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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.

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.

Resume Objectif Decrire les prevalences des expositions professionnelles a des facteurs de risque sur la reproduction chez des couples vus au centre ARTEMIS (plateforme d’evaluation et de prevention de la sante environnementale dediee a la reproduction). Methode Les couples vus en entretien etaient adresses par des professionnels de sante pour des troubles de la reproduction (trouble de la fertilite, pathologie de la grossesse, malformation congenitale chez l’enfant). Une consultation medicale et un entretien infirmier protocolise (a l’aide d’un questionnaire) permettaient l’identification et la caracterisation des expositions professionnelles a des facteurs de risque (FDR) pour la reproduction. Resultats Expositions professionnelles les plus frequemment retrouvees chez les femmes vues pour trouble de la fertilite : medicaments (9,5 %), solvants (4,2 %) et pesticides (3,2 %) ; chez les hommes : HAP (10,2 %), pesticides (9,3 %) et solvants (9,3 %). Chez les femmes vues pour fausses couches ou malformations congenitales : medicaments (4,8 %), pesticides (4,0 %) et solvants (4,0 %). Chez les femmes vues pour grossesse pathologique : contraintes physiques (32,3 %) et organisationnelles (6,3 %) medicaments (4,4 %) et pesticides (4,4 %). Conclusion Cette etude permet d’identifier des expositions a des FDR pour la reproduction en milieu de travail chez la femme comme chez l’homme. La mise en evidence precoce du risque reprotoxique au poste de travail doit permettre au medecin du travail de limiter l’exposition du travailleur afin de garantir sa sante reproductive. Pour cela, developpement de la recherche en sante environnementale (toxicologie, epidemiologie …), sensibilisation et education de l’ensemble des acteurs du monde du travail sont necessaires.

International audience; 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.

International audience; BackgroundThe objective of the study was to compare the prevalence of occupational exposure to asbestos and crystalline silica according to histological types of lung cancer and age at diagnosis.MethodsCaProMat study is a pooled case‐only study conducted between 1996 and 2011. The current study consisted of 6521 lung cancer cases. Occupational exposure to asbestos and crystalline silica was assessed by two Job‐Exposure Matrices. A weighted prevalence of exposure was derived and compared according to histological types and age at diagnosis.ResultsThere was no difference of weighted prevalence of exposure to asbestos and crystalline silica according to histological types of lung cancer. There was a statistically significant difference of weighted prevalence of exposure to asbestos and crystalline silica according to age at diagnosis.ConclusionsDue to the limited clinical importance of the difference, neither the histological type, nor the age at diagnosis can be used as an indicator for the occupational exposure to asbestos or crystalline silica.

Objectives The aim of this study was to assess the effect modification of the association between tobacco smoking and phenotypes of lung cancer (histological type, tumor location, and age at diagnosis) by occupational exposure to asbestos or to crystalline silica. Materials and methods The CaProMat study is a pooled case-only study including 7256 male lung cancer cases recruited between 1996 and 2011 in France and Canada. Two job-exposure matrices (JEMs) were used to assess occupational exposure to asbestos and crystalline silica. Statistical interactions between tobacco smoking and occupational exposure to asbestos or crystalline silica were assessed using unconditional logistic regression models for histological type and tumor location and linear regression models for age at diagnosis. Results Tobacco smoking was associated with squamous cell carcinoma and small cell carcinomas as well as an earlier age at diagnosis. Additional exposure to either asbestos or crystalline silica did not modify the effect of tobacco smoking for either histological type or age at diagnosis. Neither tobacco smoking nor occupational exposure to asbestos or crystalline silica influenced tumor location. Conclusions Tobacco smoking was the main factor related to histological type and age at diagnosis. Those associations were not modified by occupational exposure to asbestos or crystalline silica.

Resume Les cancers bronchopulmonaires sont les plus frequents des cancers professionnels, avec a ce jour de nombreuses etiologies ou situations d’expositions pour lesquelles le lien est retenu comme certain chez l’homme par le Centre International de Recherche sur le Cancer : amiante, silice cristalline, gaz d’echappement de moteurs diesel, rayonnements X et γ, radon et ses produits de filiation, plutonium, composes du nickel, derives du chrome hexavalent, beryllium, cadmium, bischloromethylether et chloromethyl-methyl-ether, procede Acheson, diverses sources d’exposition a des hydrocarbures aromatiques polycycliques (production d’aluminium, brai de houille, gazeification du charbon, production de coke, suies, fonderies de fonte et d’acier), activite souterraine dans les mines de fer, activite de peinture, production de caoutchouc, tabagisme passif, fumees de soudage. Le reperage des expositions et la mise en œuvre d’actions de prevention visant a les supprimer ou les minimiser sont une etape essentielle pour les acteurs de sante au travail. Une recommandation de bonne pratique a ete elaboree en France en 2015 sous l’egide de la Societe Francaise de Medecine du Travail, de la Societe de Pneumologie de Langue Francaise et de la Societe Francaise de Radiologie, qui preconise la realisation d’une experimentation afin d’evaluer dans quelques departements la faisabilite et l’interet d’un depistage du cancer bronchopulmonaire par scanner thoracique faiblement dose dans des populations a haut risque de cancer bronchopulmonaire. Le pneumologue doit par ailleurs etre vigilant dans le reperage des expositions professionnelles anterieures aux cancerogenes professionnels devant tout cas incident de cancer pulmonaire, du fait des enjeux importants sur le plan medico-social, a l’echelon individuel et sur le plan collectif.

Suite notamment au signalement par plusieurs agences nationales et internationales de cas de silicose aigue survenant apres l’usinage de pierres reconstituees contenant des teneurs elevees en quartz (> 85 %), l’Anses s’est auto-saisie et a mis en place un groupe de travail afin de mettre a jour l’ensemble des connaissances concernant les risques pour la sante des professionnels exposes a la silice cristalline. Cette demarche, outre une etude de filieres et la caracterisation de l’exposition des travailleurs, visait plus particulierement a faire le point sur les effets sanitaires, en particulier cancerigenes de la silice cristalline et sur les pistes de prevention. Concernant plus specifiquement la question des effets sanitaires associes a la silice cristalline, une synthese de rapports institutionnels a ete realisee, puis completee par une analyse critique, selon une methode standardisee de lecture et d’evaluation (R-AMSTAR), des revues publiees dans la litterature scientifique depuis la parution de ces rapports. Certaines questions, nouvelles ou peu documentees, ont fait l’objet d’une revue narrative sur la base des articles originaux collectes jusqu’a la fin de l’expertise. Par ailleurs, l’expertise de l’Anses a beneficie d’un regard socio-historique replacant la demarche d’expertise menee par le groupe dans la longue histoire de l’etude et de la reconnaissance des pathologies professionnelles associees a la silice cristalline. L’Anses a ainsi evalue les effets sanitaires de la silice cristalline et plus particulierement les differentes formes de silicose, la relation silice–cancer bronchique, y compris en l’absence de silicose, les cancers extra-pulmonaires, l’ensemble des pathologies respiratoires non malignes, les pathologies auto-immunes, et les atteintes renales. L’Anses a egalement analyse les principaux mecanismes de toxicite associes aux poussieres en general, et a la silice cristalline en particulier. Des developpements specifiques ont notamment ete consacres a la silice fraichement fracturee, et aux particules ultra fines (PUF). L’Anses a propose plusieurs recommandations, en particulier sur la prevention medicale, la valeur limite d’exposition professionnelle (VLEP) et les tableaux de maladies professionnelles. Une synthese des donnees relatives aux effets sanitaires associes a des expositions a la silice cristalline et des principales recommandations en matiere de prevention sera presentee lors du Congres. Deux autres presentations sont consacrees a la caracterisation des expositions a la silice cristalline en France et a l’adaptation de la methode R-Amstar aux etudes epidemiologiques et toxicologiques realisees dans le cadre de cette expertise.

La litterature scientifique rapporte un exces de complications de grossesse en lien avec les expositions aux medicaments anticancereux, aux gaz anesthesiques et aux protoxydes d’azote telle qu’une augmentation du risque d’avortement spontane, de malformation congenitale et de retard de developpement intra-uterin. En prenant l’exemple des medicaments anticancereux, il a ete montre que l’ensemble du personnel d’etablissements de soins en contact avec le medicament, le patient traite ou ses excretions, a peut etre expose professionnellement. D’ou la necessite de la mise en place d’intervention en sante travail lors d’une grossesse. En l’absence d’une reglementation adaptee au monde du travail sur les preparations medicamenteuses et la grossesse, la gestion des risques sur la reproduction en milieu hospitalier doit passer par des actions ciblees sur differentes periodes : – avant la grossesse chez les femmes et les hommes en âge de procreer par un inventaire a priori des risques et une information des personnels ; – pendant la grossesse par un contact le plus precocement possible des femmes ayant declare une grossesse, une enquete sur les expositions et si necessaire une adaptation de poste ; – apres la grossesse lors de la visite de reprise apres maternite pour assurer une veille sanitaire sur les eventuelles complications de grossesse. Une revue de la litterature ainsi qu’une enquete aupres des services de sante au travail des etablissements hospitaliers francais ont ete realisees. Elles avaient pour objectif d’identifier des actions de prevention mises en place pour les salariees enceintes en milieu hospitalier. Des demarches specifiques ont ete identifiees : – sur l’information du service de sante au travail sur l’etat de grossesse pour les femmes manipulant du protoxyde d’azote ou des medicaments anticancereux ; – autour de l’amenagement de poste pour les risques lies aux medicaments anticancereux et pour les gaz anesthesiques. Ces resultats mettent en exergue que peu de demarches sont mises en place dans les etablissements de sante pour le suivi de la grossesse des membres du personnel et que ces demarches ne sont pas harmonisees entre les differentes structures. Il semble donc indispensable de developper ce type de demarche. Le renforcement du controle des expositions vis-a-vis de ces trois risques, reposant a la fois sur les preventions collectives, individuelles et l’information du personnel, associe a une reflexion pluridisciplinaire sur les amenagements de poste pendant les grossesses en sont la pierre angulaire. Reste a identifier les freins et leviers au developpement d’une telle approche.

Introduction Le cancer broncho-pulmonaire est le deuxieme cancer le plus frequent chez l’homme, et la premiere cause de mortalite en France. Le principal facteur de risque identifie est le tabac, associe a 8 cas sur 10. Des facteurs professionnels ont egalement ete identifies, et seraient susceptibles d’expliquer 15 % a 30 % des cas. Un depistage par scanner thoracique annuel a ete propose aux Etats-Unis (National Lung Screnning Trial, NLST) selon trois criteres d’inclusion : l’âge (55-74 ans), et le tabagisme (30 paquets-annee ou PA) non sevre (depuis moins de 15 ans). En France, le depistage n’est pas recommande chez les fumeurs par la Haute Autorite de sante (HAS), mais les recommandations emises en 2015 par les societes savantes et labelisees par la HAS et l’INCA preconisent un depistage chez les agents exposes professionnellement. La faisabilite de ces recommandations doit etre evaluee par l’etude LUCSO (LUng Cancer Screnning with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens). Objectif Decrire une population repondant aux criteres de LUCSO et du NLST dans une cohorte de patients pris en charge au CHU de Bordeaux pour un cancer broncho-pulmonaire. Materiel et methode Tous les patients suivis pour un cancer broncho-pulmonaire dans les services de pneumologie et chirurgie thoracique beneficient d’une enquete medico-socio-professionnelle au lit du malade, secondairement tele-expertisee, par un specialiste des risques professionnels (preventeur et/ou medecin) suivant une methode formalisee. Ont ete decrits les pourcentages de patients repondant aux criteres du NLST et de LUCSO : exposition au moins 10 ans a un cancerogene et tabac ≥ 30 PA, ou co-exposition a deux cancerogenes et tabac ≥ 20 PA, ou co-exposition a trois cancerogenes et tabac ≥ 10 PA, chez les patients âges de 55 a 74 ans. Resultats Parmi les 318 cas expertises, 38 % auraient ete eligibles aux criteres du NLST, et 23 % selon les criteres de LUCSO. Parmi les patients non eligibles, 26 % sont exclus sur criteres d’âge, 48 % sur criteres d’exposition (non expose ou exposition inferieure a 10 ans), et 46 % sur critere tabagique. Plus d’un tiers des patients exclus a ete co-expose a des agents cancerogenes pulmonaires au moins 10 ans. Conclusion Sur l’ensemble des patients suivis pour cancers broncho-pulmonaires au CHU de Bordeaux, 38 % selon le NLST et 23 % selon LUCSO seraient eligibles au depistage. Ces resultats sont a corroborer a des analyses sur une population plus representative de la population generale.

In France, a new approach is being developed through the ARTEMIS Center, which is a prevention platform for environmental health dedicated to reproduction. The objective is to describe the clinical management of patients in the ARTEMIS center. Couples with a condition affecting reproduction are referred to the ARTEMIS center. Management includes a medical consultation and a standardized interview. Current exposure is assessed by a questionnaire that includes exposure circumstances to reproductive risk factor and on the basis of which it is possible to implement preventive action in clinical practice without prejudging the role of such exposure in the onset of disease. From 16 February 2016 to 2 May 2019, 779 patients were seen in the ARTEMIS center. On the day of the consultation, 88.3% men and 72.2% women were employed. Among employed men, 61.5% had at least one instance of occupational exposure to a reproductive risk factor, and among employed women, 57.8%. The main nonprofessional circumstances of exposure identified were proximity of the residence to an agricultural area (35.3%) and domestic pesticide exposure (79.7%). The preventive actions implemented by the ARTEMIS center are targeted to the individual practices of patients. However, patient care also allows their physicians to become familiarized with environmental health.

Background Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice. Objectives To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes. We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared. Results Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up. Conclusions The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health. Key messages A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.

IntroductionGuidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.ObjectiveTo evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.Methods and analysisThis trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.Ethics and disseminationThis protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03562052; Pre-results.

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 &lt, 25%, moderate: between 25 and 50% and severe: &gt, 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.

Highly sensitive ESI-LC-MS/MS methods were developed for urinary biological monitoring of occupational exposure to cyclophosphamide (CP), ifosfamide (IF), and methotrexate (MTX), which are hazardous antineoplastic drugs frequently handled by healthcare professionals. Extraction methods consisted of liquid/liquid extraction for simultaneous urinary CP and IF assays, and of solid phase extraction for the urinary MTX assay. A good linearity (r20.997), precision (CV14.6%), and accuracy (bias9.9%) were achieved for all compounds. The limit of detection (LOD) was 10pg/ml and the lower limit of quantification (LOQ) was 20pg/ml for all three drugs. Applying these methods in routine, more than 116 healthcare professionals occupationally exposed to antineoplastic drugs were monitored and 635 urines were analysed. Eleven healthcare professionals (9.5%) were found to be contaminated to at least one of the three antineoplastic drugs. Among analysed urines, 22 samples were found positives. The measured concentrations ranged from 20.1 to 1850pg/ml and, for six samples, concentrations were at CP trace level, between the LOD and LOQ values (10-20pg/ml). Such efficient analytical tools combining high specificity with high sensitivity are essential for reliable detection and routine biological monitoring of healthcare professionals occupationally exposed to these widely used antineoplastic drugs. These methods allow to monitor the healthcare professionals exposure to antineoplastic drugs in the aim to assess the effectiveness of collective and individual protective measures.

International audience; Despite the reduction of global asbestos consumption and production due to the ban or restriction of asbestos uses in more than 50 countries since the 1970s, malignant mesothelioma remains a disease of concern. Asbestos is still used, imported, and exported in several countries, and the number of mesothelioma deaths may be expected to increase in the next decades in these countries. Asbestos exposure is the main risk factor for malignant pleural mesothelioma, but other types of exposures are linked to the occurrence of this type of cancer. Although recent treatments improve the quality of life of patients with mesothelioma, malignant pleural mesothelioma remains an aggressive disease. Recent treatments have not resulted in appreciable improvement in survival, and thus development of more efficient therapies is urgently needed. The development of novel therapeutic strategies is dependent on our level of knowledge of the physiopathological and molecular changes that mesothelial cells acquired during the neoplastic process. During the past 5 years, new findings have been published on the etiology, epidemiology, molecular changes, and innovative treatments of malignant pleural mesothelioma. This review aims to update the findings of recent investigations on etiology, epidemiology, and molecular changes with a focus on (1) attributable risk of asbestos exposure in men and women and (2) coexposure to other minerals and other elongated mineral particles or high aspect ratio nanoparticles. Recent data obtained on genomic and gene alterations, pathways deregulations, and predisposing factors are summarized.

Resume Objectif Realiser une revue de la litterature sur la relation dose–effet entre les facteurs de risque professionnels chimiques classifies par le Centre international de recherche sur le cancer (CIRC) comme agents cancerogenes certains et le risque de cancer bronchopulmonaire ainsi que sur l’effet conjoint avec le tabac sur ce meme risque. Methodes Une recherche de la litterature scientifique a ete realisee dans trois bases de donnees ainsi que dans les monographies du CIRC entre janvier 1990 et avril 2015. Resultats La litterature est abondante pour certains cancerogenes tels que l’amiante, la silice cristalline et les fumees d’echappement de moteur diesel mais est plus rare pour de nombreux cancerogenes et ceci plus particulierement concernant l’effet conjoint avec la fumee de tabac sur le risque de cancer bronchopulmonaire. Conclusion Peu de litterature existe pour la plupart des cancerogenes professionnels pulmonaires notamment sur l’effet conjoint avec le tabac. En cas de multi-expositions professionnelles et d’une co-exposition a la fumee de tabac, il existe un double objectif de prevention primaire : la suppression des facteurs de risque professionnels et du tabac.

Resume Objectif Faire un etat des lieux de la frequence des principales complications de la grossesse chez le personnel du CHU de Bordeaux et les comparer aux donnees de la population generale (enquete perinatale). Methode Nous avons realise une enquete epidemiologique descriptive sur l’ensemble des femmes salariees du CHU de Bordeaux (hors medecin et personnel de recherche) ayant donne naissance en 2012. Cette etude est basee sur un questionnaire renseigne lors de la visite de reprise apres maternite. Resultats Nous avons obtenu 364 questionnaires sur 447 femmes incluses. On constate une augmentation significative de l’HTA gravidique (10,6 % vs 4,9 %, p p p = 0,97) et le taux d’hypotrophie (6,4 % vs 7,1 %, p = 0,62). Les agents hospitaliers arretent leur activite professionnelle plus precocement que la population generale, entre 15 et 28 SA (60,7 % vs 40 %, p Conclusion En comparaison a une precedente etude realisee au CHU d’Angers en 2002, le taux de prematurite est plus eleve malgre un arret plus precoce de l’activite professionnelle. Les salariees du CHU de Bordeaux ont significativement plus d’HTA gravidique et de menace d’accouchement premature que la population generale.

Introduction Les Resultats de l’etude NLST aux Etats-Unis et de l’etude NELSON en Europe ont ouvert le debat sur l’opportunite d’un depistage du cancer broncho-pulmonaire (CBP) chez des patients exposes a des carcinogenes respiratoires [1] , [2] . L’objectif de cette analyse est d’evaluer l’impact medico-economique, en France, de la mise en place d’un programme de depistage du CBP dans une cohorte de sujets exposes a l’amiante. Methodes L’analyse est basee sur une modelisation MCMC (Monte Carlo Markok Chain) permettant d’etablir le rapport cout utilite de la mise en place d’un depistage annuel du CBP par tomodensitometrie thoracique chez des sujets fumeurs et exposes fortement a l’amiante. Les donnees utilisees dans la modelisation sont l’incidence de CBP dans la cohorte francaise ARDCO (cohorte multiregionale de sujets exposes a l’amiante avec suivi longitudinal depuis 2002), et leurs consommations de soins, les parametres d’intervention sont issus de l’etude NLST. Les donnees d’utilites et de couts de prise en charge des CBP diagnostiques sont issues de la litterature. Une analyse de sensibilite a permis d’evaluer differentes strategies de depistage selon l’intervalle entre les scanners et la population cible. Resultats La mise en place d’un depistage annuel par TDM thoracique chez les sujets fumeurs et exposes fortement a l’amiante permet un gain de QALY de 0.041 par personne [IC 95 % 0.028–0.052] pour un cout de 6208 € par personne [IC 95 % 4536€–7904€], soit un ratio cout-utilite differentiel de 93 020 €/QALY [IC 95 % 51 898€–170 492€]. Lorsque le depistage repose sur un scanner tous les 2 ans, le rapport cout-utilite est plus favorable: 40 938 €/QALY [IC 95 % 22 440€–65 364€]. Conclusion Au regard des seuils habituels pour une intervention de sante, un depistage du CBP par TDM thoracique tous les 2 ans est acceptable et preferable a un depistage annuel dans cette population.

International audience; Objectives: Nanoscale particles (1-100 nm) can be of natural origin, and either intentionally or unintentionally produced by human activities. Toxicological data have suggested a possible carcinogenic effect of such particles. The aim of this study was to estimate the association between occupational exposure to nanoscale particles and risk of lung cancer, pleural mesothelioma and brain tumors in adults.Methods: Three French population-based case-control studies were analyzed: 1) the ICARE study including 2,029 lung cancer cases and 2,591 controls; 2) the PNSM study including 371 pleural mesothelioma cases and 730 controls and 3) the CERENAT study including 257 brain tumor cases and 511 controls. Occupational exposure to unintentionally emitted nanoscale particles (UNPs) was retrospectively assessed by a job exposure matrix providing a probability and a frequency of exposure.Results: In adjusted analyses among men, significant associations between occupational exposure to UNPs and lung cancer (OR=1.51; 95% CI: 1.22-1.86 and brain tumors (OR=1.69; 95% CI: 1.17-2.44) were observed. No increased OR was observed for pleural mesothelioma (OR=0.78; 95% CI: 0.46-1.33).Conclusion: This is the first study showing positive associations between occupational exposure to UNPs and increased risk of lung cancer and brain tumors. These preliminary results should encourage further epidemiological research.

Resume Dans le cadre de son expertise collective visant evaluer les risques pour la sante des travailleurs exposes a la silice cristalline en France, l’Anses a mis a jour de l’ensemble des connaissances concernant les risques pour la sante des professionnels exposes a la silice cristalline. Cette demarche, outre une etude de filieres et la caracterisation de l’exposition des travailleurs, visait plus particulierement a faire le point sur les effets sanitaires, en particulier cancerigenes de la silice cristalline et sur les pistes de prevention. Concernant plus specifiquement la question des effets sanitaires associes a la silice cristalline, le groupe de travail (GT) mis en place par l’Anses a tout d’abord procede a une synthese de rapports institutionnels. Concernant la silicose et le cancer bronchopulmonaire, cette synthese a ete completee par une analyse critique des revues de synthese publiees dans la litterature scientifique depuis la parution de ces rapports. Les autres types d’effets et notamment certaines questions, nouvelles ou peu documentees, ont fait l’objet d’une revue narrative sur la base des articles originaux collectes jusqu’a la fin de l’expertise. Pour realiser l’analyse critique des revues de synthese portant sur la silicose et le cancer bronchopulmonaire en lien avec une exposition a la silice cristalline, le GT s’est appuye sur une methode standardisee de lecture et d’evaluation (R-AMSTAR) qu’il a adaptee. Cette methode, initialement developpee par des chercheurs universitaires pour analyser la qualite methodologique des revues systematiques d’essais cliniques, repose sur un principe de cotation de 11 items au travers de differents criteres definis. Ces items portent notamment sur les modalites de recherche documentaire, de selection des etudes et d’extraction des donnees, sur les conditions d’inclusion des etudes dans la synthese, etc. Le score final permet de classer differentes revues systematiques portant sur un meme sujet selon leur qualite methodologique. Le GT a modifie certains criteres d’evaluation et elabore des regles de decisions afin d’analyser la qualite methodologique des revues de synthese epidemiologiques et toxicologiques relatives aux effets de la silice cristalline dans le domaine de la sante au travail.

Dans le cadre de son expertise collective visant evaluer les risques pour la sante des travailleurs exposes a la silice cristalline en France, l’Anses a realise une caracterisation des expositions a la silice cristalline par secteur d’activite en s’appuyant sur les donnees de mesures d’exposition disponibles dans les bases de donnees Colchic® et Scola® et sur les donnees de prevalence d’exposition issues des enquetes SUMER 2010 et 2017. Ce travail a permis d’identifier les secteurs d’activite, les tâches et les metiers pour lesquels les niveaux d’exposition excedent certains seuils. Les seuils pris en compte correspondent a la valeur limite d’exposition professionnelle (VLEP-8 h) reglementaire en France pour le quartz (0,1 mg.m−3), a la VLEP-8 h recommandee pour la silice cristalline par differents organismes dont le SCOEL et l’OSHA (0,05 mg.m−3), et a la VLEP-8 h la plus basse actuellement definie par l’ACGIH et retenue comme seuil d’action par l’OSHA (0,025 mg.m−3). D’autres sources de donnees ont egalement ete investiguees en vue d’evaluer les expositions professionnelles a la silice cristalline notamment les matrices emplois expositions disponibles et une revue de la litterature scientifique. Par ailleurs, une synthese des donnees disponibles relatives aux expositions a des particules ultrafines de silice cristalline a ete realisee. Ainsi, en France pres de 365 000 travailleurs seraient exposes par inhalation a la silice cristalline, en particulier au quartz. Selon la methode suivie, entre 23 000 et 30 000 salaries seraient exposes au-dela de 0,1 mg.m−3. L’ensemble des donnees d’exposition convergent pour indiquer que quatre secteurs d’activite sont plus particulierement concernes, avec des niveaux d’exposition a la silice cristalline plus eleves et des depassements frequents des valeurs limites actuelles : La construction, La fabrication de produits mineraux non metalliques, la metallurgie et les industries extractives. Une presentation de ces resultats, sera realisee apres un rappel sur les enjeux lies aux methodes de mesures d’exposition a la silice cristalline. Enfin, les principales recommandations emises par l’Anses en matiere de prevention et portant sur les expositions a la silice cristalline seront exposees. Deux autres presentations sont consacrees a l’analyse des donnees relatives aux effets sanitaires associes a des expositions a la silice cristalline et a l’adaptation de la methode standardisee de lecture et d’evaluation des revues de syntheses scientifiques (R-Amstar) aux etudes epidemiologiques et toxicologiques realisees dans le cadre de cette expertise.

Objectifs Mis en place en 1998, le Programme national de surveillance du mesotheliome pleural fonctionne depuis vingt ans. Il permet de dresser un bilan de l’evolution de la situation epidemiologique des mesotheliomes pleuraux entre 1998 et 2017, en France, en termes d’incidence, de survie, d’expositions des patients atteints et de leur reconnaissance medico-sociale. Methodes Dans les 21 departements couverts par le programme, une procedure standardisee de recueil actif et de confirmations diagnostiques anatomopathologique et clinique des tumeurs primitives de la plevre est mise en œuvre. Les expositions vie entiere a l’amiante et aux autres facteurs etudies, professionnelles et extra-professionnelles, sont recueillies par questionnaire aupres de chaque cas. Les recours des cas de mesotheliome aux dispositifs d’indemnisation (maladie professionnelle et Fonds d’indemnisation des victimes de l’amiante-Fiva) sont recueillis et analyses. Resultats Sur la periode 1998-2016, on observe une augmentation du nombre de cas annuel estime, passant de 800 a1100 cas avec une augmentation de la proportion de femmes de 20 a 25 %. Chez les hommes, les expositions professionnelles sont encore largement predominantes et restent stables depuis 1998 (environ 90 %), avec toutefois un deplacement de la problematique des metiers d’utilisation et de transformation de l’amiante vers les metiers d’intervention sur des materiaux contenant de l’amiante tel que le secteur du BTP. Chez les femmes, la part des expositions professionnelles a l’amiante reste faible (environ 40 %), mais 35 % des femmes ont ete exposees en dehors du travail (via le fait de resider avec des proches exposes professionnellement, le bricolage ou expos domestiques). Pour 25 % des femmes, on ne retrouve aucune de ces expositions. Le recours aux dispositifs d’indemnisation est encore insuffisant, avec 27 % des cas affilies au regime general de securite sociale (RGSS) ne faisant aucune demarche et 53 % des cas hors RGSS n’ayant pas recours au Fiva. Perspectives La mise en œuvre du dispositif national de surveillance des mesotheliomes (DNSM) integrant le PNSM et la declaration obligatoire (DO) permettra de moderniser et optimiser la surveillance de tous les mesotheliomes (plevre et autres localisations) sur le territoire national, de l’adapter aux nouveaux enjeux (dont les expositions environnementales), d’optimiser le dispositif national d’enquetes d’expositions et de renforcer l’articulation avec les travaux de recherche, tel que l’estimation de la proximite des lieux de vie des sujets a des sources naturelles ou industrielles potentiellement exposantes.

Le milieu hospitalier expose a de nombreux risques professionnels pouvant etre deleteres pour la grossesse. L’objectif de ce travail est de presenter un etat des lieux de la strategie de surveillance des salariees enceintes mise en place depuis 2008 par le Service Sante Travail (SST) du CHU de Bordeaux avec la mise en place, en autre d’une « consultation grossesse » ou d’une cartographie des services et postes a risque pour la grossesse. Methode Point des connaissances sur la grossesse et le travail en milieu de soins. Etude qualitative aupres du personnel de sante au travail. Recueil des informations par entretiens semi-diriges. Etude quantitative aupres des femmes salariees, ayant eu un debut de grossesse entre le 15 fevrier 2017 et 14 fevrier 2018. Recueil des informations par questionnaire renseigne par les femmes en suite de couches. Resultats Etude qualitative : Mise en evidence de pratiques professionnelles heterogenes dans la surveillance des salariees enceintes entre les differentes unites, notamment dans l’organisation de la consultation dediee et l’utilisation d’une cartographie des postes a risque. Etude quantitative : Quatre cent vingt et une femmes enceintes incluses et 252 questionnaires obtenus, 140 femmes ont ete recues en consultation grossesse au cours du 4eme mois de grossesse, dont 72 % travaillaient dans les services cibles, 34 % ont beneficie d’un amenagement de poste. L’âge gestationnel moyen a l’arret etait de 26 ± 8 SA en lien pour 60 % avec leur condition de travail. Aucune information n’a pu etre obtenue concernant les femmes medecins suggerant un non reperage. Conclusion Meme si plus de la moitie des salariees enceintes ont beneficie d’une consultation grossesse, elles sont recues tardivement et la plupart des femmes s’arrete de travailler avant la fin de leur 6eme mois. Plusieurs axes d’amelioration suggeres comme la communication autour des risques pour la grossesse dans les services cibles, la sensibilisation des directions pour aider a la transmission au plus tot de l’information de l’etat de grossesse des salariees, l’harmonisation des pratiques au sein du SST, une reflexion sur les organisations de travail afin d’anticiper les situations a risque, et enfin une reflexion pluridisciplinaire associant l’ensemble des partenaires de l’etablissement dans la perspective de s’orienter vers une logique organisationnelle de conciliation grossesse et travail comme le recommande l’ANACT et la litterature, plutot que de tendre vers une logique individuelle de retrait anticipe. La reference a des recommandations nationales pour le suivi des femmes enceintes faciliterait la mise en place d’une politique de prevention globale dans les etablissements de soins.

Objectives The aim of Evalutil is to document occupational exposure to asbestos and man-made mineral fibers. Methods These databases provide grouped descriptive and metrological data from observed situations of occupational exposure, collected through the analysis of scientific articles and technical reports by industrial hygienists. Results Over 5,000 measurements were collected. We describe the occupations, economic activities, fiber-containing products, and operations on them that have been documented most often. Graphical measurement syntheses of these data show that the situations presented for asbestos and RCF, except mineral wools, report fiber concentrations mainly above historical occupational exposure limits. Conclusion Free access to these data in French and in English on the Internet (https://ssl2.isped.u-bordeaux2.fr/eva_003/) helps public health and prevention professionals to identify and characterize occupational exposures to fibers. Extended recently to nanoscale particles, Evalutil continues to contribute to the improvement of knowledge about exposure to inhaled particles and the health risks associated with them. Am. J. Ind. Med. 58:1059–1074, 2015. © 2015 Wiley Periodicals, Inc.

Given the results of experimental studies, occupational or environmental exposures to manufactured nanoparticles or to unintentionally produced ultrafine particles may result in health effects or diseases in humans. In this review, we synthesize published data of experimental studies on the distribution of inhaled nanoparticles and the first case reports to discuss the potential usefulness of their biological monitoring for clinical purposes. Toxicokinetic studies suggest that nanoparticles may be absorbed predominantly by respiratory and oral routes with possible systemic translocation, leading to accumulation in the peripheral organs or excretion in feces or urine. Some methods used in these studies may be applied successfully in retrospective evaluation of exposure or in follow-up of occupational exposure in the workplace. Biological monitoring of nanoparticles should be based on imaging methods that are essential to confirm their presence and to characterize them in tissue associated with analytical quantitative methods. The first case reports reviewed emphasize the urgent need for the development of standardized procedures for the preparation and analysis of biological samples with a view to characterizing and quantifying nanoparticles.

Background The association between air pollution exposure and cardiovascular events is well established, and the effect of short-term exposure on out-of-hospital cardiac arrest (OHCA) has received some attention. The effect of air pollution exposure and the activation of mobile intensive care units (MICUs) for cardiac arrest have never been studied. Objective We analyzed associations between air pollutants and MICU activation for OHCA. Method This is a retrospective study including 4558 patients with OHCA and MICU activation from 2007 to 2012. A time-stratified case crossover design was used. Particulate matter (PM) of median aerodynamic diameter less than 2.5 μ m (PM2.5), less than 10 μ m, and ozone were the 3 main pollutants used to determine the effects of pollution exposure on the event. Results A daily average increase of 27.6 μ g/m 3 in ozone was associated with an increase of MICU activation for OHCA the following day (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.03-1.22). For women, a daily average increase of 27.6 μ g/m 3 in ozone was associated with an increase of MICU activation for OHCA the following day (OR, 1.19; 95% CI, 1.01-1.37). An hourly average increase of 10.5 μ g/m 3 in PM2.5 was associated with an increase of MICU activation for OHCA in the current hour (OR, 1.11; 95% CI, 1.02-1.19). For men, an increase in PM2.5 was associated with an increase in MICU activation for OHCA the current hour (OR, 1.10; 95% CI, 1.01-1.20). No association was found with PM of median aerodynamic diameter less than 10 μ m. Conclusion An association was found between air pollution and MICU activation for OHCA (ozone and PM2.5)

Resume La telepathologie se definit en pratique comme la capacite d’examiner des lames histologiques a partir de lames virtuelles analogues des lames physiques, d’aboutir a un diagnostic histologique sans deroger aux criteres de qualite et de securite et de rapidite que ceux obtenus lors d’un examen conventionnel au microscope. Nous rapportons dans cet article l’experience du reseau Mesotheliome pour la certification standardisee du diagnostic de mesotheliome par le Centre national referent [CNR] MESOPATH, les enjeux et les avantages a utiliser cette nouvelle technologie, les contraintes et le futur de cet outil et des solutions informatiques necessaires a leur mise en place.

La question de l’experience quotidienne de la bronchopneumopathie chronique obstructive (BPCO) se pose avec une force particuliere tant elle frappe par son invisibilite, pour la societe et pour l’individu, malgre sa prevalence. Notre analyse, fondee sur les recits d’experience de 69 personnes atteintes, vise a montrer comment et pourquoi cette pathologie, pourtant a forte prevalence et invalidante, reste socialement invisible. Les sujets ne decrivent pas systematiquement une rupture dans leur parcours biographique qui entrainerait des modifications identitaires. L’experience de la BPCO est a la fois celle d’une continuite des trajectoires individuelles et de desordres periodiquement introduits par les symptomes mais pas toujours associes a une « maladie » etiquetee comme telle. Elle se resume a des processus d’ajustement et de normalisation, ainsi qu’a des strategies d’invisibilisation de la pathologie. Ces trois tendances donnent de nouvelles indications sur les processus de (re)definition de soi du sujet malade.

Objectives To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. Methods The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. Results κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. Conclusions Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.

Objectives Consensus methods are increasingly used as alternatives to traditional assessment methods, because of their low cost and high efficiency. The objective of our study was to investigate whether the assessment of occupational hazards linked to the use of carcinogenic, mutagenic and reprotoxic chemicals differed when done by two consensus methods, the nominal group method (based on a face-to-face group meeting) and the Delphi method (a questionnaire-based method) in comparison to direct observation. The CMR’s have been chosen due to the specificity of substances used in the laboratories and due also to the lack of prevention practices. Methods 119 professionals from 13 French research laboratories were randomly allocated to use either the Delphi or nominal group methods. Direct observation of the presence and use of chemicals was done by an external occupational hygienist who used a standardized protocol. After data collection, chemicals identified by consensus methods but not by observation were checked by local hygiene and safety correspondents. The final combined list of the present and used chemicals was defined as the reference. Sensitivities (Se) and specificities (Sp) were estimated to assess the performance of the three methods to identify the presence, and the actual use of chemicals. Characteristics associated with performance were assessed using logistic regression models. Results The total number of chemicals listed in the initial lists was 360. Observation identified 50 additional chemicals, and consensus methods another two, which were neither on the lists nor observed. Performance of the nominal group (Se presence 0.57; Se use 0.86; Sp presence 0.65; Sp use 0.74) and Delphi method (Se presence 0.59; Se use 0.83; Sp presence 0.57; Sp use 0.57) was similar. Higher seniority of the participants was the main characteristic related to better performance. Conclusions Performance of both consensus methods was low. Because of their advantages over observation (local collective involvement and lower workload), these methods might be useful before and after a valid assessment based on observation, therefore contributing at presumably affordable cost to maintain accuracy of the list, as well as team awareness and prevention commitment. Even if the observations are more burdensome to carry out, they make it possible to understand the complexity of the compromises made by operators when they face risks. In that perspective they can unearth accounts of incidents and strategies that would be otherwise difficult to verbalise through other methods. What is more, such observation methods can also help involve workers in a bottom-up approach and turn them into active stakeholders in the prevention process. It may thus be possible and relevant to develop an articulation between consensus methods and those centred on ergonomics observations.

The aim of this study was to investigate the hypothesis of an increased risk of pleural mesothelioma due to co-exposure to asbestos and refractory ceramic fibres (RCF) compared to asbestos exposure alone. Males were selected from a French case-control study conducted in 1987-1993 and from the French National Mesothelioma Surveillance Program in 1998-2006. Two population controls were frequency matched to each case by year of birth. Complete job histories were collected and occupational asbestos and RCF exposures were assessed using job exposure matrices. The dose-response relationships for asbestos exposure were estimated from an unconditional logistic regression model in subjects exposed to asbestos only (group 1) and subjects exposed to both asbestos and RCF (group 2). A total of 988 cases and 1125 controls ever-exposed to asbestos were included. A dose-response relationship was observed in both groups but it was stronger in group 2. In comparison with subjects exposed at the minimum value of the cumulative index of exposure, the odds ratio was 2.6 (95% CI 1.9-3.4) for subjects exposed to 75 fibres · mL(-1) · year(-1) in group 1 increasing to 12.4 (95% CI 4.6-33.7) in group 2. Our results suggest that the pleural carcinogenic effect of occupational asbestos exposure may be modified by additional exposure to RCF.

Mesothelioma is a rare disease less than 0.3% of cancers in France, very aggressive and resistant to the majority of conventional therapies. Asbestos exposure is nearly the only recognized cause of mesothelioma in men observed in 80% of case. In 1990, the projections based on mortality predicted a raise of incidence in mesothelioma for the next three decades. Nowadays, the diagnosis of this cancer is based on pathology, but the histological presentation frequently heterogeneous, is responsible for numerous pitfalls and major problems of early detection toward effective therapy. Facing such a diagnostic, epidemiological and medico-legal context, a national and international multidisciplinary network has been progressively set up in order to answer to epidemiological survey, translational or academic research questions. Moreover, in response to the action of the French Cancer Program (action 23.1) a network of pathologists was organized for expert pathological second opinion using a standardized procedure of certification for mesothelioma diagnosis. We describe the network organization and show the results during this last 15years period of time from 1998-2013. These results show the major impact on patient's management, and confirm the interest of this second opinion to provide accuracy of epidemiological data, quality of medico-legal acknowledgement and accuracy of clinical diagnostic for the benefit of patients. We also show the impact of these collaborative efforts for creating a high quality clinicobiological, epidemiological and therapeutic data collection for improvement of the knowledge of this dramatic disease.

Objectif Les particules nanometriques (PN) soulevent de nombreuses questions quant a leurs effets sur la sante des travailleurs, en particulier les PN manufacturees. Pourtant, celles generees non intentionnellement des procedes de travail (PNNI) sont presentes dans le milieu de travail depuis plus longtemps et dans de nombreux secteurs, y compris ceux impliquant les manufacturees. Les expositions professionnelles aux PNNI restent cependant peu connues. L’objectif est donc de decrire ces expositions a partir de la base de donnees (BDD) online Ev@lutil ( https://ssl2.isped.u-bordeaux2.fr/eva_003 ). Methode A travers une veille bibliographique realisee en routine, les articles scientifiques ciblant les expositions professionnelles aux PN sont analyses par des hygienistes industriels. Prealablement, une pre-analyse des articles est mise en ligne presentant le type de PN cible, la situation d’exposition et les donnees de mesure disponibles. En parallele, une BDD documentaire est progressivement alimentee avec les donnees decrivant chaque situation de travail et de facon precise, les methodes et resultats de mesure correspondants. Sur Internet, un moteur de recherche permet d’interroger la BDD selon des criteres ou une saisie libre de mots cles. Cependant, aucune synthese d’information n’est a ce jour possible via ce mode de consultation, des requetes dans la BDD ont donc ete effectuees afin de decrire les donnees d’exposition aux PNNI. Resultats Au 1er janvier 2018, les expositions professionnelles aux PNNI sont les plus documentees, 218 articles sur 342 au total. Les procedes de travail emetteurs de PNNI les plus representes sont les moteurs thermiques (17 %), la soudure (14 %), l’impression et photocopie (9 %), l’usinage (8 %), les fours industriels (7 %) et les procedes de traitement et revetement de surface (7 %). Concernant la metrologie, la granulometrie et la concentration en nombre sont les metriques les plus mesurees (74 %, 69 %) et seulement un article sur deux presente une caracterisation chimique et/ou morphologique des PNNI. Pour avoir un apercu des niveaux d’exposition aux PNNI, des representations graphiques de synthese des resultats de mesures ont ete realisees pour quelques procedes. Conclusion Ev@lutil est la seule BDD en open access a documenter les expositions professionnelles aux PNNI contribuant ainsi a sensibiliser et a ameliorer la prevention des risques associes aux PNNI mais aussi a une evaluation plus fine des expositions dans les secteurs impliquant des PN manufacturees. Enfin, pour les epidemiologistes, Ev@lutil constitue une source d’information sur les niveaux d’exposition aux PN afin d’ameliorer les connaissances sur le lien entre exposition et effets sur la sante des travailleurs.

Introduction De nombreuses etudes ont montre que les femmes enceintes sont exposees dans le monde a une variete importante de pesticides. Or, l’exposition aux pesticides pendant la grossesse a ete impliquee dans la survenue d’effets indesirables sur la grossesse. L’objectif de ce travail est de faire une revue systematique des etudes epidemiologiques recentes etudiant le lien entre l’exposition prenatale aux pesticides et les issues defavorables de grossesse. Methode Les articles ont ete identifies a partir des bases de donnees MEDLINE et Scopus. La selection a ete limitee aux articles publies en anglais ou en francais de janvier 2012 a decembre 2016. Pour prendre en compte les articles publies avant cette periode, nous avons presente une synthese des resultats de l’expertise collective Inserm publiee en 2013. Le risque de biais et la qualite des methodes ont ete evalues pour chaque article. Resultats Au total, 25 articles repondaient aux criteres d’inclusion. Les pesticides de la famille des organochlores, organophosphores et atrazine, deja mentionnes dans l’expertise collective de l’Inserm, ont ete associes a des issues defavorables de la grossesse et ont montre une forte presomption du lien de causalite. De recentes etudes montrent aussi que les pesticides de la famille des neonicotinoides, bipyridiums, pyridazinones et strobilurines sont associes a la survenue de complications de grossesse. De meme, les substances chimiques suivantes, non identifies dans l’expertise collective de l’Inserm, sont associees a des grossesses pathologiques : bromure de methyle, nonyl phenoxy poly (ethylene oxy) ethanol, sulfate de cuivre, polyoxyethylene sorbitol, paraffine- huile de petrole a base, acide dichlorophenoxy, acide monochlorophenoxy, abamectine, acephate, dimethoate et phorate. Conclusion L’exposition a certains pesticides pendant le developpement intra-uterin peut augmenter le risque d’issue defavorable de la grossesse. Des mesures preventives specifiques doivent etre prises pour limiter les expositions pendant les periodes vulnerables de developpement.

Introduction Le taux d’emploi est maximal entre 25 et 49 ans (80 %) depuis plus de 40 ans. La majorite des couples en projet de grossesse appartienne a cette meme tranche d’âge. Or, l’exposition professionnelle de chaque membre du couple a des facteurs de risque sur la reproduction peut perturber le bon deroulement d’une grossesse avant meme la connaissance de celle-ci. L’evaluation et la maitrise de ces risques est necessaire pour proteger les futurs parents dans leur milieu professionnel. L’objectif est de decrire la prevalence des expositions professionnelles a des facteurs de risque sur la reproduction en periode peri-conceptionnelle chez des couples vus au centre ARTEMIS. Methodes La population etudiee est celle des couples ayant consulte au centre ARTEMIS dans les suites d’une grossesse pathologique. L’entretien permet de recueillir les activites professionnelles du couple dans les deux mois precedant le debut de grossesse jusqu’a la date de connaissance de la grossesse. L’analyse de cet entretien permet d’identifier les facteurs de risque chimiques, physiques et organisationnels sur la reproduction. Ces expositions sont codees selon trois criteres : probabilite (doute 89 %) – niveau (tres faible, faible, moyen, fort) – frequence (sporadique 1/mois, frequent > 1/semaine, permanent 1/jour). Resultats Du 1er janvier 2016 au 1er janvier 2018, sur les 319 couples ont ete vus au centre, 245 repondaient aux criteres (soit 490 patients). Parmi eux, 335 patients etaient en activite. Pour chaque membre du couple, l’analyse permet de decrire la prevalence d’exposition peri-conceptionnelle aux facteurs de risque sur la reproduction selon le niveau de preuve (avere, presume, suspecte) et selon l’existence ou non d’une reglementation. Conclusion Avant meme la connaissance de la grossesse, la medecine du travail a un role preponderant a jouer dans la prevention des expositions environnementales susceptibles de favoriser les evenements indesirables de la grossesse.

Contexte Defini par le Code de sante publique et le Code du travail, le cadre d’exercice et le role des infirmiers en matiere de prevention et d’education ont ete renforces et developpes. Le metier d’infirmier sante travail fait partie des acteurs essentiels de la prevention, de l’evaluation des risques la sante des salaries. Ce travail a pour objectif de decrire l’entretien infirmier protocolise utilise au Centre ARTEMIS. Cet entretien permet de detecter des expositions environnementales a des agents reprotoxiques chez les patients, en vue de leur proposer des actions de prevention et/ou de precaution proportionnees selon le risque. L’ouverture de l’entretien par le medecin rappelle la finalite de la demarche de la consultation (la mise en place de moyens de prevention et non la recherche de causalite, les troubles multifactoriels de la reproduction, exploration du versant environnemental dans une optique de prevention). Dans une logique de prevention, les questions posees lors de l’entretien infirmier protocolise sont davantage axees sur la situation actuelle. L’entretien cherche a retracer les differentes tâches professionnelles exercees par le patient, pouvant potentiellement l’exposer a des agents reprotoxiques. Des questions portant sur les noms des produits, la frequence d’utilisation, les personnes utilisatrices, le respect des recommandations, le port d’EPI… permettent de rechercher de potentielles expositions professionnelles. Il est explique au patient l’interet d’une prise de contact avec son medecin du travail avec son consentement pour juger du niveau reel d’exposition. Dans une demarche de prevention, l’accent est porte sur le domicile actuel. La date de construction du logement permet de determiner si la presence de plomb dans l’habitat est possible. De nombreux composes peuvent etre emis lors de travaux de construction ou de renovation (poncage de peinture au plomb, pose de revetement emissifs). Concernant les habitudes personnelles (tabac, d’alcool ou autres substances), l’objectif est de detecter chez le patient des conduites a risque afin de lui proposer une prise en charge adaptee. Concernant les activites extra-professionnelles, l’entretien permettra de specifier si le patient est expose directement ou indirectement a des agents reprotoxiques et d’apprecier un niveau d’exposition (exemple : utilisation de pesticides). Conclusion Les competences de l’infirmiere completent celle du medecin et permettent une approche globale des entretiens a la fois technique, ciblee et preventive. Par son ecoute attentive et bienveillante, l’infirmiere favorise les echanges avec les patients et de nombreux messages de prevention peuvent ainsi etre delivres au cours de l’entretien.

Methods: A total of 1,199 male cases and 2,379 control subjects were included in a French pooled case-control study. Complete job histories were collected, and occupational exposure to asbestos, mineral wool (MW), and silica were assessed by three French job exposure matrices.Unconditional logisticregressionmodelsadjustedfor age, birth date, and occupational asbestos exposure were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Measurements and Main Results: A significant association between mesothelioma and MW exposure was observed after adjustment for occupational asbestos exposure. OR for subjects exposed to less than 0.01 fibers$ml 21 $yr 21 was 1.6 (95% CI, 1.2–2.1) and increased to 2.5 (95% CI, 1.8–3.4) for subjects exposed to more than 0.32 fibers$ml 21 $yr 21 . All ORs for silica exposure were around the null. CoexposuretoeitherasbestosandMWorasbestosandsilicaseemed toincreasethe risk ofpleuralmesothelioma. ORswere 17.6 (95%CI, 11.8–26.2) and 9.8 (95% CI, 4.2–23.2) for subjects exposed to both asbestos and MW and for subjects exposed to both asbestos and silica, respectively, compared with 4.3 (95% CI, 1.9–9.8) for occupational asbestos exposure alone. Conclusions: Our results are in favor of an increased risk of pleural mesothelioma for subjects exposed to both asbestos and MW or asbestos and silica.

Background The association between pleural plaques and pleural mesothelioma remains controversial. The present study was designed to examine the association between pleural plaques on computed tomography (CT) scan and the risk of pleural mesothelioma in a follow-up study of asbestos-exposed workers. Methods Retired or unemployed workers previously occupationally exposed to asbestos were invited to participate in a screening program for asbestos-related diseases, including CT scan, organized between October 2003 and December 2005 in four regions in France. Randomized, independent, double reading of CT scans by a panel of seven chest radiologists focused on benign asbestos-related abnormalities. A 7-year follow-up study was conducted in the 5287 male subjects for whom chest CT scan was available. Annual determination of the number of subjects eligible for free medical care because of pleural mesothelioma was carried out. Diagnosis certification was obtained from the French mesothelioma panel of pathologists. Survival regression based on the Cox model was used to estimate the risk of pleural mesothelioma associated with pleural plaques, with age as the main time variable and time-varying exposure variables, namely duration of exposure, time since first exposure, and cumulative exposure index to asbestos. All statistical tests were two-sided. Results A total of 17 incident cases of pleural mesothelioma were diagnosed. A statistically significant association was observed between mesothelioma and pleural plaques (unadjusted hazard ratio (HR) = 8.9, 95% confidence interval [CI] = 3.0 to 26.5; adjusted HR = 6.8, 95% CI = 2.2 to 21.4 after adjustment for time since first exposure and cumulative exposure index to asbestos). Conclusion The presence of pleural plaques may be an independent risk factor for pleural mesothelioma.

Background Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. Methods Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. Results Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. Conclusion A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

Aims Unintentional nanoscale particles (UNP) are generated from usual work processes and thus exist since a long time and are more prevalent than the manufactured nanoscale particles. The objective of this study was to develop a job-exposure matrix, a useful tool to estimate prevalence of occupational exposure to UNP for epidemiologic studies. . Methods Work-processes generating UNP and their associated chemical families have been identified through an extensive literature review and the knowledge of an expert’s panel in various domain such as industrial hygiene, toxicology, atmospheric physics and chemistry, epidemiology… These processes were associated to occupations extracted from the ISCO classification edition 1968. A probability and a frequency were assessed for each specific combination “occupation × work-process”. When an occupation was related to several work-processes, the final exposure assessment consisted in the highest probability of exposure and a weighted-frequency of exposure combining assessments from each related work-process. Exposure assessment for some specific occupations could differ according to industries and historical periods. Due to the few available measurement data, intensity could not be assessed at that time. Results Over 50 work-processes generating UNP have been identified and were related with seven UNP chemical families: metal, mineral, carbon, wood, polymer, polycyclic aromatic hydrocarbon (PAH) and other organic. A little less than 50% occupational ISCO codes were unexposed, and 9%, 13% and 31% were possibly, probably and certainly exposed, respectively. Most of occupations were exposed to carbonaceous, PAHs UNP and then to metallic and mineral UNP. Conclusions These results suggest that occupational exposure to UNP might be important at the workplace and might concern a wide variety of workers. In order to assess intensity of exposure, we are currently organising measurement campaigns in French and Canadian workplaces (ExproPNano program).

For lung cancer, there is evidence of a joint effect between smoking and asbestos. However, little is known about a possible joint effect between asbestos and other inorganic particles. The objective was to study the association between lung cancer and occupational asbestos exposure in the abscence or presence of additional exposure to inorganic particles. A 12-year follow-up study was conducted to analyse lung cancer incidence in a cohort of 13,814 retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey program (Asbestos Related Diseases Cohort, ARDCO) from October 2003 and December 2005. From complete work histories, occupational exposure to asbestos, mineral wools, refractory ceramic fibers, crystalline silica and cement dust were assessed by job-exposure matrices. Association between lung cancer and occupational asbestos exposure was estimated by Cox model, adjusted for smoking, in the presence or absence of additional exposure to inorganic particles. At the end of follow-up (April 2015), 364 incident lung cancer cases were diagnosed. The association between lung cancer and asbestos exposure was statistically significant (HR=2.3 [95% CI=1.0-5.4]), but it seemed increased in the presence of additional exposure to mineral wools (HR=3.1 [95% CI=1.4-7.2]). However, at equal asbestos exposure level, the association was no longer different in the presence of additional exposure to mineral wools. Other inorganic particles did not modify the association between asbestos and lung cancer. Mineral wools may modify the association between lung cancer and asbestos. However, subjects exposed to both factors seemed also to be more exposed to asbestos.

Introduction Nanoscale particles (1-100 nm) may be naturally occurring; intentionally-produced for commercial purposes or unintentionally-produced by manufacturing processes or human activities. Toxicological data have suggested a possible carcinogenic effect of nanoscale particles and have shown that they have the ability to translocate into different organs including the brain. While epidemiological data on nanoscale particles are very scarce to date, there is some suggestion of their potential role in cancer (e.g. diesel exhaust emissions classified as carcinogenic for humans by IARC). The objective of this study was to estimate the association between occupational exposure to nanoscale particles and risk of brain tumour in adults. Methods The CERENAT study is a multicenter case-control study carried out in four districts of France between 2004 and 2006. From detailed occupational histories, occupational exposure to unintentionally-produced nanoscale particles was retrospectively assessed by the MatPUF job exposure matrix providing a probability and frequency of exposure for each combination occupation × industry according to international and national classifications. Conditional logistic regression was used to estimate ORs and 95% CIs. Results Overall, 596 brain tumour cases and 1192 matched controls were included in this study. Among men, a significant association between occupational exposure to nanoscale particles and brain tumour was observed (OR = 1.5; 95% CI: 1.1–2.2). This increased OR was essentially observed in the highest exposure categories (OR = 1.6; 95% CI: 1.1–2.4 for a total duration of exposure over 30 years) as well as for carbonaceous (OR = 1.5; 95% CI: 1.1–2.3) and HAP nanoscale particles (OR = 1.6; 95% CI: 1.1–2.4). Conclusion Even if these preliminary results should be confirmed by other analyses including the intensity of exposure (on-going work in a further version of the job-exposure matrix), these results should encourage further epidemiological research on nanoscale particles.

Introduction Toxicological studies have shown potential health effects related to nanoscale particles (NP). These particles could be emitted unintentionally from usual work-processes (“ultrafine particles”) or produced intentionally for commercial purpose (“manufactured NP”) at workplace. Thus, associated exposure might concerned many workers. However, in the absence of NP strategy measurement consensus, occupational exposure is poorly monitored. Aim In this context, the ExproPNano project aims at make operational existing NP exposure assessment recommendations, combine them with work activity analysis and test the developed strategy in French and Canadian industries involving both unintentional and manufactured NP. Methods The first year, in 2015, was dedicated to the implementation of the project (method, team training, equipment and industries selection) with partner institutions (INRS, INERIS, LEPI, InVS, Aquitaine CARSAT, and University of Montreal – DSEST). Campaigns in different industries (aeronautics, rubber and composite, construction, mines…) will be conducted in 2016–2017 following two main steps: (1) pre-visit: prevention system analysis, process understanding, interviews and preliminary measures; (2) NP measurement and work observation: video recording synchronised with real-time measures and air sampling for physic-chemical characterisation; (3) results analysis and presentation in companies. Expected results and conclusion Work task analysis combined with NP measurement must ensure a better understanding of the NP exposure determinants and result in recommendations of adapted prevention which may be extended to various workplaces. The tested exposure assessment method must be operational and thus easily used by all actors involved in unintentional and manufactured NP risk management. Therefore, relevant NP occupational exposure data could be produced, recording them in specific database such as Evalutil or NECID-PEROSH, it will contribute to knowledge improvement of NP exposure levels and associated health effects by public health professionals such as epidemiologists.

Background Tobacco smoking is the main cause of lung cancer, but it is not the sole causal factor. Significant proportions of workers are smokers and exposed to occupational lung carcinogens. This study aims to systematically review the statistical interaction between occupational lung carcinogens and tobacco smoking, in particular asbestos, crystalline silica and diesel engine exhaust emissions. Methods Articles were identified using Scopus, PubMed, and Web of Science, and were limited to those published in English or French, without limitation of time. The reference list of selected studies was reviewed to identify other relevant papers. One reviewer selected the articles based on the inclusion and exclusion criteria. Two reviewers checked the eligibility of articles to be included in the systematic review. Data were extracted by one reviewer and revised by two other reviewers. Cohorts and case–control studies were analyzed separately. The risk of bias was evaluated for each study based on the outcome. The results of the interaction between the tobacco smoking and each carcinogen was evaluated and reported separately. Results Fifteen original studies were included for asbestos-smoking interaction, seven for silica-smoking interaction and two for diesel-smoking interaction. The results suggested the absence of multiplicative interaction between the three occupational lung carcinogens and smoking. There is no enough evidence from the literature to conclude for the additive interaction. We believe there is a limited risk of publication bias as several studies reporting negative results were published. Conclusion There are no multiplicative interactions between tobacco smoking and occupational lung carcinogens, in particular asbestos, crystalline silica and diesel engine exhaust emissions. Even though, specific programs should be developed and promoted to reduce concomitantly the exposure to occupational lung carcinogens and tobacco smoking. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4025-1) contains supplementary material, which is available to authorized users.

Resume But de l’etude Notre objectif est de decrire les effets respiratoires d’une exposition chronique et subaigue a l’hydrogene sulfure (H 2 S). Rapport de cas Nous avons etudie les cas de dix salaries (sept electromecaniciens et trois pilotes de secheur thermique) de stations d’epuration des eaux usees urbaines et industrielles vus en consultation de pathologie professionnelle du centre hospitalier universitaire (CHU) de Bordeaux de 2005 a 2010. Le travail en station d’epuration des eaux usees expose a des emanations d’H 2 S de facon chronique et subaigue (pics d’exposition). Ces salaries sont venus en consultation, devant l’apparition de symptomes respiratoires et/ou d’alteration de spirometries effectuees lors des visites periodiques de medecine du travail. Sur les dix salaries exposes professionnellement a l’H 2 S, on a diagnostique neuf cas d’asthme dont sept cas d’asthme professionnel imputable a l’exposition a l’H 2 S. Six salaries ont ete reconnus en maladie professionnelle (tableau n o 66 du regime general de la securite sociale). Des amenagements ont ete effectues dans les stations concernees. Discussion L’innovation technique de ces stations (filiere de traitement biologique en anaerobie pour la station industrielle et utilisation d’un secheur thermique pour les stations urbaines) a nettement majore l’exposition des salaries a l’H 2 S et a mene a l’apparition de symptomes respiratoires et d’hyperreactivite bronchique compatibles avec un asthme. Conclusion Une exposition chronique ou subaigue a l’H 2 S peut alterer la fonction respiratoire.