV-2 infection. Patients washing and dressing and aerosol-generating procedures were additional risk factors, with or without appropriate use of protective equipment (OR 1.37 [1.04-1.81] and 1.74 [1.05-2.88]). CONCLUSIONS: Risk factors for SARS-CoV-2 infection among HCWs are (1) contact with relatives or HCWs with COVID-19, (2) close or prolonged contact with patients, (3) aerosol-generating procedures. Enhanced protective measures during the two latter care-activities may be warranted.

Effectiveness of mRNA-BNT162b2, mRNA-1273, and ChAdOx1 nCoV-19 vaccines against COVID-19 in healthcare workers: an observational study using surveillance data.

OBJECTIVES: Healthcare workers (HCWs) at increased risk of coronavirus disease 2019 (COVID-19) were among the primary targets for vaccine campaigns. We aimed to estimate the protective efficacy of the first three COVID-19 vaccines available in Western Europe. METHODS: We merged two prospective databases that systematically recorded, in our institution: (a) HCWs positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR on nasopharyngeal samples, and (b) HCWs who received at least one dose of COVID-19 vaccine. We excluded HCWs with SARS-CoV-2 infection during the 6 months prior to the study. HCWs were categorized as non-vaccinated if they received no vaccine and until the first injection +13 days, partially vaccinated from the first injection +14 days to the second injection +13 days, and fully vaccinated thereafter. RESULTS: Of the 8165 HCWs employed in our institution, 360 (4.4%) tested positive for SARS-CoV-2 by RT-PCR during the study period (4th January to 17th May 2021). Incidence was 9.1% (8.2-10.0) in non-vaccinated HCWs, 1.2% (0.7-1.9) after one dose of ChAdOx1 nCoV-19, 1.4% (0.6-2.3) and 0.5% (0.1-1.0) after one and two doses of mRNA BNT162b2, 0.7% (0.1-1.9) and 0% after one and two doses of mRNA-1273 (p < 0.0001). Vaccine effectiveness (Cox model) was estimated at, respectively, 86.2% (76.5-91.0), 38.2% (6.3-59.2), and 49.2% (19.1-68.1) 14 days after the first dose for ChAdOx1 nCoV-19, mRNA-1273, and mRNA-BNT162b2, and 100% (ND) and 94.6% (61.0-99.2) 14 days after the second dose for mRNA-1273 and mRNA-BNT162b2. CONCLUSIONS: In this real-world study, the observed effectiveness of COVID-19 vaccines in HCWs was in line with the efficacy reported in pivotal randomized trials.

Effect of Joint Exposure to Psychosocial and Physical Work Factors on the Incidence of Workplace Injuries: Results From a Longitudinal Survey.

OBJECTIVE: To analyze the interaction between physical and psychosocial work factors regarding the workplace injuries incidence among 6900 workers out of a longitudinal survey. METHODS: Based on responses to questionnaires, we obtained exposure groups respectively for physical factors and for psychosocial factors using hierarchical clustering. We performed multiple Poisson regression model with the workplace injuries incidence during 4 years of follow-up as the outcome and the clusters as the independent variables of interest. RESULTS: High psychosocial exposure had a deleterious effect on workplace injuries incidence, which was no longer significant when adjusting for physical factors. The difference in model-based workplace injuries rates between high and low psychosocial exposures seemed to increase (non-significantly) with increasing physical exposure. CONCLUSIONS: The risk of workplace injuries was highest among workers with high physical exposures regardless of the psychosocial exposures.