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.

A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France.

INTRODUCTION: Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas. METHODS: The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use. RESULTS: After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed. DISCUSSION: Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred.

Maternal occupational exposure to carbonaceous nanoscale particles and neurodevelopmental outcomes in early childhood: Analysis of the French Longitudinal Study of Children - Elfe study.

OBJECTIVE: To investigate the association between occupational exposures to carbonaceous unintentionally emitted nanoscale particles (UNPs) during pregnancy and the child's language development and behaviour at two years old. METHODS: Using data from the French Longitudinal Study of Childhood - ELFE, we selected mothers who worked during pregnancy and their children. Exposure to carbonaceous UNPs was assessed by the MatPUF (job-exposure matrix for ultrafine particles). Children's lexical development was analysed using 'the Mac Arthur - Bates communicative development inventories-words and sentences-short form' (MB-CDI) in a multivariate binary logistic regression. Their risk for autism spectrum disorders was studied using 'the Modified-CHecklist for Autism in Toddler' (M-CHAT) according to the recommended thresholds (low risk = 0-2; intermediate risk = 3-6 and high risk = 7-23) in unordered multinomial logistic regression models. RESULTS: Maternal occupational exposure to carbonaceous UNPs was associated with delayed child language development (ORadj: 1.34; 95 % CI: 1.00, 1.80) but not with behavioural disorders (autism spectrum disorders) at two years old. CONCLUSION: This is the first epidemiological study to show a significant association between maternal occupational exposure to carbonaceous nanoscale particles and child language development at 2 years old.

Occupational quantitative exposure to crystalline silica, solvents, pesticides, and risk of clinical forms of systemic sclerosis.

OBJECTIVES: To estimate the association between SSc clinical phenotypes and quantitative occupational exposure to crystalline silica, chlorinated solvents, trichloroethylene, and pesticides using job-exposure matrices. METHODS: In the VISS-EXPOSITION transversal study, data on declarative occupational exposure to crystalline silica, solvents, and pesticides were retrieved. In parallel, the Lifetime Occupational History was evaluated using a questionnaire and cursus laboris for SSc patients followed at Bordeaux University Hospital (France). Using job-exposure matrices, we assessed patients' occupational exposure in relation to relevant clinical phenotypic forms of the disease. RESULTS: Toxic exposure to crystalline silica and pesticides is underestimated by patients. Non-biased job-exposure matrices retrieved more exposed patients than the declarative assessment (10.1% of patients by job-exposure matrices versus 6.3% by declaration for crystalline silica and 25.9% versus 12.2% for pesticides). Patients overestimate their solvent exposure (7.9% for chlorinated solvents and 4.8% for trichlorethylene assessed by job-exposure matrices and 24.4% declarative exposure to solvents at large). Clinical form evaluation revealed a nonsignificant trend toward an increased risk of crystalline silica occupational exposure in the pulmonary fibrotic group of SSc patients (OR 3.12 CI 95% [0.80-12.15]). We also observed a nonsignificant trend toward elevated OR (OR 2.89 CI 95% [0.93-8.95]) for chlorinated solvent occupational exposure and the vascular phenotype of SSc. Of note, pesticide occupational exposure evaluation represents one of the largest to date in SSc patients. CONCLUSION: This study emphasizes that many exposed SSc patients are unaware of their occupational exposure. Job-exposure matrices allow better exposure screening for SSc secondary prevention and occupational exposure compensation. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, https://www.clinicaltrials.gov, NCT03543956.

Indoor exposure to ultrafine particles related to domestic activities: A systematic review and meta-analysis.

Ultrafine particles (< 100 nm) are of increasing concern because of their toxicological potential. Emission processes suggest their presence in all environments, including at home, where particularly at-risk populations may be exposed. However, knowledge of their impact on health is still limited, due to difficulties in properly assessing exposure in epidemiological studies. In this context, the objective of this study was to provide a complete summary of indoor exposure to ultrafine particles in highly industrialised countries by examining the domestic activities that influence such exposure. We conducted a systematic review, according to PRISMA guidelines using PubMed, Web of Science and Scopus up to and including 2021. We carried out a qualitative and quantitative analysis of the selected studies with a standardised template. Exposure circumstances, measurement methods, and results were analysed. Finally, a meta-analysis of the measured concentrations was performed to study exposure levels during domestic activities. The review included 69 studies resulting in the analysis of 346 exposure situations. Nine main groups of activities were identified: cooking, which was the most studied, smoking, the use of air-fresheners, cleaning, heating, personal care, printing, do-it-yourself activities, and others. Over 50 different processes were involved in these activities. Based on available particle number concentrations, the highest average of mean concentrations was associated with grilling (14,400 × 103 cm-3), and the lowest with wood stove (18 × 103 cm-3). The highest average of peak concentrations was that for the use of hair dryers (695 × 103 cm-3), and the lowest for the use of air cleaners (11 × 103 cm-3). A hierarchy of domestic activities and related processes leading to ultrafine particle exposure is provided, along with average exposure concentrations at home. However, more extensive measurement campaigns are needed under real-life conditions to improve assessments of indoor exposure to ultrafine particles.

Association between pre-diagnosis geriatric syndromes and overall survival in older adults with cancer (the INCAPAC study).

INTRODUCTION: Several population-based studies have reported disparities in overall survival (OS) among older patients with cancer. However, geriatric syndromes, known to be associated with OS in the geriatric population, were rarely studied. Thus, our aim was to identify the determinants of OS among French older adults with cancer, including geriatric syndromes before cancer diagnosis. MATERIALS AND METHODS: Using cancer registries, we identified older subjects (≥65 years) with cancer in three French prospective cohort studies on aging from the Gironde department. Survival time was calculated from the date of diagnosis to the date of all-cause death or to the date of last follow-up, whichever came first. Demographic and socioeconomic characteristics, smoking status, self-rated health, cancer-related factors (stage at diagnosis, treatment), as well as geriatric syndromes (polypharmacy, activity limitation, depressive symptomatology, and cognitive impairment or dementia) were studied. Analyses were performed using Cox proportional hazard models for the whole population, then by age group (65-84 and 85+). RESULTS: Among the 607 subjects included in the study, the median age at cancer diagnosis was 84 years. Smoking habits, activity limitations, cognitive impairment or dementia, advanced cancer stage and absence of treatment were significantly associated with lower OS in the analysis including the whole population. Women presented higher OS. Factors associated with OS differed by age group. Polypharmacy was inversely associated with OS in older adults aged 65-84 and 85 + . DISCUSSION: Our findings support that geriatric assessment is needed to identify patients at higher risk of death and that an evaluation of activity limitation in older adults is essential. Improving early detection could enable interventions to address factors (activity limitations, cognitive impairment) associated with OS, potentially reducing disparities and lead to earlier palliative care.

Pesticide Exposure of Residents Living in Wine Regions: Protocol and First Results of the Pestiprev Study.

The PESTIPREV study has been designed to investigate residential exposure to pesticides applied to vines and ultimately propose mitigation measures. A feasibility study was carried out to validate a protocol for measuring six pesticides in three houses located near vineyards in July 2020. Samples included indoor and outdoor surfaces sampled with wipes (n = 214), patches on the resident's skin (n = 7), hand or foot washing (n = 5), and pets sampled using wipes (n = 2). Limits of quantification for wipes ranged between 0.02 ng for trifloxystrobin and 1.50 ng for pyraclostrobin. Tebuconazole and trifloxystrobin were quantified in nearly 100% of the surface samples, whereas the other fungicides were less frequently found (from 39.7% for pyraclostrobin to 55.1% for boscalid). The median surface loadings ranged from 3.13 ng/m2 for benalaxyl to 82.48 ng/m2 for cymoxanil. The pesticides most frequently quantified in hand washing, patch samples, and pet wipes were the same as those quantified on surfaces. Finally, the analyses proved to be successful. The tools developed to collect information on determinants were well completed. The protocol was well received by the participants and appeared to be feasible and relevant to the objective of the PESTIPREV study, although some improvements have been identified. It was applied on a larger scale in 2021 to study the determinants of pesticide exposure.

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.

Effects of air pollution on clinical pregnancy rates after in vitro fertilisation (IVF): a retrospective cohort study.

OBJECTIVE: To evaluate the effect of air pollution, from oocyte retrieval to embryo transfer, on the results of in vitro fertilisation (IVF) in terms of clinical pregnancy rates, at two fertility centres, from 2013 to 2019. DESIGN: Exploratory retrospective cohort study. SETTING: This retrospective cohort study was performed in the Reproductive Biology Department of Bordeaux University Hospital localised in Bordeaux, France and the Jean Villar Fertility Center localised in Bruges, France. PARTICIPANTS: This study included 10 763 IVF attempts occurring between January 2013 and December 2019, 2194 of which resulted in a clinical pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome of the IVF attempt was recorded as the presence or absence of a clinical pregnancy; exposure to air pollution was assessed by calculating the cumulative exposure of suspended particulate matter, fine particulate matter, black carbon, nitrogen dioxide and ozone (O3), over the period from oocyte retrieval to embryo transfer, together with secondary exposure due to the presence of the biomass boiler room, which was installed in 2016, close to the Bordeaux University Hospital laboratory. The association between air pollution and IVF outcome was evaluated by a random-effects logistic regression analysis. RESULTS: We found negative associations between cumulative O3 exposure and clinical pregnancy rate (OR=0.92, 95% CI = (0.86 to 0.98)), and between biomass boiler room exposure and clinical pregnancy rate (OR=0.75, 95% CI = (0.61 to 0.91)), after adjustment for potential confounders. CONCLUSION: Air pollution could have a negative effect on assisted reproductive technology results and therefore precautions should be taken to minimise the impact of outdoor air on embryo culture.

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.

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.

Biomechanical and organisational constraints of pregnant women at work: definition of exposure levels using a consensus method (Delphi).

OBJECTIVES: To identify the biomechanical and organisational constraints that influence pregnancy outcomes and define the exposure levels at which the risks for pregnancy become significant. SETTING AND PARTICIPANTS: We applied a consensus method (Delphi) consisting of a literature review followed by expert opinions on exposure levels. The group of experts was made up of 12 people from different medical specialities and working in various structures in France. OUTCOME MEASURES: The studied variables were: (1) exposure: night work/shift work, weekly hours at work, lifting of heavy loads, prolonged standing and multiple exposure and (2) pregnancy outcomes: prematurity, low birth weight and spontaneous miscarriages. RESULTS: The consensus method resulted in the following recommendations. The time spent working must not exceed 40 hours/week; in the absence of a consensus on the level of exposure, night and/or shift work must be avoided; prolonged standing must not exceed 3 hours/day; lifting must be limited to carrying loads <11 kg, with a daily load <100 kg; multiple exposure must be avoided, in particular: vibration, night work/shift work, time spent working exceeding 40 hours/week, prolonged standing and lifting of heavy loads. CONCLUSIONS: These results could help the occupational physician to address the question of whether an exposed employee should remain at work, considering her individual characteristics (medical history, family situation, socioeconomic level, etc) in consultation with pregnancy specialists (obstetricians, midwives).

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.

Greater Risk of Pregnancy Complications for Female Surgeons: A Cross-Sectional Electronic Survey.

BACKGROUND: Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. METHODS: We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. RESULTS: Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84]. CONCLUSION: Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy.

Occupational Exposure to Ultrafine Particles and Placental Histopathological Lesions: A Retrospective Study about 130 Cases.

Ultrafine particles (UFPs) are particles smaller than 100 nanometers that are produced unintentionally during human activities or natural phenomena. They have a higher biological reactivity than bigger particles and can reach the placenta after maternal exposure. One study has shown an association between maternal occupational exposure to UFPs and fetal growth restriction. Yet few studies have focused on the effects of UFP exposure on placental histopathological lesions. The aim of this study was to investigate the association between maternal occupational exposure to UFPs and histopathological lesions of their placenta. The analyses were based on data from the ARTEMIS Center. A job-exposure matrix was used to assess occupational exposure to UFPs. The histopathological placental exam was performed by two pathologists who were blinded to the exposure of each subject. The examination was conducted in accordance with the recommendations of the Amsterdam consensus. The study sample included 130 placentas (30 exposed, 100 unexposed). Maternal occupational exposure to UFPs during pregnancy is significantly associated with placental hypoplasia (the phenomenon affected 61% of the exposed patients and 34% of the unexposed ones, p < 0.01). Further research is needed to explain its pathophysiological mechanisms.

Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age.

OBJECTIVE: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. METHODS: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema <25%, moderate: between 25 and 50% and severe: >50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. RESULTS: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02-1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. CONCLUSION: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos.

Development of a Job-Exposure Matrix for Ultrafine Particle Exposure: The MatPUF JEM.

OBJECTIVE: Ultrafine particles (UFPs) are generated from common work processes and have thus existed for a long time. Far more prevalent than engineered nanoparticles, they share common toxicological characteristics with them. However, there is no existing retrospective assessment tool specific to UFPs, for example, for epidemiological purposes. Thus, we aimed to develop a job-exposure matrix dedicated to UFPs. METHOD: Fifty-seven work processes were identified as well as the chemical composition of UFPs emitted, following a literature review and the input of an expert panel. These work processes were associated with occupational codes as defined by the ISCO 1968 classification. The probability and frequency of UFP exposure were assessed for each combination of occupational code and process. Summarized probabilities and frequencies were then calculated for all ISCO occupational codes associated with several processes. Variations in exposure over time or across industrial sectors were accounted for in the assessment of each occupational code. RESULTS: In the ISCO classification, 52.8% of the occupational codes (n = 835) assessed were associated with exposure to UFPs, consisting mainly of carbonaceous, metallic, and mineral families (39.5%, 22 and, 15.8%, respectively). Among them, 42.6% involved very probable exposure, and at a high frequency (regularly or continuously). CONCLUSION: These results suggest that occupational exposure to UFPs may be extensive at the workplace and could concern a wide variety of workers. Pending the integration of a third parameter assessing the intensity of UFP exposure, the MatPUF JEM already constitutes a promising and easy-to-use tool to study the possible adverse health effects of UFPs at work. It may also guide prevention policies in the occupational environments concerned, including those involving engineered nanoparticles.

Determinants of non-dietary exposure to agricultural pesticides in populations living close to fields: A systematic review.

BACKGROUND: There is growing evidence in the scientific literature that individuals living near fields are more exposed to agricultural pesticides than people living further away. OBJECTIVE: The main objective of this systematic review was to identify the non-dietary determinants of pesticide exposure related to the drift pathway in residents living in agricultural areas, including spatial indictors related to agricultural activities, hygiene practices, behaviors and sociodemographic parameters. METHODS: Three databases were consulted (PubMed, Web of sciences, Scopus). At least two experts selected the eligible studies. RESULTS: A total of 27 original studies (2002-2020) fulfilled the eligibility criteria of this review. These publications explored pesticide exposure of individuals through measurements in biological samples (n = 13), environmental samples (n = 11) or both (n = 3). Spatial indicators, including residential proximity to fields, crop acreage around the residence and amounts of pesticides applied in the vicinity were identified as determinants of pesticide exposure in many studies (n = 17), including publications considered to be of very good or good quality (n = 12). Season of spraying tended to increase the levels of pesticides measured in five publications out of seven. Meteorological parameters and physical barriers showed an inconsistent and complex influence on the presence and levels of pesticides in urine samples and house dust. Frequent housekeeping reduced the presence of pesticides at home and consequently in biological matrices in three studies out of six. Finally, the effect of the occupants' sociodemographic characteristics, behaviors, and hygiene practices on the exposure measurement was less well documented and results were fairly inconsistent. DISCUSSION AND CONCLUSION: This study consolidates our knowledge of the determinants influencing pesticide exposure levels in people living in agricultural areas. Nevertheless, the available scientific data is still too limited to serve as a basis for developing risk management measures. More research is needed to improve knowledge of the determinants of exposure.