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To validate self-reported occupational loud noise exposure against expert evaluation of noise levels in a French case–control study on acoustic neuroma and to estimate the impact of exposure misclassification on risk estimation. Noise levels were evaluated in 1006 jobs held by 111 cases and 217 population controls by an expert. Case–control differences in self-reporting were analyzed with logistic models. Sensitivity, specificity, positive and negative predictive values, and observed agreement of the self-reports were computed relative to the expert evaluation. They were used to calibrate the odds ratio (OR) between lifetime ever occupational loud noise exposure and the risk of acoustic neuroma, without adjustment for measurement error of the expert assessments. Cases reported noise levels in individual jobs closer to the expert assessment than controls, but the case–control difference was small for lifetime exposures. For expert-rated exposure of 80 dB(A), reporting of individual jobs by cases was more sensitive (54% in cases, 37% in controls), whereas specificity (91% in cases, 93% in controls) and observed agreement (82% in cases, 81% in controls) were similar. When lifetime exposure was considered, sensitivity increased (76% in cases, 65% in controls), while cases specificity decreased (84%). When these values were used to calibrate self-reports for exposure misclassification compared to expert evaluation at 80 dB(A), the crude OR of 1.7 was reduced to 1.3. Despite the relatively accurate reporting of loud noise, the impact of the calibration on the OR was non-negligible.

Objective: This study assesses the effectiveness of protective clothing (motorcycle jacket, trousers, gloves, knee-high or ankle boots, back protection) for motorized 2-wheeler (MTW) riders. Methods: This retrospective observational study used injury data from the Rhône Registry of Road Accident Victims, plus a postal survey conducted in 2016. Seven thousand one hundred forty-eight MTW riders involved in accidents between 2010 and 2014 were identified from the Registry and were invited to complete a questionnaire. Nine hundred seventy-nine individuals returned the questionnaire with relevant information; 951 with complete injury descriptions and clothing information were included in the study. The impact of protective clothing on injury risk was estimated using Poisson regression, with weighting for nonrespondents. Results: Sixty-seven percent of MTW riders sustained upper limb injuries and 47% sustained lower limb injuries. Gloves were the most frequent gear worn (76%), followed by jackets (59%) and knee-high or ankle boots (37%). Only 23% had back protection and 0.3% had an airbag. Wearing protective clothing was associated with a lower risk of soft tissue injury to upper and lower limbs: For upper limbs, the risk was lower when one of 2 items (a motorcycle jacket or gloves) was worn (relative risk [RR]=0.36; 95% confidence interval [CI], 0.18-0.75) and was lowest when both were worn (RR = 0.28; 95% CI, 0.12-0.69); for lower limbs, risk was reduced by wearing both motorcycle trousers and boots (RR = 0.60; 95% CI, 0.40-0.91) but was not significantly reduced when only one of these items was worn (RR = 0.90; 95% CI, 0.67-1.21). This protective effect was mainly due to a reduction in abrasions/lacerations rather than contusions. However, protective clothing did not reduce the risk of fracture, dislocation, or sprain, except for knee-high or ankle boots, which were associated with lower risk of ankle or foot fracture (RR = 0.43; 95% CI, 0.24-0.75). No effect of back protectors was shown. Conclusions: This study confirms the potential for motorcycle clothing to protect users from injury, in particular abrasions and lacerations. However, it did not show any significant protective effect against more serious injuries, such as fracture, dislocation, or sprain, except for knee-high or ankle boots, which reduced foot and ankle fracture risk. Our results argue for more widespread use of protective clothing by MTW users.

PURPOSE: Psychosocial consequences of road accidents are a major clinical problem that incurs significant social, occupational, and economic costs. The purpose of our study was to assess medical and socio-occupational factors of psychological distress in the severely injured 5 years after a road accident. METHODS: A total of 691 of the 1168 subjects enrolled in a prospective cohort of road accident casualties (ESPARR cohort) responded to both standardized follow-up questionnaires at 1 and 5 years, assessing socio-occupational characteristics, physical and psychological sequelae, pain and perceived quality of life. RESULTS: One quarter of participants exhibited psychological distress 5 years after the road accident; most of whom are women, with low educational level,and suffering from spinal lesions. After adjusting for several factors, psychological distress at 5 years was predicted by female gender and low educational level, and by several other factors observed 1 year after the road accident: poor self-reported quality of life, attention deficit and symptoms of anxiety. CONCLUSIONS: Early-stage improvement in the screening and care of mental disorders in road accident casualties should help to reduce long-term psychological distress. Language: en

Introduction Several studies of the working conditions of drivers, and in particular on their pace of work, have enabled a better understanding of the risk factors for road accidents that occur during work. However, few studies are available on the risk exposure and working conditions of employees whose occupations involve driving. The purpose of this paper is to identify the different groups of employees occupationally exposed to road risk and to classify them according to working conditions. Methodology A Multiple Correspondence Analysis (MCA) was implemented on the 41,727 individuals from the SUMER 2010 survey (Medical Monitoring of Occupational Risk Exposure: SUrveillance Medicale des Expositions aux Risques professionnels) and for 45 variables about working conditions. The analysis used 5 categories of weekly driving exposure as a supplementary variable (variable which is not used to perform the MCA): Non-exposure; Exposed 20 h. The results of the MCA were used to construct an ascending hierarchical classification. Results The first factorial axis differentiates between conventional and unconventional work schedules. Axis 2 differentiates modalities corresponding to the working hours of the most recent working week. The third axis chiefly contrasts persons who have rules to follow with those who have none. An ascending hierarchical classification distinguishes 10 clusters of individuals according to working conditions. Four clusters of employees were excessively exposed to occupational driving. Clusters also have distinct demographic, occupational and psychosocial characteristics. Conclusion Analysis of data from the SUMER survey confirms that employees exposed to road risk are particularly affected by atypical work time characteristics, but can be found in all activity sectors and in all types of job.

International audience; The aim of the study was to examine associations between occupational exposure to metals and meningioma risk in the international INTEROCC study. INTEROCC is a seven-country population-based case-control study including 1906 adult meningioma cases and 5565 population controls. Incident cases were recruited between 2000 and 2004. A detailed occupational history was completed and job titles were coded into standard international occupational classifications. Estimates of mean workday exposure to individual metals and to welding fumes were assigned based on a job-exposure-matrix. Adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated using conditional logistic regression. Although more controls than cases were ever exposed to metals (14 vs. 11 %, respectively), cases had higher median cumulative exposure levels. The ORs for ever vs. never exposure to any metal and to individual metals were mostly greater than 1.0, with the strongest association for exposure to iron (OR 1.26, 95 % CI 1.0-1.58). In women, an increased OR of 1.70 (95 % CI 1.0-2.89) was seen for ever vs never exposure to iron (OR in men 1.19, 95 % CI 0.91-1.54), with positive trends in relation with both cumulative and duration of exposure. These results remained after consideration of other occupational metal or chemical co-exposures. In conclusion, an apparent positive association between occupational exposure to iron and meningioma risk was observed, particularly among women. Considering the fact that meningioma is a hormone dependent tumor, the hypothesis that an interaction between iron and estrogen metabolism may be a potential mechanism for a carcinogenic effect of iron should be further investigated.

BackgroundLittle is known about occupational risk factors for meningioma.ObjectivesTo study whether risk of meningioma is associated with several occupational exposures, including selected combustion products, dusts and other chemical agents.MethodsThe INTEROCC study was an international case-control study of brain cancer conducted in seven countries. Data collection by interview included lifetime occupational histories. A job exposure matrix was used to derive estimates of exposure for the 12 agents. ORs for ever versus never exposed and for exposure-response using duration of exposure and cumulative exposure were derived using conditional logistic regression stratified by sex, age group, country/region, adjusted for education.ResultsThese analyses included 1906 cases and 5565 controls. For 11 of the 12 agents, no excess risk was found for ever exposed. For ever exposure to oil mists, an elevated OR of 1.57 (95% CI 1.10 to 2.22, 51 exposed cases) was found. Statistically significant exposure-response relationships were observed with cumulative exposure (p=0.01) and duration of exposure (p=0.04). Among women, there were also significant trends for cumulative and duration of exposure to asbestos and excesses in the highest exposure categories for formaldehyde.ConclusionsMost agents examined did not provoke excess risks of meningioma. The main finding from this study is that it is the first study to identify a statistical association between exposure to oil mists and meningioma. This may be a chance finding or could be due to confounding with iron exposure and further research is required to understand whether the relationship is causal.

Background Road accidents may impact victims' physical and/or mental health and socio-occupational life, notably including return to work. Objectives To assess whether the occupational medical consequences sustained by subjects injured in road accidents occurring in a work-related context differ from those associated with private accidents. Methods 778 adults who were in work or occupational training at the time of their accident were included. Two groups were distinguished: 354 (45.5%) injured in road accidents occurring in a work-related context (commuting or on duty) and 424 (54.5%) injured in a private accident. The groups were compared on medical and occupational factors assessed on prospective follow-up at 6 months and 1 and 3 years. Multivariate analysis explored for factors associated at 6 months and 1 year with sick leave following the accident and duration of sick leave. Results There were no significant differences between groups for demographic data apart from a slightly higher injury severity in private accidents (32.5% of private accidents with MAIS3+(Maximum Abbreviated Injury Scale greater or equal to 3) vs. 23.7% for work-related accidents, p = 0.007). Victims of work-related accidents were more often on sick leave (OR = 1.8; 95% CI, 1.1-2.9). Although the length of sick leave is higher for work-related accidents that for private accidents, multivariate analysis showed that the injury severity and the post-traumatic stress disorder (PTSD) are significant factors to explain the time to return to work. There were no significant differences according to occupational impact during follow-up, notably including sick-leave duration, number of victims returning to work within 3 years and number of victims out of work due to incapacity. Conclusions In the ESPARR (follow-up study of a road-accident population in the Rhone administrative county: Etude de Suivi d'une Population d'Accidentes de la Route dans le Rhone) cohort, the fact that a road accident occurred in a work-related context did not affect the occupational consequences.

OBJECTIVE: The variety and extent of impairments occurring after traumatic brain injury vary according to the nature and severity of the lesions. In order to better understand their interactions and long-term outcome, we have studied and compared the cognitive and neurobehavioral profile one year post onset of patients with and without traumatic brain injury in a cohort of motor vehicle accident victims. METHOD: The study population is composed of 207 seriously injured persons from the ESPARR cohort. This cohort, which has been followed up in time, consists in 1168 motor vehicle accident victims (aged 16 years or more) with injuries with all degrees of severity. Inclusion criteria were: living in Rhone county, victim of a traffic accident having involved at least one wheel-conducted vehicle and having occurred in Rhone county, alive at the time of arrival in hospital and having presented in one of the different ER facilities of the county. The cohort's representativeness regarding social and geographic criteria and the specificities of the accidents were ensured by the specific targeting of recruitment. Deficits and impairments were assessed one year after the accident using the Neurobehavioral Rating Scale - Revised and the Trail-Making Test. Within our seriously injured group, based on the Glasgow Score, the presence of neurological deficits, aggravation of neurological condition in the first 72hours and/or abnormal cerebral imaging, we identified three categories: (i) moderate/severe traumatic brain injury (n=48), (ii) mild traumatic brain injury (n=89), and (iii) severely injured but without traumatic brain injury (n=70). RESULTS: The most frequently observed symptoms were anxiety, irritability, memory and attention impairments, depressive mood and emotional lability. While depressive mood and irritability were observed with similar frequency in all three groups, memory and attention impairments, anxiety and reduced initiative were more specific to traumatic brain injury whereas executive disorders were associated with moderate/severe traumatic brain injury. DISCUSSION-CONCLUSION: The presence and the initial severity of a traumatic brain injury condition the nature and frequency of residual effects after one year. Some impairments such as irritability, which is generally associated with traumatic brain injury, do not appear to be specific to this population, nor does depressive mood. Substantial interactions between cognitive, affective and neurobehavioral disorders have been highlighted. Language: en

International audience; In absence of clear evidence regarding possible effects of occupational chemical exposures on brain tumour aetiology, it is worthwhile to explore the hypothesis that such exposures might act on brain tumour risk in interaction with occupational exposure to extremely low frequency magnetic fields (ELF).INTEROCC is a seven-country (Australia, Canada, France, Germany, Israel, New Zealand and UK), population-based, case-control study, based on the larger INTERPHONE study. Incident cases of primary glioma and meningioma were ascertained from 2000 to 2004. Job titles were coded into standard international occupational classifications and estimates of ELF and chemical exposures were assigned based on job-exposure matrices. Dichotomous indicators of cumulative ELF (≥50th vs

BACKGROUND: The aetiology of glioma remains largely unknown. Occupational solvent exposure has been suggested as a putative cause of glioma, but past studies have been inconsistent. We examined the association between a range of solvents and glioma risk within the INTEROCC project, a study of brain tumours and occupational exposures based on data from seven national case-control studies conducted in the framework of the INTERPHONE study. We also investigated associations according to tumour grade.METHODS: Data from the seven countries were standardised and then combined into one aggregate data set. Pooled odds ratios (ORs) were estimated for adjusted models that included sex, age, country-region of residence and level of educational attainment. Exposures to any solvent or 11 specific solvents or subgroups were assessed using a modified version of the FINJEM job exposure matrix (JEM) specifically developed for the study, called INTEROCC-JEM.RESULTS: Analysis included 2000 glioma cases and 5565 controls. For glioma and ever/never exposure to any solvent, the OR was 0.91 (95% confidence interval: 0.74-1.11). All ORs were CONCLUSIONS: The results of this study show no consistent associations for any solvent exposures overall or by grade of tumour.British Journal of Cancer advance online publication 14 September 2017; doi:10.1038/bjc.2017.285 www.bjcancer.com.

Background: Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess socio-occupational and medical factors of non-return to work in the severely injured 3 years after a road accident. Methods: Among 1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 (63.5%) of the 222 severely injured (Maximal Abbreviated Injury Scale ³3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n=113; 79.1%) and had not returned to work (n=28; 19.9%) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group, tiring work, strenuous work) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Results: Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head (Relative Risk [RR] = 7.5 ; 95% Confidence Interval [CI], 2.8-19.6) and lower-limb injury (RR = 1.9 ;95% CI,1.2-3.0), intense persistent pain at 3 years (RR = 8.3 ;95% CI, 2.6-26.9) and post-traumatic stress disorder (RR = 2.2 ;95% CI, 1.2-3.7) were significantly associated with non-return to work 3 years following severe road-accident injury. Conclusions: Post-traumatic stress disorder and chronic pain were essential medical determinants of non-return to work in the severely injured after a road accident, on which it is possible to act: early adapted management could promote return to work in the severely injured.; Objectifs : Estimer les déterminants socioprofessionnels et médicaux associés à une absence de reprise de l'activité professionnelle 3 ans après un accident de la voie publique chez des blessés graves. Matériels et Méthodes: ESPARR est une cohorte prospective sur 5 ans de 1 168 blessés de la route du département du Rhône, âgés de plus de 16 ans. Sur les 222 sujets gravement blessés (Maximal Abbreviated Injury Scale ³ 3) et en activité professionnelle au moment de l'accident, 141 sujets (63.5%) ont indiqué s'ils avaient repris une activité professionnelle au cours des 3 années après l'accident. Deux groupes ont été distingués : ceux qui n'avaient jamais repris le travail (N=28 ; 19.9%) et ceux qui avaient repris le travail au cours des 3 années (N=113 ; 79.1%). Les groupes ont été comparés sur des facteurs socioprofessionnels et des facteurs médicaux liés à l'accident et sur des facteurs médicaux à 3 ans de l'accident (analyse univariée : test du chi2 ou de fisher ; analyse multivariée : modèle linéaire généralisé). Résultats : La séÎrité des lésions initiales (New Injury Severity Score³16), la gravité des lésions initiales de la tête, de la face, des membres inférieurs, la persistance de douleurs intenses, la survenue d'un état de stress post-traumatique, une mauvaise perception de la qualité de vie et de l'état de santé à 3 ans de l'accident, sont des facteurs associés à l'absence de reprise du travail après analyse univariée. La gravité des lésions initiales de la tête, et des membres inférieurs, la persistance de douleurs intenses à 3 ans de l'accident et la survenue d'un état de stress post-traumatique restent significativement associés après analyse multivariée à l'absence de reprise du travail à 3 ans à la suite d'un accident corporel grave. Conclusion: L'état de stress post-traumatique et la douleur chronique apparaissent comme des déterminants essentiels du retour au travail chez les blessés graves, sur lesquels il est possible d'agir : Une prise en charge précoce et adaptée de ces facteurs pourrait favoriser la reprise du travail chez les blessés graves.

The aim of this study was to characterize different possible profiles of emotional experiences of victims of traffic accident based on verbatim accounts collected one year after the accident, and to relate these profiles to various socio-demographic and health data. A hierarchical cluster analysis of the emotional lexicon was made by categorizing and quantifying the EMOTAIX© lexicon using Tropes© text analysis software. Out of the 751 selected subjects, 328 expressed one or more emotional experiences. A link appeared between quality of life (QoL), post-traumatic stress disorder (PTSD) and the valence of expressed emotions. Injury severity and history distinguished two sets expressing negative-valence emotional experience. Paradoxically, a group also emerged with a large proportion of severely injured persons, associated with the expression of positive-valence emotional experiences and with domains of QoL and PTSD. The analysis of subjective data sheds light on the functioning of traffic accident victims and shows a way forward for research and clinical intervention.; L'objet de ce travail est de mettre en évidence des profils de Îcus émotionnels à partir de verbatims de victimes un an après leur accident de la circulation. Ces profils sont ensuite mis en lien avec des données sociodémographiques et de santé. Une analyse par regroupement hiérarchique appliquée au lexique de l'émotion catégorisé et comptabilisé via le répertoire EMOTAIX© piloté par le logiciel d'analyse linguistique Tropes© est réalisée. Parmi les sept cent cinquante et un sujets sélectionnés, trois cent vingt-huit expriment un (des) Îcu(s) émotionnel(s). Un lien apparait entre la qualité de vie (QOV), l'état de stress post-traumatique (ESPT) et la valence des émotions exprimées. La gravité des lésions et les antécédents permettent de discriminer deux ensembles dans lesquels sont exprimés des Îcus émotionnels à valence négative. Un profil contre-intuitif fait apparaitre un groupe avec une forte proportion de personnes portant des lésions graves associée à l'expression de Îcus émotionnels à valence positive et aux marqueurs de la qualité de vie et du syndrome de stress post-traumatique. Ainsi, l'analyse des données subjectives apporte des éclairages sur le fonctionnement des personnes accidentées de la circulation et ouvre une voie pour la recherche et l'intervention clinique.

Objective The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at 2 years. Design Prospective follow-up study. Methods The cohort was composed of 1168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident. Results 46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life. Conclusions Overall, victims were affected by their accident even 2 years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at 2 year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged /=3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3-14.6] and ORw, 6.5 [95% CI, 1.9-21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social-physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.

When investigating the association between brain tumors and use of mobile telephones, accurate data on tumor position are essential, due to the highly localized absorption of energy in the human brain from the radio-frequency fields emitted. We used a point process model to investigate this association using information that included tumor localization data from the INTERPHONE Study (Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the United Kingdom). Our main analysis included 792 regular mobile phone users diagnosed with a glioma between 2000 and 2004. Similar to earlier results, we found a statistically significant association between the intracranial distribution of gliomas and the self-reported location of the phone. When we accounted for the preferred side of the head not being exclusively used for all mobile phone calls, the results were similar. The association was independent of the cumulative call time and cumulative number of calls. However, our model used reported side of mobile phone use, which is potentially inuenced by recall bias. The point process method provides an alternative to previously used epidemiologic research designs when one is including localization in the investigation of brain tumors and mobile phone use.; Il s'agit d'explorer la relation entre dose de radiofréquences reçue ds le cerveau lors de l'utilisation de téléphone mobile et la survenue de tumeurs du cerveau.

Objective: Reducing the rates of death, trauma and sequelae associated with road accidents is the prime goal of road safety authorities, and success requires having data on victims' outcomes in the long term. The present study examined the outcome of adult road accident victims one year after their accident. Design: A follow-up study. Methods: The cohort comprised 886 injured road-accident victims, aged ≥ 16 years, and living in the Rhône administrative Département, France (taken from the ESPARR Cohort). Data were collected on victim characteristics at the time of crash, and self-reported outcomes one year later. The population of respondents at the one-year questionnaire follow-up was divided into two categories according to injury severity, as mild-to-moderate (M.AIS

Purpose Associations between cellular telephone use and glioma risk have been examined in several epidemiological studies including the 13-country INTERPHONE study. Although results showed no positive association between cellular telephone use and glioma risk overall, no increased risk for long-term users, and no exposure-response relationship, there was an elevated risk for those in the highest decile of cumulative call time. However, results may be biased as data were collected during a period of rapidly increasing cellular telephone use, and as controls were usually interviewed later in time than cases. Methods Further analyses were conducted in a subset of five INTERPHONE study countries (Australia, Canada, France, Israel, New Zealand) using a post hoc matching strategy to optimize proximity of case-to-control interview dates and age. Results Although results were generally similar to the original INTERPHONE study, there was some attenuation of the reduced odds ratios and stronger positive associations among long-term users and those in the highest categories for cumulative call time and number of calls (eighth–ninth and 10th decile). Conclusions Proximity and symmetry in timing of case-to-control interviews should be optimized when exposure patterns are changing rapidly with time.

The objective of the present study was to validate sequelae prediction by the Maximal Injury Impairment Score (M-IIS) in comparison with the Functional Independence Measure (FIM) assessed at 1-year follow-up of severe road crash victims.The study population came from "the Etude et Suivi d'une Population d'Accidentés de la Route dans le Rhône" (ESPARR; Rhône Area Road Crash Victim Follow-up Study) cohort: 178 victims (with Maximal Abbreviated Injury Scale ≥ 3) of road crashes in the Rhône administrative department of France, aged ≥ 16 years and with medical examination including FIM scoring 1 year postaccident. Two thresholds were tested for both scores. Firstly, the relation between FIM and M-IIS was assessed on logistic regression models adjusted on age and presence of complications at 1 year postaccident. The predictive capacity of M-IIS was expressed as its negative and positive predictive values and was considered good when 80 percent or better.Sixty-three of the 178 adult subjects (mean age = 37.7 years; range = 16.1-82.9 years) showed postaccident complications. One-year sequelae prediction on M-IIS was greater in head, spine, and limb lesions but limited to slight impairments (M-IIS = 1). There was a significant correlation between FIM and M-IIS, although age and medical complications were confounding factors on certain multivariate models. The predictive capacity of M-IIS was low for all types of sequelae.M-IIS, in this severely injured population, failed to predict sequelae at 1 year as measured by the FIM, despite a good correlation between the two. Complications are to be taken into account in assessing the M-IIS's capacity to predict sequelae. Further evaluation will be needed on larger series or assessment of other indicators and measures of sequelae at 1 year to obtain a robust tool to predict road crash sequelae.

Summary Objective It is essential to know about the long-term consequences of road crashes involving corporal injury in order to adopt relevant public health measures. Methods The ESPARR cohort comprises 1168 road-crash victims, aged 16 or over, managed in hospitals in the Rhone administrative department (France). It is based on the Registry of Road Traffic Casualties, which has been collecting exhaustive data since 1995. Two groups are monitored: mild to moderate (M-AIS 1 or 2) and severe (M-AIS ≥3). Patients were interviewed at the point of primary care, between 1 October 2004 and 31 July 2006. 6 months later, their state of health and presence of pain were compared. Multivariate analysis (logistic regression) was performed to identify factors related to residual pain. Results Adults of the cohort were compared to the road crash population as a whole recorded over the same period in the same area. At 6 months post-accident, only 31.9% of victims deemed their health status to have entirely returned to normal; 63.8% of mild to moderate and 89.2% of severe cases reported residual pain, but neither pain frequency nor intensity correlated with M-AIS. Residual pain was related to lower limb injuries (OR = 1.6; 95% CI = 1.1–2.4). After adjustment, pain was essentially related to age, seriousness of the lesions and a stay in a rehabilitation unit. Conclusion The ESPARR cohort provides a unique opportunity in France to describe the trajectory of a road crash victim, in terms both of care and rehabilitation and of resumption of work and personal activity.

Objectives: The output power of a mobile phone is directly related to its radiofrequency (RF) electromagnetic field strength, and may theoretically vary substantially in different networks and phone use circumstances due to power control technologies. To improve indices of RF exposure for epidemiological studies, we assessed determinants of mobile phone output power in a multinational study. Methods: More than 500 volunteers in 12 countries used Global System for Mobile communications software-modified phones (GSM SMPs) for approximately 1 month each. The SMPs recorded date, time, and duration of each call, and the frequency band and output power at fixed sampling intervals throughout each call. Questionnaires provided information on the typical circumstances of an individual's phone use. Linear regression models were used to analyse the influence of possible explanatory variables on the average output power and the percentage call time at maximum power for each call. Results: Measurements of over 60 000 phone calls showed that the average output power was approximately 50% of the maximum, and that output power varied by a factor of up to 2 to 3 between study centres and network operators. Maximum power was used during a considerable proportion of call time (39% on average). Output power decreased with increasing call duration, but showed little variation in relation to reported frequency of use while in a moving vehicle or inside buildings. Higher output powers for rural compared with urban use of the SMP were observed principally in Sweden where the study covered very sparsely populated areas. Conclusions: Average power levels are substantially higher than the minimum levels theoretically achievable in GSM networks. Exposure indices could be improved by accounting for average power levels of different telecommunications systems. There appears to be little value in gathering information on circumstances of phone use other than use in very sparsely populated regions.

Objectives: To investigate possible associations between risk of acoustic neuroma and exposure to loud noise in leisure and occupational settings. Methods: A case-control study was conducted in France within the international INTERPHONE study. The cases were the 108 subjects diagnosed with acoustic neuroma between 1 June 2000 and 31 August 2003. Two controls per case were selected from the electoral rolls and individually matched for gender, age (5 years) and area (local authority district) of residence at the time of the case diagnosis. Multivariate analyses were conducted using conditional logistic regression. Adjustment was made for socioeconomic status. Results: Acoustic neuroma was found to be associated with loud noise exposure (odds ratio (OR) = 2.55; 95% CI 1.35 to 4.82), both in leisure settings, particularly when listening to loud music (OR = 3.88; 95% CI 1.48 to 10.17) and at work (OR = 2.26; 95% CI 1.08 to 4.72). This risk increased with exposure duration (>6 years’ leisure exposure: OR = 3.15; 95% CI 1.07 to 9.24). Risk varied according to the type of noise (continuous or explosive vs intermittent). Conclusion: The present results agree with other recent reports implicating loud noise in the risk of acoustic neuroma.

Introduction An analysis of the occupational constraints and exposures to which employees facing road risk at work are subject was performed, with comparison versus non-exposed employees. Objective was to improve knowledge of the characteristics of workers exposed to road risk in France and of the concomitant occupational constraints. The descriptive study was based on data from the 2010 SUMER survey (Medical Monitoring of Occupational Risk Exposure: Surveillance Medicale des Expositions aux Risques professionnels), which included data not only on road risk exposure at work but also on a range of socio-occupational factors and working conditions. Materials and methods The main variable of interest was “driving (car, truck, bus, coach, etc.) on public thoroughfares” for work (during the last week of work). This was a dichotomous “Yes/No” variable, distinguishing employees who drove for work; it also comprised 4-step weekly exposure duration: Results 75% of the employees with driving exposure were male. Certain socio-occupational categories were found significantly more frequently: professional drivers (INSEE occupations and socio-occupational categories (PCS) 64), skilled workers (PCS 61), intermediate professions and teaching, health, civil service (functionaries) and assimilated (PCS 46) and company executives (PCS 36). Employees with driving exposure more often worked in small businesses or establishments. Constraints in terms of schedule and work-time were more frequent in employees with driving exposure. Constraints in terms of work rhythm were more frequent in non-exposed employees, with the exception of external demands requiring immediate response. On the Karasek's Job Demand-Control Model, employees with driving exposure less often had low decision latitude. Prevalence of job-strain was also lower, as was prevalence of “iso-strain” (combination of job-strain and social isolation). Employees with driving exposure were less often concerned by hostile behavior and, when they did report such psychological violence (inspired on the Leymann questionnaire), it was significantly more frequently due to clients, users or patients. Discussion Employees with driving exposure at work showed several specificities. The present study, based on a representative nationwide survey of employees, confirmed the existence of differences in working conditions between employees with and without driving exposure at work. In employees with driving exposure, constraints in terms of work-time and rhythm increased with weekly exposure duration, as did tension at work and exposure to hostile behavior.

Objectives: We examined which occupations and industries are currently at high risk for bladder cancer in men. Methods: We combined data from 11 case–control studies conducted between 1976–1996 in six European countries. The study comprised 3346 incident cases and 6840 controls, aged 30–79 years. Lifetime occupational and smoking histories were examined using common coding. Results: Odds ratios for eight a priori defined high-risk occupations were low, and with the exception of metal workers and machinists (OR = 1.16, 95% CI = 1.02–1.32), were not statistically significant. Higher risks were observed for specific categories of painters, metal, textile and electrical workers, for miners, transport operators, excavating-machine operators, and also for non-industrial workers such as concierges and janitors. Industries entailing a high risk included salt mining, manufacture of carpets, paints, plastics and industrial chemicals. An increased risk was found for exposure to PAHs (OR for highest exposure tertile = 1.23, 95% CI = 1.07–1.4). The risk attributable to occupation ranged from 4.2 to 7.4%, with an estimated 4.3% for exposure to PAHs. Conclusions: Metal workers, machinists, transport equipment operators and miners are among the major occupations contributing to occupational bladder cancer in men in Western Europe. In this population one in 10 to one in 20 cancers of the bladder can be attributed to occupation.

Aims: To evaluate occupational exposure to toxic pollutants at municipal waste incinerators (MWIs). Methods: Twenty nine male subjects working near the furnaces in two MWIs, and 17 subjects not occupationally exposed to combustion generated pollutants were studied. Individual air samples were taken throughout the shift; urine samples were collected before and after. Stationary air samples were taken near potential sources of emission. Results: Occupational exposure did not result in the infringement of any occupational threshold limit value. Atmospheric exposure levels to particles and metals were 10–100 times higher in MWIs than at the control site. The main sources were cleaning operations for particles, and residue transfer and disposal operations for metals. MWI workers were not exposed to higher levels of polycyclic aromatic hydrocarbons than workers who are routinely in contact with vehicle exhaust. The air concentrations of volatile organic compounds and aldehydes were low and did not appear to pose any significant threat to human health. Only the measurement of chlorinated hydrocarbon levels would seem to be a reliable marker for the combustion of plastics. Urine metal levels were significantly higher at plant 1 than at plant 2 because of high levels of pollutants emanating from one old furnace. Conclusion: While biological monitoring is an easy way of acquiring data on long term personal exposure, air monitoring remains the only method that makes it possible to identify the primary sources of pollutant emission which need to be controlled if occupational exposure and environmental pollution are to be reduced.

Background: Occupational exposure to extremely low-frequency magnetic fields (ELF) is a suspected risk factor for brain tumors, however the literature is inconsistent. Few studies have assessed whether ELF in different time windows of exposure may be associated with specific histologic types of brain tumors. This study examines the association between ELF and brain tumors in the large-scale INTEROCC study. Methods: Cases of adult primary glioma and meningioma were recruited in seven countries (Australia, Canada, France, Germany, Israel, New Zealand, and the United Kingdom) between 2000 and 2004. Estimates of mean workday ELF exposure based on a job exposure matrix were assigned. Estimates of cumulative exposure, average exposure, maximum exposure, and exposure duration were calculated for the lifetime, and 1 to 4, 5 to 9, and 10+ years before the diagnosis/reference date. Results: There were 3,761 included brain tumor cases (1,939 glioma and 1,822 meningioma) and 5,404 population controls. There was no association between lifetime cumulative ELF exposure and glioma or meningioma risk. However, there were positive associations between cumulative ELF 1 to 4 years before the diagnosis/reference date and glioma [odds ratio (OR) ≥ 90th percentile vs. < 25th percentile, 1.67; 95% confidence interval (CI), 1.36–2.07; PLinear trend < 0.0001], and, somewhat weaker associations with meningioma (OR ≥ 90th percentile vs. < 25th percentile, 1.23; 95% CI, 0.97–1.57; PLinear trend = 0.02). Conclusions: Results showed positive associations between ELF in the recent past and glioma. Impact: Occupational ELF exposure may play a role in the later stages (promotion and progression) of brain tumorigenesis. Cancer Epidemiol Biomarkers Prev; 23(9); 1863–72. ©2014 AACR.

A newly developed smartphone application was piloted to characterize and validate mobile phone use in young people. Twenty-six volunteers (mean age 17.3 years) from France, Spain, and the Netherlands used a software-modified smartphone for 4 weeks; the application installed on the phone recorded number and duration of calls, data use, laterality, hands-free device usage, and communication system used for both voice calls and data transfer. Upon returning the phone, participants estimated their mobile phone use during those 4 weeks via an interviewer-administered questionnaire. Results indicated that participants on average underestimated the number of calls they made, while they overestimated total call duration. Participants held the phone for about 90% of total call time near the head, mainly on the side of the head they reported as dominant. Some limitations were encountered when comparing reported and recorded data use and speaker use. When applied in a larger sample, information recorded by the smartphone application will be very useful to improve radiofrequency (RF) exposure modeling from mobile phones to be used in epidemiological research.

Objective To examine associations between occupational exposure to selected organic solvents and meningioma. Methodology A multicentre case–control study conducted in seven countries, including 1906 cases and 5565 controls. Occupational exposure to selected classes of organic solvents (aliphatic and alicyclic hydrocarbons, aromatic hydrocarbons, chlorinated hydrocarbons and ‘other’ organic solvents) or seven specific solvents (benzene, toluene, trichloroethylene, perchloroethylene, 1,1,1-trichloroethylene, methylene chloride and gasoline) was assessed using lifetime occupational histories and a modified version of the FINJEM job-exposure matrix (INTEROCC-JEM). Study participants were classified as ‘exposed’ when they had worked in an occupation for at least 1 year, with a 5-year lag, in which the estimated prevalence of exposure was 25% or greater in the INTEROCC-JEM. Associations between meningioma and each of the solvent exposures were estimated using conditional logistic regression, adjusting for potential confounders. Results A total of 6.5% of study participants were ever exposed to ‘any’ solvent, with a somewhat greater proportion of controls (7%) ever exposed compared with cases (5%), but only one case was ever exposed to any chlorinated hydrocarbon (1,1,1-trichloroethane). No association was observed between any of the organic solvents and meningioma, in either men or women, and no dose–response relationships were observed in internal analyses using either exposure duration or cumulative exposure. Discussion We found no evidence that occupational exposure to these organic solvents is associated with meningioma.

Objective.To compare health status, effect on family, occupational consequences, and quality of life (QOL) 1 year after an accident between patients with whiplash versus other mild injuries, and to explore the relationship between initial injury (whiplash vs other) and QOL.Methods.This was a prospective cohort study. The study used data from the ESPARR cohort (a representative cohort of road accident victims) and included 173 individuals with “pure” whiplash and 207 with other mild injuries. QOL at 1-year followup was assessed on the World Health Organization Quality of Life questionnaire. Correlations between explanatory variables and QOL were explored by Poisson regression to provide adjusted relative risks, with ANOVA for the various QOL scores explored.Results.One year post-accident, more patients who had whiplash than other casualties complained of nonrecovery of health status (56% vs 43%) and of the occupational effect of pain (31% vs 23%). QOL and posttraumatic stress disorder (PTSD) were similar in the 2 groups. Impaired QOL did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress. Whatever the initial lesion, PTSD was a determining factor for poorer QOL.Conclusion.Sociodemographic factors, preaccident psychological history prior to the accident, and PTSD were the main factors influencing QOL, rather than whether the injury was whiplash. PTSD may also be related to pain.

The primary risk factor for bladder cancer is cigarette smoking. Using a combined analysis of 11 case-control studies, we have accurately measured the relationship between cigarette smoking and bladder cancer in men. Available smoking information on 2,600 male bladder cancer cases and 5,524 male controls included duration of smoking habit, number of cigarettes smoked per day and time since cessation of smoking habit for ex-smokers. There was a linear increasing risk of bladder cancer with increasing duration of smoking, ranging from an odds ratio (OR) of 1.96 after 20 years of smoking (95% confidence interval [CI] 1.48–2.61) to 5.57 after 60 years (CI 4.18–7.44). A dose relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15–20 cigarettes per day, OR = 4.50 (CI 3.81–5.33), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% after 1–4 years, OR = 0.65 (0.53–0.79), and was over 60% after 25 years of cessation, OR = 0.37 (0.30–0.45). However, even after 25 years, the decrease in risk did not reach the level of the never-smokers, OR = 0.20. (0.17–0.24). The proportion of bladder cancer cases attributable to ever-smoking was 0.66 (0.61–0.70) for all men and 0.73 (0.66–0.79) for men younger than 60. These estimates are higher than previously calculated. Int. J. Cancer 86:289–294, 2000. © 2000 Wiley-Liss, Inc.

A history of allergy has been inversely associated with several types of cancer although the evidence is not entirely consistent. We examined the association between allergy history and risk of glioma, meningioma, acoustic neuroma, and parotid gland tumors using data on a large number of cases and controls from five INTERPHONE study countries (Australia, Canada, France, Israel, New Zealand), to better understand potential sources of bias in brain tumor case–control studies and to examine associations between allergy and tumor sites where few studies exist. A total of 793 glioma, 832 meningioma, 394 acoustic neuroma, and 84 parotid gland tumor cases were analyzed with 2,520 controls recruited during 2000–2004. Conditional logistic regression models were used to obtain odds ratios (ORs) and 95 % confidence intervals (CIs) for associations between self-reported allergy and tumor risk. A significant inverse association was observed between a history of any allergy and glioma (OR = 0.73, 95 % CI 0.60–0.88), meningioma (OR = 0.77, 95 % CI 0.63–0.93), and acoustic neuroma (OR = 0.64, 95 % CI 0.49–0.83). Inverse associations were also observed with specific allergic conditions. However, inverse associations with asthma and hay fever strengthened with increasing age of allergy onset and weakened with longer time since onset. No overall association was observed for parotid gland tumors (OR = 1.21, 95 % CI 0.73–2.02). While allergy history might influence glioma, meningioma, and acoustic neuroma risk, the observed associations could be due to information or selection bias or reverse causality.

BACKGROUND: There are a few studies assessing repercussions in road accident victims, which reported their results in quality of life (QoL), on an epidemiologic point of view. METHODS: ESPARR (follow-up of victims of road accident in the Rhone) is a prospective cohort study of 1,168 individuals (age ≥ 16 years) involved in road traffic accidents, having been admitted to one of the hospitals in the Rhone departement (France). The World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) was used to assess QoL at the 1-year follow-up.χ analysis was performed to test differences between groups, logistic regression was performed to examine predictors of global QoL and health, and linear regression was performed to examine predictors of the four functioning domains of the WHOQOL-Bref. RESULTS: Lesion severity (New Injury Severity Index ≥ 16; odds ratio, 2.6; 95% confidence interval, 1.7-3.9) and presence of head lesions (odds ratio, 1.5; 95% confidence interval, 1.1-2.2) were predictive of unsatisfactory QoL. Female sex, educational level lower than school graduation, severe injury, intention to lodge a complaint, early postaccident medical complications were predictive of health dissatisfaction. Several factors seemed to be associated to a poor QoL; notably, posttraumatic stress disorder was associated with low scores in all four WHOQOL-Bref domains. Socioeconomic factors were also significant, notably financial problems. CONCLUSION: The strong points of the present study lie in the fact that it is based on a representative cohort of road accident victims in an area in which all those treated within the hospital system after a road accident have been registered. The present study shows the strong correlation between QoL and posttraumatic stress disorder. LEVEL OF EVIDENCE: prospective study, all patients enrolled at the same point, 76% follow-up. Language: en

Background: The rapid increase in mobile telephone use has generated concern about possible health risks of radiofrequency electromagnetic fields from these devices. Methods: A case-control study of 1105 patients with newly diagnosed acoustic neuroma (vestibular schwannoma) and 2145 controls was conducted in 13 countries using a common protocol. Past mobile phone use was assessed by personal interview. In the primary analysis, exposure time was censored at one year before the reference date (date of diagnosis for cases and date of diagnosis of the matched case for controls); analyses censoring exposure at five years before the reference date were also done to allow for a possible longer latent period. Results: The odds ratio (OR) of acoustic neuroma with ever having been a regular mobile phone user was 0.85 (95% confidence interval 0.69-1.04). The OR for >= 10 years after first regular mobile phone use was 0.76 (0.52-1.11). There was no trend of increasing ORs with increasing cumulative call time or cumulative number of calls, with the lowest OR (0.48 (0.30-0.78)) observed in the 9th decile of cumulative call time. In the 10th decile (>= 1640 h) of cumulative call time, the OR was 1.32 (0.88-1.97); there were, however, implausible values of reported use in those with >= 1640 h of accumulated mobile phone use. With censoring at 5 years before the reference date the OR for >= 10 years after first regular mobile phone use was 0.83 (0.58-1.19) and for >= 1640 h of cumulative call time it was 2.79(1.51-5.16). but again with no trend in the lower nine deciles and with the lowest OR in the 9th decile. In general, ORs were not greater in subjects who reported usual phone use on the same side of the head as their tumour than in those who reported it on the opposite side, but it was greater in those in the 10th decile of cumulative hours of use. Conclusions: There was no increase in risk of acoustic neuroma with ever regular use of a mobile phone or for users who began regular use 10 years or more before the reference date. Elevated odds ratios observed at the highest level of cumulative call time could be due to chance, reporting bias or a causal effect. As acoustic neuroma is usually a slowly growing tumour, the interval between introduction of mobile phones and occurrence of the tumour might have been too short to observe an effect, if there is one. (C) 2011 Elsevier Ltd. All rights reserved.

International audience; OBJECTIVES: The objective of this study was to examine the associations of brain tumours with radio frequency (RF) fields from mobile phones. METHODS: Patients with brain tumour from the Australian, Canadian, French, Israeli and New Zealand components of the Interphone Study, whose tumours were localised by neuroradiologists, were analysed. Controls were matched on age, sex and region and allocated the 'tumour location' of their matched case. Analyses included 553 glioma and 676 meningioma cases and 1762 and 1911 controls, respectively. RF dose was estimated as total cumulative specific energy (TCSE; J/kg) absorbed at the tumour's estimated centre taking into account multiple RF exposure determinants. RESULTS: ORs with ever having been a regular mobile phone user were 0.93 (95% CI 0.73 to 1.18) for glioma and 0.80 (95% CI 0.66 to 0.96) for meningioma. ORs for glioma were below 1 in the first four quintiles of TCSE but above 1 in the highest quintile, 1.35 (95% CI 0.96 to 1.90). The OR increased with increasing TCSE 7+ years before diagnosis (p-trend 0.01; OR 1.91, 95% CI 1.05 to 3.47 in the highest quintile). A complementary analysis in which 44 glioma and 135 meningioma cases in the most exposed area of the brain were compared with gliomas and meningiomas located elsewhere in the brain showed increased ORs for tumours in the most exposed part of the brain in those with 10+ years of mobile phone use (OR 2.80, 95% CI 1.13 to 6.94 for glioma). Patterns for meningioma were similar, but ORs were lower, many below 1.0. CONCLUSIONS: There were suggestions of an increased risk of glioma in long-term mobile phone users with high RF exposure and of similar, but apparently much smaller, increases in meningioma risk. The uncertainty of these results requires that they be replicated before a causal interpretation can be made.

Objective: To analyse factors associated with late return to work in road accident victims. Materials and methods: The ESPARR cohort comprises road accident victims monitored over time from initiation of hospital care. A total of 608 ESPARR cohort subjects were working at the time of their accident and answered questionnaires at 6 months and/or 1 year. For each level of overall severity of injury (Maximum – Abbreviated Injury Scale (M-AIS) 1, 2, 3 and 4–5), a time-off-work threshold was defined, beyond which the subject was deemed to be a late returner; 179 subjects were considered to be late in returning to work, while 402 showed a normal pattern of return. Logistic regression identified factors associated with late return. Results: Type of journey, overall injury severity and intention to press charges emerged as factors predictive of late return to work on the basis of the data collected at inclusion alone. After adjustment, pain (odds ratio (OR): 2.6; 95% confidence interval (95% CI) 1.0–6.7) and physical sequelae (OR: 3.8; 95% CI 1.7–8.3) at 6 months and the fact of pressing charges (OR: 2.6; 95% CI 1.2–5.5) remained significantly linked with late return to work. Conclusion: Impaired health status at 6 months after the initial accident (in the form of persistent pain and physical sequelae) is a determining factor delaying return to work following a road traffic accident.

Objective: The aim of this study was to examine the selfreported health status of road traffic accident victims and the predictors of self-assessed recovery 1 year after major trauma in a French population. Design: A follow-up study. Methods: The cohort comprised 276 seriously injured victims of road traffic accidents, aged > 16 years from the Rhone administrative department, France. Victim characteristics at the time of the crash and self-reported health status 1 year after trauma were collected. Predictive factors for self- assessed recovery were examined using a Poisson regression approach. Results: The majority of victims were male (76%); most had severe injuries (76%), involving mainly the lower limbs and the head (68% and 55%, respectively). At 1-year follow-up, 80% reported being not fully recovered. Self-reported health status was not significantly associated with age, gender, being in employment, type of road user, or health status during the year preceding the accident, but rather with low socioeconomic status, high injury severity, and presence of lower limb injury. Conclusion: Care for subjects who are at high risk of not fully recovering (manual workers, the very seriously injured, and those with lower limb injury) needs to be extended and improved. Longer follow-up studies on the risk factors for not fully recovering are needed in order to reduce harmful consequences for victims.

Background: This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. Methods: The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhone area administrative departement. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. Results: 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR = 0.4; 0.2-0.9). Conclusion: Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.

PURPOSE: To quantitatively assess the impact of selection bias caused by nonparticipation in a multinational case-control study of mobile phone use and brain tumor. METHODS: Non-response questionnaires (NRQ) were completed by a sub-set of nonparticipants. Selection bias factors were calculated based on the prevalence of mobile phone use reported by nonparticipants with NRQ data, and on scenarios of hypothetical exposure prevalence for other nonparticipants. RESULTS: Regular mobile phone use was reported less frequently by controls and cases who completed the NRQ (controls, 56%; cases, 50%) than by those who completed the full interview (controls, 69%; cases, 66%). This relationship was consistent across study centers, sex, and age groups. Lower education and more recent start of mobile phone use were associated with refusal to participate. Bias factors varied between 0.87 and 0.92 in the most plausible scenarios. CONCLUSIONS: Refusal to participate in brain tumor case-control studies seems to be related to less prevalent use of mobile phones, and this could result in a downward bias of around 10% in odds ratios for regular mobile phone use. The use of simple selection bias estimation methods in case-control studies can give important insights into the extent of any bias, even when nonparticipant information is incomplete.

The role of medical conditions in crashes is a topic of public debate. Some studies suggest that there has been a reduction in road traffic crashes subsequent to the medical restrictions introduced on drivers with medical deficiencies. As in today’s society the car is an important factor for independence and socialization, it seems important to consider whether diseases or consumption of drugs increase the risk of causing a road crash in comparison to well-known major crash risk factors. A case–control study was conducted (733 injured drivers). The cases were subjects who were partly or totally responsible for their crash. The 304 controls were the non-responsible drivers. Diseases and medicine consumption were analyzed using logistic regression models. Cases were characterized by a higher percentage of young men. They were more frequently affected by fatigue, as were subjects who had consumed alcohol. A higher risk in subjects suffering from hypertension is observed (adjusted odds ratio [adjOR] = 3.82; 95%CI = [1.42–10.24]). An association between antidepressant consumption and responsibility appeared (adjOR = 3.61; 95%CI = [1.30–10.03]). Conclusion: Medical factors associated with responsibility were arterial hypertension and antidepressant consumption. Other medical conditions do not seem to play a preponderant role comparing to individual

Objectives: To assess the mortality of a cohort of workers in a synthetic textile spinning plant and to evaluate the relationship between mortality from lung, liver and bladder cancer and the processes or the products used. Methods: The study population consisted of male workers present for at least 6 months in the plant from 1968 to 1984. The cohort was followed until 1999. Vital status and the causes of death were determined by consulting national registries. The population of the Franche-Comte region was used for comparison. In total, 17 groups of exposure were assessed by the industrial hygienist, based on the consensus of an expert group that determined the exposure levels of each job to selected occupational hazards. Each worker was assigned to one or several groups, according to his occupational history. Confounding factors could not be assessed. Standardised mortality ratios (SMR) and 95% bilateral confidence intervals were calculated based on an assumed Poisson distribution of the number of cases to compare the plant mortality and the population mortality. Internal analyses were performed with Cox models in order to assess the risks of death related to the various exposures. Results: In the whole cohort, mortality from all malignant neoplasms was lower than expected, but this was not significant. All the estimated SMRs were lower than or close to 1. The “hot -line fitters” (RR = 2.13; n = 9; 1.06 to 4.29) and the “fibre-drawing workers” (RR = 1.83; n = 20;1.09 to 3.07) experienced a statistically significant excess in mortality from lung cancer. A slightly elevated but not significant risk of death related to lung cancer (RR = 1.5; n = 41; 0.8 to 2.7) was observed in the groups with the highest exposure to mineral fibres. A statistically significant increase in cancer deaths was observed for workers with high exposure to dust (higher intensity: RR = 1.42; n = 79; 1.06 to 1.89). Conclusion: Some findings, mainly of lung cancer, justify further exploration in other plants in this industry

A method for a semi-quantitative retrospective assessment of exposure to trichloroethylene (TCE) was implemented for a case-control study conducted in the Arve valley (France), an area with a widely developed screw-cutting industry, where teams of occupational physicians have collected a large quantity of well-documented measurements. A task-exposure matrix was developed to link the main working circumstances in a screw-cutting workshop to corresponding TCE-exposure levels: a 'basic level' was assigned to each task, standing for usual working procedures; exposure circumstances, such as duration or distance from the TCE source, were introduced as corrective factors. In parallel, a detailed occupational questionnaire was designed, setting subjects' descriptions of their successive jobs and working circumstances against levels assessed in the matrix. Possible exposure to TCE, plus some other occupational compounds (other solvents, oils, some metals, asbestos, welding fumes and ionizing radiations), were assessed for any job in all job histories. An average level of exposure to TCE, related to an 8 h usual working day, was attributed to each job period in turn, which was then categorized into six classes: 0; 1-35; 35-50; 50-75; 75-100; and100 p.p.m. A total of 402 study subjects described their occupational life (average 3.7 jobs/subject, from 1924 to 2003). About 19% of the 1486 job periods described were assessed as being exposed to TCE; of these, 72.2% involved levels35 p.p.m., 13.2% involved levels50 p.p.m. and 5.4% above the French occupational exposure limit of 75 p.p.m. (TWA 8 h). A total of 41 job periods included exposure with peaks. Compared with levels encountered in other studies, the more severely exposed part of our study population seemed more exposed than most other populations previously studied, owing to vapor degreasing practices.

To test the effect of the exposure to trichloroethylene (TCE) on renal cell cancer (RCC) risk, a case-control study was performed in the Arve Valley (France), a geographic area with a high frequency and a high degree of such exposure. Cases and controls were selected from various sources: local general practitioners and urologists practicing in the area and physicians (urologists and oncologists) from other hospitals of the region who might treat patients from this area. Blinded telephone interviews with cases and controls were administered by a single trained interviewer using occupational and medical questionnaires. The analysis concerned 86 cases and 316 controls matched for age and gender. Three approaches were developed to assess the link between TCE exposure and RCC: exposure to TCE for at least one job period (minimum 1 year), cumulative dose (number of p.p.m. of TCE per job period multiplied by the number of years in the job period) and the effect of exposure to peaks. Multivariate analysis was performed taking into account potential confounding factors. Allowing for tobacco smoking and Body Mass Index, a significantly 2-fold increased risk was identified for high cumulative doses: odds ratio (OR)=2.16 (1.02-4.60). A dose-response relationship was identified, as was a peak effect; the adjusted OR for highest class of exposure-plus-peak being 2.73 (1.06-7.07). After adjusting for exposure to cutting fluids the ORs, although still high, were not significant because of lack of power. This study suggests an association between exposures to high levels of TCE and increased risk of RCC. Further epidemiological studies are necessary to analyze the effect of lower levels of exposure.

International audience; OBJECTIVE: A recent study suggested that risk of bladder cancer may be higher in women than in men who smoked comparable amounts of cigarettes. We pooled primary data from 14 case-control studies of bladder cancer from Europe and North America and evaluated differences in risk of smoking by gender. METHODS: The pooled analysis included 8316 cases (21% women) and 17,406 controls (28% women) aged 30-79 years. Odds ratios (ORs) and 95% confidence intervals (95% CI) for smoking were adjusted for age and study. Exposure-response was evaluated in a stratified analysis by gender and by generalized additive models. RESULTS: The odds ratios for current smokers compared to nonsmokers were 3.9 (95% CI 3.5-4.3) for males and 3.6 (3.1-4.1) for females. In 11 out of 14 studies, ORs were slightly higher in men. ORs for current smoking were similar for men (OR = 3.4) and women (OR = 3.7) in North America, while in Europe men (OR = 5.3) had higher ORs than women (OR = 3.9). ORs increased with duration and intensity in both genders and the exposure-response patterns were remarkably similar between genders. CONCLUSION: These results do not support the hypothesis that women have a higher relative risk of smoking-related bladder cancer than men.

To analyze occupational and non-occupational exposure factors suspected of being associated with scleroderma (SSc), with a view to inculpating or excluding certain potentially toxic substances (e.g., solvents), thereby contributing to the recognition of such toxins in the field of occupational health.The study comprised 10 men and 83 women diagnosed with SSc between 1995 and 1999 (American College of Rheumatology criteria) and early SSc, and 206 age and sex matched controls. The SSc registry is all-inclusive in the French administrative departments of Isere and Savoie so controls were randomly selected from the general population (using telephone directories) in these departments to ensure full representation. Exposure factors were analyzed for each subject by a personal questionnaire, and an individual evaluation was carried out by an industrial expert. Data were analyzed by conditional logistical regression adjusting for educational level.Construction workers were at significantly higher risk of contracting SSc; odds ratio (OR) = 4.01 (95% confidence interval 1.14-14.09). Analysis by industrial experts identified exposure to certain toxic substances regularly used by these same workers as risk factors for SSc: cleaning products: OR = 1.66 (0.90-3.08) (both sexes) and OR = 1.71 (0.92-3.20) (women only); solvents: OR = 3.23 (1.58-6.63) (both sexes) and OR = 2.80 (1.28-6.11) (women only); synthetic adhesives: OR 25.36 (1.36-472.28) (on 3 exposed cases).Exposure to either cleaning products or solvents emerged as a risk factor for SSc. Exposure factors should be characterized and results of all studies compared to implement appropriate preventive measures in relevant workplaces.

In order that the occupational exposures and health risks for municipal waste incinerator operators be better determined, a study was carried out in three centres. A transversal study was carried out for 102 male incinerator workers matched for age with 94 male workers from other industrial activities. Three groups of exposed workers were considered (group 1: "crane operators" and "equipment operators"; group 2: "furnace " workers ; group 3: "maintenance" and "effluent-treatment" workers). Data were collected through a questionnaire and medical examination. The respiratory function was explored and blood samples were taken for biological analysis. Statistical analysis using chi2 or Student's test, and calculation of odds-ratio (OR) using logistic regression analysis were performed. There were no significant differences in general symptoms between the two groups. Skin symptoms (OR =4.85; 2.04–11.51 for the "maintenance and effluent" workers) were more often observed in the exposed group. An excess of respiratory problems was also encountered: daily coughing ["maintenance and effluent" groups (OR =2.55; 0.84–7.75); "furnace men" (OR =6.58; 2.18–19.85)]. A significant relationship between exposure and the decrease of several pulmonary parameters was observed. The liver and haematological tests were well within the normal range; nevertheless, a slight but significant increase in the white blood cells was observed in the exposed group. Higher blood lead levels were found for exposed workers. There were few adverse health effects in our morbidity study but skin irritation and cough were more frequent in the exposed workers. A slight decrease in pulmonary function was observed. These findings are in agreement with those of several other studies.

Transitional-cell carcinoma is the dominant histological type of malignant tumors of the urinary bladder. There is limited information on risk factors for non-transitional-cell carcinoma (NTCC) of the bladder. We used data from 9 case-control studies on bladder cancer from 6 European countries to examine the association between NTCC, tobacco smoking and occupation. Information on 146 cases diagnosed with NTCC were matched by age, gender and study center to 727 non-cancer population or hospital controls and also with 722 transitional-cell-bladder-cancer controls. Lifetime smoking and occupational history were evaluated. A statistically significant excess risk for NTCC was observed for current smoking [odds ratio (OR) = 3.61, 95% confidence interval (CI) 2.08-6.28]. The risk increased with higher tobacco consumption (OR for highest tertile of pack-years = 7.01, 95% CI 3.60-13.66). The risks were higher for squamous-cell carcinomas than for other types of NTCC. Among major occupational groups, a significant excess risk was seen for field-crop and vegetable-farm workers (OR = 2.06, 95% CI 1.03-4.10). These results indicate that NTCC of the bladder is associated with smoking and specific occupations. The risk pattern seems to differ, in part, from that observed for transitional-cell carcinoma of the bladder.

The very rapid worldwide increase in mobile phone use in the last decade has generated considerable interest in the possible health effects of exposure to radio frequency (RF) fields. A multinational case-control study, INTERPHONE, was set-up to investigate whether mobile phone use increases the risk of cancer and, more specifically, whether the RF fields emitted by mobile phones are carcinogenic. The study focused on tumours arising in the tissues most exposed to RF fields from mobile phones: glioma, meningioma, acoustic neurinoma and parotid gland tumours. In addition to a detailed history of mobile phone use, information was collected on a number of known and potential risk factors for these tumours. The study was conducted in 13 countries. Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the UK using a common core protocol. This paper describes the study design and methods and the main characteristics of the study population. INTERPHONE is the largest case-control study to date investigating risks related to mobile phone use and to other potential risk factors for the tumours of interest and includes 2,765 glioma, 2,425 meningioma, 1,121 acoustic neurinoma, 109 malignant parotid gland tumour cases and 7,658 controls. Particular attention was paid to estimating the amount and direction of potential recall and participation biases and their impact on the study results.

Chemical workers have become increasingly concerned about the presence of carcinogens in their occupational environment. As a result, a number of studies of excess cancer mortality have been undertaken in groups of workers with well-characterized exposures. This paper reports the results of one such study carried out in a polyamide-polyester factory in France. A retrospective cohort design was chosen to evaluate the effect of exposure to phthalates, nickel catalyzers, and other chemicals in the work environment. Only a slight excess of cancers, marginally related to exposure category yet not significantly related to length of exposure, was found. The cohort, however, was young but stable, and a continued follow-up is therefore both feasible and justifiable, since it is likely to yield important information about the potential hazards associated with the tergal polymer industry.

In 1981-2 a retrospective study was undertaken in a polyamide-polyester factory in Lyon, France, to evaluate the effect of exposure to phthalates, nickel catalysers, and other chemicals in the work environment. The present paper reports the results of the follow up of this cohort up to July 1986. A slightly increased risk of cancers, in particular of the lung (44 cases), marginally related to exposure category but not significantly related to duration of exposure was found. The excess of skin cancers noted previously has disappeared, whereas an excess of cases of bladder cancer (based on seven cases) may be noted, mainly among nylon workers. The cohort is still young, however, and a continued follow up is likely to yield important information about the potential hazards associated with the nylon and tergal polymer industry.

BACKGROUND: This study aims to compare health status and quality of life five years after a road accident between casualties with whiplash versus other mild injuries, to compare evolution of quality of life at 1 and 5 years after the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life. METHODS: The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with "pure" whiplash and a population of 185 casualties with other mild injuries (MAIS-1). All subjects with lesions classified as cervical contusion (AIS code 310402) or neck sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. Whiplash injuries were then classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored by Poisson regression and variance analysis. RESULTS: Between 1 and 5 years, global QoL improved for both whiplash and non-whiplash casualties; but, considering the two whiplash groups separately, improvement in grade 2 was much less than in grade 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4 %; p < 0.05) than non-whiplash (24.3 %) or grade-1 whiplash casualties (27.0 %). Deteriorated quality of life in the mental, social and environmental domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD; unsatisfactory health at 5 years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role. CONCLUSIONS: Deteriorated quality of life in the physical domain remained 5 years after the accident, specifically in the grade-2 whiplash group, pain playing a predominant intermediate role, which may be in line with the hypothesis of neuropathic pain.; Cette étude a pour objectif de comparer l'état de santé et la qualité de vie cinq ans après l'accidents de la route chez des blessés légers atteints d'une part de "coup du lapin", d'autre part de toute autre lésion considérée comme mineure. l'évolution de cet état de santé entre la première année et la cinquième année est également étudiée. L'étude est basée sur les données de la cohorte ESPARR et inclut 167 blessés légers avec coup du lapin et 185 blessés légers sans coup du lapin. la qualité de vie est mesurée à l'aide du questionnaire WhoQol-Bref. Des correlations entre les variables explicatives et la qualité de vie à l'aide de reghression de Poisson et d'analysss de variance. Entre un et cinq ans, la qualité de vie s'améliore pour les deux groupes, mais si l'on sépare au sein du groupe 'coup du lapin', ceux qui ont eu une simple contusion cervicale et ceux qui ont eu une entorse cervicale, l'amélioration est nettement moins importante ds ce dernier groupe. Les victimes d'entorses du cou sont plus insatisfaites de leur santé. les analyses permettant de rechercher les facteurs explicatifs montrent que la dégradation de la qualité de vie ds les domaines, mental, environnemental et social sont plus associés à des facteurs psychologiques ou sociaux, auusi bien pour les victimes de coup du lapin que pour les autres; alors que la dégardation de la qualité de vie ds le domaine physique est associé au coup du lapin: notamment la douleur toujours présente à 5 ans est un facteur intermédiaire primordial. ce qui suggère qu'il y a bien une composante d'atteinte neurologique ds le syndrome chronique dont souffrent les victimes atteintes d'entorse cervicale.