Search

ObjectivesTo identify the biomechanical and organisational constraints that influence pregnancy outcomes and define the exposure levels at which the risks for pregnancy become significant.Setting and participantsWe applied a consensus method (Delphi) consisting of a literature review followed by expert opinions on exposure levels. The group of experts was made up of 12 people from different medical specialities and working in various structures in France.Outcome measuresThe studied variables were: (1) exposure: night work/shift work, weekly hours at work, lifting of heavy loads, prolonged standing and multiple exposure and (2) pregnancy outcomes: prematurity, low birth weight and spontaneous miscarriages.ResultsThe consensus method resulted in the following recommendations. The time spent working must not exceed 40 hours/week; in the absence of a consensus on the level of exposure, night and/or shift work must be avoided; prolonged standing must not exceed 3 hours/day; lifting must be limited to carrying loads ConclusionsThese results could help the occupational physician to address the question of whether an exposed employee should remain at work, considering her individual characteristics (medical history, family situation, socioeconomic level, etc) in consultation with pregnancy specialists (obstetricians, midwives).

International audience; OBJECTIVE: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos. METHODS: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques. RESULTS: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years. CONCLUSIONS: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy.

ObjectivesThe aim of this study was to analyse, within a French cohort of workers previously occupationally exposed to asbestos, incidence and mortality from various sites of head and neck cancers (larynx excluded) and to examine the potential link of these cancers with pleural plaques.MethodsA 10-year follow-up study was conducted in the 13 481 male subjects included in the cohort between October 2003 and December 2005. Asbestos exposure was assessed by industrial hygienist analysis of a standardised questionnaire. The final cumulative exposure index (CEI; in equivalent fibres.years/mL) for each subject was calculated as the sum of each employment period’s four-level CEI. The number of head and neck cancers recorded by the National Health Insurance fund was collected in order to conduct an incidence study. Complementary analysis was restricted to men who had performed at least one chest CT scan (N=4804). A mortality study was also conducted. We used a Cox model with age as the time axis variable adjusted for smoking, time since first exposure, CEI of exposure to asbestos and pleural plaques on CT scans.ResultsWe reported a significant dose–response relationship between CEI of exposure to asbestos and head and neck cancers after exclusion of laryngeal cancers, in the mortality study (HR 1.03, 95% CI (1.01 to 1.06) for an increase of 10 f.years/mL) and a close to significant dose–response relationship in the incidence study (HR 1.02, 95% CI (1.00 to 1.04) for an increase of 10 f.years/mL). No statistically significant association between pleural plaques and head and neck cancer incidence was observed.ConclusionsThis large-scale study suggests a relationship between asbestos exposure and head and neck cancers, after exclusion of laryngeal cancers, regardless of whether associated pleural plaques were present.

International audience; Ultrafine particles (UFPs) are particles smaller than 100 nanometers that are produced unintentionally during human activities or natural phenomena. They have a higher biological reactivity than bigger particles and can reach the placenta after maternal exposure. One study has shown an association between maternal occupational exposure to UFPs and fetal growth restriction. Yet few studies have focused on the effects of UFP exposure on placental histopathological lesions. The aim of this study was to investigate the association between maternal occupational exposure to UFPs and histopathological lesions of their placenta. The analyses were based on data from the ARTEMIS Center. A job-exposure matrix was used to assess occupational exposure to UFPs. The histopathological placental exam was performed by two pathologists who were blinded to the exposure of each subject. The examination was conducted in accordance with the recommendations of the Amsterdam consensus. The study sample included 130 placentas (30 exposed, 100 unexposed). Maternal occupational exposure to UFPs during pregnancy is significantly associated with placental hypoplasia (the phenomenon affected 61% of the exposed patients and 34% of the unexposed ones, p < 0.01). Further research is needed to explain its pathophysiological mechanisms.

Background: Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties. Methods: We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties. Results: Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27–9.84]. Conclusion: Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy.

National audience; The objective of this French Guideline is to present through a narrative review the impact of SARS-CoV2 infection in pregnant women and its occupational health consequences.; L'objectif de cette recommandation est de présenter à travers une revue narrative l'impact de l'infection par le SARS-CoV2 chez la femme enceinte et ses conséquences en santé au travail.

International audience; Objectives: To investigate the association between exposure to unintentionally emitted carbonaceous nanoscale particles (NPs) and small for gestational age (SGA), as well as head circumference (HC) at birth and at two years of age.Methods: Mothers from the French Longitudinal Study of Children (Elfe cohort) who worked during pregnancy were selected for our study. Data collected at birth and during follow-up (up to two years) were used. The probability and frequency of maternal occupational exposure to unintentionally emitted carbonaceous NPs was estimated using a job exposure matrix (MatPUF). Multivariate logistic regression, linear regression, and mixed models were applied to estimate any associations. Analyses were carried out depending on whether mothers stopped working during the first, second, or third trimester of pregnancy.Results: Maternal occupational exposure to unintentionally emitted carbonaceous NPs was associated with SGA in the overall study population by multivariate analysis (ORa = 1.80, 95% CI: 1.29, 2.46), as well as in sub-groups of mothers who stopped working during the second (ORa = 1.84, 95% CI: 1.13, 3.02) or third (ORa = 1.80, 95% CI: 1.10, 2.95) trimesters. There were no significant associations with HC at birth or two years of age.Conclusions: We found a significant association between occupational exposure to carbonaceous NPs and SGA, with the effect depending on the period of exposure during pregnancy. These results should encourage further studies concerning the adverse effects of exposure to carbonaceous NPs on the development of offspring.

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

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

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

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

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

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

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

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

Objectives: To investigate the association between maternal occupational exposures to nanoscale particles (NPs) during pregnancy and small for gestational age (SGA). Methods: This study included 11,224 mothers and singleton birth pairs from the French Longitudinal Study of Children (ELFE cohort), which included infants born after 33 weeks of gestation or more in continental France in 2011. Mothers who did not work during pregnancy were excluded from the analyses. Maternal occupational exposures to NPs was estimated using a job-exposure matrix for the probability (>50%: occupationally exposed group, n = 569; 0%: occupationally non-exposed group, n = 9113; between these two thresholds: uncertain group, n = 1542) and frequency of exposure. Associations were estimated from multivariate logistic regression models for occupationally exposed vs occupationally unexposed groups in a first analysis, and with the frequency-weighted duration of work for the occupationally exposed group only in a second analysis. Results: Among working mothers, 5.1% were occupationally exposed to NPs. Maternal occupational exposures to NPs was associated with SGA (ORa = 1.63, 95% CI: 1.22, 2.18). The frequency-weighted duration of work for the occupationally exposed group (n = 569) was not associated with SGA (ORa = 1.02, 95% CI: 0.97, 1.08) in adjusted analyses. Conclusions: These results, showing a significant association between occupational exposures to NPs and SGA, should encourage further studies to examine the adverse effect of NPs exposure on fetal development. Keywords: Small for gestational age, Occupational exposures, Nanoscale particles, Job-exposure matrix, ELFE cohort

In 2015, the International Federation of Gynecology and Obstetrics established the prevention of exposures to environmental reprotoxic substances as a priority for health professionals. However, available information about reproductive hazards is voluminous, dispersed, and complex, and this is a severe limitation for physicians to incorporate the prevention of environmental exposure into standard preventive care. One difficulty frequently cited by physicians is the lack of evidence-based information. The objective of our study was to identify a list of environmental chemical hazards to reproduction. We used lists present in relevant regulations or included in scientific reports or databases to identify reproductive hazards. The reproductive hazards were prioritized according to the strength of evidence concerning their impact on fertility or development of the offspring. We identified 1251 reproductive hazards. Our prioritization approach resulted in a high-priority classification for 462 risk factors belonging to the following eight classes: drugs (n = 206), metals (n = 116), pesticides (n = 38), organic solvents (n = 27), synthesizing and/or processing agents in industrial processes (n = 23), phthalates (n = 13), perfluorinated compounds (n = 13), and other compounds (n = 26). Despite the limitations of this work, the generated lists constitute a useful working basis to put in place innovative environmental preventive measures according to the principle of evidence-based medicine.

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

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

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

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

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

Background: The relationships between asbestos exposure and colorectal cancer remain controversial. Objectives: We examined the association between asbestos exposure and colorectal cancer incidence. Methods: Volunteer retired workers previously exposed to asbestos were invited to participate in the French ARDCo screening program between 2003 and 2005. Additional data on risk factors for colorectal cancer were collected from the ARDCo-Nut subsample of 3,769 participants in 2011. Cases of colon and rectal cancer were ascertained each year through 2014 based on eligibility for free medical care following a cancer diagnosis. Survival regression based on the Cox model was used to estimate the relative risk of colon and rectal cancer separately, in relation to the time since first exposure (TSFE) and cumulative exposure index (CEI) to asbestos, and with adjustment for smoking in the overall cohort and for smoking, and certain risk factors for these cancers in the ARDCo-Nut subsample. Results: Mean follow-up was 10.2 years among 14,515 men, including 181 colon cancer and 62 rectal cancer cases (41 and 17, respectively, in the ARDCo-Nut subsample). In the overall cohort, after adjusting for smoking, colon cancer was significantly associated with cumulative exposure (HR = 1.14; 95% CI: 1.04, 1.26 for a 1-unit increase in ln-CEI) and ≥ 20–40 years since first exposure (HR = 4.67; 95% CI: 1.92, 11.46 vs. 0–20 years TSFE), and inversely associated with 60 years TSFE (HR = 0.26; 95% CI: 0.10, 0.70). Although rectal cancer was also associated with TSFE 20–40 years (HR = 4.57; 95% CI: 1.14, 18.27), it was not associated with ln-CEI, but these findings must be interpreted cautiously due to the small number of cases. Conclusions: Our findings provide support for an association between occupational exposure to asbestos and colon cancer incidence in men. Citation: Paris C, Thaon I, Hérin F, Clin B, Lacourt A, Luc A, Coureau G, Brochard P, Chamming’s S, Gislard A, Galan P, Hercberg S, Wild P, Pairon JC, Andujar P. 2017. Occupational asbestos exposure and incidence of colon and rectal cancers in French men: the Asbestos-Related Diseases Cohort (ARDCo-Nut). Environ Health Perspect 125:409–415; http://dx.doi.org/10.1289/EHP153

International audience; BACKGROUND:Our study aimed at analyzing incidence and mortality from esophageal cancer within a cohort of workers with previous occupational asbestos exposure (ARDCo Program).METHODS:A 10-year follow-up study was conducted in the 14 515 male subjects included in this program between October 2003 and December 2005. Follow-up began when exposure stopped. Asbestos exposure was analyzed by industrial hygienists using data from a standardized questionnaire. The Cox model was used, with age as the time axis variable adjusted for smoking, time since first exposure (TSFE) and cumulative exposure index (CEI) of exposure to asbestos.RESULTS:We reported a significant dose-response relationship between CEI of exposure to asbestos and esophageal cancer, in both incidence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.58), and mortality (HR 1.40, [95%CI 1.12-1.75]).CONCLUSIONS:This large-scale study suggests the existence of a relationship between asbestos exposure and cancer of the esophagus.

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

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

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

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

In France, the present regulations on occupational exposure to asbestos fibers take into account fibers (FRp: fibers measured for industrial hygiene) with the following dimensions: L > 5 μm, D 3 where L is the length and D the diameter of the fiber. The limit value is set at 0.1 f/cm3 for 1 hr. By definition short asbestos fibers (SAFs) are the fibers with 0.5 μm < L< 5 μm, D < 3 μm, and L/D ≥ 3; thin asbestos fibers (TAFs) are the fibers with L ≥ 5 μm, D < 0.2 μm, and L/D ≥ 3. The aim assigned to the French Agency for Environmental and Occupational Health Safety (AFSSET) Occupational Exposure Limit (OEL) Committee, was essentially to evaluate the following elements: the relevance of the present French OEL, knowing that this limit excludes the counting of SAFs and TAFs; the consistency of the OEL in light of the different varieties of asbestos by studying possible differential toxicity according to the type of asbestos (chrysotile vs. amphiboles); and the assessment of different measurin...

Objective Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001–2009. Method Data were collected from the French national network of occupational health surveillance and prevention ( Reseau National de Vigilance et de Prevention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. Results Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p=0.007), aldehydes (p=0.01) and latex (p=0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p=0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. Conclusions WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.

Background In the course of setting up the National Mesothelioma Surveillance Program (PNSM), established in France in 1998, the question arose as to the most suitable method of assessing occupational exposure. The aim of this study was to define the most suitable rating method for assessing occupational asbestos exposure in order to assess medico-social care. Method The study included 100 subjects—50 cases of mesothelioma and 50 controls—randomly selected and representing 457 jobs held. Job asbestos exposure was assessed by a six-expert panel using two methods: “by job” rating, where all the jobs in were assessed regardless of the subjects; and “by subject” rating, where all the jobs of a subject were assessed at the same time. Consensus was obtained and subjects' exposure was calculated for each rating. Then, two internal experts assessed job asbestos exposure with the “by subject” rating. Kappa coefficients were used to measure agreement between the ratings. Results Agreement between “by job” and “by subject” ratings was very good for subject probability of exposure (kappa = 0.84) and cumulative exposure index (kappa = 0.80). Agreement between the six-expert panel and the two internal experts was good for subject exposure (kappa for probability = 0.71; kappa for cumulative exposure index= 0.68). Conclusion This study shows that the two rating systems have good or very good agreement. These results validate the routine use in the PNSM of the “by subject” rating, with the advantage of being convenient and quick to provide feedback on occupational asbestos exposure to mesothelioma cases for compensation. Am. J. Ind. Med. 55:440–449, 2012. © 2012 Wiley Periodicals, Inc.

Asbestos is the primary cause of pleural mesothelioma (PM). The objective of this study was to elucidate the importance of different temporal patterns of occupational asbestos exposure on the risk of PM using case–control data in male subjects. Cases were selected from a French case–control study conducted in 1987–1993 and the French National Mesothelioma Surveillance Program in 1998–2006. Population controls were frequency matched to cases by year of birth. Occupational asbestos exposure was evaluated with a job–exposure matrix. The dose–response relationships were estimated using restricted cubic spline functions in logistic regression models. A total of 2,466 ever-asbestos-exposed males (1,041 cases and 1,425 controls) were used. After adjustment for intensity and total duration of occupational asbestos exposure, the risk of PM was lower for subjects first exposed after the age of 20 yrs and continued to increase until 30 yrs after cessation of exposure. The effect of total duration of exposure decreased when age at first exposure and time since last exposure increased. These results, based on a large population-based case–control study, underline the need to take into account the temporal pattern of exposure on risk assessment.

Summary Introduction The relationships between benign asbestos-related diseases (asbestosis and pleural plaques) and thoracic cancers are still debated. The aim of this paper was to review the epidemiological data relevant to this issue. Current knowledge Published studies show a significant relationship between occupational exposure to asbestos and lung cancer risk, even in the absence of abnormalities consistent with asbestosis on the postero-anterior chest x-ray. For a given cumulative asbestos exposure, the presence of radiographic evidence of asbestosis is associated with an increased risk of lung cancer. Among asbestos-exposed individuals, those having radiographic evidence of pleural plaques are at increased risk for lung cancer and pleural mesothelioma, compared to the general population. However, there is no evidence that pleural plaque confers an increased risk of lung cancer or pleural mesothelioma within a population of individuals having the same cumulative asbestos exposure. Perspectives The studies identified for this review relied only on chest radiograph data. Studies involving accurate evaluations of asbestos exposure and computed tomography of the chest are needed. Conclusion Currently available data indicate that patient follow-up modalities should be dictated solely by the estimated cumulative asbestos exposure and not by the existence of pleural plaques.

Objective The aim of the PHYTONER study is to investigate the role of pesticides on neurobehavioral performances in French vineyard workers. Methods 929 workers affiliated to the health insurance system for farmers in the Bordeaux area of south-western France were enrolled in the study in 1997e1998. They were contacted for a first follow-up in 2001e2003. Participants completed a questionnaire and nine neurobehavioral tests. They were classified according to their life-long pesticide exposure, as directly exposed, indirectly exposed or non-exposed. Educational level, age, sex, alcohol consumption, smoking, psychotropic drug use and depressive symptoms were taken into account in the analysis. Results 614 subjects were available for investigation at follow-up. Follow-up analysis confirmed that the risk of obtaining a low performance on the tests was higher in exposed subjects, with ORs ranging from 1.35 to 5.60. Evolution of performances over the follow-up period demonstrated that exposed subjects had the worst decreases in performance. The risk of having a two-point lower score on the Mini-Mental State Examination was 2.15 (95% CI 1.18 to 3.94) in exposed subjects. Conclusion These results suggest long-term cognitive effects of chronic exposure to pesticides and raise the issue of the risk of evolution towards dementia. The PHYTONER study is the first to provide prospective data on the natural history of neurological disorders associated with pesticide exposure.

Background Occupational exposure to asbestos, widely used in various industries for decades, is the most important risk factor for pleural mesothelioma. We report here the ranking of occupations and industries in France at high risk for this cancer among men and women. Methods A population-based case–control study, conducted from 1998 to 2002, included 462 cases (80.3% men) and 897 controls. Data were collected in face-to-face interviews with a standardized questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each occupation and industry; subjects never employed in each category were the reference. Results For men, risks were high for several occupations and industries. Besides the expected high risks for non-metallic mineral product makers and manufacturing asbestos products, occupations such as plumbers (OR ¼ 5.57, 95% CI: 2.90–10.69), sheet-metal workers, welders, metal molders, coremakers, and cabinetmakers were also at high risk. Elevated risks were found in the industries of shipbuilding (OR ¼ 9.13, 95% CI: 5.20– 16.06) and construction, but also in the manufacturing of metal products, chemicals, and railroad and aircraft equipment. The results for women showed increased but not significant risks in several occupational activities. Conclusions This report provides new insight into the epidemiology of mesothelioma, confirming risks for occupational activities reported earlier and pointing out risks in activities never previously reported. It offers guidance to authorities for the compensation of asbestos victims and for prevention in at-risk activities still involving asbestoscontaining products. Am. J. Ind. Med. 53:1207–1219, 2010. 2010 Wiley-Liss, Inc.

Background: Determination of background levels of lung retention of nonfibrous mineral particles (NFMP) in control populations is a key issue for a correct use of mineralogical analysis of lung samples as a tool for the identification of the occupational or environmental origin of some pulmonary disorders. Aims: The objective of the study was to characterize the level of retention of NFMP in the lung in 2 series of subjects free of occupational exposure to such particles and undergoing lung surgery, recruited over a 20 years period, to study the evolution of background levels. Methods: Mineralogical analysis of lung tissue for quantification of NFMP was performed in these 2 series : 35 subjects recruited in 1994-1999 (G1: 17 females, 18 males, mean age: 58.7 years), and 36 subjects in 2009-2014 (G2: 19 females, 17 males, mean age: 63.2 years). Analytical transmission and scanning electron microscope equipped with an energy dispersive X-ray device was used to quantify and characterize NFMP greater than 0.1 μm. Non parametric tests were used to compare results of the quantification in the two series. Results: Median concentration of all NFMP was 21.2 x 10 7 particles/gram of dry lung (p/g) and 43.5 x 10 7 p/g in G1 and G2, respectively (p=0.02). The most significant change when comparing G1 and G2 was the increase in the level of titanium particles (median: 5 x 10 7 p/g and 8.8 x 10 7 p/g in G1 and G2, respectively; p= 0.005). Conclusions: The increase between 1994-1999 and 2009-2014 concerning the level of retention of titanium particles in the lung of subjects free of specific occupational exposure warrants further investigation to identify possible new environmental or household sources.

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

Objectives Asbestosis remains difficult to diagnose, particularly in its early stages. The aim of this study was to determine criteria for independently associated features of pulmonary fibrosis in high-resolution computed tomograms among persons occupationally exposed to asbestos. Methods Retired persons with documented occupational asbestos exposure and no known asbestos-related diseases were assessed for occupational, clinical, functional respiratory, and chest X-ray criteria. In addition, they all underwent high-resolution computed tomography (HRCT) in the prone position. Results Altogether 51 (7.2%) of the 706 enrolled participants had features of pulmonary fibrosis consistent with asbestosis in the HRCT. Among those with small irregular opacities of

Aims: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. Methods: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). Results: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25–75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. Conclusions: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

The objective of this study was to determine the factors associated with central airway versus peripheral bronchial location of lung cancer. All patients diagnosed with lung cancer from 1997 through 2000 in the Respiratory Disease Department of Rouen University Hospital were prospectively interviewed about their smoking and occupational history using a standardized questionnaire. All patients underwent white-light bronchial endoscopy using a 4.5 mm flexible endoscope. Tumors were classified as central when they were accessible and visible using this technique. Out of 217 cases of lung cancer included in this study, 155 (71%) were central. Histological type of lung cancer was strongly associated with bronchial location as central location was observed in 48, 82 and 92% of Adenocarcinoma (AC), Squamous Cell (SqC), and Small Cell Carcinoma (SCC), respectively (P0.0001). Among non asbestos-exposed patients, location varied little with smoking status, with central location frequency ranging from 74 to 80%. In contrast, lung cancer was recorded central in 41% of long-term (or =10 years) ex-smokers, 67% of short-term (10 years) ex-smokers and 75% of current smokers (P=0.04) among patients exposed to asbestos, suggesting an interaction between duration of smoking cessation and occupational asbestos exposure with respect to lung cancer location. These findings were confirmed after adjustment for sex, age and histologic type in multivariate analysis. These results suggest that individually-tailored multimodality screening strategies relying on various combinations of low-dose CT scan, sputum analysis and fluorescence endoscopy according to each patient's profile may be more effective than standard strategies based on a single approach for all patients.

Objectifs Les etudes experimentales ou epidemiologiques realisees sur les expositions aux nanoparticules ou sur la pollution particulaire ultrafine indiquent que ces expositions peuvent induire des effets deleteres sur la sante. Notre objectif est de synthetiser les donnees sur la biodistribution des nanoparticules inhalees et sur les methodes utilisees dans les etudes toxicologiques qui pourraient etre utilisees dans la surveillance des travailleurs exposes a ce type de particules. Methode Revue de la litterature portant sur les etudes de toxicocinetiques des nanoparticules et sur les case reports lies a des expositions professionnelles ou environnementales a ces particules. Resultats Les etudes toxicokinetiques suggerent que les nanoparticules sont preferentiellement absorbees par les voies respiratoires et orales avec une translocation systemique possible pouvant conduire a une accumulation dans les tissus peripheriques ou une excretion fecale et/ou urinaire. Certaines methodes utilisees dans ces etudes pourraient etre utilisees dans l’evaluation retrospective des expositions lors de la recherche d’une origine professionnelle ou environnementale d’une maladie ou dans le suivi des expositions professionnelles. Les premiers case reports publies soulignent l’importance de developper rapidement des methodes standardisees de preparation et d’analyse des echantillons afin de pouvoir caracteriser et quantifier les nanoparticules dans les echantillons biologiques. Conclusion La biometrologie des nanoparticules devrait associer des methodes d’imagerie (ex.: microscopie electronique) indispensables pour confirmer leur presence et les caracteriser dans les tissus a des methodes analytiques (ex.: ICP/MS) permettant de les quantifier et d’etablir des valeurs limites.

Although asbestos is a well-known lung carcinogen, the pleural plaque-lung cancer link remains controversial.This study was designed to examine this link in asbestos-exposed workers.A 6-year follow-up was conducted to study lung cancer mortality in the 5,402 male subjects participating in an asbestos-related disease screening program conducted from October 2003 to December 2005 in four French regions. Chest computed tomography (CT) scan was performed in all subjects with randomized, independent, double reading of CT scans focusing on benign asbestos-related abnormalities. Cox model survival regression analysis was used to model lung cancer mortality according to the presence of pleural plaques, with age as the main time variable, adjusting for smoking and asbestos cumulative exposure index. All statistical tests were two-sided.Thirty-six deaths from lung cancer were recorded. Lung cancer mortality was significantly associated with pleural plaques in the follow-up study in terms of both the unadjusted hazard ratio of 2.91 (95% confidence interval = 1.49-5.70) and the adjusted hazard ratio of 2.41 (95% confidence interval = 1.21-4.85) after adjustment for smoking and asbestos cumulative exposure index.Pleural plaques may be an independent risk factor for lung cancer death in asbestos-exposed workers and could be used as an additional criterion in the definition of high-risk populations eligible for CT screening.

Objectives To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos exposure in France including non-occupational exposure. Methods A population-based case-control study including 437 incident cases and 874 controls was conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a conditional logistic regression. Results A clear dose-response relationship was observed between occupational asbestos exposure and pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs 67.0 (99% CI 25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI 74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI −33.5% to 73.5%) in men and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was 87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women. Conclusions Our study suggests that the overall ARp in women is largely driven by non-occupational asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence. Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the observed difference in ARp between men and women.

The Phytoner study investigated a possible association between neuropsychologic performances and long-term exposure to pesticides in Bordeaux vineyard workers, most of whom use fungicides. Among the 917 subjects interviewed from February 1997 to August 1998, 528 were directly exposed to pesticides through mixing and/or spraying (mean exposure duration: 22 years), 173 were indirectly exposed through contact with treated plants, and 216 were never exposed. All subjects performed neuropsychologic tests administered at home by trained psychologists. The risk of scoring a low performance on the tests was constantly higher in exposed subjects. When taking into account educational level, age, sex, alcohol consumption, smoking, environmental exposures, and depressive symptoms and when restricting analysis to subgroups, results remained significant for most tests, with odds ratios (OR) exceeding 2. These results point to long-term cognitive effects of low-level exposure to pesticides in occupational conditions. Given the frequency of pesticide use and the potential disabilities resulting from cognitive impairments, further toxicologic and epidemiologic research is needed to confirm these results and assess the impact on public health.

The fibrogenicity and carcinogenicity of asbestos fibers are dependent on several fiber parameters including fiber dimensions. Based on the WHO (World Health Organization) definition, the current regulations focalise on long asbestos fibers (LAF) (Length: L ≥ 5 μm, Diameter: D < 3 μm and L/D ratio > 3). However air samples contain short asbestos fibers (SAF) (L < 5 μm). In a recent study we found that several air samples collected in buildings with asbestos containing materials (ACM) were composed only of SAF, sometimes in a concentration of ≥10 fibers.L-1. This exhaustive review focuses on available information from peer-review publications on the size-dependent pathogenetic effects of asbestos fibers reported in experimental in vivo and in vitro studies. In the literature, the findings that SAF are less pathogenic than LAF are based on experiments where a cut-off of 5 μm was generally made to differentiate short from long asbestos fibers. Nevertheless, the value of 5 μm as the limit for length is not based on scientific evidence, but is a limit for comparative analyses. From this review, it is clear that the pathogenicity of SAF cannot be completely ruled out, especially in high exposure situations. Therefore, the presence of SAF in air samples appears as an indicator of the degradation of ACM and inclusion of their systematic search should be considered in the regulation. Measurement of these fibers in air samples will then make it possible to identify pollution and anticipate health risk. © 2014 Boulanger et al. licensee BioMed Central Ltd., SCOPUS: re.j, info:eu-repo/semantics/published

Background More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors. Methods From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases. Results Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) “non-exposure” characteristics (59.4%). Conclusion These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease. Am. J. Ind. Med. 56:1307–1316, 2013. © 2013 Wiley Periodicals, Inc.

More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors.From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases.Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) "non-exposure" characteristics (59.4%).These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease.

OBJECTIVES--The aim of this analysis of the French Cooperative PAARC (Pollution Atmosphérique et Affections Respiratoires Chroniques) survey, was to test whether occupational exposures to dusts, gases, or chemical fumes or to specific hazards, estimated by job exposure matrices, were related to a decrease in forced expiratory volume in one second (FEV1). METHODS--The most recent occupation was recorded in adults, aged 25-59, from non-manual worker households. Analysis was restricted to 10,046 subjects whose occupation was encountered at least 10 times in the study and who performed good FEV1 tracings. From occupational title, exposures to dusts, gases, and chemical fumes, and to specific hazards were classified in three categories (no, low, and high) with a British, a French, and an Italian job exposure matrix. Specific hazards were analysed for the British and French job exposure matrices for the same 42 specific dusts, gases, and chemical fumes. To limit spurious associations, a selection of seven hazard groups and 12 specific hazards was set before the start of the analysis. Based on the consistency of the relations according to sex and the British and French job exposure matrices, associations of age, height, city, and smoking adjusted FEV1 score with occupational exposures were classified as very likely, possible, or unlikely. RESULTS--For the three job exposure matrices and both sexes clear exposure-response relations between the level of exposure to dusts, gases, and chemical fumes, and a decrease in FEV1 were found. Associations with FEV1 were classified as very likely for known hazards such as organic dusts and textile dusts, and not previously recognised hazards such as polycyclic aromatic hydrocarbons (PAHs) and detergents, and as possible for solvents, waxes and polishes, and diesel fumes. Associations found for PAHs and solvents were confirmed by the Italian job exposure matrix. Associations remained significant in women, but not in men, after adjustment for educational level. CONCLUSIONS--Hypotheses have been generated for exposure to detergents, PAHs, and solvents, but they need to be interpreted with caution before replication. Significant associations found for known risk factors with a decrease in FEV1 are arguments for the validity of the matrices. Despite the expected limitations of job exposure matrices, these results encourage further work to improve exposure assessment by job exposure matrices.