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International audience; This article analyzes the consequences of the increasing reference to scientific expertise in the decision and implementation process of occupational health policy. Based on examples (exposure limits and attributable fractions) taken from an interdisciplinary seminar conducted in 2014 to 2015 in France, it shows how the measurement or regulation of a problem through biomedicine-based tools produces blind spots. It also uses a case study to show the contradictions between scientific and academic aims and public health intervention. Other indirect implications are also examined, such as the limitation of trade unions’ scope for action. Finally, the article suggests launching a broad political debate accessible to nonspecialists about collective occupational health issues—a dialogue made difficult by the rise of the afore-mentioned techno-scientific perspective.

This study aims to describe the socio-demographic profile of so-called “key workers” during the first lockdown in France and to assess their potential occupational exposure to SARS-CoV-2 under routine, pre-pandemic working conditions. We used the French list of essential jobs that was issued during the first lockdown to identify three subgroups of key workers (hospital healthcare, non-hospital healthcare, non-healthcare). Based on the population-based “Conditions de travail-2019” survey, we described the socio-demographic composition of key workers and their potential work-related exposures (to “infectious agents,” “face-to-face contact with the public,” and “working with colleagues”) using modified Poisson regression. In general, women, clerical and manual workers, workers on temporary contracts, those with lower education and income, and non-European immigrants were more likely to be key workers, who accounted for 22% of the active population. Non-healthcare essential workers (57%) were the most socially disadvantaged, while non-hospital healthcare workers (19%) were polarized at both extremes of the social scale; hospital healthcare workers (24%) were intermediate. Compared to non-key workers, all subgroups had greater exposure to infectious agents and more physical contact with the public. This study provides evidence of accumulated disadvantages among key workers concerning their social background, geographical origin, and potential SARS-CoV-2 exposure.

Les fractions de risque attribuables en population (FRA) sont largement utilisées dans la prévention des cancers. Toutefois, peu de travaux semblent les avoir mobilisées comme outil de quantification des déterminants sociaux de la santé. À partir de l’exemple des cancers d’origine professionnelle, notre approche interdisciplinaire (épidémiologie-sociologie) s’appuie sur une revue de la littérature internationale, la conduite d’entretiens auprès de chercheurs en santé publique, et la ré-analyse d’une enquête cas-témoins conduite en population française. La part des cancers attribués au travail varie entre moins de 2 % et plus de 8 % selon les études. Tandis que nombre d’auteurs reconnaissent une concentration des expositions dans les groupes socio-professionnels moins qualifiés, cette dimension n’a jamais été explicitement prise en compte dans les estimations. Ce point aveugle est lié au manque de données, mais aussi à des mécanismes de « production d’ignorance » bien décrits en sociologie des sciences. Nos travaux empiriques illustrent la possibilité et l’utilité de prendre en compte les inégalités d’expositions professionnelles au cours de la vie dans la construction des mesures d’impact.

BackgroundWe aimed to study whether social patterns of exposure to SARS-CoV-2 infection changed in France throughout the year 2020, in light to the easing of social contact restrictions.MethodsA population-based cohort of individuals aged 15 years or over was randomly selected from the national tax register to collect socio-economic data, migration history, and living conditions in May and November 2020. Home self-sampling on dried blood was proposed to a 10% random subsample in May and to all in November. A positive anti-SARS-CoV-2 ELISA IgG result against the virus spike protein (ELISA-S) was the primary outcome. The design, including sampling and post-stratification weights, was taken into account in univariate and multivariate analyses.ResultsOf the 134,391 participants in May, 107,759 completed the second questionnaire in November, and respectively 12,114 and 63,524 were tested. The national ELISA-S seroprevalence was 4.5% [95%CI: 4.0%-5.1%] in May and 6.2% [5.9%-6.6%] in November. It increased markedly in 18-24-year-old population from 4.8% to 10.0%, and among second-generation immigrants from outside Europe from 5.9% to 14.4%. This group remained strongly associated with seropositivity in November, after controlling for any contextual or individual variables, with an adjusted OR of 2.1 [1.7-2.7], compared to the majority population. In both periods, seroprevalence remained higher in healthcare professions than in other occupations.ConclusionThe risk of Covid-19 infection increased among young people and second-generation migrants between the first and second epidemic waves, in a context of less strict social restrictions, which seems to have reinforced territorialized socialization among peers.

Introduction: Major economic and social changes occurred over the last 50 years, such as the increased participation of women in the labour market and the development of non-standard forms of employment. These trends question the importance of work/employment conditions in the shaping of social inequalities in health over the life course. We thus hypothesize that (1) precarious occupational trajectories may contribute to ill health in adulthood, and that (2) they may affect genders differently. Methods We used the French SIP (Santé Itinéraire Professionnel) national survey that collected information on occupational career and major health events of people aged 40–74 in 2006. We described poor employment conditions in terms of job instability, career discontinuity, qualification trends and versatility. We then applied multiple correspondence analysis and hierarchical ascending classification to identify patterns reflecting the accumulation of precarious employment conditions over job histories. Finally, we quantified the association between the type of occupational trajectory and self-reported health (Mini European Health Module) through multivariate logistic regression. Results We included more than 9500 participants of working-age or < 5 -years retirees at the time of the survey. The classification showed that women were over-represented among most precarious trajectories. We also found that people with precarious trajectories more often reported less than good self-perceived health, currently experiencing longstanding illness or health problem, and activity limitation due to health problems. The trend of increasing ill health across work trajectories (stable/qualified/continuous trajectories serving as a reference) was similar among men and women, although adjusted ORs were slightly higher among women. Conclusion We bring evidence that women experienced more precarious employment trajectories in France over the last decades than did men, with similar health outcomes among men and women. We now seek to expand our gendered perspective by taking into account hazardous working conditions as a potential mediating pathway.

Background There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap. Methods We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ Results Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZp = 0.003), while MUAC p = 0.01), even among children with a MUAC ≥ 125 mm. Of note, more than 80 % of the events of relapse as SAM would have been missed if WHZ had not been monitored and used in the definition of relapse. Conclusions Our results suggest that the priority for SAM management programs should be to ensure that children reach a high level of WHZ at discharge, at least above or equal to the WHO recommended cut-off. The validity of using a single MUAC cut-off such as 125 mm as a suitable discharge criterion for all age groups is questioned. Further follow-up studies providing a complete assessment of nutritional status at discharge and not based on a restricted MUAC-only definition of relapse as SAM would be urgently needed to set evidence-based discharge criteria. These studies are also required to assess programs currently discounting or omitting WHZ for identification and management of SAM.

Background: Our main objective was to study the early social dynamics of the COVID-19 epidemic in France, taking into account gender, class, and ethnicity inequalities in living conditions. Methods: A random population-based survey was conducted in France in May 2020, during and post COVID-19 lockdown, in which 77,588 participants aged 18-64 were included in this study. We used multinomial regressions to identify changes in social position and exposure factors associated with symptoms of anosmia/ageusia during the first epidemic peak in late March and thereafter. Findings: In all, 2,045 (1.53% (95%CI 1.46%-1.61%)) participants reported anosmia/ageusia (1.13% during the epidemic peak and 0.40% after), with strong variations according to regions. Women and ethno-racial minorities remained at higher risk of anosmia/ageusia during and after the peak. Whereas senior executive professionals were more affected than lower social classes at the peak of the epidemic, this effect disappeared afterwards. Adjusting on key exposure factors substantially attenuated these associations, except for gender differences. While high density of the place of residence was associated with anosmia/ageusia during the peak, but no longer after, the opposite trend was observed for living in overcrowded housing. Having worked outside the home during lockdown was the most strongly associated exposure factor, and even more so after the peak. Interpretation: The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of stringent collective prevention measures. Our results notably stress the importance of working outside the home, all the more so in essential occupations. Funding Statement: Inserm (Institut National de la Sante et de la Recherche Medicale). French Ministry for Research. Drees. Dr. Bajos has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. [856478]) Declaration of Interests: None. Ethics Approval Statement: The survey was approved by the CNIL (French independent administrative authority responsible for data protection) on April 25th 2020 (ref: MLD/MFI/AR205138) and by the “Comite de protection des personnes” (French equivalent of the Research Ethics Committee) on April 24th. The survey also obtained an agreement from the “Comite du Label de la statistique publique”, proving its adequacy to statistical quality standards.

International audience; À l’occasion d’un colloque organisé en 2009 par l’INRS avec onze partenaires, un point complet de la prévention des risques cancérogènes et un état de l’existant avaient été faits à travers plusieurs dizaines d’exposés et de communications. Certains aspects, moins stabilisés à l’époque ou faisant encore l’objet de débats, avaient été abordés de façon plus allusive. L’idée est venue ensuite de rassembler, sous la forme d’un ouvrage collectif, des contributions à cet état de l’art in progress. En effet, la prévention des risques cancérogènes évolue sans cesse parce que les modes de production, les technologies et les procédés industriels évoluent eux-mêmes, que le débat social est fructueux, que des initiatives naissent fréquemment de la part de scientifiques, de préventeurs institutionnels ou d’entreprises, etc.

International audience; Background - In occupational epidemiology, a male-centered perspective often predominates. We aimed to describe current research practices in terms of gender consideration at different stages of epidemiological studies. Methods - A systematic review of occupational lung cancer publications indexed in PubMed was conducted over the period 2003-2014. Articles were described according to the sex composition of their study sample. Results - In 243 studies, 7 (3%) were women-only, 101 (41%) were mixed, with a disproportionate men-to-women ratio (P50 = 3.5; P75 = 12.4). A shift was observed from mixed and unspecified source populations to men-only final samples. Our results also suggest implicit generalization of results from men-only studies, a lack of tests of interaction and often unjustified sex-adjustment for mixed studies. Conclusions - The lower proportion of women in studies cannot be fully explained by their under-representation in the target populations, since there were large numbers of women among both potentially exposed workers and patients diagnosed with lung cancer.

Les fractions de risque attribuable en population (FAP) sont largement utilisées dans la prévention des cancers. Bien qu’erreurs conceptuelles et problèmes de validité soient soulevés dans la littérature épidémiologique, peu de travaux se sont intéressés à l'impact des FAP dans la prise de décision, et à leur faible prise en compte des déterminants professionnels et environnementaux des inégalités sociales de santé (ISS). Nos objectifs sont: (1) de décrire l’évolution des estimations de cancers attribués au travail; (2) d'analyser l'outil FAP comme manifestation des obstacles épistémiques dans la recherche sur les ISS; (3) d'explorer des modalités de prise en compte de ces inégalités dans la construction d'indicateurs relatifs au travail.Notre approche interdisciplinaire (épidémiologie-sociologie) s'appuie sur une revue de la littérature internationale, la conduite d'entretiens auprès de chercheurs en santé publique, et la ré-analyse d'une enquête cas-témoins (ICARE) conduite en population française.La part des cancers attribués au travail varie entre moins de 2% et plus de 8% (moyenne 4-5%). Tandis que nombre d’auteurs reconnaissent une concentration des expositions dans les groupes socio-professionnels moins qualifiés, cette dimension n'a jamais été explicitement prise en compte dans les estimations. Ce point aveugle est lié au manque de données documentant le gradient social d'expositions professionnelles. Plus généralement, le gradient social de cancer est souvent interprété à la lumière de déterminants proximaux et comportementaux, une tendance attribuée par les historiens des sciences aux fondations mêmes de l'épidémiologie moderne, et pouvant résulter dans la production de "non-savoirs". Nos travaux empiriques illustrent les difficultés mais aussi les opportunités de prise en compte des inégalités de parcours professionnel dans la construction des mesures d'impact.Les mesures d'impact telles que les FAP devraient intégrer la dimension des ISS. Ceci nécessite de réfléchir à la place particulière des déterminants professionnels et plus largement environnementaux dans les chaînes de causalité.

International audience; Purpose of ReviewPopulation attributable fractions (PAFs) are increasingly used for setting cancer prevention priorities. Our review aims, first, to gather published estimates of the percentage of cancer attributed to causal agents in the workplace and, second, to analyze them from the perspective of their potential effects on population health inequities.Recent FindingsThe estimates generally ranged from less than 2% to more than 8%, with an average of 4–5%. While most authors acknowledge that exposures concentrate in lower-socioeconomic status and more vulnerable workers, the literature has never considered the occupational group as a source of variation in the calculations. This knowledge gap is linked to the paucity of data describing the occupational patterning of exposures and cancer. More globally, the social gradient in cancer is often interpreted in the light of behavioral factors alone, a tendency linked by historians to the very foundations of modern epidemiology. Yet, there is accumulated evidence that work affects health and the risk of death through different pathways, which are also relevant to cancer.SummaryWhile the epidemiologic literature addressed conceptual and validity issues surrounding PAFs, it seldom questioned their potential impacts. There is in particular a lack of consideration of factors beyond individual behaviors and a paucity of attention to population health inequities. We hence propose to further the discipline’s reflexivity by changing the focus, scope, and metrics in order to assess the burden of work-related cancer in a way that is more meaningful to the most disadvantaged workers.

International audience; The epidemiological approach helps to provide scientific evidence of cause-and-effect relations with respect to population health. Applied to productive activities, it has contributed to advances in the regulation of occupational risks, sometimes beyond the walls of the factory. However, it has been difficult in recent decades to produce new knowledge, not only on emerging risks but also on those that accumulate throughout working life and beyond. In this respect, work can be analysed as a particular sphere in which conflicts of standards in epidemiology complicate the emergence of a scientific discourse on responsibilities of/at work. At the heart of these tensions, debates around causal inference hold a prominent place in view of their implications for prevention and compensation. Multi-causality models that refer to shared responsibilities eventually tend to give predominant weight to so-called behavioural factors, including in the analysis of the differentials in health and mortality between socio-occupational groups. Confronted with a certain form of blindness toward workers with multiple disadvantages, some researchers are calling for the epidemiological community to include work in its various dimensions as a determinant of social inequalities in health.; La démarche épidémiologique concourt à construire des preuves scientifiques de relations de cause à effet en matière de santé des populations. Appliquée aux activités productives, elle a contribué aux avancées en matière de régulation des risques professionnels, parfois au-delà des murs de l’usine. Toutefois, les dernières décennies sont marquées par des difficultés à produire de nouvelles connaissances, non seulement sur les risques émergents, mais aussi sur les risques qui se cumulent au cours de la vie professionnelle et au-delà. À ce titre, le travail peut être analysé comme un terrain particulier d’expression des conflits de normes qui traversent la discipline et qui, précisément, compliquent l’émergence d’un discours scientifique sur les responsabilités au/du travail. Au cœur de ces tensions, les débats autour de l’inférence causale occupent une place centrale, aussi bien par leurs implications en termes de prévention que de réparation. Les modèles de multi-causalité qui renvoient à des régimes de responsabilités partagées tendent finalement à accorder un poids prépondérant aux facteurs dits comportementaux, y compris dans l’analyse des différentiels de santé et de mortalité entre groupes socio-professionnels. Face à une certaine forme de cécité vis-à-vis des travailleurs cumulant les désavantages, certains chercheurs appellent à une prise en compte du travail dans ses différentes dimensions comme déterminant à part entière des inégalités sociales de santé.

Notre pays — et la planète — traverse une crise épidémique majeure. Comme toute crise, elle peut être révélatrice des forces et faiblesses de la société, et de ses composantes : celles de son système de santé, de son système de recherche, du fonctionnement de la démocratie sanitaire… Cet article aborde la question des inégalités sociales au temps du Covid-19 : la crise sanitaire, la réaction politique et celle du système de santé les ont-elles amplifiées, atténuées ou les ont-elles laissées telles qu’elles étaient auparavant ? Ce numéro spécial de la revue Questions de Santé Publique apporte un éclairage sur cette question à partir de résultats originaux provenant de l’enquête « Épidémiologie et conditions de vie » (EpiCoV), permettant de documenter dans les meilleurs délais la situation exceptionnelle que nous traversons.

Cet article analyse les effets du recours croissant a l’expertise scientifique dans l’elaboration et la mise en œuvre des politiques de sante au travail. S’appuyant sur des exemples (valeurs limites et fractions attribuables) abordes lors d’un seminaire interdisciplinaire organise en 2014-2015, il montre comment l’adoption d’un outil de mesure ou de regulation issu de disciplines biomedicales induit des points aveugles dans la definition et la prise en charge d’un enjeu. Il analyse egalement a partir d’autres exemples les effets plus indirects de cette evolution, qui limite les possibilites d’intervention des organisations syndicales. Il invite aussi a s’interroger sur la place des sciences humaines et sociales et des savoirs de terrain, notamment dans la mise au jour des dimensions conflictuelles de ces enjeux, souvent occultees par l’expertise institutionnelle. Il propose enfin l’ouverture aux non-specialistes d’un large debat politique sur les questions collectives de sante au travail, rendu plus difficile par leur definition en termes technoscientifiques.

International audience; Studies assessing socio-economic disparities in air pollution exposure and susceptibility are usually based on a single air pollution model. A time stratified case-crossover study was designed to assess the impact of the type of model on differential exposure and on the differential susceptibility in the relationship between ozone exposure and daily mortality by socio-economic strata (SES) in Montreal. Non-accidental deaths along with deaths from cardiovascular and respiratory causes on the island of Montreal for the period 1991–2002 were included as cases. Daily ozone concentration estimates at partictaipants’ residence were obtained from the five following air pollution models: Average value (AV), Nearest station model (NS), Inverse-distance weighting interpolation (IDW), Land-use regression model with back-extrapolation (LUR-BE) and Bayesian maximum entropy model combined with a land-use regression (BME-LUR). The prevalence of a low household income (< 20,000/year) was used as socio-economic variable, divided into two categories as a proxy for deprivation. Multivariable conditional logistic regressions were used considering 3-day average concentrations. Multiplicative and additive interactions (using Relative Excess Risk due to Interaction) as well as Cochran's tests were calculated and results were compared across the different air pollution models. Heterogeneity of susceptibility and exposure according to socio-economic status (SES) were found. Ratio of exposure across SES groups means ranged from 0.75 [0.74–0.76] to 1.01 [1.00–1.02], respectively for the LUR-BE and the BME-LUR models. Ratio of mortality odds ratios ranged from 1.01 [0.96–1.05] to 1.02 [0.97–1.08], respectively for the IDW and LUR-BE models. Cochran's test of heterogeneity between the air pollution models showed important heterogeneity regarding the differential exposure by SES, but the air pollution model was not found to influence heterogeneity regarding the differential susceptibility. The study showed air pollution models can influence the assessment of disparities in exposure according to SES in Montreal but not that of disparities in susceptibility.

International audience; Complex exposure situations are frequent at the workplace, but few studies have characterized multiple occupational carcinogenic exposures (MOCE) and their gendered differences across jobs’ characteristics. We assessed MOCE separately in male and female jobs and identified patterns of MOCE at job level. Participants (834 men and 183 women) were cancer patients recruited between March 2002 and December 2010 in the ongoing SCOP93 cohort study, Seine-Saint-Denis department, France. Job histories were collected through personal interviews, and carcinogenic exposures were assessed by a multidisciplinary expert committee using a list of 53 carcinogens. Proportion of MOCE (i.e. ≥2 carcinogens) was assessed for male and female jobs separately. Principal component analysis combined with hierarchical ascendant classification was used to identify patterns of MOCE. Among the 5202 male jobs and 885 female jobs, respectively 42 and 9% were multi-exposed. Blue-collar workers and jobs in the construction and industry sectors had the highest rates of MOCE, contrasting with jobs held in recent periods (≥1997) and by patients aged ≥45 years at job start. A gradient of MOCE was also observed according to occupational segregation for both men and women. Eight patterns of MOCE were identified among male jobs: widespread carcinogens, mixed silica dust, heavy metals/combustion products, organic compounds/radiation, metal working, solvents/heavy metals, wood dust/formaldehyde/pesticides, and fuel exhausts. Three patterns of MOCE were found among female jobs: biological/organic compounds, industrial working, and fuel exhausts. Some patterns of MOCE were job-specific, whereas other patterns were found across different occupations. These results suggest that patterns of MOCE partly differ between men and women. They stress the importance of gendering multiple exposure assessment studies and point out the inadequacy of occupational disease compensation systems based on a single factor and non-gendered approach of carcinogenesis, ignoring differences between men and women in complex occupational exposure situations.

National audience

To analyze the associations between marine n-3 polyunsaturated fatty acids (PUFAs) and blood pressure (BP), resting heart rate (HR), and heart rate variability (HRV) in a population highly exposed to methylmercury through the diet.Concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in erythrocytes membranes were measured in 180 French Polynesian adults (≥18 years) residing in Tubuai, which is a community with a traditional lifestyle, or Papeete, which has a modern lifestyle. HRV was measured using a 2-hour ambulatory electrocardiogram (Holter). Resting HR and BP were measured using standardized protocols and pulse pressure (PP) was calculated as systolic BP - diastolic BP. The associations between n-3 PUFAs and the dependent variables were studied using simple and multiple linear regressions.Increasing DHA concentration was associated with lower resting HR (β = -2.57, p = 0.005) and diastolic BP (β = -1.96, p = 0.05) and higher HRV in multivariable models. Specifically, DHA was associated with high frequency (HF; β = 0.19, p = 0.02) and the square root of the mean squared differences of successive R-R intervals (difference between two consecutive R waves; rMSSD; β = 0.08, p = 0.03), which are specific indices of the parasympathetic activity of the autonomic nervous system.DHA was associated with lower BP and resting HR and higher HRV among French Polynesians who are also exposed to high methylmercury levels.

Several national and international initiatives were conducted to estimate or monitor current occupational carcinogenic exposures (OCE). However, older periods are usually less well documented. Moreover, both the methodological approaches used and the limited number of agents considered are likely to underestimate situations of multiple-exposure. The aim of this study was to characterise multiple OCE at the job level among patients with cancer. We used data from the GISCOP93 permanent survey to describe OCE from a list of 54 carcinogens, separately for men and women. Associations between these exposures and jobs’ characteristics were assessed by using Poisson model with robust variance. Principal Component Analysis and Hierarchical Ascendant Classification were used to identify gendered patterns of multiple OCE. Respectively 61.1% of men jobs (834 patients, 5202 jobs) and 26.7% of women jobs (183 patients, 885 jobs) were exposed to at least one carcinogen. Among exposed jobs, two-third were multiply-exposed (i.e. ≥ 2 OCE) in men (n = 2173) and 1/3 in women (n = 82). Among men, blue collars workers had an increased risk (factor of three to four) of OCE as compared to employees. Women working as blue collar workers in the metallurgy, confection and mechanics industries were also two to three times more often exposed to carcinogens than employees. Eight patterns of multiple OEC were identified in men’s jobs: multiple-exposures to widespread carcinogens, mixed silica dust, heavy metals/combustion products, organic compounds/radiations, metal working, solvents/heavy metals, wood dust/formaldehyde/pesticides, and fuels exhausts. Three patterns of multiple OCE were observed among women’s jobs: biological/organic compounds, industrial working, and fuels exhausts. These results based on a study considering cancer as a sentinel event highlight evidence of a gendered pattern in multiple OCE, inconsistent with the criteria in use among the occupational disease compensation system based on a single-factor approach of carcinogenesis.

Occupational carcinogenic exposure is rarely about a single factor; rather, it involves a combination of factors (i.e, multiple exposures to chemical substances, radiations, and work related conditions) occurring at the same time or accumulating through occupational lifespan. However, few studies have attempted to consider occupational carcinogenic exposures (OCE) following a diachronic and cumulative approach. Therefore, the aim of this study was to develop a method to analyse OCE trajectories – regardless of the type of carcinogen involved – among patients diagnosed with mostly respiratory cancer. We used data from the GISCOP93 permanent survey to describe OCE from a list of 54 carcinogens. Groups-based trajectory modelling (GBTM) performed with “PROC TRAJ” procedure (SAS.9.3) was used to estimate OCE trajectories patterns among 739 men and 132 women, separately. To ensure convergence, trajectories were modelled based on 6-months OCE’s average (mean number of carcinogens) from the patients first day to their last day at work. The range of career duration was set from 10 to 45 years. Nine OCE trajectory groups were estimated among men that can be further gathered in four groups: unexposed (10.8%), constantly multi-exposed (2 groups at different levels of multi-exposure, 27.8%), multi-exposed decreasing (3 groups, 29.4%), increasing OCE trend (3 groups, 31.9%). Three OCE trajectory patterns were estimated among women: unexposed (47.7%), stable mono-exposed (38.6%), and middle career peak multi-exposed (13.7%). OCE trajectories in men and women were „significantly associated with both jobs characteristics (main occupational activity and sector through occupational lifespan) and career changes (employment instability and discontinuity, job qualification). This study suggests that the individual history of occupational carcinogenic exposures should also be taken into account as various lifelong exposure trajectories may have different impact on health.

Official recognition of cancer as “occupational disease” (OD) by the Social Security compensation system depends on medical and legal criteria, plus the information and willingness of patients to assert their rights. In France, only 1 in 10 work-related lung cancer are recognised as OD, even less so for urinary bladder ( An intervention research was set within an ongoing prospective cancer patients study (Giscop93) from March-2002 to December-2013. Once occupational exposures were reconstructed, patients eligible for OD notification were followed-up as to their access to OD recognition. The second phase of intervention (October-2009/December-2013) was very pro-active, with personalised counselling and close partnership with social services and lawyers. We assessed factors that could favour/hamper OD notification and compensation through multiple logistic regression. Delays between OD notification and death or recognition were assessed through Kaplan-Meier estimator followed by Cox proportional hazards modelling (SAS 9.3). Among the 1058 lung cancer patients, 558 were eligible for OD notification; 72% notified their cancer as an OD, of whom 76% were officially recognised. The median delay between notification and recognition by Social Security was 5.70 months (95% CI [5.57; 5.77]). About 39% of patients died within 6 months after they notified. In multivariate Cox-models (outcome: OD recognition), the hazard ratio was 1.74 for asbestos exposure (ref: exposed less than 10 years; p = 0.0003) and 1.29 for the intervention period (ref: first phase March-2003/September-2009, p = 0.036). These results suggest that personalised interventions may improve notification by patients and its outcome in terms of OD recognition and shorter delays. Yet, asbestos remains the main recognised exposure and the legal response delay (6 months) seems incompatible with access to compensation during lifetime for many patients since lung cancer has a bad prognosis.

Introduction The CMMP (Comptoir des Mineraux et des Matieres Premieres) is a former mineral grinding plant whose activity "asbestos" continued from the 1930s to the mid-1970s. Responsible of an imp...

Objectives. Because of their recent adoption of a Westernized lifestyle, an increased risk of developing hypertension (HTN) is suspected among Inuit populations. This study aimed to assess the exact prevalence of HTN in Nunavik Inuit and to examine its association with other major risk factors of cardiovascular disease. Study design. A cross-sectional population-based study. Methods. We analysed biological and anthropometric data and the medical history of 832 Inuit. Results. The overall prevalence of HTN (≥140/90 mmHg or the use of medication) was 19% with no gender difference. Obesity (body mass index [BMI] ≥30 kg/m2) was the highest prevalent cardiovascular risk factor (23%), and was significantly associated with HTN (OR for BMI

Background The Inuit are commonly portrayed to be somehow protected from cardiovascular diseases (CVDs) through their traditional lifestyle and diet. However, actual sociocultural transition and related major, modifiable risk factors have scarcely been quantified in the Inuit population. Such knowledge is extremely valuable in terms of public health intervention. Methods A total of 887 Inuit residents from Nunavik, Quebec, participated in a cohort study. The estimates presented were derived from anthropometric and biological measurements gathered at the time of recruitment and enhanced by information collected in the medical file of each participant. All estimates were corrected for a complex sampling strategy and bootstrapped to ensure the representativeness of the general Nunavik population. Results Overall, 19% of Inuit had a disease of the circulatory system according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision . Among all disorders, peripheral circulatory system disease was the most prevalent (9%). Prevalences of ischemic heart disease and cerebrovascular disease were of similar magnitude (2.5%). No significant difference in disease prevalence was noted between sexes. The major modifiable CVD risk factors were smoking (84%), obesity (49%) (body mass index of greater than 30kg/m 2 ) and elevated blood pressure (130/85mmHg or greater) (18%). Prevalences were globally higher among women. Conclusion The current belief that the Inuit are protected from CVD is seriously questioned by the results of the present study. Considering the extremely high prevalence of CVD risk factors, a population-based intervention reinforced for women is urgently needed to reduce their risk.

As part of the rapid socio-cultural transition observed in Arctic populations, the Inuit diet is changing. We present original data derived from the baseline Inuit Health in Transition cohort study regarding biological levels ofn-3 fatty acids andtrans-fatty acids (TFA), lipids with opposite health effects found respectively in traditional marine diets and recently introduced low-quality imported foods. A total of 524 Inuit from the Disko Bay area (Greenland) and 888 Inuit from the fourteen communities of Northern Québec (Nunavik) participated in the study. We measured the fatty acid profile of erythrocyte (RBC) membrane phospholipids (PL) as a surrogate for individual intakes. Moreover, the contribution of store-bought foods to energy intakes was assessed through dietary questionnaires. Our results show that whilen-3 fatty acid levels were slightly lower in Nunavik (9·4 % of RBC membrane PL) than in Greenland (12·1 %), TFA levels were on average nearly thrice as high in Nunavik Inuit (1·20 %) as they were in Greenlanders (0·43 %). Moreover, younger Nunavik Inuit accumulated higher intakes of TFA and lower intakes ofn-3 fatty acids. Finally, the average proportion of energy derived from store-bought foods was high in both groups (77·5 % and 83·5 %), especially in youth. Our results call for action to rehabilitate and recover access to country foods and point to the importance for Nunavik and the entire circumpolar world to follow the example of Denmark and Greenland, which imposed a maximum content of 2 g/100 g fat on industrially producedtrans-fats in 2003.

En depit de son interdiction a la fin des annees 90, l’amiante constitue toujours un probleme majeur de sante publique du fait du temps de latence pluridecennal des pathologies associees. Parmi les nombreuses formes d’exposition renseignees, les expositions professionnelles ont generalement concerne des lieux, par hypothese, plus facilement identifiables et localisables. Nous proposons, dans cet article, un recensement des sources actuelles existantes permettant la realisation d’un inventaire cartographique de sites, en nous interessant a un departement pilote particulierement bien documente : la Seine-Saint-Denis. Nous questionnons egalement la potentielle utilite sociale de ce travail visant a rompre l’invisibilite de ces lieux et des pollutions associees.

The contamination of foods dedicated to human consumption varies over space and time. In exposure assessment, this is usually addressed through probabilistic modelling. The present work explores how the variability and uncertainty of exposures estimated at the population level are affected by: (a) the (non-)parametric nature of input contamination distributions; (b) the time-window used to sample contamination values within those distributions. Focusing on exposure of the French population to food mycotoxin ochratoxin A, we implement a range of second-order Monte-Carlo simulations that allow distinguishing variability of exposures from uncertainty of distributional parameters estimates. A simulation runs 10,000 iterations. Overall estimates of parameters are given by the median across iterations and 95%CI by 2.5th and 97.5th percentiles. Our results show that: (a) parametric (log-normal) input distributions may lead to over-estimation of variability and greater uncertainty as compared to non-parametric ones (P97.5 [95%CI] of 7.1 [6.6; 7.7] for Parametric-Occasion, 4.6 [4.3; 5.0] for Non-Parametric-Occasion), and that (b) the ‘Occasion’ time-window combines better estimate of variability and lower uncertainty when exposure modelling is applied to populations living in developed countries with complex agri-food systems (P97.5 [95%CI]: 7.3 [6.2; 8.9] for Non-Parametric-Week, 4.6 [4.3; 5.0] for Non-Parametric-Occasion). A deterministic approach is nevertheless preferred to probabilistic modelling every time input data quality is questionable.

Introduction Diverses initiatives nationales et internationales ont estime l’exposition a des cancerogenes en milieu professionnel. Cependant, tant les approches methodologiques que le nombre d’agents consideres sont susceptibles de sous-estimer les expositions multiples. L’objectif de cette etude est de caracteriser la multi-exposition parmi des patients atteints de cancers pouvant avoir une origine professionnelle, en se placant au niveau des postes de travail et en partant d’une liste etendue de cancerogenes. Methode Les donnees issues de l’enquete du GISCOP93 chez des patients atteints de cancer principalement pulmonaire ont ete utilisees pour decrire semi-quantitativement, separement chez les hommes et les femmes, l’exposition aux cancerogenes a partir d’une liste de 54 agents (ou groupe d’agents) cancerogenes. Ces expositions ont ensuite ete confrontees aux caracteristiques des postes (modele de Poisson avec variance robuste). Des analyses multidimensionnelles ont permis d’identifier des profils de cancerogenes frequemment associes. Resultats Respectivement 61,1 % et 26,7 % des postes occupes par des hommes (834 patients, 5202 postes) et des femmes (183 patientes, 885 postes) ont ete exposes a au moins un cancerogene. La multi-exposition (au moins deux cancerogenes) concerne les deux tiers des postes exposes chez les hommes (2173 postes) et un tiers chez les femmes (82 postes). Chez les hommes, les postes d’ouvriers avaient un risque trois a quatre fois plus important d’etre exposes comparativement aux employes. Chez les femmes, les postes d’ouvrieres dans la metallurgie, la mecanique et la confection etaient egalement deux a trois fois plus souvent exposes que les postes d’employees. Conclusion Huit profils de postes multi-exposes associant des cancerogenes communs ont ete identifies chez les hommes, et trois chez les femmes Ces resultats provenant d’une enquete considerant le cancer comme un evenement sentinelle vis-a-vis des expositions viennent attester d’une multi-exposition genree aux cancerogenes professionnels, en decalage frappant avec la realite d’un systeme de reparation fonde sur une conception mono-factorielle de la cancerogenese.

Contexte Diverses initiatives nationales et internationales ont permis d’estimer l’exposition de la population a des cancerogenes en milieu professionnel. Cependant, tant les approches methodologiques que le nombre restreint d’agents pris en compte sont de nature a sous-estimer les situations de multi-exposition, hier comme aujourd’hui. L’objectif de cette etude est de caracteriser la multi-exposition parmi des patients atteints de cancers pouvant avoir une origine professionnelle, en se placant au niveau des postes de travail et en partant d’une liste etendue de cancerogenes. Methodes Les donnees issues de l’enquete du GISCOP93, conduite chez des patients atteints de cancer principalement pulmonaires, ont ete utilisees afin de decrire semi-quantitativement, separement chez les hommes et les femmes, l’exposition aux cancerogenes des postes expertises a partir d’une liste de 54 agents (ou groupe d’agents) cancerogenes. Ces expositions ont ensuite ete confrontees aux caracteristiques des postes (modele de poisson avec variance robuste). Des analyses multidimensionnelles ont ete realisees afin d’identifier des profils de cancerogenes frequemment associes sur les postes multi-exposes. Resultats Respectivement 61,1 % et 26,7 % des postes occupes par des hommes (834 patients, 5202 postes expertises) et des femmes (183 patientes, 885 postes expertises) ont ete exposes a au moins un cancerogene. La multi-exposition concerne egalement les 2/3 des postes exposes chez les hommes (2173 postes exposes a au moins deux cancerogenes) et 1/3 chez les femmes (82 postes). Chez les hommes, les postes d’ouvriers avaient un risque trois a quatre fois plus important d’etre exposes comparativement aux employes. Chez les femmes, les postes d’ouvrieres dans la metallurgie et la mecanique ainsi que ceux de la confection etaient egalement de deux a trois fois plus souvent exposes que les postes d’employees. Huit profils de postes multi-exposes associant des cancerogenes communs ont ete identifies chez les hommes : multi-exposition courante ; courante a dominante silice ; metaux lourds et produits de combustion ; composes organiques ; travaux sur metaux ; solvants et metaux lourds ; bois, formol et pesticides ; carburants. Trois profils ont ete degages chez les femmes : multi-exposition aux composes biologiques et organiques ; travaux sur metaux ; carburants. Conclusion Ces resultats provenant d’une enquete considerant le cancer comme un evenement sentinelle vis-a-vis des expositions cancerogenes viennent attester d’une multi-exposition genree aux cancerogenes professionnels, en decalage frappant avec la realite d’un systeme de reparation fonde sur une conception mono-factorielle de la cancerogenese.

International audience; OBJECTIVES: Social position and social mobility are associated with cancer incidence and mortality, yet little is known about their association with mediating factors such as occupational exposures to carcinogens. Our aim was to assess the association between the type of professional trajectory and multiple occupational exposure profiles. METHOD: Data were extracted from the Giscop93 study (n = 1 009), which is a cohort of cancer patients with (mainly) respiratory tumours. Job histories were reconstructed through interview, then a multi-disciplinary expert group examined the probability of occupational exposure to a list of 54 potentially carcinogenic agents. The typology of professional trajectories was built based on employment stability, employment continuity, job qualification trend, and multiple skills through Multiple Correspondence Analysis followed by Ascending Hierarchical Classification. Association with multiple-exposure profiles was then assessed through multiple logistic regression. RESULTS: Men and women differed in terms of predominant job category over the lifecourse (68,2% of blue-collar-workers among men, 57,3% of employees among women, p \textless 0.0001). Professional trajectories were grouped in four classes as "stable qualified, employee" (21,3%), "stable manual, independent blue-collar-worker" (24,4%), "stable tiring, no gain in qualification" (30,5%), and "very unstable, precarious" (23,8%). Among men, the last two categories were associated with exposure to at least five different occupational carcinogens (ORstable_tiring/stable_qualified=2,0 [1,3;3,1], ORvery_unstable/stable_qualified=2,6 [1,6;4,2]). No such association was found among women. CONCLUSIONS: The association found between the type of professional trajectory and multiple occupational exposures among men should be replicated among people not suffering cancer. Forthcoming analysis will investigate the gendered differences observed.

Objectifs La division sexuee du travail et des risques constitue un enjeu majeur dans la comprehension des risques professionnels. Les differences d’expositions entre les sexes de par les emplois occupes, mais aussi de par les differences de tâches effectuees au sein de postes similaires, ont ete identifiees comme de potentiels biais dans l’evaluation d’expositions professionnelles. Les matrices emplois-expositions (MEE), outils largement utilises dans ces evaluations, presentent des limites dans la prise en compte de la variabilite intra-emploi. L’objectif etait de comparer des estimations produites par une MEE a celles d’une evaluation a dire d’experts, ce en contrastant les resultats obtenus pour des postes traditionnellement masculins et feminins. Methodes Les donnees generees sont issues d’une enquete permanente (etude Giscop93) menee en Seine-Saint-Denis, France. Entre mars 2002 et decembre 2014, 1253 patients atteints de cancer (1029 hommes et 224 femmes) ont ete recrutes et les parcours professionnels detailles ont ete recueillis par le biais d’entretiens semi-directifs. Sur la base des 7945 postes recenses (6786 portes par des hommes et 1159 par des femmes), l’exposition aux solvants chlores telle qu’evaluee par une equipe d’experts (mesure servant de standard) a ete comparee a une evaluation effectuee par une MEE en population generale francaise, le programme Matgene. Les indices d’exposition (probabilite et intensite) ont ete compares par des mesures d’accord (coefficient κ) entre estimations obtenues pour des emplois traditionnellement occupes par des hommes et emplois traditionnellement occupes par des femmes. Resultats La prevalence de l’exposition aux solvants chlores etait plus importante lorsqu’evaluee par les experts par rapport a la MEE. L’accord dans la classification des emplois exposes oscillait de « modere » a « fort » selon les seuils choisis pour la MEE (52–80 %), mais demeurait relativement « faible » lorsque l’intensite de l’exposition etait egalement prise en compte. Conclusions Pour les solvants chlores, les estimations produites par la MEE ont ete globalement en accord avec les evaluations d’experts. Les resultats preliminaires suggerent toutefois un faible accord au-dela de l’analyse binaire. Des etudes complementaires en cours sur le benzene et l’amiante permettront de mieux caracteriser le comportement des MEE.

Au debut des annees 1980, le concept de « medecine fondee sur les preuves » fait son apparition. Ce courant se materialise par le recours grandissant aux donnees de l’epidemiologie dans une optique d’objectivation quantitative de la sante et de ses determinants qui s’etend progressivement au-dela de la clinique. L’epidemiologie est ainsi convoquee pour construire des « preuves » destinees a eclairer la prise de decision en sante publique. Cependant, cette construction de l’information peut comporter de nombreux points aveugles et contribuer a l’invisibilisation de certains determinants de la sante : c’est le cas des conditions de travail, et ce, davantage encore chez les femmes. Pour exemple, les expositions cancerigenes qu’elles peuvent rencontrer dans leur milieu de travail. Nous avons effectue une revue systematique de la litterature epidemiologique portant sur les liens entre activite professionnelle et cancer du poumon, avec pour objectifs : – de decrire la prise en compte du sexe dans les pratiques de recherche recentes ; – de discuter ces pratiques en termes de biais conceptuels et methodologiques lies au genre. La revue porte sur les publications indexees dans PubMed entre 2003 et 2014. Un questionnaire a ete concu pour recueillir de maniere systematique des informations sur des pratiques (conduite, analyse et interpretation) susceptibles d’induire une appreciation differentielle entre hommes et femmes. Les articles ont ete classes selon la repartition par sexe de l’echantillon d’etude et evalues en fonction de certaines variables d’interet. Dans cet echantillon de 248 articles, l’inclusion des femmes reste negligeable comme le montre la faible proportion d’etudes portant uniquement sur les femmes (2,9 % contre 55,6 % portant uniquement sur des hommes) et ce independamment des secteurs d’activite. Paradoxalement, les auteurs ont tendance a generaliser les resultats obtenus a partir d’etudes conduites uniquement chez des hommes. L‘evaluation des expositions est principalement realisee avec des methodes moyennant les expositions (matrices emplois-expositions) plutot que celles effectuant des estimations plus individualises (jugement d’expert). La faible inclusion des femmes ne peut pas etre entierement expliquee par leur sous-representation a la fois comme travailleurs potentiellement exposees (cohortes) et comme patients diagnostiques pour un cancer du poumon (cas-temoins). Ainsi, postulons-nous que les pratiques relevees revelent la persistance de certains prejuges lies au sexe dans les etudes portant sur les cancers d’origine professionnelle. Cette etude souligne la necessite de combiner aux enquetes epidemiologiques, des approches et savoirs developpes par les sciences sociales.

Following our results, based on population studies conducted in Greenland and Northern Canada, that Nunavik Inuit were thrice as highly exposed to dietary trans -fat as were Greenlandic Inuit, and that the biological levels found in Nunavik were already associated with deleterious blood lipid profiles, we decided to engage in translational activities. Our goal was to support Inuit communities in the practical implementation of a reduction of the trans -fat content of food sold in Nunavik. We carried out a preliminary feasibility study in Kuujjuaq and participated in several meetings. This translational phase involved an Inuk leader, an Inuk student, a southern student, a southern nutritionist and a southern researcher in the framework of a public health project. In the present article, we recount the different phases of the process, from research implementation to results dissemination and institutional commitment to implement a primary prevention program of reduction in trans -fat exposure in Nunavik. This is the occasion to draw broader conclusions on the factors that could either act in favour of or, on the contrary, would likely compromise the implementation of primary prevention interventions dealing with food and nutrition in the Arctic. Finally, we share some reflections on future translational activities dealing with trans -fat as well as other junk food issues. The analytical framework we propose integrates a range of factors, from geo-climatic to socio-economic, ethnocultural, and even political, that we think should be examined while identifying and building preventive recommendations and strategies related to the Northern diet. Keywords: trans -fat; translational research; intervention; Inuit diet (Published: 20 July 2012) Citation: Int J Circumpolar Health 2012, 71 : 18833 - http://dx.doi.org/10.3402/ijch.v71i0.18833