Factors associated with psychoactive drug initiation in a sample of workers in France: results of the VISAT cohort study.

PURPOSE: To identify which psychosocial factors at work are associated with the initiation of psychoactive drug use in a cohort of healthy French workers. METHOD: This study used data collected from the VISAT ('Vieillissement, Santé, Travail') cohort which included workers aged 32, 42, 52 and 62 years in 1996 with follow-ups conducted over the following 5 years. Data were collected through interviews and five standardized questionnaires in annual occupational medical examinations in 1996, 1999 and 2001. We defined new consumers of psychoactive drugs according to their answers during the follow-ups and compared their psychosocial and working characteristics to non-consumers. A multivariate logistic regression analysis was performed to investigate factors related to a psychoactive drug initiation. RESULTS: Among 1533 subjects, 5.4% began consuming psychoactive drugs during the follow-up with a twofold rate for women than for men. Factors related to psychoactive drug initiation were different according to gender. In men, initiation was mainly found in participants who were separated, showed high emotional reaction scores and were members of the white-collar working class. We did not find any other occupational factors associated to psychoactive drug initiation in men. By contrast, among women, drug initiation was more frequent in participants who were 52 years old and over, and whose job control-reward level was lower. CONCLUSIONS: Psychoactive drug initiation concerned 5.4% of workers within the 5-year interval in this study. The pressure of psychosocial environment was more important in men, whereas age and work-related psychosocial factors were the main factors associated with new consumption among women.

Evolution of drug consumption in a sample of French workers since 1986: the 'Drugs and Work' study.

PURPOSE: France is known to have a relatively high prescription rate for medicines. Few studies have investigated drug use among a healthy worker population. The aim of this study was to describe the changing patterns of drug use in French workers since 1986 and to evaluate the impact of programs developed to reduce drug consumption. METHOD: A cross-sectional survey has been performed every 10 years since 1986 among workers from the Toulouse metropolitan area (Southwestern, France) using an anonymous questionnaire given to workers during their compulsory annual medical visit. Results of the 2006 survey (2213 workers) were compared to those obtained in 1986 and 1996. A multivariate analysis was performed to investigate factors associated to the modification of drug use with time. RESULTS: During the last ten years, prevalence of overall drug consumption decreased (40.7% in 2006 vs. 46.7% in 1996, p < 0.001) in contrast to the increase observed between 1986 and 1996. Since 1986, patterns of drug use have been modified with a decrease in anti-infectious (OR = 0.24) digestive (OR = 0.54), psychotropic (OR = 0.54), endocrine (OR = 0.57) and cardiotropic (OR = 0.68) drug use. In contrast, there was a significant increase in musculosqueletic (OR = 2.16) drug use. Whatever the period, overall drug consumption was related to age, gender or extraprofessional problems. CONCLUSIONS: This study illustrates the changing patterns of drug use in a population of workers during the last 20 years and underlines the importance of awareness raising campaigns on prescription patterns.

Effects of working conditions and sleep of the previous day on cognitive performance.

The study examined the consequences of working conditions on the previous day on cognitive performance the following day. It also addressed the issue of whether this relationship was mediated by sleep and whether it differed as a function of age. The data were taken from the VISAT study (aging, health and work) and concerned the participant's general work schedule, general sleep quality, working conditions on the previous day (content, duration, load and schedule), subsequent sleep length and quality, and cognitive performance. Results showed that both physical activity and working before 6 am or after 10 pm on the previous day were significantly associated with poorer cognitive performance. Significant effects of working conditions on the previous day were also observed on subsequent sleep, but these effects did not mediate the relationship between working conditions and cognitive performance. The observed effect on cognitive performance of atypical work hours on the previous day was similar for all ages, probably because of the healthy worker effect.

Psychoactive drug consumption: performance-enhancing behaviour and pharmacodependence in workers.

PURPOSE: The aim of this study was to investigate factors associated to psychoactive medication use and dependence in working environment during a 1-year period. METHODS: We performed a 1-year-follow-up cohort study including workers from Toulouse metropolitan area. During their annual compulsory examination to assess their aptitude to work, subjects were asked to fill in an anonymous questionnaire at 1 year interval, in May 2000 and May-June 2001. RESULTS: Among a study sample of 1273 subjects (47.4% of men, mean age 39.2 +/- 9.2 years), the prevalence of psychoactive medication use at baseline was 9.1% (4.3% anxiolytic, 1.9% hypnotic, 1.7% antidepressant, 2.1% opiate analgesic and 0.5% antipsychotic drugs, according to ATC classification). Dependence on these drugs was found in 3.5% of workers. This consumption was associated with professional categories (higher in employees versus senior executive, Odds Ratio: 1.80; 95% Confidence Interval [1.04-3.11]), low job satisfaction and outside workplace (1.92; [1.30-2.84] and 3.40; [2.27-5.09] respectively), and patterns of medication use at workplace: for sleeping disorders related to job (18.27; [11.81-28.26]), for enhancing performance at work (28.13; [12.00-65.92]), for relieving unpleasant symptoms at work (22.98; [9.59-55.01]). The risk of psychoactive medication chronic use (psychoactive drug users in 2000 and 2001), and dependence at 1 year were both strongly associated with nicotine dependence (5.99 and 6.23, respectively) and performance-enhancing behaviour with drugs and/or alcohol (8.35 and 3.32 respectively), whereas current use (psychoactive drug users only in 2001) was strongly associated with performance-enhancing behaviour. CONCLUSIONS: Among workers using psychoactive drugs, one out of three are dependent on psychoactive medications. Performance-enhancing behaviour and coping strategies might be a determinant of psychoactive drug use and could lead to dependence in the workplace.

Job stress and occupational status in a French cohort.

BACKGROUND: The goal of this study was to examine a large, varied occupational French cohort for possible relationships between various dimensions of occupational stress, on the one hand, and the occupational status and socio-demographic characteristics of workers on the other. METHODS: Data was taken from the first, cross-sectional phase of the VISAT study (aging, health, and work), which took place in 1996. Participants were randomly drawn from the patient lists of about one hundred occupational physicians in three regions of southern France. The current study concerned 2,768 wage earners born in 1944, 1954, or 1964. The material consisted of 59 questions aimed at assessing a broad set of working conditions, some of which were proxy measures of the dimensions described in the Karasek and Siegrist models. RESULTS: From a principal component analysis, three main factors were extracted that accounted for 40% of the total variance. The first factor (a=0.79) included items that referred to the decision latitude in the Karasek model and items that referred to the reward dimension in the Siegrist model. The second factor (a=0.77) was made up of items tapping physical stressors, while the third factor (a=0.71) pooled items that corresponded fairly well to psychological demands in the Karasek model. Highly significant relationships (p<10(-4)) were found between the mean factor scores and both occupational status and educational level, with a lower occupational status and educational level being associated with greater lack of job control and rewards, higher physical stress, but lower psychological demands. Less job control and fewer rewards were also found to be greater in older workers (p<10(-3)) and females (p<10(-4)). CONCLUSION: Our results thus confirm the existence of a strong association, in a French cohort, between occupational status and dimensions of job stress known to be associated with adverse health outcomes.

Skin manifestations associated with toxocariasis: a case-control study.

BACKGROUND: Human toxocariasis is one of the most common zoonotic helminthiases. The recent development of sensitive and specific diagnostic laboratory tests has led to identify a large spectrum of diseases, including cutaneous diseases, induced by Toxocara infection. OBJECTIVE: The purpose of our study was to assess the risk of having a positive Toxocara ELISA test in patients with different cutaneous symptoms. METHODS: The diagnosis of toxocariasis was based on an ELISA test which was performed in 653 patients suffering from different skin conditions during a prospective case-control study. RESULTS: The excess of risk (adjusted odds ratio) of having a positive result in the Toxocara ELISA was statistically significant for 134 patients with urticaria (whatever the clinical presentation) and for 22 patients with prurigo compared to a control group (249 patients). No statistical excess of risk was observed for patients with atopic dermatitis, pruritus or non-atopic eczema. CONCLUSION: The authors conclude that patients suffering from urticaria or prurigo should be tested for Toxocara infection. Whether these patients should be treated with anthelminthic drugs remains to be determined in further studies.

[Consumption of antihypertensive agents in obese patients: a cross-sectional study in a sample of 3,291 wage-earners in the Toulous region]. / Consommation de médicaments antihypertenseurs chez le sujet obèse: enquête transversale auprès d'un échantillon de 3,291 salariés de la région toulousaine.

A cross-sectional study in a sample of 3,291 healthy workers was performed in May 1997 to assess the prevalence of obesity (BMI > or = 30 kg/m2) in a working population, and to compare prescription of antihypertensive drugs in obese and non obese subjects. Obesity was found in 7.4% (245) subjects and morbid obesity concerned 0.4% of the total sample (mean age 37.6 +/- 9.7 [SD] years, 52.4% of males). Risk of obesity was significantly associated with age, male sex, professional classes (higher in blue collars workers, lower in senior executive), business travels, atypical schedules, professional and private difficulties. Albeit the prevalence of drug users (49.7%) was similar whatever the BMI, obese subjects used a higher number of drugs than non obese (2.0 +/- 1.2 versus 1.6 +/- 0.9, p < 0.001). Risk of consumption of cardiovascular drugs was higher in obese than in non obese subjects (OR 2.9, 95% CI [2.2-4.1]). After adjustment on confounding factors, obesity increased specific drug use such as angiotensin converting enzyme inhibitors (OR 3.3, 95% CI [1.7-6.4]), beta-blocking agents (OR 2.83, 95% CI [1.01-8.01]), calcium channel blockers (OR 2.44, 95% CI [1.06-5.63]) or diuretics only in women (OR 5.7, 95% CI [2.1-16.3]). Prescribed antihypertensive drugs were different in obese (beta-blockers = angiotensin converting enzyme inhibitors > diuretics > calcium channels blockers) and non obese (angiotensin converting enzyme inhibitors > calcium channel blockers > diuretics > beta-blockers) subjects.

Allergy to complex platinum salts: A historical prospective cohort study.

OBJECTIVE: To assess the incidence of allergy to complex platinum salts in a platinum refinery. METHODS: A historical prospective cohort study was carried out on 77 workers (67 men) who started work between 1 January 1979 and 31 December 1991 and who were not atopic on skin prick tests to three common allergens at the time of recruitment. Skin prick tests with complex platinum salts were carried out and diagnosis of allergy to complex platinum salts made by the company's doctor. Skin tests and medical examinations were carried out routinely every six months. Follow up was until 30 September 1992 or until leaving refinery work. RESULTS: 18 workers developed a positive result on skin tests and 23 developed symptoms, including all 18 subjects with positive skin tests; the probability of surviving (95% confidence interval (95% CI)) for 72 months after joining the company, with negative skin test results was 0.67 (0.51-0.79) or with no symptoms was 0.63 (0.49-0.75). The incidence of positive skin tests and symptoms was highest during the first two years of work. Symptoms occurred more frequently in September and October than during the other months of the year. The exclusion of atopic subjects did not seem to have resulted in a lower incidence of sensitisation. Smoking was a significant predictive factor for both positive skin tests (estimated relative risk 5.53) and symptoms (4.70). CONCLUSION: The findings confirm that smoking is and that atopy may not be a high risk factor for the development of allergy to complex platinum salts. The high incidence of sensitisation and the available data on the clinical course of sensitised workers show that sensitised workers must be promptly and completely removed from exposure.