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Long-term care facility (LTCF) older residents display physiological alterations of cellular and humoral immunity that affect vaccine responses. Preliminary reports suggested a low early postvaccination antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to focus on the specific T-cell response. We quantified S1-specific IgG, neutralizing antibody titers, total specific IFNγ-secreting T cells by ELISpot, and functionality of CD4+- and CD8+-specific T cells by flow cytometry, after two doses of the BNT162b2 vaccine in younger and older people, with and without previous COVID-19 infection (hereafter referred to as COVID-19-recovered and COVID-19-naive subjects, respectively). Frailty, nutritional, and immunosenescence parameters were collected at baseline in COVID-19-naive older people. We analyzed the immune response in 129 young adults (median age 44.0 years) and 105 older residents living in a LCTF (median age 86.5 years), 3 months after the first injection. Humoral and cellular memory responses were dramatically impaired in the COVID-19-naive older (n = 54) compared with the COVID-19-naive younger adults (n = 121). Notably, older participants’ neutralizing antibodies were 10 times lower than the younger’s antibody titers (p + and IFNγ+IL-2+TNFα+ cells among specific CD4+ T cells, and the frequency of specific CD8+ T cells were lower in COVID-19-naive older participants than in COVID-19-naive young adults (p p = 0.0018, respectively). However, COVID-19-recovered older participants (n = 51) had greater antibody and T-cell responses, including IFNγ+ and IFNγ+IL-2+TNFα+-specific CD4+ T cells (p +-specific CD8+ T cells (p + and CD8+ T cells, in addition to impaired antibody response, and that specific studies are warranted to assess the efficiency of SARS-CoV-2 mRNA-based vaccines, as in other immunocompromised subjects. Our study also shows that, despite their physiological alterations of immunity, vaccination is highly efficient in boosting the prior natural memory response in COVID-19-recovered older people.

Objective Low beryllium exposure can induce pulmonary granulomatosis, so called berylliosis. For occupational health monitoring, it is more relevant to assess the internal dose of Be received by the lungs than urinary or atmospheric Be. Exhaled breath condensate (EBC) is a matrix collected non-invasively that derives from the airway lining fluid. EBC beryllium (Be) levels were evaluated as a marker of occupational exposure in a primary aluminum production plant. Methods We collected urine and EBC from controls and workers recently exposed to beryllium in the pot room and the anode repair sectors, and calculated a cumulative beryllium exposure index (CBEI) summing the number of years of employment in each task and multiplying by the estimated average beryllium exposure for the task. Concentrations of beryllium and aluminum were measured in EBC (Be-EBC and Al-EBC) and in urine (Be-U and Al-U) by ICP-MS. Results and conclusion We have shown that it was possible to measure Be and Al in workers’ EBC. Compared with controls and after adjustment for smoking status, levels of Be-EBC and Al-EBC were higher in pot room workers and exposed subjects, respectively. Due to its relationship with CBEI, but not with Be-U, it appears that Be-EBC could be a promising marker of occupational exposure and provide additional toxicokinetic information in occupational health studies.

Annual vaccination rates among French health care workers (HCWs) are in decline even in Emergency Services to which patients at highest risk of influenza complications are admitted, and in which HCWs have the greatest risk of exposure to influenza from patients. We aimed here to identify knowledge and attitudes towards influenza vaccination of HCWs in Emergency Services. We collected 344 self-administered questionnaires of 1060 HCWs. Only 18% of HCWs were vaccinated against influenza. Physicians were vaccinated more often (55%) than nurses (16%) or aid nurses (11%). The most important barriers to vaccination were reported as being a lack of time (33%), lack of safety of the vaccine (31%), fear of contracting influenza due to vaccination (29%), and lack of effectiveness (23%). Being vaccinated was significantly related to a higher knowledge score based on epidemiological influenza items (OR (95% CI)) (1.63 (1.08-2.46)) and vaccine features items (2.36 (1.36-4.10)).

OBJECTIVE: This study aimed to test longitudinal associations linking the work-unit-level psychosocial and organizational work environment and biomechanical constraints to workers’ shoulder pain in the French multi-centre cohort ORSOSA study of registered nurses (RN) and nursing assistants (NA). METHODS: We analyzed 1896 female RN and NA, who were free of shoulder pain in 2006 and in the same position and work unit in 2008. Incident shoulder pain (SP) was defined as self-reported pain that persists for ≥4 days and/or increases during a lateral movement of the arm away from the midline of the body (abduction). Both cross-sectional and longitudinal models were built to test if work-unit-level features or their influences on both work tasks and individual perception of the work environment directly influence the risk of developing incident SP. RESULTS: RN in work units with understaffing issues or poor relationships reported higher levels of biomechanical constraints in movements and postures and a lower level of perceived job security and stability. NA who experienced such issues reported higher levels of biomechanical constraints in indirect patient-handling activities only. The exposure to these latter factors was associated with higher two-year incident SP among workers. CONCLUSION: This study shows that the work-unit-level organizational characteristics may impact workers’ musculoskeletal disorders by conditioning both work-task-related biomechanical exposures and individual perception of the working environment. In healthcare settings, primary prevention programs to reduce MSD would benefit from a focus on work unit level exposures.

International audience; Objectives: This longitudinal study aimed to test the hypothesis that organizational work factors (OWFs) may be related to depressive symptoms through an increased effort-reward imbalance (ERI) ratio among registered nurses (RNs) and nursing assistants working in hospitals. Methods:We studied 2117 female RNs and nursing assistants who stayed in the same work unit and position during the follow-up from the ORSOSA (ORganisation des SOins-SAnt'e) longitudinal study. The work characteristics and workers' health were assessed in 2006 and 2008. Results: We confirmed our hypothesis of both direct and mediated effects of OWFs on workers' health. We showed that issues about patient-related information exchanges increased RNs' depressive disorders by increasing first a perceived ERI. Conclusions: Our results advocate integrating both the work organizational level and the individual level into preventive actions to improve workers' mental health.

A particle exposure assessment based on the dose deposited in the lungs would be the gold standard for the evaluation of any resulting health effects. Measuring particles in exhaled breath condensate (EBC)-a matrix containing water and airway lining fluid-could help to evaluate particle retention in the lungs. This study aimed to (1) validate a nanoparticle tracking analysis (NTA) method for determining the particle number concentration and their hydrodynamic size distribution in EBC, and (2) apply this method to EBC collected from workers exposed to soapstone (n = 55) or quartz dust (n = 12) and controls (n = 11). A standard latex bead solution was used to determine the linear range, limit of detection (LOD), repeatability (coefficient of variation, CV), and bias in spiked EBC. An LM10 NanoSight instrument with NTA version 3.1 software was used for measurement. RTubes(®) were used for field collection of EBC. The repeatability obtained for a D50 size distribution in EBC showed less than 8% variability, with a bias

Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control.Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples.Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9-29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/mCrystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239-247, 2017. © 2017 Wiley Periodicals, Inc.

Pulmonary fibrosis in systemic sclerosis (SSc) involves inflammatory processes in the lower respiratory tract. Analysis of exhaled breath condensate (EBC) is a non-invasive method for studying inflammatory mediators, such as cytokines, which are of interest from both physiological and therapeutic perspectives. The aim of this study was to assess and compare cytokine concentrations in the EBC of SSc patients and controls.EBC was collected from 19 SSc patients and 19 controls. We used a multiplex assay test kit to assay interleukin (IL)-2, -4, -6, -10, tumour necrosis factor-alpha, and interferon-gamma in samples concentrated by lyophilization.Cytokine concentrations in EBC were higher in SSc patients than in controls. The stepwise analyses showed that IL-4 was the biomarker which contributed most to the discrimination between controls and patients (Wilk's Lambda = 0.55, p0.001). We observed significant negative correlations of EBC cytokines with total lung capacity and diffusion capacity of the lung for carbon monoxide.These findings suggest that EBC sampling permits the non-invasive study of inflammation in SSc patients, and may be correlated with the severity of interstitial lung disease.

To evaluate the frequency and morphologic characteristics of air trapping in volunteers with various smoking habits.Two hundred fifty volunteers (133 women, 117 men; mean age, 39 years), including 144 smokers, 47 ex-smokers, and 59 nonsmokers, prospectively underwent inspiratory and expiratory high-spatial-resolution computed tomography (CT) and pulmonary function tests (PFTs). The frequency and characteristics of air trapping were evaluated according to the population's smoking habits and PFT results.The overall frequency of air trapping was 62% (155 of 250 subjects). Lobular air trapping was depicted in 117 (47%) of 250 subjects, without significant differences among smokers (n = 91), ex-smokers (n = 33), and nonsmokers (n = 31) (P =.118). Segmental and lobar air trapping (38 [15%] of 250) were more frequent among smokers (24 [26%] of 91) and ex-smokers (nine [27%] of 33) (P.001). No relationship was found between air trapping and functional indexes of small-airway disease when the CT pattern of air trapping was considered. The strongest relationship between CT abnormalities and functional alterations at the small-airways level was between inspiratory CT features of bronchiolitis: ground-glass opacity, ill-defined micronodules, bronchiolectasis, and air flow at low lung volumes.Whereas a significant relationship was observed between segmental and lobar air trapping and cigarette consumption, lobular air trapping was not found to reflect functional impairment at the small-airways level.

A back school was established in 1992 at the University Hospital of Lille (France) for employees with low back pain. We report its medical and socioeconomic benefits with a mean time to follow-up of 4 years. Our retrospective study included 108 health care workers and provides objective data (absenteeism, use of health care) and subjective information (progression of pain and disorder, social and professional impact) before training and a mean of 4 years after training. We found that 92% of the participants were satisfied with the training and that back pain had regressed or resolved for 55% of them. Both the frequency and duration of pain had decreased significantly. Seventy percent continue to apply the advice they received in their everyday life. Dealing with the problems specific to professional activities contributed to reduce the strain experienced on the job by the health care workers and improved their satisfaction at work. Global absenteeism was reduced by 57.8%, whereas it was reduced by 33% for back pain alone 4 years after implementing this program. Our study provides evidence of the positive impact of this type of training on the way back pain is perceived and on everyday life. The assessment of the cost/efficiency ratio completes the list of durable benefits reported here.

In the last few years, many studies have been carried out concerning the effects of fumes from stainless steel (SS) welding on the health of welders. The respiratory effects of exposure to SS welding fumes have already been studied, but the results of lung function investigations have not been consistent. However, the main factor of risk for the welders' health seems to be related to the great concentration of chromium and nickel contained in fumes coming from SS welding. The aim of this study was to detect the chronic effects of SS welding exposure on pulmonary symptoms and ventilatory function tests. Respiratory symptoms and lung function tests were studied in 134 SS welders and 252 controls (C). Welders and controls were of similar average age, height, and duration in employment. The smoking habits of the groups were also similar. The medical questionnaire on respiratory symptoms was a version of the Medical Research Council questionnaire, modified by the British Occupational Hygiene Society. The flow-volume curves were performed with a calibrated pneumotachograph spirometer before each subject started working. After adjustment for tobacco habits, the SS welders presented a higher prevalence of bronchial irritative symptoms such as cough (P = 0.01) or sputum production (P = 0.02) than the controls. On the other hand, chronic bronchitis appeared to be significantly linked to tobacco consumption. The pulmonary function analysis underscored no significant difference between stainless steel welders and controls (forced expiratory volume in one second, observed/predicted: SS = 0.99 vs C = 0.98; maximal midexpiratory flow, observed/predicted: SS = 0.90 vs C = 0.92; maximal expiratory flow at 50 % of the forced vital capacity, observed/predicted: SS = 0.95 vs C = 0.95). On the other hand, by the mean of the two-ways analysis, a significant tobacco effect was found, without exposure or interaction of tobacco-exposure effects. There was no influence of the specific welding processes on the spirographic parameters, but a decrease in spirographic values after 25 years of welding activity was evident. The results of multiple regression indicated that age was not a confounding factor.

International audience; Background: Many studies have supported the role of organizational work factors (OWFs) on the risk of cardiovascular diseases (CVDs) and CVD risk factors, including arterial hypertension. However, a little information is available concerning the role of collective stressors deriving from work organization on nurse's risk of hypertension. This study aimed to test the independent longitudinal relationships linking the 2-year incidence of arterial hypertension to collective stressors at the work unit level, among baseline normotensive female hospital registered nurses and nursing assistants, after adjusting for known individual predictors of CVDs and for occupational stress.Method: Arterial hypertension was defined as the intake of antihypertensive drug or as blood pressure (BP) measures higher than 140 mmHg (SBP) or 90 mmHg (DBP) at both the clinical visit and 1 month later. We analyzed the effect of OWFs at the work unit level, constraints related to the physical work environment and the individual perception of the work environment in 2006 on the risk of arterial hypertension in 2008 among 1882 initially normotensive female healthcare workers followed in the French Organisation des soins et santé des soignants (ORSOSA) cohort.Results: We showed that OWFs at the work unit level may influence the 2-year risk of arterial hypertension independently of work factors at the worker level, baseline BP, age and BMI. In this study, OWFs affected 2-year risk of arterial hypertension only through direct effects.Conclusion: Our results pointed out the possibility of a primary prevention of arterial hypertension through interventions based at the work unit level among healthcare workers.

Air and biological monitoring were used for assessing external and internal chromium exposure among 116 stainless steel welders (SS welders) using manual metal arc (MMA), metal inert gas (MIG) and tungsten inert gas (TIG) welding processes (MMA: n = 57; MIG: n = 37; TIG: n = 22) and 30 mild steel welders (MS welders) using MMA and MIG welding processes (MMA: n = 14; MIG: n = 16). The levels of atmospheric total chromium were evaluated after personal air monitoring. The mean values for the different groups of SS welders were 201 micrograms/m3 (MMA) and 185 micrograms/m3 (MIG), 52 micrograms/m3 (TIG) and for MS welders 8.1 micrograms/m3 (MMA) and 7.3 micrograms/m3 (MIG). The curve of cumulative frequency distribution from biological monitoring among SS welders showed chromium geometric mean concentrations in whole blood of 3.6 micrograms/l (95th percentile = 19.9), in plasma of 3.3 micrograms/l (95th percentile = 21.0) and in urine samples of 6.2 micrograms/l (95th percentile = 58.0). Among MS welders, mean values in whole blood and plasma were rather more scattered (1.8 micrograms/l, 95th percentile = 9.3 and 1.3 micrograms/l, 95th percentile = 8.4, respectively) and in urine the value was 2.4 micrograms/l (95th percentile = 13.3). The analysis of variance of chromium concentrations in plasma previously showed a metal effect (F = 29.7, P0.001), a process effect (F = 22.2, P0.0001) but no metal-process interaction (F = 1.3, P = 0.25). Concerning urinary chromium concentration, the analysis of variance also showed a metal effect (F = 30, P0.0001), a process effect (F = 72, P0.0001) as well as a metal-process interaction (F = 13.2, P = 0.0004). Throughout the study we noted any significant differences between smokers and non-smokers among welders. Taking in account the relationships between chromium concentrations in whole, plasma or urine and the different welding process. MMA-SS is definitely different from other processes because the biological values are clearly higher. These higher levels are due to the very significant concentrations of total soluble chromium, mainly hexavalent chromium, in welding fumes.

Objective: We present pulmonary disorders of four employees who were exposed to high concentration of pure mica dust in a muscovite milling unit. Method: All cases underwent traditional examinations with a dualenergy chest computed tomographic scan. An analysis of exhaled breath condensate by Raman microspectrometry and of mineralogical content of a lung biopsy was performed for one case. Results: All cases showed bilateral micronodular ground glass opacities and mediastinal and hilar hyperdense lymph nodes consistent with the nodal sequestration of mineral particles. Histological analysis showed giant cell granulomas without typical silicotic nodule with high concentration of birefringent particles consistent with mica. Mica particles found in the exhaled breath condensate were identical to particles in ambient air at the company. Conclusion: Occupational exposure to mica dust is responsible for diffuse infiltrative lung disease by overload processes.

Objective To evaluate manganese in exhaled breath condensate (Mn–EBC) as an indicator of exposure to fumes from metal inert gas welding process. Methods We collected EBC and urine from 17 welders and 16 unexposed control subjects after 5 days exposure. Concentrations of manganese (Mn), nickel (Ni), iron (Fe) and chromium (Cr) were measured in EBC and urine samples and correlated with cumulative exposure indices for the working week (CIW) and for the total welding years (WY), based on duration of welding activity and atmospheric metal measurements. Results Concentrations of Mn and Ni in EBC were significantly higher among welders than controls whereas this difference was not significant for Mn in urine. Levels of Mn and Ni in EBC were not correlated with their respective levels in urine. The linear regressions found significant positive coefficients between Mn–EBC, Ni–EBC, Ni–U and Cr–U concentrations and the cumulative exposure indices. Taking into account tobacco use, statistical analysis showed the same trends except for the relationship between Mn–U and CIW. Conclusion This pilot study showed that Mn–EBC, as well as Ni–EBC, can serve as reliable indices of occupational exposure to welding fumes and provide complimentary toxicokinetic information to that provided by urine analyses.

PurposeTo provide quantitative information on emphysema in asymptomatic smokers in correlation with pulmonary function tests (PFT).Patients and methodsThe study population included 75 smokers (current smokers: n=39; ex-smokers: n=36) and 25 nonsmokers who underwent volumetric high-resolution CT of the chest with automated quantification of emphysema and PFTs.ResultsCurrent smokers had a higher percentage of emphysema in the right lung (P=0.041) and right upper lobe (P=0.037). The overall percentage of emphysema did not differ according to the Gold stage (P=0.77). Smokers with emphysema had significantly higher mean values of FRC (P=0.012), RV (0.05). Correlations were found between the percentage of emphysema and (a) cigarette consumption of current (r=0.34215; P=0.0330) and ex-smokers (r=0.44104; P=0.0071); and (b) alterations of TLC, FRC, RV and DLCO of smokers.ConclusionQuantitative CT allows recognition of regional specificities and subclinical functional alterations in smokers with emphysema.

New methods for exploring pulmonary inflammation might be useful: measurements of exhaled nitric oxide (NO) and hydrogen peroxide (H2O2) in exhaled breath condensate (EBC). The authors describe the application and utility of these methods in a case report of pediatric nurse presenting an occupational asthma to latex. Despite compliance with avoidance measures, respiratory discomfort had worsened during work. Classical tests (spirometry, monitoring of peak expiratory flow) were not contributing to objectify the discomfort. Exhaled NO and H2O2 in EBC increased immediately after work periods, compared with rest periods. Application of these new methods, at the same time, in workplace appears useful in the objective demonstration of a temporal relation between work and respiratory problems. The results allowed the occupational physician to transfer the patient to a new work station more appropriate for her respiratory health status.

A prospective computed tomographic (CT) study was performed to determine the prevalence of lung changes in smokers. The study group comprised 175 healthy adult volunteers (current smokers, n = 98; ex-smokers, n = 26; nonsmokers, n = 51). The subjects underwent clinical examination, pulmonary function tests, chest radiography, and conventional and high-resolution CT (HRCT). Significant differences between current smokers, ex-smokers, and nonsmokers were observed with HRCT in the identification of subpleural (P = .11) and parenchymal (P < .001) micronodules, emphysema (P < .001), and areas of ground-glass attenuation (P = .0001). All subjects had normal pulmonary function. Parenchymal micronodules, areas of ground-glass attenuation, and emphysema were observed with a significant predominance in the upper lung zones (P < .01). Presence of emphysema and abnormal bronchial wall thickening were the only HRCT signs associated with significantly lower values of functional parameters. These data support the concept that parenchymal abnormalities can be detected in healthy smokers with normal findings at chest radiography and pulmonary function tests.

SummaryBackgroundHealthcare workers often are unsatisfied with their working conditions despite declaring to like their jobs. Psychosocial constraints in the workplace have increased recently due to changes in work organization. These psychosocial constraints are linked to cardiovascular diseases.AimTo analyze the relationship between blood pressure levels and organizational occupational risk factors in female hospital workers, using a new questionnaire (the Nursing Work Index-Extended Organization [NWI-EO] questionnaire), which quantifies psychological and organizational work factors.MethodsThe ORSOSA study is a national, multicentre, cohort study conducted in seven voluntary French university hospitals, including 214 work units with a total of 2307 nurses and 1530 nursing assistants.ResultsSystolic and diastolic blood pressure appeared to be significantly associated with age (P

The role of psychosocial factors in the development of upper limb musculoskeletal disorders has now been clearly demonstrated. However, only a few studies have analysed the association between the organisational work environment and musculoskeletal disorders in health care workers. The main goal of this study was to test the hypothesis that some specific organisational constraints may be related to upper limb musculoskeletal symptoms experienced by registered nurses, independently of the effort/reward imbalance model and major confounding factors. In 2006, 2194 female registered nurses in 7 French teaching hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded to valid self-report questionnaires (ERI [effort-reward imbalance], Nordic-style questionnaire). The organisational work environment was assessed by the self-rated Nursing Work Index-Extended Organisation scale. Multilevel models were used for analyses. We found that 2 organisational health care constraints: low level of shared values about work between members in the unit and lack of support from the administration were significantly associated with upper limb symptoms, independently of ERI perceptions. This study identified and quantified specific health care organisational factors that have an impact on nurses' upper limb symptoms, sometimes independently of ERI perception. A prospective study is needed to clarify the causal role of psychosocial and organisational work factors in upper limb injury in nurses. Organisational approaches may be more effective in improving health at work and may also have a longer-lasting impact than individual approaches.

The objective of this work was to compare the seroprevalence of cytomegalovirus in an unexposed and exposed population, both working in a hospital, and to study the occupational risk factors related to seropositivity, while taking personal risk factors into account. We conducted a cross-sectional study in a French hospital over a period of 12 months. The overall seroprevalence among the 550 subjects was 49.5%. The multivariate analysis showed that seropositivity was significantly associated with age (36–43 years: odds ratio [OR] = 1.7; 95% confidence interval [CI]: [1.1–2.8]) and working as a pediatric nurse’s aide (OR = 1.8; 95% CI: [1.1–2.8]). This study confirms the need to improve prevention procedures in the workplace, including screening, information, and hygiene rules.

A comparative, randomised, double-blind trial was performed in the medical departments of five hospitals to study the effects of regular consumption of short-chain fructo-oligosaccharides (sc-FOS) on the digestive comfort of subjects with minor functional bowel disorders (FBD). In step 1, 2235 subjects were questioned to assess the incidence and intensity of digestive disorders. In step 2, 105 of these patients diagnosed with minor FBD were randomised into two groups to receive either 5 g sc-FOS or 5 g placebo (sucrose and maltodextrins) per d over a 6-week period. The incidence and intensity of digestive disorders were assessed at the end of the treatment period (day 43) using the step 1 questionnaires. A quality-of-life questionnaire was also completed at the start and end of the treatment period to assess potential effects on well-being and social performance. In step 1, 44 % of the subjects questioned presented FBD, of whom 57·1 % suffered from minor FBD. In step 2, on day 43, the intensity of digestive disorders decreased by 43·6 % in the sc-FOS group v. a 13·8 % increase in the placebo group (P = 0·026). Symptoms were experienced less frequently by 75·0 % of subjects in the sc-FOS group, while 53·8 % of controls experienced no change (P = 0·064). Using the functional digestive disorders quality of life questionnaire, the discomfort item scores increased in the sc-FOS group (P = 0·031). However, expressed as change in quality of life (improvement, worsening or unchanged), daily activities were significantly improved in the sc-FOS group (P = 0.022). Regular consumption of sc-FOS may improve digestive comfort in a working population not undergoing medical treatment.

To evaluate thin-section computed tomography (CT) in depicting longitudinal changes in the lung parenchyma.One hundred eleven volunteers underwent sequential examination with thin-section CT and pulmonary function tests over a mean period of 5.5 years. According to their smoking habits between initial evaluation (T0) and follow-up (T1), the subjects were classified as persistent current smokers (n = 57), persistent nonsmokers (n = 31), persistent ex-smokers (n = 13), or quitters (n = 10).Significant differences in CT findings between T0 and T1 were seen in only the group of persistent current smokers, who showed a higher frequency of emphysema (40% vs 26%; P =.005) and ground-glass attenuation (42% vs 28%; P =.02). Individual analysis of follow-up CT scans in the 19 persistent current smokers with micronodules at T0 demonstrated (a) no changes in seven cases, (b) a higher profusion of micronodules in seven cases, and (c) replacement of micronodules with emphysema in five cases. Subjects with emphysema and/or areas of ground-glass attenuation at T0 had a significantly more rapid decline in lung function than did those with a normal CT scan.Emphysema and/or ground-glass attenuation are linked with impairment of ventilatory lung function over time in persistent current smokers.

Ethylene oxide (EtO) is a powerful disinfectant and sterilant for heat-sensitive surgical items and instruments. Its use in hospitals constitutes an important source of occupational exposure that is sometimes underestimated, such as in cases of EtO device malfunction when the safety rules of procedure are not strictly followed or when individual or collective protective equipment is lacking. We carried out a descriptive study of the health care workers who were assigned to EtO sterilization units of the Lille University Hospital Centre in Lille, France (n = 16). Before the modification of the sterilization units in the development of a single, central sterilization site, we studied the workplaces, occupational conditions, and work procedures of the health care workers exposed to EtO. The aim was to assess the risk of EtO overexposure of the workers in order to improve workers' health and security in the future sterilization center. The study was based on a physical examination, a questionnaire covering each subject's personal and occupational history, and a complete ocular examination. For occupational conditions, the studies of each workplace were also performed by the occupational physician. Area and personal breathing air samplings were performed at each exposure site. Fourteen of the 16 operators had posterior and anterior subcapsular lens opacities, three of which seemed to be directly and primarily related to occupational exposure; the other ten seemed to be rather common and compatible with age. High levels of EtO exposure were reported in the oldest site (90 parts per million [ppm] during the changing of the gas bottle), where exposure often exceeded French threshold limits (permissible exposure limit: 1 ppm 8-hour time-weighted average (TWA) in air; short-term excursion limit: 5 ppm 15-minute TWA in air), or the current US recommended and legal exposure limits for EtO advocated by the Occupational Safety and Health Administration and the American Conference of Governmental Industrial Hygienists (permissible exposure limit: 1 ppm 8-hour TWA in air; excursion limit: 5 ppm 15-minute TWA in air), and the National Institute for Occupational Safety and Health standard (recommended exposure limits: 0.1 ppm 8-hour TWA in air; 5 ppm 10-minute TWA in air). The faults in the work processes, such as interruption of the sterilization cycle and disregard for the use of protective devices, were very common.

Over the past few years, many studies, including one on our previous work, have examined the chronic effects of fumes from stainless steel (SS) welding on the health of welders. These chronic effects have been related to concentrations of chromium and nickel in SS welding fumes. The present study examined the acute respiratory effects of welding fumes in the workplace by measuring the across-shift changes in a population of 144 SS and mild steel (MS) welders and 223 controls. Manual Metal Arc, Metal Inert Gas, and Tungsten Inert Gas welding processes were studied. Pulmonary function tests were performed at the start (ante, or A) and at the end (post, or P) of the work shift. The study of sensitization to harmful respiratory effects of welding was based on the study of the (P-A)/A ratio (%) of the spirometric variations during the shift. The means of these ratios in the control subjects were used to account for the circadian effect. In SS welders we observed a significant decrease in forced vital capacity (FVC) during the shift. Significant across-shift decrements in forced expiratory volume in 1 second (FEV1) and FVC were related to the SS welding exposure compared with MS welding. Moreover, the across-shift decreases in FEV1, FVC, and peak expiratory flow (PEF) were significantly related to the Manual Metal Arc welding process, compared with Metal Inert Gas techniques (respectively, PEF = -2.7% of baseline values [SD, 11.9] vs 2.0% of baseline values [SD, 7.7] P = 0.04; FVC = -1.5% of baseline values [SD, 4.8] vs 0.2% of baseline values [SD, 4.5] P = 0.05). We also demonstrated the influence of duration of SS welding exposure on the course of lung function during the work shift. After 20 years of SS welding activity, SS welders had more significant across-shift decreases than MS welders with a similar MS exposure duration (respectively, FEV1 = -2.7% of baseline values [SD, 5.9] vs 0.7% of baseline values [SD, 4.2] P = 0.008; PEF = -3.8% of baseline values [SD, 9.6] vs 2.3% of baseline values [SD, 6.5] P = 0.04). We concluded that welding-related lung function responses are seen in SS compared with MS welders and in those with a longer lifetime welding history.