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Study objective: To evaluate the odds of being exposed to pesticides in asthmatic adults. Design: A case-control study was performed in Lebanon. Setting: People were approached when consulting physicians as outpatients. Patients: Asthmatic patients and non-asthmatic controls in several Lebanese hospitals were interviewed. Main results: The study included 407 subjects from 10 medical centres. Any exposure to pesticides was associated to asthma (OR = 2.11 (1.47 to 3.02); p −4 ). Occupational use presented the highest association (OR = 4.98 (1.07 to 23.28); p = 0.02), followed by regional exposure (OR 3.51 (2.11 to 5.85); p −4 ). Results were confirmed by multivariate analysis, particularly for regional exposure (OR a = 2.78; p = 0.02) and house exposure (OR a = 2.17; p = 0.001). Conclusions: Results are comparable to those found in other studies; especially for occupational exposure. Pesticides toxicological effects may explain chronic respiratory symptoms and asthma associations found with all exposure types. Pesticide exposure was associated with asthma in Lebanese adults.

Resume Objectif Evaluer l’impact sanitaire a court et moyen termes des activites antipollution, liees au naufrage du Prestige, sur les professionnels intervenus en Aquitaine, et tester la mise en œuvre d’etudes epidemiologiques impliquant les medecins du travail et de prevention. Methode Suite a la demande du Conseil regional d’Aquitaine, une etude a ete realisee en 2004 par l’Institut de sante publique, d’epidemiologie et de developpement (ISPED) en collaboration avec les medecins du travail et de prevention des professionnels impliques dans les activites antipollution. Cette etude comprenait trois parties : 1) etude aupres des services des ressources humaines, 2) auto-questionnaire envoye aux professionnels, 3) etude retrospective des dossiers medicaux. Les donnees recueillies portaient sur les activites antipollution et les troubles de sante lies aux activites. Resultats La participation des medecins etait differente selon les corps professionnels : militaires (35/35), sapeurs-pompiers (3/4, dont un qui a participe a l’etude medicale), gens de mer (1/1), collectivites territoriales (3/12) et prive (2/8) ; 1341/3897 (34,4 %) professionnels ont repondu a l’auto-questionnaire. Leur duree moyenne d’intervention etait de 9,7 jours. Des problemes de sante ont ete declares chez 502 professionnels (37,4 %), principalement : cephalees, dorsalgies et irritations cutanees, conduisant a 24 arrets de travail. D’apres l’etude retrospective, 1352/2349 professionnels avaient ete vus par leur medecin depuis janvier 2003, 44 professionnels presentaient des pathologies (rhumatologiques ou traumatiques pour 23). Conclusion Cette etude a montre que les activites antipollution avaient eu des effets sanitaires a court terme, majoritairement benins, chez plus d’un tiers des professionnels et que les medecins du travail et de prevention etaient mobilisables pour des etudes epidemiologiques de terrain ainsi que pour la veille sanitaire.

Resume Notre travail s'inscrit dans le cadre du service de medecine du travail et de consultation de pathologie professionnelle dont la vocation est de recevoir des salaries de tous secteurs d'activite sur l'ensemble de l'Aquitaine, a la demande essentiellement des medecins du travail. L'objectif des consultations est de prononcer un avis en matiere de sante au travail et de conseiller le medecin du travail dans le suivi et la prise de decision pour ses salaries. Le service a ete confronte a une recrudescence de plaintes de harcelement moral au travail. L'enjeu pour l'equipe a ete d'adapter sa pratique pour le traitement de ces plaintes. Une reflexion a donc ete menee sur la necessite d'envisager les modalites d'analyse de la plainte de la souffrance mentale au travail. Avant de poser le diagnostic de harcelement moral, quatre diagnostics differentiels sont a evoquer : le conflit, la fragilite psychologique initiale, le mode de management, la strategie du salarie. Cette methodologie de travail nous amene ainsi a poser des diagnostics concernant les conditions relationnelles, le vecu au travail et un pronostic quant aux possibilites de maintien dans le poste. Cette demarche, selon nous, s'envisage necessairement dans une configuration d'equipe pluridisciplinaire.

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

Contexte La bronchopneumopathie chronique obstructive (BPCO) est une maladie respiratoire chronique lentement progressive, tres frequente avec un fort impact en sante publique (5 % de la population francaise, soit 3,5 millions de sujets), conduisant a une insuffisance respiratoire chronique severe. A cote de la BPCO post-tabagique, il est desormais etabli qu’il existe des etiologies professionnelles avec une fraction de risque attribuable estimee a environ 15 % (secteurs : agricole, bâtiment et travaux publics, minier, fonderie-siderurgie, textile…). Malgre la frequence importante de la BPCO, son impact socio-professionnel sur le devenir des patients est largement meconnu. L’objectif de l’etude proposee est d’evaluer l’impact socio-professionnel de la maladie selon deux dimensions : le maintien dans l’emploi et l’activite professionnelle (accomplissement des tâches). Patients et methode L’analyse se fonde sur un materiau discursif recueilli au cours d’entretiens semi-directifs avec des patients atteints de BPCO et recrutes dans deux centres de consultation de pathologie professionnelle (CHI de Creteil et CHU de Bordeaux). L’echantillon se compose de 69 entretiens avec des patients recrutes sur la base du volontariat, donc sans selection a priori. Il s’agit de 20 femmes et 49 hommes, âges de 45 a 84 ans. Dans la lignee de la grounded theory , la construction de l’analyse repose sur les categorisations proposees par les individus eux-memes, a travers leurs recits d’experience et leur recoupement. Le traitement des donnees est thematique. La collecte des donnees a pris fin, soit quand le point de saturation a ete atteint, soit quand chaque entretien supplementaire n’apportait plus de donnees nouvelles. Resultats La BPCO, d’origine professionnelle ou non, est sous-diagnostiquee. De plus, le patient ignore sa denomination et l’appelle ma « maladie ». Les patients font en sorte de conserver leurs roles sociaux « normaux » et notamment de maintenir leurs activites professionnelles. L’experience de la BPCO au travail apparait problematique pour le travailleur, parce qu’elle releve de phenomenes diffus, progressifs, qui ne s’imposent pas toujours a la conscience du sujet. Ainsi, l’apparente continuite des carrieres professionnelles declarees masque des strategies construites par les patients et leur entourage professionnel, pour « faire avec » la BPCO. Il s’agit de strategies de maintien dans l’emploi et de masque des difficultes, ainsi que de strategies visant l’accomplissement des activites quotidiennes de travail, par des d’ajustements pragmatiques la plupart du temps informels (du temps de travail, des tâches a realiser ou des processus de realisation des tâches).

Contexte La biometrologie des particules minerales non fibreuses (PMNF) est un ensemble de techniques permettant d’evaluer le niveau de retention en PMNF dans differents milieux biologiques. Ces analyses aident a l’identification d’expositions professionnelles ou environnementales a rapprocher de diverses maladies, notamment respiratoires. Leur interpretation necessite de connaitre le profil de retention pulmonaire dans des series de patients indemnes d’exposition significative (temoins). Objectif L’objectif de cette etude est d’evaluer l’evolution du niveau de retention pulmonaire en PMNF et de valider l’hypothese d’une augmentation sur une periode de 20 ans, du niveau de retention en particules de titane dans 2 series de patients non exposes professionnellement a ces PMNF. Patients et methodes Deux series de patients atteints de cancer broncho-pulmonaire ont ete recrutees a partir de services de pneumologie : serie 1 (entre 1994 et 1999, n = 33, âge moyen : 58,7 ans, tous fumeurs) et serie 2 (entre 2009 et 2014, n = 36, âge moyen : 63,2 ans, 31 fumeurs). L’analyse detaillee de l’interrogatoire professionnel par des experts en pathologie professionnelle ne retrouvait pas d’exposition a des PMNF. Les echantillons de parenchyme pulmonaire preleves lors de l’intervention d’exerese pulmonaire ont ete analyses en microscopie electronique a transmission couplee a un dispositif d’analyse chimique elementaire, afin d’identifier et de quantifier les PMNF mesurant au moins 0,1 μm. Resultats Il a ete observe une augmentation de la retention pulmonaire pour la totalite des PMNF entre les series 1 et 2. L’element le plus notable etait l’augmentation du niveau de retention en particules de titane (mediane : 5 × 107 et 8,8 × 107 p/g, pour les series 1 et 2, respectivement ; p = 0,005). Au sein de la serie 2, il n’y avait pas d’influence du sexe, de l’âge, du tabagisme ou du mode de recueil des echantillons (paraffine/formaldehyde) sur le resultat de la mesure de concentration des particules de titane. Discussion-Conclusion Ces resultats, obtenus sur des series importantes comparativement aux donnees de la litterature, confirment l’hypothese d’une augmentation du niveau de retention pulmonaire en particules de titane entre 1994–1999 et 2009–2014 chez des personnes sans exposition professionnelle specifique identifiee a des PMNF. Il apparait important de documenter les sources d’expositions potentielles responsables de cette augmentation. La prise en compte du resultat de populations « temoins » est essentielle a l’interpretation des resultats biometrologiques chez les patients atteints d’une pathologie respiratoire pour laquelle le role d’une exposition professionnelle a des particules minerales est suspecte.

Contexte et objectifs Le mesotheliome pleural malin est un cancer rare dont le lien avec l’amiante est bien connu et l’origine professionnelle de la maladie le plus souvent evoquee. Le travail presente ici etudie les facteurs associes a la prise en charge medico-sociale des mesotheliomes pleuraux inclus dans le Programme national de surveillance du mesotheliome (PNSM) qui couvre actuellement 21 departements en France. Methodes Les declarations en maladie professionnelle (DMP) pour la periode 1999–2014 et le recours au Fonds d’indemnisation des victimes de l’amiante (FIVA) pour les annees 2005–2014, ont ete analyses chez les sujets dont le diagnostic de mesotheliome a ete confirme par le college des anatomopathologistes specialistes du mesotheliome (groupe Mesopath). Les tests du Chi 2 , ou le test exact de Fisher ainsi qu’un modele de regression logistique non conditionnelle ont ete utilises pour tester l’association avec differentes variables : sexe, âge au diagnostic, categorie socio-professionnelle, situation familiale, probabilite d’exposition professionnelle a l’amiante, regime de protection sociale, departement de residence. Resultats Parmi les 2839 sujets etudies entre 1999 et 2014 et qui relevent du Regime general de la Securite sociale (RGSS), 60 % ont effectue une DMP. Les facteurs associes a la DMP chez les hommes etaient l’âge, la categorie socio-professionnelle, la situation familiale et la probabilite d’exposition professionnelle a l’amiante. Chez les femmes, seule la probabilite d’exposition professionnelle a l’amiante etait associee a la DMP. Chez les hommes comme chez les femmes, la proportion de DMP variait selon les departements. Parmi les 2746 sujets identifies entre 2005 et 2014, 55 % avaient adresse une demande au FIVA. Cette proportion significativement plus importante chez les sujets relevant du RGSS que pour ceux relevant d’autres regimes de protection sociale, variait selon les departements. La demande aupres du FIVA etait associee a l’âge, a la situation familiale, et a l’exposition professionnelle a l’amiante. Au total, sur les 2193 sujets relevant du RGSS sur la meme periode (2005–2014), seulement 45 % avaient conjointement effectue une DMP et adresse une demande au FIVA. Il est a noter que 27 % n’avaient effectue aucune demarche. Conclusion Ces resultats confirment l’importance de renforcer l’information des acteurs medicaux prenant en charge ce type de patients, afin de les sensibiliser aux enjeux medico-sociaux lies au mesotheliome pleural.

Introduction Depuis 2012, la declaration obligatoire (DO) des mesotheliomes vise a renforcer la surveillance des mesotheliomes et a ameliorer la connaissance des expositions, notamment environnementales a l’amiante. Pour cela, la DO est completee depuis 2014 par des enquetes d’exposition professionnelle et environnementale dans 9 regions pilotes. Apres 4 ans de fonctionnement, l’Institut de veille sanitaire fait un bilan du dispositif. Methode L’exhaustivite de la DO est estimee par comparaison avec les donnees du Programme national de surveillance des mesotheliomes (PNSM). Les cas survenant chez les femmes, les hommes de moins de 50 ans et les cas hors plevre font l’objet dans 9 regions, d’une enquete d’exposition realisee par un enqueteur du PNSM ou de la cellule de l’InVS en region. Les expositions sont evaluees a partir du parcours professionnel, residentiel et scolaire et des activites potentiellement exposantes. Le patient est informe des demarches de reconnaissance medico-sociale. Le resultat de l’expertise sur l’exposition professionnelle a l’amiante fourni par l’universite de Bordeaux est adresse au medecin traitant du patient. Resultats Le nombre de cas de mesotheliomes diagnostiques entre 2012 et 2014 et declares jusqu’en juin 2015 est de 2026. Notifies par un clinicien (51 %) et/ou un pathologiste (75 %), ces cas sont localises a la plevre (87 %) ou au peritoine (10 %). Le taux d’exhaustivite de la DO par rapport au PNSM pour les mesotheliomes pleuraux est de l’ordre de 50 %, avec des variations regionales importantes. Parmi les 127 cas des populations cibles des enquetes, 67 ont ete enquetes et ont beneficie d’une expertise des expositions professionnelles. Pour les cas non enquetes, le principal motif etait le deces (50 %). L’expertise a identifie une exposition professionnelle averee a l’amiante pour 16 cas. Les analyses des expositions non professionnelles des 51 autres cas seront presentees, notamment les expositions environnementales determinees par la distance des lieux de vie des patients a des sources d’exposition d’amiante. Conclusion Le dispositif est fonctionnel mais encore insuffisamment exhaustif. Les medecins sont appeles a participer activement a la DO pour ameliorer l’exhaustivite et la reactivite du dispositif, essentiels pour une connaissance non biaisee des expositions. La participation des medecins du travail et des consultations de pathologies professionnelles pourrait permettre d’augmenter l’exhaustivite et la qualite des donnees sur l’exposition a l’amiante chez les sujets jeunes. Dans la perspective d’une generalisation des enquetes d’exposition a toutes les regions francaises, l’apport de la DO au futur dispositif national de surveillance des mesotheliomes sera essentiel.

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.

A case-control study was performed in southwestern France in order to assess the relationship between pesticide exposure and Parkinson’s disease (PD) in the elderly. During the period from 1997 to 1999, 84 cases were recruited together with 252 population-based controls. Experts in occupational health reviewed job codes and provided pesticide exposure levels, making it possible to calculate cumulated exposure lifelong for individuals. Environmental pesticide exposure was considered in relation to the place of residence. A positive association was found with occupational pesticide exposure (odds ratio = 2.2, 95% confidence interval 1.1–4.3) in conditional logistic multiple regression analysis taking into account age, sex, educational level and smoking; however, no clear dose relationship was found. Our results support the hypothesis of an association between occupational pesticide exposure and PD and point to the need to investigate the role of fungicides, for which toxicological hypotheses exist.

Objective To explore mortality of French professional male firefighters. Methods Standardized mortality ratios (SMR) were calculated for 10,829 professional male firefighters employed in 1979 and compared with the French male population between 1979–2008. Firefighters were identified from 89 French administrative departments (93% of population). Results One thousand six hundred forty two deaths were identified, representing significantly lower all-cause mortality than in the general population (SMR = 0.81; 95%CI: 0.77–0.85). SMR increased with age and was not different from 1 for firefighters >70 years. No significant excess of mortality was observed for any specific cause, but a greater number of deaths than expected were found for various digestive neoplasms (rectum/anus, pancreas, buccal-pharynx, stomach, liver, and larynx). Conclusion We observed lower all and leading-cause mortality likely due to the healthy worker effect in this cohort, with diseases of the respiratory system considerably lower (SMR = 0.57). Non-significant excesses for digestive neoplasms are notable, but should not be over-interpreted at this stage. Am. J. Ind. Med. 58:437–443, 2015. © 2015 Wiley Periodicals, Inc.

Background The number of cases of pleural mesothelioma in France has varied substantially according to methods of assessment. Materials and Methods We collected information from certifying physicians about 316 subjects who died between 1 July 1992 and 30 June 1993 in three regions of France with a cause of death coded as ICD-9 category 163. The ICD codes selected as the cause of death for 178 deaths between 1 January 1987 and 31 December 1992 histologically confirmed and diagnosed as pleural mesothelioma by an expert committee were examined. Finally, we used this information to estimate the number of deaths from pleural mesothelioma in France in 1992. Results In Part I, 45% (men: 54%; women: 28%) of the cases coded as ICD-9 section 163 were definitely or probably mesothelioma; 18% (men: 16%; women: 21%) possibly mesothelioma; and 37% (men: 30%; women: 51%) other tumors, primarily adenocarcinoma metastases. In Part II, 74% of the confirmed pleural mesotheliomas were coded in category 163 (men: 75%; women: 70%). Extrapolation nationwide indicated that 902 deaths were coded as ICD-9 163 in 1992: 521 cases involved definite or probable mesothelioma and 724 definite, probable, and possible cases. Conclusions The analysis of this sample suggests that estimating the number of mesothelioma cases from the cause-of-death statistics may overestimate their incidence, but that death certificates appeared to report the diagnosis of histologically confirmed mesothelioma accurately. Am. J. Ind. Med. 42:188–199, 2002. © 2002 Wiley-Liss, Inc.

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.

A case-control study on respiratory cancers was conducted in New Caledonia (South Pacific), where a high incidence of malignant pleural mesothelioma had been observed. The disease pattern suggested an environmental exposure to asbestos. The first results showed that, in some areas, tremolite asbestos derived from local outcroppings was used as whitewash (locally named "pö"). All cases diagnosed between 1993 and 1995 (including 15 pleural mesotheliomas, 228 lung cancers, and 23 laryngeal cancers) and 305 controls were included in the study. Detailed information on past or present use of the whitewash, residential history, smoking, diet, and occupation was collected. The risk of mesothelioma was strongly associated with the use of the whitewash (odds ratio (OR) = 40.9; 95% confidence interval (CI): 5.15, 325). All Melanesian cases had been exposed. Among Melanesian women, exposure to the whitewash was associated with an increased risk of lung cancer (OR = 4.89; 95% CI: 1.13, 21.2), and smokers exposed to po had an approximately ninefold risk (OR = 9.26; 95% CI: 1.72, 49.7) compared with women who never smoked and had never used the whitewash. In contrast, no association was noted between exposure to pö and lung cancer risk among Melanesian men, probably because of lower exposure levels. Among non-Melanesians, the numbers of exposed subjects were too small to assess the effect of exposure to po. There was no indication of elevated risks for the other cancer sites.

This article is a description of the current situation in France with regard to occupational cancer: research, prevention, and occupation. Toxicologic experiments are carried out using (italic)in vitro(/italic) and (italic)in vivo(/italic) tests, particularly using transgenic mice. Several epidemiologic studies have been conducted over the last decades: population-based case-control studies; mortality studies and cancer incidence studies carried out in historical cohorts of workers employed in the industry; and case-control studies nested in occupational cohorts. French ethical aspects of toxicologic and epidemiologic studies are described. The results thus obtained are used to establish regulations for the prevention and the compensation of cancers attributable to occupational exposure. This French regulation for prevention of occupational cancer involves several partners: (italic)a(/italic)) the states authorities, including labor inspectors, responsible for preparing and implementing the labor legislation and for supervising its application, particularly in the fields of occupational health and safety and working conditions; (italic)b(/italic)) the Social Security Organisation for the analysis of present or potential occupational risks based on tests, visits in plants, complaints or requests from various sources, and statistics. These activities are performed within the framework of the general French policy for the prevention of occupational cancer. This organization includes the National Institute for Research and Safety, particularly involved in research in the various fields of occupational risks--animal toxicology, biologic monitoring, exposure measurements epidemiology, psychology, ergonomy, electronic systems and machineries, exposure to chemicals, noise, heat, vibration, and lighting; and (italic)c(/italic)) companies where the regulation defines the role of the plant manager, the occupational physician, and the Health, Safety and Working Conditions Committee (comprising the manager, employees' representatives, the occupational physician, and the safety department) in dealing with any problem regarding safety, occupational hygiene, and working conditions. These organizations along with medical practitioners are involved with the compensation of occupational cancers. The regulation for compensation includes the tables of occupational cancer, the possibility of recognition of a cancer case when the requirements of the tables are not met, and the postprofessional follow-up of workers exposed to a carcinogenic agent.

Introduction Les resultats de l’essai NLST ont ouvert le debat sur l’opportunite d’un programme de depistage du cancer bronchopulmonaire (CBP) chez les personnes exposees a des cancerigenes respiratoires. L’objectif de ce travail est l’analyse cout–efficacite d’un programme de depistage du CBP dans une cohorte de sujets exposes a l’amiante. Methodes Les resultats de l’etude NLST (ajustes a l’âge) sont appliques a la population de la cohorte APEXS (6453 hommes exposes a l’amiante, ayant passe un scanner du thorax, suivi sans intervention specifique pendant 8 ans) pour determiner le nombre et le stade de CBP supplementaires qui seraient depiste ; la survie des CBP depistes a ete modelise en utilisant les donnees de la cohorte KBP 2010 ; les couts, limites aux couts directs, du point de vue de la Securite sociale, prennent en compte le cout du programme de depistage et de la prise en charge des CBP depistes. Resultats On estime 2,5 cas de CBP incident supplementaires pour 1000 sujets ayant les caracteristiques de la cohorte APEXS, depistes selon les donnees du NLST sur 2 ans ; un gain en annee de vie compris entre 6,2 a 9,7 et un ratio cout–efficacite variant de 32 039 a 40 359 euros par annee de vie gagnee. Conclusion Bien que superieur a ceux des programmes de depistage du cancer du sein ou du colon, ce ratio cout–efficacite se situe dans le champ de l’acceptable au regard des seuils habituels pour une intervention de sante.

Introduction Depuis 2012, la declaration obligatoire (DO) des mesotheliomes par les medecins (cliniciens, pathologistes) a l’Agence regionale de sante vise a renforcer la surveillance des mesotheliomes (tous sites anatomiques, territoire national) et a ameliorer la connaissance des expositions, notamment environnementales a l’amiante. Pour cela, la DO est completee depuis 2014 par des enquetes d’exposition professionnelle et environnementale dans 9 regions pilotes. Apres plus de 3 ans de fonctionnement, l’Institut de veille sanitaire fait un bilan du dispositif de DO et des enquetes d’exposition. Methodes L’exhaustivite de la DO est estimee par comparaison avec les donnees du programme national de surveillance des mesotheliomes (PNSM). Les cas survenant chez les femmes, les hommes de moins de 50 ans et les cas de mesotheliome hors plevre font l’objet d’une enquete d’exposition realisee par un enqueteur du PNSM ou de la cellule interregionale d’epidemiologie de l’InVS. Les expositions professionnelles et environnementales sont evaluees a partir du parcours professionnel, residentiel et scolaire et des activites potentiellement exposantes. Le patient est informe des demarches de reconnaissance medicosociale par l’enqueteur. Le resultat de l’expertise sur l’exposition professionnelle a l’amiante fourni par l’universite de Bordeaux est adresse au medecin traitant du patient. Resultats Le nombre de cas declares diagnostiques entre 2012 et 2014 est de 2026 (environ 52 % par un clinicien). Le niveau de declaration est de l’ordre de 50 %, avec des variations regionales importantes (1/3 des regions proches de l’exhaustivite). Par ailleurs, 69 enquetes d’exposition ont ete menees en 2014 et les resultats preliminaires de ces enquetes seront presentes. Conclusion Le dispositif de DO est fonctionnel et informatif mais encore insuffisamment exhaustif. Pour une connaissance non biaisee des expositions en France, il est essentiel d’ameliorer l’exhaustivite. Aussi les medecins sont vivement appeles a participer a la DO.

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.

The basis of a preventative health policy for humans against potential risks from chemical products is based on risk assessment leading to the classification and labelling of substances. However, the different existing classifications do not give an homogeneous framework that can be used in every country. Therefore, a tiered approach to assessing and classifying the health risk of exposure to fibres is proposed based on the EU Directive on carcinogens. The aim of this paper is to propose an algorithm for the risk assessment of existing and future fibres. Clearly chemically defined respirable fibres should be classified according to an algorithm based on a step-by-step procedure: a priori criteria, screening tests, long-term inhalation tests and epidemiological data (for commercial fibres). Then fibre-containing poducts should be labelled according to the classification of each type of fibre it contains, on one hand, and the ability of the product to release fibre in the air, on the other. The different tests listed in this algorithm, extensively discussed during the Workshop, are presented in detail in the following paper.

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.

Introduction Les particules nanometriques sont couramment definies comme ayant un diametre nominal inferieur a 100 nm. Il est possible de distinguer les particules manufacturees, generees a des fins commerciales, de celles non intentionnellement emises et qui peuvent etre d’origine naturelle (erosion des sols…), ou anthropique lors des emissions secondaires de procedes technologiques courants tels que les moteurs thermiques. Les donnees toxicologiques ont montre une relation probable entre particules nanometriques et cancer. De meme, les donnees epidemiologiques ont permis de classer les particules diesel et les particules de la pollution atmospherique comme cancerogenes certains pour l’homme (independamment de leur taille). Enfin, la capacite des particules nanometriques a traverser les differentes barrieres biologiques et notamment, la barriere hemato-encephalique a fait emerger l’hypothese d’un possible lien avec la survenue de tumeurs du systeme nerveux central. L’objectif de ces analyses est d’etudier l’association entre l’exposition professionnelle aux particules nanometriques non-intentionnellement generees au travers de differents procedes de travail et la survenue de tumeurs du systeme nerveux central. Methode Les donnees de l’etude cas-temoins CERENAT incluant 596 cas de tumeurs du systeme nerveux central et 1192 temoins, entre 2004 et 2006, dans 4 departements francais, ont ete analysees. A partir de l’histoire professionnelle complete des sujets, l’exposition professionnelle aux particules nanometriques a ete evaluee par le biais d’une matrice emplois-exposition. Pour chaque sujet, la duree totale d’exposition ainsi qu’un score d’exposition ont ete calcules. Les rapports de cotes et intervalles de confiance a 95 % ont ete estimes par une regression logistique conditionnelle. Resultats Une association significative entre exposition professionnelle aux particules nanometriques et tumeurs du systeme nerveux central a ete observee chez les hommes (RC = 1,5 ; IC 95 % = 1,1–2,2). Cet exces de risque semble etre plus particulierement lie a de fortes expositions (RC = 1,9 ; IC 95 % = 1,2–2,8 pour des durees totales d’exposition superieures a 30 ans) ainsi qu’aux particules carbonees (RC = 1,5 ; IC 95 % = 1,1–2,3) et HAP (RC = 1,6 ; IC 95 % = 1,1–2,4). Conclusion Meme si ces premieres analyses doivent etre confirmees, notamment en prenant en compte l’intensite des expositions (en cours de determination dans une nouvelle version de la matrice), ces resultats incitent au developpement de recherches epidemiologiques sur ces nuisances ainsi qu’a une reflexion sur les expositions et sur les mesures de prevention en milieu de travail.

En 2007, afin de renforcer et d’elargir l’action medicale, le service de sante au travail du CHU de Bordeaux s’est engage dans la pluridisciplinarite avec l’introduction d’une competence en psychologie de la sante au travail. Depuis l’hygiene et securite, l’ergonomie et l’epidemiologie sont venues elargir le champ disciplinaire et d’action de l’equipe, bien avant l’evolution recente des textes reglementaires qui prevoient cette pluridisciplinarite dans la fonction publique hospitaliere. Une posture reflexive constante, assuree avec les medecins sur l’activite de chacun, a permis de formaliser une charte sur la prevention et la gestion des RPS puis une seconde sur les missions de l’equipe pluridisciplinaire. En 2012, a la faveur de l’obtention d’un contrat local d’amelioration des conditions de travail (CLACT) sur la prevention conjointe des troubles musculo-squelettiques et des risques psychosociaux, une methodologie d’intervention en binome ergonome et psychologue en sante au travail a ete eprouvee. Dans le cadre de ce dispositif, l’equipe pluridisciplinaire a beneficie d’une analyse des pratiques animee par l’equipe d’ergonomie des systemes complexes de Bordeaux-institut polytechnique de Bordeaux (INP) au rythme d’environ une seance par bimestre. Ces seances presentaient un double enjeu. Le premier etait de mettre en debat les logiques disciplinaires, a travers les pratiques professionnelles, entre hygiene et securite, ergonomie et psychologie puis de les articuler avec celle de la responsabilite et du pilotage medical. Le second etait de consolider une organisation de travail en equipe permettant la construction d’un veritable collectif de travail pluridisciplinaire pilote par les medecins du travail. Dans ce sens, deux modalites organisationnelles ont ete posees. Tout d’abord, la mise en place de staffs mensuels dans lesquels les intervenants en prevention des risques professionnels (IPRP) et medecins du travail de secteur debattent des demandes et s’entendent sur une conduite a tenir. Puis a ete creee une mission de coordination de l’equipe IPRP assuree par le membre le plus ancien de l’equipe pluridisciplinaire. Enfin, institutionnellement, la mise en place d’une cellule sante travail animee par la Direction des ressources humaines et impliquant les instances representatives du personnel, a permis a la reflexion–action du service de sante au travail de s’inscrire dans un contexte favorable au developpement et a la reussite de cette pluridisciplinarite. Ce travail d’equipe permet au service de sante au travail de mieux repondre a ses missions, par le renforcement de l’expertise medicale et le developpement des actions sur le terrain tant sur le plan individuel que collectif.

Les fragments de clivage (FC) sont des particules minerales produites a partir de roches naturelles sous l’effet de contraintes mecaniques, notamment lors de travaux publics (enrobes routiers). Certains peuvent, par leur composition chimique et leurs dimensions, etre assimiles a des fibres d’amiante. Si les effets des fibres d’amiante sur la sante sont bien documentes, il existe des incertitudes sur la toxicite des FC. De plus, les methodes analytiques actuelles ne permettent pas toujours de distinguer de facon simple les FC des fibres d’amiante. Dans ce contexte, l’Anses a ete saisie par les ministeres en charge de la Sante, du Travail et de l’Environnement pour documenter les circonstances d’expositions professionnelles aux FC, les effets sanitaires en resultant et les methodes ou criteres permettant d’affiner les analyses de materiaux et d’air. Les FC d’interet sont ceux susceptibles d’etre comptabilises comme fibres d’amiante lors des analyses d’air, c’est-a-dire les FC d’amphiboles homologues des amiantes reglementes, a savoir l’actinolite, l’anthophyllite, la tremolite, la grunerite et la riebeckite, ayant les dimensions d’une fibre definies par l’Organisation mondiale de la sante (OMS) (L > 5 μm, D 3) et donc susceptibles d’etre inhalees. Les donnees concernant d’autres especes chimiques d’amphiboles ont egalement ete etudiees. Au vu des donnees analysees, il n’est pas possible d’exclure un risque pour la sante lie a l’exposition aux FC des 5 amphiboles precitees. Certaines donnees indiquent de plus des risques pour la sante similaires a ceux induits par l’amiante pour des silicates fibreux non reglementes a ce jour : des amphiboles (winchite, richterite, fluoro-edenite) et une zeolite (erionite). Aucune donnee d’exposition specifique aux FC n’a ete identifiee, en raison notamment de co-expositions avec des fibres d’amiante et des difficultes analytiques pour les distinguer formellement de celles-ci. D’autres methodes ou d’autres criteres permettent d’affiner l’analyse mais sont difficilement utilisables en routine. Dans ce contexte, l’Anses recommande une evolution du cadre reglementaire en vigueur afin de prendre en compte les effets sanitaires associes aux FC d’actinolite, d’anthophyllite, de tremolite, de grunerite et de riebeckite, et aux particules minerales de winchite, richterite, fluoro-edenite et erionite ayant les dimensions d’une fibre « OMS ». La mise en place de dispositions permettant le suivi et la surveillance des sites, ainsi que la tracabilite et la reduction des expositions professionnelles est egalement preconisee. Enfin, des mesures visant a homogeneiser le prelevement et l’analyse des particules minerales dans les materiaux naturels sont proposees.

Objectif Ev@lutil est une base de donnees on-line qui documente depuis 1992 les expositions professionnelles aux fibres dont l’amiante. Recemment, afin de repondre aux attentes des acteurs de la sante publique et de la prevention, une nouvelle nuisance particulaire a ete introduite : les particules nanometriques (PN) manufacturees et non intentionnelles. Depuis aout 2014, les donnees d’exposition professionnelle aux PN sont progressivement incrementees dans la base. Methode Une veille bibliographique a ete mise en place afin de reperer en routine les dossiers d’interet. Les informations decrivant les situations de travail observees (profession, operation, type de PN…) et les resultats de mesure (caracteristiques physico-chimiques, concentrations…) sont analyses, puis enregistres dans une base documentaire developpee specifiquement pour les PN. En l’absence de strategie de mesurage standardisee des PN, une attention particuliere a ete portee a la retranscription en claire et detaillee des methodes employees. Sans attendre l’analyse complete des dossiers, une synthese des donnees disponibles est accessible sous format Excel sur le site et est regulierement mise a jour. Resultats La base PN est en acces libre et gratuit en version francaise et anglaise sur le site Internet « Ev@lutil » https://ssl2.isped.u-bordeaux2.fr/eva_003/ . Elle peut etre interrogee selon trois modes de recherche : « simple » (saisie de mots-cles), « avancee » (renseignement de criteres : auteur, profession, operation…) et « experte » (combinaison libre de ces memes criteres). Les documents retrouves presentent le detail des circonstances d’exposition et des mesures. Chaque document peut etre imprime. La base PN, de developpement recent, contient deja plus de 200 mesures et la synthese sous Excel analyse plus de 250 dossiers. Les PN non intentionnelles, les procedes de combustion et les moteurs thermiques sont les plus documentes. Environ 80 % des dossiers presentent une information sur la concentration en particules et 90 %, sur les caracteristiques physico-chimiques. Conclusion En regroupant l’ensemble des donnees d’exposition professionnelle aux PN disponibles, Ev@lutil represente un outil d’aide a l’evaluation des expositions a ces particules pour les medecins du travail et hygienistes impliques dans la prevention des risques associes. Destinee egalement aux chercheurs, notamment en epidemiologie, elle contribue de plus a l’amelioration des connaissances sur les effets sur la sante des PN. Enfin, en recensant egalement toutes les methodes de metrologie utilisees, Ev@lutil participe a l’effort de determination du ou des parametres de mesure de cette exposition les plus justes pour predire les effets sur la sante.

Contexte et objectifs L’impact sanitaire suppose des particules nanometriques (PN) necessite de documenter et surveiller les expositions, particulierement dans l’environnement professionnel ou les niveaux sont generalement plus eleves. Pourtant, les expositions sont peu documentees en raison de l’absence d’harmonisation des strategies de mesurage des PN. A ce jour, les preconisations generales de caracterisation des PN en milieu de travail ne sont pas operationnelles pour les acteurs de la prevention. C’est pourquoi l’equipe Cancer et environnement (Epicene) a mis en place le projet ExproPNano qui vise a evaluer les expositions professionnelles aux PN dans des entreprises aquitaines et quebecoises. Plusieurs partenaires institutionnels participent au projet : l’INRS, l’INERIS, la CARSAT Aquitaine, le laboratoire d’etude des particules inhalees de la ville de Paris (Lepi), l’InVS et au Canada, l’universite de Montreal. Le projet est finance par l’ANSES. Une these adossee au projet est cofinancee par l’INRS et la Region Aquitaine. Methode Ce projet repose sur l’elaboration d’une methode operationnelle d’evaluation innovante alliant mesurage et analyse de l’activite. Des campagnes dans des entreprises de differents secteurs (Aeronautique, BTP, Caoutchouc, Mines, Ports…) seront mises en place afin de tester la methode d’evaluation des expositions. Plus precisement, les campagnes conduites par l’equipe Epicene s’articuleront autour : – d’une pre-visite des entreprises (presentation du projet, echange et visite) ; – de la campagne avec des phases d’analyse des pratiques de prevention (observations et entretiens), d’analyse de l’activite couplee a des mesures en temps reel (individuelles et fixes) et de prelevement d’aerosols sur filtre pour caracterisation physico-chimique ; – d’une analyse des resultats et rendus dans les entreprises. Resultats et retombees Le projet aboutira a la validation d’une strategie d’evaluation des expositions transferable et applicable en routine en milieu de travail en alimentant les reflexions actuelles au niveau national et international. La prise en compte de l’activite de travail assurera une comprehension fine des determinants de l’exposition, tout en precisant l’influence de l’activite physique sur l’exposition. Pour les entreprises, le projet permettra de proposer une demarche de prevention adaptee a la problematique des PN. Une visibilite des ressources de prevention reelles des entreprises sera possible, afin de mesurer l’impact des recommandations actuelles. Finalement, les donnees d’exposition produites contribueront a l’amelioration des connaissances des niveaux d’exposition aux PN emises a l’occasion d’activites professionnelles.

Contexte Plusieurs travaux ont rapporte l’existence d’un lien possible entre une exposition professionnelle a l’amiante et le risque de cancer colo-rectal. Toutefois, les differentes etudes disponibles sont discordantes et le CIRC dans sa derniere evaluation de 2012 n’a retenu qu’un lien probable. Le but de cette etude est de rechercher l’existence d’une association eventuelle entre ce type de cancer et l’amiante au sein de l’etude de cohorte « Asbestos-Related Diseases COhort » (ARDCO). Methodes Entre 2003 et 2005, plus de 16 000 volontaires retraites ou sans emploi, ayant ete exposes professionnellement a l’amiante ont ete inclus dans un programme de depistage des pathologies benignes de l’amiante par TDM. Depuis, un suivi annuel des prises en charge pour cancer en ALD ou en MP a ete effectue jusqu’en 2014 et permet d’approcher l’incidence des cancers dans cette cohorte. Les expositions a l’amiante ont ete expertisees de maniere independante par plusieurs hygienistes industriels et ont ete caracterisees selon un indice d’exposition cumulee (IEC) sur la carriere entiere. En 2011, un questionnaire complementaire a ete envoye a l’ensemble des sujets, permettant de recueillir les principaux facteurs de risque du cancer colo-rectal chez un echantillon de sujets appele ARDCO-NUT. Les analyses statistiques reposent sur le modele de Cox, avec prise en compte du tabagisme, de l’IEC et de la latence pour l’amiante, et des principaux facteurs de risque alimentaires (alcool, viande rouge), personnels (IMC) et familiaux (polypes) du cancer colo-rectal. Resultats Pres de 14 500 hommes ont ete retenus pour cette analyse, dont 3769 ont repondu au questionnaire complementaire. Dans la cohorte globale ARDCO, une relation dose-reponse est mise en evidence entre le risque de cancer colique et l’IEC a l’amiante ( hazard risk = 1,14 [1,04–1,26]) apres ajustement sur le tabagisme et la latence de l’exposition a l’amiante. Apres stratification sur la latence (moins de 40 ans, 40 ans et plus), une relation plus forte est mise en evidence pour une latence Conclusions Cette etude est en faveur d’une relation dose-reponse entre l’exposition a l’amiante et le cancer du colon, apres prise en compte des principaux facteurs de risque de ce cancer.

For diagnostic purposes, mineralogical analysis was performed in bronchoalveolar la-vage fluid and lung tissue from a 58-year-old patient previously exposed to asbestos and rare earth dusts. No significant retention of asbestos was demonstrated in lung tissue by light microscopy (asbestos bodies) or transmission electron microscopy analysis (un-coated fibers). Particles containing rare earth (cerium, lanthanum) and phosphorus were identified in alveolar macrophages in bronchoalveolar lavage fluid, and cerium-containing particles accounted for 70% of particles observed in the lung tissue. Ultrastructural analysis of lung tissue revealed the presence of particles containing cerium and phosphorus in interstitial macrophages and elastic fibers. These results suggest that rare earth is metabolized and should be considered as biopersistent in the human respiratory tract, since occupational inquiries revealed that exposure to cerium oxide abrasive powder had ceased at least 15 years earlier.

A retrospective study was conducted in 23 subjects with previous occupational exposure to asbestos and exhibiting rounded atelectasis (RA) on high-resolution computed tomography scan (HRCT scan) to evaluate the retention of asbestos bodies (ABs) using light microscopy in the bronchoalveolar lavage (BAL) fluid or lung parenchyma in such patients. A total of 31 RAs were identified, usually located in the lower (25 RAs) and posterior (23 RAs) parts of the lung. Pleural thickening in contact with the RA was observed in 27 RAs and parenchymal bands were detected in 15 cases. Twelve of the 20 patients who underwent BAL or surgery exhibited significant retention of ABs in BAL fluid or lung tissue. Moreover, a significant retention of ABs was observed in five of nine patients with a history of asbestos exposure but no diffuse pleural thickening on chest radiograph or interstitial opacities on HRCT scan. Patients with RAs and coexisting diffuse pleural thickening and/or interstitial fibrosis should be considered at a higher risk for lung cancer in comparison to patients with isolated circumscribed pleural plaques based on increased AB counts. By contrast, the excess risk of lung cancer is more questionable in patients with only RAs and circumscribed pleural plaques as they may have AB counts either above or below that associated with pleural plaques alone. This emphasizes the need for further follow-up studies to define criteria indicating the need for thoracotomy in these subjects.

Background The aim of this study was to determine the rates of compensation awarded to patients presenting with pleural mesothelioma and factors linked to such compensation in France. Methods The study population consisted of 2,407 patients presenting with pleural mesothelioma, recorded by the National Mesothelioma Surveillance Programme between January 1, 1999 and December 31, 2009. Analysis of claims for recognition as “occupational disease” (OD) and claims for compensation by the Compensation Fund for Asbestos Victims (FIVA) were analyzed. Results Approximately 30% of subjects presenting with pleural mesothelioma, affiliated to the General National Health Insurance fund, neither sought recognition as an OD nor claimed for FIVA compensation. Gender, age at diagnosis, type of health insurance, and socio-professional category influence the likelihood of patients presenting with mesothelioma seeking compensation for this disease. Conclusions Results show an under-compensation of pleural mesothelioma as OD and by the FIVA in France. Am. J. Ind. Med. 56:146–154, 2013. © 2011 Wiley Periodicals, Inc.

Buildings at a university in Paris, first examined 15 years ago, were re-evaluated in 1989 to assess the effectiveness of remedial action directed against sprayed-on asbestos materials. Twenty indoor samples and 2 outdoor samples were collected. These included 15 sites common to the two studies. The levels of airborne asbestos fibers were determined by transmission electron microscopy using an indirect preparation method. A comparison of fiber levels in 1975 and 1989, at different sites, with and without remedial action, was performed using mass and numerical concentrations. Although the number of samples in the current study was limited, the 1989 results showed a significant reduction in the concentration of airborne asbestos fibers in comparison with findings from the earlier study. In 1975, indoor asbestos concentrations varied from 1 to 750 ng/m3; in 1989, the concentrations varied from less than 0.1 to 39 ng/m3 (while the concentrations of fibers longer than 5 μm varied from less than 0.0001...

In order to characterize the response of various pulmonary cell types to polycyclic aromatic hydrocarbons, the expression of cytochrome P450 (CYP) 1A1 and 2B1 mRNA in the lung of rats, with or without induction by 3-methylcholanthrene (3MC), was analyzed by in situ hybridization using appropriate 35S-labeled riboprobes. The expression of the corresponding proteins was investigated immunohistochemically. Following induction with 3MC, the kinetics of mRNA expression differed considerably between Clara cells and type II pneumocytes and venous endothelial cells. In Clara cells, mRNA expression was detected as early as 1 h after induction, peaked between 2 and 4 h, and was completely undetectable at 14 h. In contrast, venous endothelial cells and type II pneumocytes exhibited permanent mRNA expression of CYP 1A1 in 3MC-pretreated rats. These kinetic results explain the striking absence of correlation between mRNA and protein expression observed in Clara cells 24 h after the end of the induction protocol, as these cells exhibited intense protein expression with no mRNA. In contrast, a good correlation was observed for mRNA and protein expression of CYP 2B1, with similar expressions for Clara cells and type II pneumocytes, but no expression in endothelial cells. This study clearly distinguished the regulation of CYP 1A1 expression in the rat lung from that described in the liver. The differences observed in the various lung cell types, whatever the post-transcriptional mechanisms involved, emphasize that studies must be performed at the cellular level in order to understand the specific response to xenobiotics, not only of this organ as a whole but also of its various anatomic structures.

The profiles of occupational asbestos exposure were investigated in a series of 66 hospital patients in whom pleural plaques constituted the only asbestos-induced abnormality. The relationship between a radiological semiquantitative score of pleural plaques and indices of asbestos exposure was also examined. On the basis of a standardized occupational questionnaire, four classes of asbestos exposure were distinguished in our study population: no evidence of exposure, low-level exposure, sporadic exposure at higher levels, and a remaining group of individuals with substantial exposure. Asbestos body count in bronchoalveolar lavage fluid (BALF) was used as an objective indicator of cumulative lung retention of asbestos. Our results support the data indicating that pleural plaques may occur in subjects with low-level or sporadic asbestos exposure. Although it is admitted that pleural plaques are strongly associated with past asbestos exposure, our data suggest that the stage of pleural plaques was not correlated to the level, frequency, duration of exposure nor to the amount of asbestos bodies in the BALF in subjects free of any lung parenchymal abnormalities on high resolution computerized tomography.

A retrospective study was conducted to evaluate lung retention of particles containing cerium in subjects with and without previous occupational exposure to mineral dusts. Analytical transmission electron microscopy was performed on 459 samples of bronchoalveolar lavage (BAL) fluid and 75 samples of lung tissue. Study of the distribution of mineralogical species in human samples showed that particles containing cerium were encountered in less than 10% of subjects. The proportion of subjects with particles containing cerium in their biological samples was not different between controls and subjects with previous occupational exposure to fibrous or nonfibrous mineral dusts. This was considered as the background level of lung retention of cerium in the general population. By contrast, determination of the absolute concentration of particles containing cerium in BAL fluid and lung tissue samples showed that 1.2% (from BAL fluid) and 1.5% (from lung tissue) of subjects with previous exposure to mineral particles had high lung retention of particles containing cerium. This study is believed to be the first one in which lung retention of cerium was estimated in the general population.

The performance of the forced oscillation technique (FOT) in the assessment of bronchial responsiveness on the methacholine challenge test was compared with that of forced expiratory volume in one second (FEV1) in 119 active workers with normal baseline pulmonary function. Changes in resistance (delta R0%), frequency dependence of resistance (delta P) and resonant frequency (delta F%) determined by the FOT were compared to the delta FEV1%. Receiver operating characteristic (ROC) curves were established to determine values of the changes in FOT parameters which corresponded to the best sensitivity and specificity for classifying the subjects as hyperresponsive or nonresponsive on the methacholine challenge test. Significant correlations were observed between delta FEV1% and delta R0%, delta P and delta F% respectively. The ROC curves showed the following cut-off values of FOT parameters to be the best values for classifying the subjects according to the presence or absence of 20% fall in FEV1: a 65% increase in R0 (sensitivity 75%; specificity: 76%); a decrease of 65 x 10(-3) hPa.l-1.s2 in P (sensitivity 58%; specificity 83%); a 50% increase in F (sensitivity 75%; specificity 62%). Our results suggest that the FOT is a useful test for assessment of bronchial hyperresponsiveness when compared to spirometry, and can be applied to epidemiological studies of a bronchial challenge test in normal active working populations.

Objectives Matgene is a program to develop job-exposure matrices (JEMs) adapted to the general population in France for the period since 1950. The aim is to create retrospective exposure assessment tools for estimating the prevalence of occupational exposure to various agents that can then be correlated to health-related parameters. Methods JEMs were drawn up by a team of six industrial hygienists who based their assessments on available occupational measurement, economic and statistical data, and several thousand job descriptions from epidemiological studies performed in France since 1984. Each JEM is specific to one agent, assessing exposure for a set of homogeneous combinations (occupation × activity × period) according to two occupational classifications (ISCO 1968 and PCS 1994) and one economic activities classification (NAF 2000). The cells of the JEM carry an estimate of the probability and level of exposure. Level is estimated by the duration and intensity of exposure-linked tasks or by description of the tasks when exposure measurement data are lacking for the agent in question. The JEMs were applied to a representative sample of the French population in 2007, and prevalence for each exposure was estimated in various population groups. All documents and data are available on a dedicated website. Results By the end of 2010, 18 JEMs have been developed and eight are under development, concerning a variety of chemical agents: organic and mineral dust, mineral fibers, and solvents. By implementation in the French population, exposure prevalences were calculated at different dates and for complete careers, and attributable risk fractions were estimated for certain pathologies. Some of these results were validated by comparison with those of other programs. Discussion Initial Matgene JEMs results are in agreement with the French and international literature, thus validating the methodology. Exposure estimates precision, however, vary between agents and according to the amount of exposure measurement data available. These JEMs are important epidemiological tools, and improving their quality will require investment in occupational health data harvesting, especially in the case of low-level exposures.

Background It is uncertain whether isolated pleural plaques cause functional impairment. Objective To analyse the relationship between isolated pleural plaques confirmed by CT scanning and lung function in subjects with occupational exposure to asbestos. Methods The study population consisted of 2743 subjects presenting with no parenchymal interstitial abnormalities on the high-resolution CT (HRCT) scan. Asbestos exposure was evaluated by calculation of an individual cumulative exposure index (CEI). Each subject underwent pulmonary function tests (PFTs) and HRCT scanning. Variables were adjusted for age, smoking status, body mass index, CEI to asbestos and the centres in which the pulmonary function tests were conducted. Results All functional parameters studied were within normal limits for subjects presenting with isolated pleural plaques and for those presenting with no pleuropulmonary abnormalities. However, isolated parietal and/or diaphragmatic pleural plaques were associated with a significant decrease in total lung capacity (TLC) (98.1% predicted in subjects with pleural plaques vs 101.2% in subjects free of plaques, p=0.0494), forced vital capacity (FVC) (96.6% vs 100.4%, p 1 ) (97.9% vs 101.9%, p=0.0032). In contrast, no significant relationship was observed between pleural plaques and FEV 1 /FVC ratio, forced expiratory flow at 25–75% FVC and residual volume. A significant correlation was found between the extent of pleural plaques and the reduction in FVC and TLC, whereas plaque thickness was not related to functional impairment. Conclusions The results show a relationship between isolated parietal and/or diaphragmatic pleural plaques and a trend towards a restrictive pattern, although the observed decrease in FVC and TLC is unlikely to be of real clinical relevance for the majority of subjects in this series.