Occupational exposure factors for mental and behavioral disorders at work: The FOREC thesaurus.

BACKGROUND: Mental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) linked with the onset of mental and behavioral disorders. METHODS: The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker's point of view using the FOREC thesaurus. RESULTS: We recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus. CONCLUSIONS: We built the first thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs.

Physical and biochemical properties of airborne flour particles involved in occupational asthma.

Aerosol particles which deeply penetrate the human airways and which trigger baker's asthma manifestations are known to represent only a part of flour and of airborne particles found in bakeries. They were a major focus of this study. To this end, aerosols were produced from different wheat and rye flours, using an automatic generator designed for bronchial challenge. Particles were characterized for their size distribution, their ability to be deposited in the airways, their protein content, their histological composition and their reactivity with immunoglobulin E (IgE) present in sera from asthmatic bakers. Like dust particles collected in the bakery, the aerosols produced showed increased protein content but decreased IgE reactive protein content when compared to the corresponding bulk flours. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of these particles showed a predominance of endosperm gluten proteins. Under scanning electron microscopy, flour particles displayed various tissue fragments with entrapped large A-starch and small B- or C-starch granules, whereas aerosol particles appeared primarily as a mixture of the endosperm intracellular interstitial protein matrix and small B- or C-starch granules free or still associated. These observations showed that aerosols supposed to penetrate deeply the airways, mainly correspond to intracellular fragments of endosperm cells enriched in gluten proteins but with lower amount of allergens belonging to albumins or globulins.