Farming activities and risk of inflammatory bowel disease: a French nationwide population-based cohort study.

BACKGROUND AND AIMS: Epidemiological data regarding inflammatory bowel disease (IBD) are lacking, in particular for occupationally exposed populations. We investigated whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with IBD than others. METHODS: Nationwide population-based insurance claims and electronic health records from all FMs that worked at least once over the period 2002-2016 were used (n=1088561, 69% males). The outcome measure was the association between 26 farming activities and the risk of IBD, Crohn's disease (CD), and ulcerative colitis (UC), measured as hazard ratios (HRs), after adjusting for age, sex, pre-existing medical comorbidities, and farm location. The time to first chronic disease declaration was used as the underlying timescale. A model was generated for every activity and disease, utilizing a reference group comprising all FMs who abstained from the specified activity from 2002 to 2016. RESULTS: There were 1752 IBD cases, with 704 CD (40.2%) and 1048 UC (59.8%) cases, respectively. Elevated HRs were observed for fruit arboriculture (HR from 1.17 to 1.52) and dairy farming (HR from 1.22 to 1.46) for all IBD, in crop farming for CD only (HR=1.26 [95CI%: 1.06-1.49]), and in shellfish farming (HR from 2.12 to 2.51) for both CD and IBD. CONCLUSIONS: Further research regarding specific farming activities and exposures likely to modify the microbiota (e.g., pesticides, pathogens) is required to identify potential occupational risk factors (agricultural exposome) for IBD. Exposure to Mycobacterium avium subspecies paratuberculosis, cryptosporidium, environmental toxins, micro/nanoplastics, and pesticides represents promising research avenues.

Using a Virtual Reality Tool to Provide Primary Prevention Training in the Construction Field Following a Periodic Medical Visit: Cross-Sectional Study.

BACKGROUND: The construction field is highly concerned with the risk of work-related accidents, and training employees is difficult due to their small numbers in most companies. OBJECTIVE: This study aimed to study the impact of a virtual reality (VR) training tool following a periodic occupational health medical visit on the feeling of personal effectiveness in preventing occupational risks related to co-activity on a construction site. METHODS: We conducted a cross-sectional study with employees who had a periodic medical visit between April 1, 2022, and October 13, 2022, in a French occupational health service specializing in the construction field (Services Médicaux Interentreprises Bâtiment Travaux Publics [SMIBTP]). The employees were divided into 2 groups according to the training received: a medical visit alone or coupled with a session with a VR tool. We compared the scores for a "feeling of self-efficacy in occupational risk prevention" using the Fisher exact test. RESULTS: Of the 588 employees included, 210 had a medical visit alone, and 378 had a medical visit coupled with VR training. Training with the VR tool was associated with an increased "feeling of self-efficacy in occupational risk prevention." The employees who benefited from the training reported a willingness to apply the advice given on prevention to a greater extent than those who did not, and they believed that risks on the worksite could be reduced using this tool. CONCLUSIONS: Using VR training as a complement to periodic medical visits in an occupational health service improves the feeling of personal effectiveness in occupational risk prevention at the end of the training. If this trend is confirmed over a longer period of time, it could be an easily accessible prevention lever for employees in the future.

Farming activity and risk of treated thyroid disorders: Insights from the TRACTOR project, a nationwide cohort study.

BACKGROUND: Epidemiological data regarding thyroid diseases are lacking, in particular for occupationally exposed populations. OBJECTIVES: To compare the risk of hypothyroidism and hyperthyroidism between farming activities within the complete population of French farm managers (FMs). METHODS: Digital health data from retrospective administrative databases, including insurance claims and electronic health/medical records, was employed. This cohort data spanned the entirety of French farm managers (FMs) who had undertaken work at least once from 2002 to 2016. Survival analysis with the time to initial medication reimbursement as timescale was used to examine the association (hazard ratio, HR) between 26 specific farming activities and both treated hypothyroidism and hyperthyroidism. A distinct model was developed for each farming activity, comparing FMs who had never engaged in the specific farming activity between 2002 and 2016 with those who had. All analyses were adjusted for potential confounders (e.g., age), and sensitivity analyses were conducted. RESULTS: Among 1088561 FMs (mean age 46.6 [SD 14.1]; 31% females), there were 31834 hypothyroidism cases (75% females) and 620 hyperthyroidism cases (67% females), respectively. The highest risks were observed for cattle activities for both hyperthyroidism (HR ranging from 1.75 to 2.42) and hypothyroidism (HR ranging from 1.41 to 1.44). For hypothyroidism, higher risks were also observed for several animal farming activities (pig, poultry, and rabbit), as well as fruit arboriculture (HR = 1.22 [1.14-1.31]). The lowest risks were observed for activities involving horses. Sex differences in the risk of hypothyroidism were observed for eight activities, with the risk being higher for males (HR = 1.09 [1.01-1.20]) than females in viticulture (HR = 0.97 [0.93-1.00]). The risk of hyperthyroidism was two times higher for male dairy farmers than females. DISCUSSION: Our findings offer a comprehensive overview of thyroid disease risks within the FM community. Thyroid ailments might not stem from a single cause but likely arise from the combined effects of various causal agents and triggering factors (agricultural exposome). Further investigation into distinct farming activities-especially those involving cattle-is essential to pinpoint potential risk factors that could enhance thyroid disease monitoring in agriculture.

Does prenatal exposure to multiple airborne and tap-water pollutants increase neonatal thyroid-stimulating hormone concentrations? Data from the Picardy region, France.

OBJECTIVE: Systematic screening for congenital hypothyroidism by heel-stick sampling has revealed unexpected heterogeneity in the geographic distribution of newborn thyroid-stimulating hormone concentrations in Picardy, France. We explored a possible relationship with environmental pollutants. METHODS: Zip code geolocation data from mothers of newborns without congenital hypothyroidism born in 2021 were linked to ecological data for a set of airborne (particulate matter with a diameter of 2.5 µm or less [PM2.5] or 10 µm or less [PM10]) and tap-water (nitrate and perchlorate ions and atrazine) pollutants. Statistical associations between mean exposure levels during the third trimester of pregnancy and Thyroid-stimulating hormone (TSH) concentrations in 6249 newborns (51 % male) were investigated using linear regression models. RESULTS: Median neonatal TSH concentration (interquartile range, IQR) was 1.7 (1-2.8) mIU/L. An increase of one IQR in prenatal exposure to perchlorate ions (3.6 µg/L), nitrate ions (19.2 mg/L), PM2.5 (3.7 µg/m3) and PM10 (3.4 µg/m3), were associated with increases in TSH concentrations of 2.30 % (95 % CI: 0.95-3.66), 5.84 % (95 % CI: 2.81-8.87), 13.44 % (95 % CI: 9.65-17.28) and 6.26 % (95 % CI: 3.01-9.56), respectively. CONCLUSIONS: Prenatal exposure to perchlorate and nitrate ions in tap water and to airborne PM over the third trimester of pregnancy was significantly associated with increased neonatal TSH concentrations.

Occupational exposures in the rubber tire industry and risk of cancer: a systematic review.

OBJECTIVE: This study aimed at investigate the association between cancer and the rubber tire industry using indicators used to estimate exposure, such as duration or historical time period of exposure. METHODS: A systematic review using MEDLINE was carried out. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement guided the systematic review. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze biases in the selected studies. RESULTS: A total of 240 articles were initially selected. Of these, 17 were included in this systematic review of 15 different cohorts and one case-control study. Five cohorts were composed of rubber industry employees including some who worked in the rubber tire industry, whereas the other 10 cohorts were composed exclusively of rubber tire industry employees. An increased risk of lung/respiratory cancer is possible in the oldest time periods without duration of exposure showing any association according to the analysis. The work areas of mixing and milling as well as compounding seem to be more specifically associated with this risk, which could be expected because of the exposure to fumes containing carcinogenic agents. CONCLUSIONS: Having worked in the rubber tire industry in the past, especially in milling, mixing as well as compounding may be associated with an increased risk of lung/respiratory cancer.

[Compensation system for pesticide exposure]. / Dispositif d'indemnisation de l'exposition aux pesticides.

COMPENSATION SYSTEM FOR PESTICIDE EXPOSURE. The French Pesticide Victims Compensation Fund (FIVP) was created on January 1, 2020 to compensate people exposed to pesticides during their professional activity, or children who were exposed in utero due to their parents' professional activity. Occupational diseases related to pesticide exposure are under-reported. The primary role of any physician is to consider the link between pathologies observed and exposure to pesticides, to provide information to patients, and then to accompany them by writing the initial medical certificate on the Cerfa document specific to work accidents and occupational diseases (AT-MP) for adults, or a certificate on plain paper attesting to the pathology for children, and by providing them with copies of all the medical reports that they deem appropriate to attach to the request. The FIVP allows for the centralized processing by the Mutualité sociale agricole (MSA) of Mayenne-Orne-Sarthe of all occupational disease claims for which the patient, advised by the doctor who wrote the initial medical certificate (CMI), has indicated that the pathology is related to exposure to pesticides. The forms have been modified by the Health Insurance since May 7, 2022.

DISPOSITIF D'INDEMNISATION DE L'EXPOSITION AUX PESTICIDES. Le Fonds d'indemnisation des victimes de pesticides (FIVP) a été créé le 1er janvier 2020 pour indemniser les personnes exposées à des pesticides au cours de leur activité professionnelle, ou les enfants y ayant été exposés in utero du fait de l'activité professionnelle de leurs parents. Les maladies professionnelles en lien avec l'exposition aux pesticides sont sous-déclarées. Le rôle premier de tout médecin est de penser au lien entre pathologies constatées et exposition aux pesti cides, de dif fuser l'information aux patients, puis de les accompagner en rédigeant le certificat mé dical initial sur le document Cerfa spécifique aux accidents de travail et maladies professionnelles (AT-MP) pour les personnes majeures, ou un certificat sur papier libre attestant de la pathologie pour les enfants, et en leur remettant des copies de l'en semble des comptes-rendus médi caux qu'ils jugent adaptés de joindre à la demande. Le FIVP permet un traitement centralisé par la Mutualité sociale agricole (MSA) de la Mayenne-Orne-Sarthe de l'ensemble des dossiers de demande de maladie professionnelle pour lequel le patient, conseillé par le médecin rédacteur du certificat médical initial (CMI), a indiqué que la pathologie était en lien avec l'ex position aux pesticides. Les formulaires ont été modifiés par l'Assurance maladie depuis le 7 mai 2022.

[End of career and end of exposure visits]. / Visites de fin de carrière et de fin d'exposition.

END-OF-CAREER AND END-OF-EXPOSURE VISITS Many legislative changes have been introduced in recent months concerning the activity of occupational physicians. Particular emphasis has been placed on the traceability of exposure and the resulting medical follow-up with the creation of end-of-career and end-of-exposure visits. These new features imply changes in terms of post-occupational monitoring in particular, but other appointments are obviously possible for workers in conjunction with their prevention and occupational health service.

VISITES DE FIN DE CARRIÈRE ET DE FIN D'EXPOSITION De nombreux changements législatifs ont eu lieu ces derniers mois concernant l'action des médecins du travail. Un accent particulier a été mis sur la traçabilité des expositions et la surveillance médicale qui en découle avec la création des visites de fin de carrière et de fin d'exposition. Ces nouveautés impliquent des modifications en matière de surveillance post-professionnelle notamment ; d'autres rendez-vous restent évidemment possibles pour les travailleurs, en lien avec leur service de prévention et de santé au travail.