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A total of 92 coronavirus disease 2019 clusters involving 1,156 individuals (729 patients and 427 healthcare workers) occurred in Lyon University Hospital between September 1, 2020 and March 31, 2021, mostly on medical and geriatric wards. The number of clusters was closely correlated to the trend in coronavirus disease 2019 community incidence over time; in-hospital clusters did not persist when community incidence decreased. Recommended preventive measures were not fully applicable due to specific ward-associated determinants and patient characteristics.

BackgroungTo cope with the persistence of the Covid-19 epidemic and the decrease in antibody levels following vaccination, a third dose of vaccine has been recommended in the general population. However, several vaccine regimens had been used initially, and the heterologous ChadOx1-S/BNT162b2 regimen had shown better efficacy and immunogenicity than the homologous BNT162b2/BNT162b2 regimen.AimWe wanted to determine if this benefit was retained after the third dose.MethodsWe combined an observational study of SARS-COV-2 infections among vaccinated healthcare workers at the University-Hospital of Lyon, France, with an analysis of immunological parameters before and after the third mRNA vaccine dose.ResultsFollowing the second vaccine dose, heterologous vaccination regimens were more protective against infection than homologous regimens, but this was no longer the case after the third dose. RBD-specific IgG levels and serum neutralization capacity against different SARS-CoV-2 variants were higher after the third dose than after the second dose in the homologous regimen group, but not in the heterologous group.ConclusionThe advantage conferred by heterologous vaccination is lost after the third dose both in terms of protection and immunogenicity. Immunological measurements suggest that heterologous vaccination induces maximal immunity after the second dose, whereas the third dose is required to reach the same level in individuals with a homologous regimen.

The diversity of vaccination modalities and infection history are both variables that have an impact on the immune memory of individuals vaccinated against SARS-CoV-2. To gain more accurate knowledge of how these parameters imprint on immune memory, we conducted a long-term follow-up of SARS-CoV-2 spike protein–specific immune memory in unvaccinated and vaccinated COVID-19 convalescent individuals as well as in infection-naïve vaccinated individuals. Here, we report that individuals from the convalescent vaccinated (hybrid immunity) group have the highest concentrations of spike protein–specific antibodies at 6 months after vaccination. As compared with infection-naïve vaccinated individuals, they also display increased frequencies of an atypical mucosa-targeted memory B cell subset. These individuals also exhibited enhanced T H 1 polarization of their SARS-CoV-2 spike protein–specific follicular T helper cell pool. Together, our data suggest that prior SARS-CoV-2 infection increases the titers of SARS-CoV-2 spike protein–specific antibody responses elicited by subsequent vaccination and induces modifications in the composition of the spike protein–specific memory B cell pool that are compatible with enhanced functional protection at mucosal sites.

Following severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine1,2, European health authorities have recommended that patients under the age of 55 who received one dose of ChAdOx1-S-nCoV-19 vaccine receive a second dose of Pfizer BNT162b2 vaccine as a booster. However, the effectiveness and the immunogenicity of this vaccination regimen have not been formally tested. Here, we show that the heterologous ChAdOx1-S-nCoV-19/BNT162b2 combination confers better protection against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection than the homologous BNT162b2/BNT162b2 combination in a real-world observational study of healthcare workers (n=13121). To understand the underlying mechanism, we conducted a longitudinal survey of the anti-spike immunity conferred by each vaccine combination. Both combinations induced strong anti-spike antibody (Ab) responses but sera from heterologous vaccinated individuals displayed a stronger neutralizing activity, regardless of the SARS-CoV-2 variant. This enhanced neutralizing potential was correlated with increased frequencies of switched and activated memory B cells recognizing the SARS-CoV-2 Receptor Binding Domain (RBD). The ChAdOx1-S-nCoV-19 vaccine induced a weaker IgG response but a stronger T cell response than the BNT162b2 vaccine after the priming dose, which could explain the complementarity of both vaccines when used in combination. The heterologous vaccination regimen could therefore be particularly suitable for immune compromised individuals.

Antigen‐specific T‐cells are essential for protective immunity against SARS‐CoV‐2. We set up a semi‐automated whole‐blood Interferon‐gamma release assay (WB IGRA) to monitor the T‐cell response after stimulation with SARS‐CoV‐2 peptide pools. We report that the WB IGRA is complementary to serological assays to assess SARS‐CoV‐2 immunity.

A comprehensive clinical and microbiological assessments of COVID-19 in front-line healthcare workers (HCWs) is needed. Between April 10th and May 28th, 2020, 319 HCWs with acute illness were reviewed. In addition to SARS-CoV-2 RT-PCR screening, a multiplex molecular panel was used for testing other respiratory pathogens. For SARS-CoV-2 positive HCWs, the normalized viral load, viral culture, and virus neutralization assays were performed weekly. For SARS-CoV-2 negative HCWs, SARS-CoV-2 serological testing was performed one month after inclusion. Among the 319 HCWs included, 67 (21.0%) were tested positive for SARS-CoV-2; 65/67 (97.0%) developed mild form of COVID-19. Other respiratory pathogens were found in 6/66 (9.1%) SARS-CoV-2 positive and 47/241 (19.5%) SARS-Cov-2 negative HCWs (p = 0.07). The proportion of HCWs with a viral load > 5.0 log10 cp/mL (Ct value 37). More than 90% of cultivable virus had a viral load > 4.5 log10 cp/mL (Ct

Introduction : La reprise du travail après un cancer favorise le rétablissement de la participation sociale mais se heurte à différents obstacles. Le projet FASTRACS vise à développer, implanter et évaluer une intervention pour faciliter le maintien en emploi après un cancer du sein. Le développement de l’intervention repose sur le protocole de l’Intervention Mapping. L’objectif de cet article est de décrire les contributions du partenariat chercheurs-acteurs dans le processus de modélisation de l’intervention durant les étapes du protocole de l’Intervention Mapping. Méthodes : Le processus de développement de l’intervention est reconstitué de façon chronologique en décrivant les méthodes mobilisées et les résultats obtenus à chaque étape du protocole grâce au partenariat chercheurs-acteurs. Résultats : Les membres du Comité stratégique (COS) ont été choisis par échantillonnage théorique parmi quatre catégories d’acteurs concernées. Une charte a été coécrite pour structurer durablement le partenariat. Les membres du COS ont contribué à l’échantillonnage des participants à l’enquête qualitative d’évaluation des besoins et à l’interprétation des résultats. Les objectifs de l’intervention ont été hiérarchisés selon leur importance et leur faisabilité perçues. Les chercheurs et membres du COS ont évalué les outils de l’intervention et débattu sur le modèle logique de l’intervention. Les professionnels de santé participant au COS ont facilité l’adhésion des équipes d’oncologie participant à l’intervention. Discussion : La construction du partenariat a permis de modifier les représentations des chercheurs. L’établissement de relations de confiance a nécessité du temps et de partager ses limites. Il a été difficile d’intégrer des patientes socialement défavorisées. Le recours accru à des patientes-expertes devrait être encouragé. Conclusion : La construction d’un partenariat de recherche collaborative entre chercheurs et acteurs nécessite du temps, des méthodes, et des financements dédiés. Cet investissement est de nature à améliorer la pertinence, l’acceptabilité, la légitimité et la pérennité des interventions développées.

The virus neutralization test (VNT) is the reference for the assessment of the functional ability of neutralizing antibodies (NAb) to block SARS-CoV-2 entry into cells. New competitive immunoassays measuring antibodies preventing interaction between the spike protein and its cellular receptor are proposed as surrogate VNT (sVNT). We tested three commercial sVNT (a qualitative immunochromatographic test and two quantitative immunoassays named YHLO and TECO) together with a conventional anti-spike IgG assay (bioMérieux) in comparison with an in-house plaque reduction neutralization test (PRNT50) using the original 19A strain and different variants of concern (VOC), on a panel of 306 sera from naturally-infected or vaccinated patients. The qualitative test was rapidly discarded because of poor sensitivity and specificity. Areas under the curve of YHLO and TECO assays were, respectively, 85.83 and 84.07 (p-value >0.05) using a positivity threshold of 20 for PRNT50, and 95.63 and 90.35 (p-value =0.02) using a threshold of 80. However, the performances of YHLO and bioMérieux were very close for both thresholds, demonstrating the absence of added value of sVNT compared to a conventional assay for the evaluation of the presence of NAb in seropositive subjects. In addition, the PRNT50 assay showed a reduction of NAb titers towards different VOC in comparison to the 19A strain that could not be appreciated by the commercial tests. Despite the good correlation between the anti-spike antibody titer and the titer of NAb by PRNT50, our results highlight the difficulty to distinguish true NAb among the anti-RBD antibodies with commercial user-friendly immunoassays.

Background The association between SARS-CoV-2 commercial serological assays and virus neutralization test (VNT) has been poorly explored in mild patients with COVID-19. Methods 439 serum specimens were longitudinally collected from 76 healthcare workers with RT-PCR-confirmed COVID-19. The clinical sensitivity (determined weekly) of 9 commercial serological assays were evaluated. Clinical specificity was assessed using 69 pre-pandemic sera. Correlation, agreement, and concordance with the VNT were also assessed on a subset of 170 samples. Area under the ROC curve (AUC) was estimated at 2 neutralizing antibody titers. Results The Wantai Total Ab assay targeting the receptor binding domain (RBD) within the S protein presented the best sensitivity at different times during the course of disease. The clinical specificity was greater than 95% for all tests except for the Euroimmun IgA assay. The overall agreement with the presence of neutralizing antibodies ranged from 62.2% (95%CI; 56.0–68.1) for bioMérieux IgM to 91.2% (87.0–94.2) for Siemens. The lowest negative percent agreement (NPA) was found with the Wantai Total Ab assay (NPA 33% (21.1–48.3)). The NPA for other total Ab or IgG assays targeting the S or the RBD was 80.7% (66.7–89.7), 90.3% (78.1–96.1), and 96.8% (86.8–99.3) for Siemens, bioMérieux IgG, and DiaSorin, respectively. None of the commercial assays have sufficient performance to detect a neutralizing titer of 80 (AUC Conclusions Although some assays show a better agreement with VNT than others, the present findings emphasize that commercialized serological tests, including those targeting the RBD, cannot substitute a VNT for the assessment of functional antibody response.

We conducted a prospective study in healthcare workers (n=296) of the University Hospital of Lyon, France. Serum samples (n=296) collected six months after disease onset were tested using three commercial assays: the Wantai Ab assay detecting total antibodies against the receptor binding domain (RBD) of the S protein, the bioMerieux Vidas assay detecting IgG to the RBD and the Abbott Architect assay detecting IgG to the N protein. The neutralising antibody (NAb) titre was also determined for all samples with a virus neutralisation assay (VNA) using live virus. The positivity rate was 100% with the Wantai assay, 84.8% with the bioMerieux assay and 55.4% with the Abbott assay. Only 51% of HCWs were positive for the presence of NAb. Less than 10 % of HCWs had a NAb titre greater than 80. At a neutralising titre of 80, the area under the curves [IC 95%] was 0.71 [0.62-0.81], 0.75 [0.65-0.85] and 0.95 [0.92-0.97] for Wantai, Abbott and Vidas respectively. The data presented herein suggest that commercial assays detecting antibodies against the N protein must not be used in long-term seroprevalence surveys while the Wantai assay could be useful for this purpose. VNA should remain the gold standard to assess the protective antibody response, but some commercial assays could be used as first-line screening of long-term presence of NAb.

With the availability of vaccines, commercial assays detecting anti-SARS-CoV-2 antibodies (Ab) evolved towards quantitative assays directed to the spike glycoprotein or its receptor binding domain (RBD). The main objective of the present study was to compare the Ab titers obtained with quantitative commercial binding Ab assays, after 1 dose (convalescent individuals) or 2 doses (naïve individuals) of vaccine, in healthcare workers (HCW).Antibody titers were measured in 255 sera (from 150 HCW) with 5 quantitative immunoassays (Abbott RBD IgG II quant, bioMérieux RBD IgG, DiaSorin Trimeric spike IgG, Siemens Healthineers RBD IgG, Wantai RBD IgG). One qualitative total antibody anti RBD detection assay (Wantai) was used to detect previous infection before vaccination. The results are presented in binding Ab units (BAU)/mL after application, when possible, of a conversion factor provided by the manufacturers and established from a World Health Organization (WHO) internal standard.There was a 100% seroconversion with all assays evaluated after two doses of vaccine. With assays allowing BAU/ml correction, Ab titers were correlated (Pearson correlation coefficient, ρ, range: 0.85-0.94). The titer differences varied by a mean of 10.6% between Siemens and bioMérieux assays to 60.9% between Abbott and DiaSorin assays. These results underline the importance of BAU conversion for the comparison of Ab titer obtained with the different quantitative assays. However, significant differences persist, notably, between kits detecting Ab against the different antigens.A true standardization of the assays would be to include the International Standard in the calibration of each assays to express the results in IU/mL.

Resume Introduction Le sentiment d’efficacite personnelle a retourner au travail est un determinant psychologique majeur du retour au travail de patients diagnostiques d’un cancer. Cependant, les investigations francaises dans ce domaine ne prennent pas en compte cette dimension en raison de l’absence d’outil adapte a son evaluation. L’objectif de cette etude etait de proposer une traduction et adaptation francaise du « Return to Work Self-Efficacy’ scale – 11 items » (RTWSE-11), valide en neerlandais dans sa version originale. Methodes Apres les etapes de traduction/contre-traduction, completees par des reunions de consensus d’experts, des entretiens ont ete menes aupres de treize patients diagnostiques d’un cancer afin de mesurer le degre de clarte, simplicite et ambiguite des differents elements de la version francaise du RTWSE-11. Resultats Les principales modifications inherentes a l’adaptation francaise du RTWSE-11 ont concerne la reformulation des modalites de l’echelle de Likert et l’inversion de trois items negatifs en items positifs. Discussion La traduction et adaptation francaise du RTWSE-11 ont ete particulierement fideles aux aspects semantiques, idiomatiques, fonctionnelles, experientielles, conceptuelles et operationnelles de la version originale. Les travaux a venir pourront des lors se concentrer sur l’evaluation psychometrique du questionnaire. Toutefois, cet outil peut d’ores et deja etre utilise en pratique clinique afin d’etablir une premiere evaluation des capacites des patients diagnostiques d’un cancer a retourner au travail.

International audience; IFN-I and IFN-III immunity in the nasal mucosa is poorly characterized during SARS-CoV-2 infection. We analyze the nasal IFN-I/III signature, namely the expression of ISGF-3–dependent IFN-stimulated genes, in mildly symptomatic COVID-19 patients and show its correlation with serum IFN-α2 levels, which peak at symptom onset and return to baseline from day 10 onward. Moreover, the nasal IFN-I/III signature correlates with the nasopharyngeal viral load and is associated with the presence of infectious viruses. By contrast, we observe low nasal IFN-I/III scores despite high nasal viral loads in a subset of critically ill COVID-19 patients, which correlates with the presence of autoantibodies (auto-Abs) against IFN-I in both blood and nasopharyngeal mucosa. In addition, functional assays in a reconstituted human airway epithelium model of SARS-CoV-2 infection confirm the role of such auto-Abs in abrogating the antiviral effects of IFN-I, but not those of IFN-III. Thus, IFN-I auto-Abs may compromise not only systemic but also local antiviral IFN-I immunity at the early stages of SARS-CoV-2 infection.

Introduction Despite safety and benefits of physical activity during treatment of localised breast cancer, successful exercise strategies remain to be determined. The primary objective of the ‘dispositif connecté’, that is, connected device in English trial is to evaluate the efficacy of two 6-month exercise interventions, either single or combined, concomitant to adjuvant treatments, on the physical activity level of patients with breast cancer, compared with usual care: an exercise programme using a connected device (activity tracker, smartphone application, website) and a therapeutic patient education intervention. Secondary objectives are to evaluate adherence to interventions, their impact at 6 and 12 months, representations and acceptability of interventions, and to assess the cost-effectiveness of the interventions using quality-adjusted life-years. Methods and analysis This is a 2×2 factorial, multicentre, phase III randomised controlled trial. The study population (with written informed consent) will consist of 432 women diagnosed with primary localised invasive breast carcinoma and eligible for adjuvant chemotherapy, hormonotherapy and/or radiotherapy. They will be randomly allocated between one of four arms: (1) web-based connected device (evolving target number of daily steps and an individualised, semisupervised, adaptive programme of two walking and one muscle strengthening sessions per week in autonomy), (2) therapeutic patient education (one educational diagnosis, two collective educational sessions, one evaluation), (3) combination of both interventions and (4) control. All participants will receive the international physical activity recommendations. Assessments (baseline, 6 and 12 months) will include physical fitness tests, anthropometrics measures, body composition (CT scan, bioelectrical impedance), self-administered questionnaires (physical activity profile (Recent Physical Activity Questionnaire), quality of life (European Organization for Research and Treatment of Cancer Quality-Of-Life Questionnaire-30, EQ-5D-5L), fatigue (Piper Fatigue Scale-12), social deprivation (Evaluation of Deprivation and Inequalities in Health Examination Centres), lifestyle, physical activity barriers, occupational status) and biological parameters (blood draw). Ethics and dissemination This study was reviewed and approved by the French Ethics Committee. The findings will be disseminated to the scientific and medical community via publications in peer-reviewed journals and conference presentations. Trial registration number NCT03529383; Pre-results.

International audience; The worldwide global increase in serum 25-hydroxyvitamin D (25(OH)D) measurements has led some countries to restrict reimbursement for certain clinical situations only. Another approach could consist in providing physicians with screening tools in order to better target blood test prescription. The objective of the SCOPYD study was to identify the best combination of predictors of serum VitD concentration among adults aged 18–70 years. Potential risk factors for VitD deficiency were collected using a comprehensive self-administered questionnaire. A multivariable linear regression was used to build a predictive model of serum 25(OH)D concentration. Among 2488 participants, 1080 (43.4%) had VitD deficiency (

Introduction Smoking prevalence in the overall population in France was 27% in 2017. There are few data about smoking prevalence in hospital workers. The aim of this study was to assess prevalence of current smoking in student and staff populations at Lyon University Hospital. Secondary objectives were to identify main variables associated with current smoking and willingness to quit. Methods We designed a single center, cross-sectional survey, using printed questionnaires. During one day, all registered staff and students were surveyed. We used optical reading to extract information from questionnaires. We performed univariate and multivariate analysis adjusted on most relevant factors. Results We analyzed 9712 questionnaires. The participating rates were high: 40.6% in the student cohort and 51.5% in the staff cohort. The proportion of current cigarette users was 26% in students and 25% in staff. In multivariate analysis, current smoking was significantly associated with: younger age, male sex, occupation type (e.g. logistical staff, and paramedical students), overnight work, and e-cigarette use. Among smokers, 53% reported a willingness to quit. In multivariate analysis, number of quit attempts, and feeling symptoms from tobacco were associated with willingness to quit. Conclusions Current smoking is less frequent in our cohorts of hospital staff and students than in the general French population. However, there are deep disparities in current smoking prevalence underlining a heterogeneous population. Among smokers, the majority reported a willingness to quit and some predictive factors may help to target this audience.

International audience; OBJECTIVE: To develop guidelines for low back pain management according to previous international guidelines and the updated literature. METHODS: A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method. RESULTS: The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5. CONCLUSION: These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.

Low concentrations of type‐I interferon (IFN) in blood seem to be associated with more severe forms of Coronavirus disease 2019 (COVID‐19). However, following the type‐I interferon response (IR) in early stage disease is a major challenge. We evaluated detection of a molecular interferon signature on a FilmArray® system, which includes PCR assays for four interferon stimulated genes. We analyzed three types of patient populations: (i) children admitted to a pediatric emergency unit for fever and suspected infection, (ii) ICU‐admitted patients with severe COVID‐19, and (iii) healthcare workers with mild COVID‐19. The results were compared to the reference tools, that is, molecular signature assessed with Nanostring® and IFN‐α2 quantification by SIMOA® (Single MOlecule Array). A strong correlation was observed between the IR measured by the FilmArray®, Nanostring®, and SIMOA® platforms (r‐Spearman 0.996 and 0.838, respectively). The FilmArray® panel could be used in the COVID‐19 pandemic to evaluate the IR in 45‐min with 2 min hand‐on‐time at hospitalization and to monitor the IR in future clinical trials., The type‐I Interferon response impairment increases the risk of severe forms of viral infections (like in COVID‐19 disease). We proposed a new integrated tool allowing the fast assessment of type‐I Interferon response (based on interferon stimulated gene expression measurement) to improve patient management.

Resume Objectif Elaborer et valider une charte de partenariat entre les differents acteurs de la metropole de Lyon impliques dans la conceptualisation d’une intervention visant la reinsertion professionnelle des femmes apres un cancer du sein. Methode Cet outil de recherche collaborative a ete concu dans le cadre de la premiere etape du projet FASTRACS base sur le protocole de l’Intervention Mapping. Un comite strategique (COS) a ete constitue entre les chercheurs et les quatre categories de parties prenantes : patientes et associations, entreprises, professionnels et organisations de sante, institutions. A partir des verbatim des echanges entre les membres du COS, une analyse qualitative thematique des donnees recueillies a permis l’elaboration de propositions, ensuite validees par methode de consensus e-Delphi. Resultats La charte comportait un preambule, 9 valeurs et 4 engagements. Elle a permis d’initier et structurer le fonctionnement du COS, et d’en fideliser ses membres. Son elaboration a repondu aux besoins des differents acteurs, en termes de connaissance mutuelle, communication, et definition des roles de chacun. Discussion L’elaboration d’une charte de partenariat entre chercheurs et parties prenantes est une approche innovante dans la prevention de la desinsertion professionnelle. Elle repond aux recommandations actuelles de la recherche interventionnelle en sante des populations pour le developpement d’interventions complexes, visant a reduire les echecs dus a un defaut de theorisation du probleme et d’implantation de l’intervention. La definition d’un engagement ecrit a genere une implication concrete et authentique des la premiere phase du projet. Les retombees de cette charte seront etudiees durant les etapes suivantes de developpement, d’implantation puis d’evaluation de l’intervention du projet FASTRACS.

Background: A comprehensive assessment of COVID-19 in healthcare workers (HCWs) including the investigation of viral shedding duration is critical. Methods: A longitudinal study including 319 HCWs was conducted. After SARS-CoV-2 screening with RT-PCR assay, other respiratory pathogens were tested with a multiplex molecular panel. For SARS-CoV-2 positive HCWs, the normalized viral load was determined weekly; viral culture and virus neutralization assay were also performed. For 190 HCWs tested negative for SARS-CoV-2, serological testing was performed one month after the inclusion. Findings: Of the 319 HCWs included, 67 (21.0%) were tested positive for SARS-CoV-2; two of them developed severe COVID-19. The proportion of smell and taste dysfunction was significantly higher in SARS-CoV-2 positive HCWs than in negative ones (38.8% vs 9.5% and 37.3% vs 10.7%, respectively, p 5.0 log 10 cp/ml (Ct value 37). More than 90% of samples with cultivable virus had a viral load > 4.5 log 10 cp/ml (Ct < 26) and were collected within 10 days after symptom onset. From HCWs tested negative, 6/190 (3.2%) exhibited seroconversion for SARS-CoV-2 IgG antibodies. Interpretation: Our data suggest that the monitoring of normalized viral load (or its estimation through Ct values) can be useful for discontinuing isolation of HCWs and facilitating their safe return to work. HCWs presenting mild COVID-19 are unlikely infectious 10 days after symptom onset. Trial Registration: The clinical study registered on ClinicalTrial.gov (NCT04341142) has been fully detailed. Funding: Fondation des Hospices Civils de Lyon. bioMerieux provided diagnostic kits. Declaration of Interests: Several authors (KBP, FAF, GO, VC) are bioMerieux employees. AB has received a grant from bioMerieux and has served as consultant for bioMerieux. KBP, FAF, GO VC and AB were involved in data analysis, interpretation and wrote the article. Ethics Approval Statement: Written informed consent was obtained from all participants and approval was obtained from the national review board for biomedical research in April 2020 (Comite de Protection des Personnes Sud Mediterranee I, Marseille, France; ID RCB 2020-A00932-37).

ObjectivesWe evaluated widely-used SARS-CoV-2 serological tests and their potential association with virus neutralization test (VNT) in a cohort of mild COVID-19 patients.MethodsA total of 439 specimens were longitudinally collected from 76 healthcare workers with RT-PCR-confirmed mild COVID-19. Nine serological assays developed by leading global companies (Abbott, DiaSorin, Siemens, Bio-Rad, Wantai, bioMérieux, Euroimmun) were assessed. For each test the sensitivity to detect SARS-CoV-2 antibodies was determined weekly after symptom onset. Correlation and concordance were assessed using the Spearman and Cohen’s Kappa coefficients, respectively. Positive percent agreement and negative percent agreement (NPA) with the VNT were also determined.ResultsThe Wantai Total Ab assay targeting the receptor binding domain (RBD) within the S protein presented the best sensitivity at different times during the course of disease. The best correlation between antibody level and neutralizing antibody titer was found with the Euroimmun S1-based IgA assay (Spearman coefficient [95%CI]: 0.71 [0.61-0.79]). A moderate concordance (Kappa [95%CI]: 0.43[0.23-0.63]) as well as the lowest NPA (33%) was found between the Wantai Total Ab assay and the VNT. Compared to the Wantai Total Ab assay, other total Ab or IgG assays targeting the S or the RBD (bioMérieux, DiaSorin, Siemens,) were more concordant with the VNT (Kappa>0.7 for the three tests) and had a higher NPA (range: 90% to 97%).ConclusionsAlthough some assays presented a better concordance with VNT than others, the present findings emphasize that commercialized serological tests including those targeting the RBD cannot substitute VNT for the assessment of functional antibody response.

Les fonctions de coordinateur du retour au travail (CORAT) decrites dans la litterature scientifique et au Quebec sont assumees en France par des personnes affiliees a differentes institutions. L’assurance maladie qui indemnise les arrets de travail est bien placee pour detecter les situations a risque. Sa preoccupation pour la prevention de la desinsertion professionnelle (PDP) a donne naissance aux cellules departementales et regionales de PDP. A la lumiere d’experimentations qu’elle a menees (case management des accidents du travail graves) et de l’apparition de referentiels structurants (recommandations HAS/SFMT) elle a redefini sa strategie. De nouvelles experimentations ont ete lancees debut 2020, en partenariat avec des services de sante au travail volontaires, reposant sur des visites de pre-reprise precoce et des rencontres tripartites associant l’employeur. Elles doivent conduire a terme a generaliser des plateformes departementales pluridisciplinaires de maintien en emploi. Au sein du systeme de soins de sante, les services de readaptation affilies au reseau Comete-France ont developpe de longue date la demarche precoce d’insertion (DPI) pour accompagner les patients. Des experimentations de reseau thematique ont egalement ete conduites (reseau Lombaction, Lutter contre la douleur). Les centres de reference en pathologie professionnelle et environnementale (CRPPE) ont developpe des consultations thematiques (epilepsie, cancer, etc.) pour le maintien en emploi. Dans le champ du handicap, le reseau CAP EMPLOI-SAMETH et des associations comme l’ADAPT disposent de personnes ressources et d’offres de service pour le maintien en emploi des personnes en situation de handicap. Dans les grandes entreprises, les groupes et missions handicap associant DRH, medecins du travail et service social sont structures pour accompagner les salaries ayant des problemes de sante. Plus recemment, certains services inter-entreprises de sante au travail ont developpe leur propre cellule de maintien en emploi. Les fonctions de coordination du retour au travail sont exercees en France par des personnes de formation diverse (psychologues, ergonomes, assistantes sociales, ressources humaines, etc.), dont l’intervention depend de leur affiliation. Le contexte francais est ainsi caracterise par une multiplicite d’acteurs et d’institutions legitimes a intervenir, mais dont la variete peut compliquer l’acces des travailleurs qui pourraient en beneficier. La definition d’un referentiel de competences et d’une formation diplomante permettrait de valoriser l’exercice de ces fonctions au carrefour du monde de la sante, du travail et de la protection sociale.

International audience; This longitudinal study aimed at exploring the direct and indirect relationships between organizational, psychosocial, biomechanical, and personal factors and carpal tunnel syndrome (CTS) in French workers. Between 2002 and 2005, 3710 workers were included in the Cosali cohort. Between 2007 and 2010, 1611 workers were re-examined using the same standardized clinical protocol. Subjects free from CTS at baseline were studied (804 men and 563 women). We used structural equation models to examine the relationships between incident CTS cases and organizational (machine-paced work or work pace dependent on customers' demand), psychosocial (job strain model), biomechanical (Borg's rating perceived exertion, wrist bending, pinching, and hand-transmitted vibrations), and personal factors at baseline. Symptomatic CTS risk was directly increased by biomechanical factors (standardized coefficient = 0.19, P = 0.011), female gender (0.25, P < 0.001), and age (0.15, P = 0.042). No psychosocial factors had a direct impact on CTS, but decision authority and skill discretion had an indirect impact by influencing biomechanical exposure. Exposure to machine-paced work had an indirect impact on increasing CTS, either by raising biomechanical exposure (0.19, P < 0.001) or by lowering decision authority (-0.18, P < 0.001) and skill discretion (-0.20, P < 0.001), which in turn increased biomechanical exposure. Similar complex relationships were observed between risk factors and CTS defined by a more strict case definition. Biomechanical exposure had a direct impact on CTS, while organizational factors and psychosocial factors had an indirect impact on CTS. The findings support conceptual models linking work organization to CTS.

Objectives This study aimed to explore the views of breast cancer (BC) specialists as to their role in the return-to-work (RTW) process of their BC patients. Methods A qualitative study using semi-structured interviews was conducted in a sample of 20 BC specialists selected according to age, gender, medical specialty (medical oncology, radiation oncology, gynecological surgery), and healthcare organization (regional cancer center, university or private hospital). All interviews were audiotaped and transcribed for qualitative thematic content analysis. Results BC specialists had heterogeneous representations and practices regarding their role in their patients` RTW process, ranging from non-involvement to frequent discussion. Most BC specialists had concerns regarding the "right time and right way" to address patient`s RTW. They hardly mentioned workplace and job factors as potential barriers but rather stressed motivation. The main reported barriers to involvement in the RTW process were lack of time, lack of knowledge, lack of skills, and a professional attitude exclusively focused on cancer care issues. Conclusion While our study showed varying representations and practices among BC specialists, participants consistently identified barriers in supporting BC survivors` RTW. The results will guide the development of an intervention to facilitate the role of BC specialists in the RTW process as part of a multicomponent intervention to facilitate BC survivors` RTW.

Return to work is a public health priority which led the French Health Authority to publish recommendations about "return to work and health: prevention of exclusion from work". The aim of this article is to present a literature review of return to work after cancer. Studies about medium-term and long-term effects of cancer are sparse. They suggest worker durable effects. Factors associated with return to work are linked to the patient characteristics, to characteristics of the illness and the treatment, to the workplace and to the help provided to the patient during the return to work process. A specific plan for returning to work in 3 phases (situation comprehension, identification of negative and positive factors for returning to work, implementation of measures concerning the patient, the workplace and the coordination between return to work actors) should be built for each patient, involving the worker, the occupational practitioner, the general and specialist practitioners.

Purpose Research of employer policies and practices to manage and prevent disability spans many disciplines and perspectives, and there are many challenges related to stakeholder collaboration, data access, and interventions. The purpose of this article is to synthesize the findings from a conference and year-long collaboration among a group of invited researchers intended to spur new research innovations in this field. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The conference goals were to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. In this paper, we summarize key points from the 6 resulting papers, compare them with an earlier 2005 conference on improving return-to-work research, and conclude with recommendations for further overarching research directions. Results/Conclusion In comparison with the 2005 conference, a greater emphasis was placed on organizational and social factors, employer roles and responsibilities, methods of implementation, non-clinical approaches, and facilitating stay-at-work as well as return-to-work. A special panel of employer consultants and representatives who were featured at the 2015 conference reinforced the importance of organizational culture, leadership style, and financial decision-making strategies at the employer level. Based on the conference proceedings, we recommend that future research in this area should strive for: (a) broader inclusion of workers and workplaces; (b) attention to multilevel influences in the workplace; (c) a focus on social as well as physical aspects of work; (d) earlier employer collaboration efforts; (e) more attention to implementation factors; and (f) a broader assessment of possible outcome domains.

Introduction Common mental disorders (CMDs) and musculoskeletal disorders (MSDs) lead the list of causes for work absence in several countries. Current research is starting to look at workers on sick leave as a single population, regardless of the nature of the disease or accident. The purpose of this study is to report the validation of the Return to Work Obstacles and Self-Efficacy Scale (ROSES) for people with MSDs and CMDs, based on the disability paradigm. Methods From a prospective design, the ROSES' reliability and validity were investigated in a Canadian sample of workers on sick leave due to MSDs (n = 206) and CMDs (n = 157). Results Exploratory and confirmatory factor analyses revealed that 46 items spread out on 10 conceptual dimensions (e.g., Fears of a relapse, Job demands, Difficult relation with the immediate supervisor), with satisfactory alpha coefficients and test-retest reliability for all subscales. Finally, several dimensions of ROSES also predict the participant's RTW within 6 months for MSDs (e.g., job demands), and CMDs (e.g., difficult relation with the immediate supervisor), even when adjusted by several variables (e.g., age, severity of symptoms). Apart from the job demands dimension, when the ROSES dimension is more external to the individual, only the perception of obstacles remains significant to predict RTW whereas it is the opposite result when the dimension is more internal (e.g., fears of a relapse). Conclusion The ROSES demonstrated satisfactory results regarding its validity and reliability with people having MSDs or CMDs, at the time of the return-to-work process.

Introduction Les accidents d’exposition au sang (AES) font partie du risque biologique et representent un des accidents les plus frequents dans le monde hospitalier. Une etude a ete realisee afin de chiffrer la survenue et le niveau de declaration des AES du personnel medical hospitalo-universitaire et d’en etudier les facteurs. En parallele les risques psychosociaux associes a la survenue et la declaration des AES ont ete analyses. Methodes Un auto-questionnaire, transmis par courriel a l’ensemble du personnel medical (medecins, chirurgiens, odontologues, pharmaciens), juniors et seniors, de quatre centres hospitalo-universitaires d’une meme region francaise, a permis d’etudier la survenue sur une annee des AES, de s’assurer de la declaration en accident du travail de ceux-ci, ainsi que de rechercher les facteurs qui conditionnent celle-ci. Resultats Au niveau des 4 centres : sur les 1228 repondants, 292 rapportent avoir eu au moins un AES en 2017, representant 869 AES (seniors : 588 AES - juniors : 281 AES). Les medecins juniors cotent leur anxiete, leur fatigue et leur niveau de « conflit de valeur » comme plus importants et leur autonomie moindre par rapport aux medecins seniors. En moyenne la pression temporelle, le niveau de « conflit de valeur » sont plus eleves pour ceux ayant eu au moins un AES sur l’annee ecoulee. L’autonomie et la conciliation entre la vie personnelle et professionnelle sont en moyenne meilleures pour ceux n’ayant pas eu d’AES. En analyse univariee, une pression temporelle elevee etait significativement liee au risque de survenue d’AES, a l’inverse d’une autonomie elevee et de la faculte a concilier vies personnelle et professionnelle, facteurs protecteurs. Lors de l’analyse quantitative, le niveau de « conflit de valeur » est retrouve comme facteur de risque significativement associe a la survenue d’AES. Le taux de declaration des AES est de 18,75 %. Plus des deux tiers du personnel medical ayant eu des AES ne les declarent pas tous et plus de la moitie n’en declare aucun. Parmi les risques psychosociaux, aucun n’est associe significativement avec le fait de declarer les AES. Conclusion Les facteurs psychosociaux influent la survenue des AES mais pas leur declaration. Superieur aux donnees de la litterature, le niveau de sous declaration mis en evidence parmi le personnel medical hospitalier, pouvant etre explique par des facteurs sociodemographiques, professionnels ou encore organisationnels necessite d’analyser avec prudence le taux recense d’AES en milieu hospitalier.

Introduction A la suite de signaux d’alerte emanant des pediatres seniors (problemes de sante mentale, demissions, courrier denoncant un mal-etre), la direction a souhaite l’evaluation de leurs RPS par le service de sante au travail, puis la mise en place d’une serie d’actions preventives. Methodes Une grille d’identification developpee par une equipe canadienne a ete utilisee, qui offre des reperes pour la comprehension et la reduction des risques ayant un impact sur la sante ? Psychologique et physique. Son contenu porte sur des caracteristiques du milieu de travail et certains aspects lies aux pratiques de gestion et s’appuie sur des modeles theoriques. Les elements qualitatifs entendus lors des entretiens, ont servi de base pour le developpement par la Direction, d’un plan concret de prevention des RPS, au sein de ce CHU. L’ensemble de ce projet a ete accompagne par un comite de pilotage pluridisciplinaire (direction, medecin du travail, praticiens de terrain). Resultats Trente-quatre medecins et 3 directeurs, sans interactions hierarchiques entre eux, formant 18 groupes, ont pu s’exprimer librement. Le contexte de l‘organisation a ete juge particulierement defavorable pour les aspects de retour au travail a la suite d’un probleme de sante, et de conciliation travail et vie personnelle. En termes de pratiques de gestion, les signaux d’alerte pointaient la charge de travail, le manque de reconnaissance, les difficultes de communication. Les aspects protecteurs restaient le soutien des collegues, la latitude decisionnelle et de facon inegale, le soutien de la hierarchie. Le plan de prevention, dont les actions ont ete identifiees par les participants aux entretiens, appuye par la direction, repose sur 8 grands axes et une cinquantaine d’actions : – carriere ; – absenteisme ; – sante au travail, devoir d’alerte ; – organisation du travail (charge de travail, charge mentale) ; – qualite de vie au travail (reconnaissance) ; – management (projet de service, entretien annuel) ; – dialogue (transparence des orientations, dialogue de gestion) ; – gestion des situations de violence. Conclusion A la suite de cet audit, des pistes d’amelioration au niveau de la gestion des ressources humaines, de la communication, de la reconnaissance, de la charge de travail et de la sante au travail ont ete mises en place par la direction, les chefs de pole et de services, des acteurs de terrain. L’objectif obtenu a ete de mobiliser les acteurs de l’hopital, les faire se rencontrer et echanger autour de la question de la sante au travail et de la prevention des RPS en etablissant un dialogue constructif, afin de trouver des solutions pour depasser les difficultes et agir collectivement, face aux enjeux de sante psychologique au travail.