[Return to work: challenges and opportunities for the primary care physician]. / Retour au travail : défis et opportunités pour le médecin de premier recours.

Return to work is at the crossroads of complex medical, legal, economic and social concepts and involves a multitude of stakeholders who are often far removed from the reality of care in the medical practice. This article presents some basic concepts on return to work and explores some good practice guidelines. It also describes the role and limits of the occupational physician in the company and mentions possible areas of collaboration with social insurers and employers. It aims to provide concrete elements for the practice of the primary care physician.

Le retour au travail est au croisement de notions médicales, juridiques, économiques et sociales complexes et implique une multitude de parties prenantes qui restent souvent éloignées de la réalité de la prise en charge au cabinet médical. Cet article présente quelques notions de base sur le retour au travail et explore certaines orientations de bonnes pratiques. Il décrit également le rôle et les limites du médecin du travail en entreprise et mentionne les champs de collaboration possible avec les assureurs sociaux et les employeurs. Il vise à fournir des éléments concrets pour la pratique du médecin de premier recours.

[Diabetes mellitus and work]. / Diabète et travail.

Diabetes mellitus (DM) affects an increasing proportion of workers, a trend that will compound with the ageing of the workforce. It is therefore important to consider DM in the workplace context. There is an interrelationship between DM and work. Indeed dysglycemia is associated with a greater risk of work accidents and long-term DM complications. On the other side work conditions can affect DM's stability. The consequences are absenteeism, presenteeism, early retirement or even disability with significant socio-economic costs. To keep patients with DM into the workforce, the evaluation of their working conditions is mandatory and ideally in collaboration with the general practitioner, diabetologist and occupational physician (OP). This article outlines some practical guidelines for the evaluation of diabetic's worker.

Le diabète sucré (DM) touche une proportion croissante de la population active et la tendance va augmenter avec le vieillissement des travailleurs. Il est donc important d'évaluer l'impact du DM sur le travail et leur interrelation. Le déséquilibre glycémique est associé à un plus grand risque d'accident de travail et les conditions de travail peuvent déséquilibrer le DM et favoriser l'émergence de complications. Les conséquences sont l'absentéisme, le présentéisme, la retraite anticipée, voire l'invalidité avec d'importants coûts socio-économiques. L'évaluation des conditions de travail en cas de DM devrait être systématique et idéalement collaborative entre médecin généraliste, diabétologue et médecin du travail (MT). Cet article résume les lignes directrices de l'évaluation du travailleur avec un DM.

Exposure to field vs. storage wheat dust: different consequences on respiratory symptoms and immune response among grain workers.

PURPOSE: The aim of this study was to understand the differential acute effects of two distinct wheat-related dusts, such as field or stored wheat dust handling, on workers' health and how those effects evolved at 6 month intervals. METHODS: Exposure, work-related symptoms, changes in lung function, and blood samples of 81 workers handling wheat and 61 controls were collected during the high exposure season and 6 months after. Specific IgG, IgE, and precipitins against 12 fungi isolated from wheat dust were titrated by enzyme-linked immunosorbent assay, dissociation-enhanced lanthanide fluorescence immunoassay, and electrosyneresis. The level of fungi was determined in the workers' environment. Levels of exhaled fraction of nitrogen monoxide (FENO) and total IgE were obtained. Exposure response associations were investigated by mixed logistic and linear regression models. RESULTS: The recent exposure to field wheat dust was associated with a higher prevalence for five of six self-reported airway symptoms and with a lower FENO than those in the control population. Exposure to stored wheat dust was only associated with cough. No acute impact of exposure on respiratory function was observed. Exposure to field wheat dust led to workers' sensitization against the three field fungi Aureobasidum, Cryptococcus, and Phoma, although exposure to storage wheat dust was associated with tolerance. The level of Ig remained stable 6 months after exposure. CONCLUSION: The clinical picture of workers exposed to field or storage wheat dust differed. The systematic characterization of the aerosol microbial profile may help to understand the reasons for those differences.

The Effects of Shift Work on Cardio-Metabolic Diseases and Eating Patterns.

Energy metabolism is tightly linked with circadian rhythms, exposure to ambient light, sleep/wake, fasting/eating, and rest/activity cycles. External factors, such as shift work, lead to a disruption of these rhythms, often called circadian misalignment. Circadian misalignment has an impact on some physiological markers. However, these proxy measurements do not immediately translate into major clinical health outcomes, as shown by later detrimental health effects of shift work and cardio-metabolic disorders. This review focuses on the effects of shift work on circadian rhythms and its implications in cardio-metabolic disorders and eating patterns. Shift work appears to be a risk factor of overweight, obesity, type 2 diabetes, elevated blood pressure, and the metabolic syndrome. However, past studies showed discordant findings regarding the changes of lipid profile and eating patterns. Most studies were either small and short lab studies, or bigger and longer cohort studies, which could not measure health outcomes in a detailed manner. These two designs explain the heterogeneity of shift schedules, occupations, sample size, and methods across studies. Given the burden of non-communicable diseases and the growing concerns about shift workers' health, novel approaches to study shift work in real contexts are needed and would allow a better understanding of the interlocked risk factors and potential mechanisms involved in the onset of metabolic disorders.

Producers of Engineered Nanomaterials-What Motivates Company and Worker Participation in Biomonitoring Programs?

Production and handling of engineered nanomaterials (ENMs) can yield worker exposure to these materials with the potential for unforeseen negative health effects. Biomonitoring enables regular exposure and health assessment and an effective risk management. We aimed to identify factors influencing biomonitoring acceptance according to hierarchical positions of ENM producers. Managers and workers were invited to complete an online questionnaire. Forty-three companies producing or handling ENMs such as titanium dioxide (61%) and multi-walled carbon nanotubes (44%) participated. The majority of managers (72%) and all workers responded positively to participating in biomonitoring studies. The main reasons for refusing participation included concerns about data confidentiality and sufficient knowledge about ENM health and safety. Acquisitions of individual study results, improvement of workers' safety, and help to the development of ENM-specific health and safety practice were among the most valuable reasons for positively considering participation. All workers indicated feeling comfortable with biomonitoring procedures of exhaled air sampling-about half were similarly comfortable with exhaled breath condensate, urine, and buccal cell sampling. The majority of both workers and managers stated that participation in a biomonitoring program should take place during working hours. Although our survey only had limited participation, our results are useful in designing appropriate biomonitoring programs for workers exposed to ENMs.

Energy, Nutrient and Food Intakes of Male Shift Workers Vary According to the Schedule Type but Not the Number of Nights Worked.

Shift work is associated with increased risk of chronic diseases due to circadian rhythm disruptions and behavioral changes such as in eating habits. Impact of type of shifts and number of night shifts on energy, nutrient and food intake is as yet unknown. Our goal was to analyze shift workers' dietary intake, eating behavior and eating structure, with respect to frequency of nights worked in a given week and seven schedule types. Eating habits and dietary intakes of 65 male shift workers were analyzed in three steps based on 365 24-h food records: (1) according to the number of nights, (2) in a pooled analysis according to schedule type, and (3) in search of an interaction of the schedule and the timing of intake. Mean nutrient and food group intake during the study period did not depend on the number of nights worked. Amount and distribution of energy intake as well as quality of food, in terms of nutrient and food groups, differed depending on the type of schedule, split night shifts and recovery day (day after night shift) being the most impacted. Shift workers' qualitative and quantitative dietary intakes varied between different schedules, indicating the need for tailored preventive interventions.

Eating Habits of Professional Firefighters: Comparison With National Guidelines and Impact Healthy Eating Promotion Program.

OBJECTIVE: Firefighters' eating habits may be an additional risk factor for metabolic diseases. We assessed eating habits of firefighters, compared them with national guidelines, and evaluated the impact of a prevention program. METHODS: Twenty-eight professional firefighters from a Swiss airport benefited from a healthy-eating program. Food intake, eating behavior, and anthropometric data were collected at baseline and 1-year follow-up using an electronic food record, questionnaires, and bio-impedance. RESULTS: Participants had unbalanced diets with low-quality food choices associated with low intakes of fibers and micronutrients compared with national guidelines. Intervention did not impact eating habits or anthropometrics data at the group level, but changes were measured in sub-groups. Main reported barriers for healthy eating were lack of motivation, prioritization, or time. CONCLUSIONS: Intensive and culturally tailored prevention interventions targeting nutritional behaviors are needed at the individual, group, and organizational levels.

Vaccination Against Seasonal or Pandemic Influenza in Emergency Medical Services.

INTRODUCTION: Influenza is a major concern for Emergency Medical Services (EMS); EMS workers' (EMS-Ws) vaccination rates remain low despite promotion. Determinants of vaccination for seasonal influenza (SI) or pandemic influenza (PI) are unknown in this setting. HYPOTHESIS: The influence of the H1N1 pandemic on EMS-W vaccination rates, differences between SI and PI vaccination rates, and the vaccination determinants were investigated. METHODS: A survey was conducted in 2011 involving 65 Swiss EMS-Ws. Socio-professional data, self-declared SI/PI vaccination status, and motives for vaccine refusal or acceptation were collected. RESULTS: Response rate was 95%. The EMS-Ws were predominantly male (n=45; 73%), in good health (87%), with a mean age of 36 (SD=7.7) years. Seventy-four percent had more than six years of work experience. Self-declared vaccination rates were 40% for both SI and PI (PI+/SI+), 19% for PI only (PI+/SI-), 1.6% for SI only (PI-/SI+), and 39% were not vaccinated against either (PI-/SI-). Women's vaccination rates specifically were lower in all categories but the difference was not statistically significant. During the previous three years, 92% of PI+/SI+ EMS-Ws received at least one SI vaccination; it was 8.3% in the case of PI-/SI- (P=.001) and 25% for PI+/SI- (P=.001). During the pandemic, SI vaccination rate increased from 26% during the preceding year to 42% (P=.001). Thirty percent of the PI+/SI+ EMS-Ws declared that they would not get vaccination next year, while this proportion was null for the PI-/SI- and PI+/SI- groups. Altruism and discomfort induced by the surgical mask required were the main motivations to get vaccinated against PI. Factors limiting PI or SI vaccination included the option to wear a mask, avoidance of medication, fear of adverse effects, and concerns about safety and effectiveness. CONCLUSION: Average vaccination rate in this study's EMS-Ws was below recommended values, particularly for women. Previous vaccination status was a significant determinant of PI and future vaccinations. The new mask policy seemed to play a dual role, and its net impact is probably limited. This population could be divided in three groups: favorable to all vaccinations; against all, even in a pandemic context; and ambivalent with a "pandemic effect." These results suggest a consistent vaccination pattern, only altered by exceptional circumstances.

Respiratory health effects of fifteen years of improved collective protection in a wheat-processing worker population.

INTRODUCTION: Occupational exposure to grain dust causes respiratory symptoms and pathologies. To decrease these effects, major changes have occurred in the grain processing industry in the last twenty years. However, there are no data on the effects of these changes on workers' respiratory health. OBJECTIVES: The aim of this study was to evaluate the respiratory health of grain workers and farmers involved in different steps of the processing industry of wheat, the most frequently used cereal in Europe, fifteen years after major improvements in collective protective equipment due to mechanisation. MATERIALS AND METHOD: Information on estimated personal exposure to wheat dust was collected from 87 workers exposed to wheat dust and from 62 controls. Lung function (FEV1, FVC, and PEF), exhaled nitrogen monoxide (FENO) and respiratory symptoms were assessed after the period of highest exposure to wheat during the year. Linear regression models were used to explore the associations between exposure indices and respiratory effects. RESULTS: Acute symptoms - cough, sneezing, runny nose, scratchy throat - were significantly more frequent in exposed workers than in controls. Increased mean exposure level, increased cumulative exposure and chronic exposure to more than 6 mg.m (-3) of inhaled wheat dust were significantly associated with decreased spirometric parameters, including FEV1 and PEF (40 ml and 123 ml.s (-1) ), FEV1 and FVC (0.4 ml and 0.5 ml per 100 h.mg.m (-3) ), FEV1 and FVC (20 ml and 20 ml per 100 h at >6 mg.m (-3) ). However, no increase in FENO was associated with increased exposure indices. CONCLUSIONS: The lung functions of wheat-related workers are still affected by their cumulative exposure to wheat dust, despite improvements in the use of collective protective equipment.