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Supplementary Table S1. Description of ELF levels in the most frequent jobs in low (

Background Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk. Methods Brain tumour cases (2644 gliomas, 2236 meningiomas, 1083 neuromas) diagnosed in 2000–02 were identified through hospitals in 13 countries, and 6068 controls (population-based controls in most centres) were included in the analysis. Participation across all centres was 64% for glioma cases, 78% for meningioma cases, 82% for acoustic neuroma cases and 53% for controls. Information on previous diagnostic radiological examinations was obtained by interviews, including the frequency, timing and indication for the examinations. Typical brain doses per type of examination were estimated based on the literature. Examinations within the 5 years before the index date were excluded from the dose estimation. Adjusted odds ratios were estimated using conditional logistic regression. Results No materially or consistently increased odds ratios for glioma, meningioma or acoustic neuroma were found for any specific type of examination, including computed tomography of the head and cerebral angiography. The only indication of an elevated risk was an increasing trend in risk of meningioma with the number of isotope scans, but no such trends for other examinations were observed. No gradient was found in risk with estimated brain dose. Age at exposure did not substantially modify the findings. Sensitivity analyses gave results consistent with the main analysis. Conclusions There was no consistent evidence for increased risks of brain tumours with X-ray examinations, although error from selection and recall bias cannot be completely excluded. A cautious interpretation is warranted for the observed association between isotope scans and meningioma.

We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case–control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58–0.92), hay fever (OR 0.72; CI 0.61–0.86), and eczema (OR 0.78, CI 0.64–0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87–4.63) and for meningioma (2.12; CI 1.27–3.56), but not for acoustic neuroma. This large-scale case–control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma. acceptedVersion

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

Objective: The present article identifies and assesses the effect of critical factors on the risk of motorcycle loss-of-control (LOC) crashes. Method: Data come from a French project on road crashes, which include all fatal road crashes and a random sample of 1/20th of nonfatal crashes in France in 2011, based on police reports. A case–control study was carried out on a sample of 903 crashes for 444 LOC motorcycle riders (case) and 470 non-LOC and nonresponsible motorcycle riders (control). The sample was weighted due to the randomization of nonfatal crashes. Missing values were imputed using multiple imputation. Results: Road alignment and surface conditions, human factors, and motorcycle type played important roles in motorcycle LOC crashes. Riding in a curve was associated with a 3-fold greater risk of losing control of motorcycle than riding in a straight line. Poor road adhesion significantly increased the risk of losing control; the risk increased more than 20-fold when deteriorated road adhesion was encountered unexpectedly, due to loose gravel, ice, oil, bumps, road marking, metal plates, etc. For motorcyclists, riding with a positive blood alcohol concentration (over or equal to the legal limit of 0.5 g/L) was very dangerous, often resulting in losing control. The risk of LOC crash varied for different types of motorcycle: Riders of roadsters and sports bikes were more likely to have an LOC crash greater than that of riders of basic or touring motorcycles. In addition, LOC risk increased with speed; a model using the square of the traveling speed showed better fit than one using speed itself. Conclusion: The LOC crash factors related to riders, vehicles, and road infrastructure identified here were expected but were rarely identified and taken simultaneously into account in previous studies. They could be targeted by countermeasures to improve motorcyclist safety.

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

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

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

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

Introduction La persistance d’une detresse psychique consecutive a un accident de la route a des repercussions humaines, economiques et sociales. L’objectif de notre etude est d’estimer les facteurs socioprofessionnels et medicaux associes a une detresse psychique cinq ans apres un accident corporel. Methode Six cent quatre-vingt-onze sujets sur 1168 sujets accidentes de la route participant a une etude prospective (la cohorte ESPARR) ont repondu a des questionnaires standardises a un an et cinq ans apres l’accident. L’evaluation des caracteristiques socioprofessionnelles, des sequelles physiques, des sequelles psychiques, de la douleur et de la qualite de vie percue s’est appuyee sur l’utilisation d’outils valides. Les analyses univariees ponderees en fonction du niveau de gravite puis multivariees (modele de regression logistique) ont permis de rechercher des associations significatives entre la detresse psychique cinq ans apres l’accident de la route et des facteurs medicaux et socioprofessionnels initiaux, a un an et a cinq ans de l’accident. Resultats Cent soixante-huit participants (24 %) expriment une detresse psychique cinq ans apres l’accident de la voie publique. Apres ajustement sur plusieurs facteurs, la detresse psychique a cinq ans de l’accident est associee a des facteurs socioeconomiques (genre, niveau d’etude), et a des symptomes deja observes un an apres l’accident (difficultes de concentration, symptomes d’anxiete) et a une alteration de la qualite de vie. A cinq ans de l’accident, la detresse psychique est associee a la presence de sequelles psycho-cognitives, a la presence de sequelles rachidiennes, a l’absence de retour au travail, a une insatisfaction de l’etat de sante percu, et a une alteration de la qualite de vie. Conclusion Suite a un accident de la route, la mise en œuvre d’une prise en charge medicale physique et psychique adaptee, et un reperage precoce des pathologies psychiques, pourraient contribuer a reduire la detresse psychique chronique.

Objectifs Le risque routier est la premiere cause d’accidents mortels du travail. Ces accidents lies a des vehicules diminuent moins que les autres accidents du travail et presentent une gravite particuliere. L’exposition des salaries a ce risque s’accroit en raison de l’augmentation des distances parcourues pour se rendre au travail. Dans le secteur hospitalier, les changements de l’organisation (postes de 12 h) peuvent induire une plus grande fatigue et pourraient representer un facteur de risque des accidents de trajet. Cette etude vise, d’une part, a decrire l’incidence des accidents de trajet pour l’ensemble de la population non medicale et des sages-femmes et par categories professionnelles, a suivre son evolution sur 5 annees, et d’autre part, a rechercher les facteurs de risque chez les soignants, dans le cadre de leur emploi (rythmes de travail). Methodes Une etude cas-temoins a ete realisee a partir des donnees sur les accidents de trajet extraites du logiciel de sante au travail ; les temoins ont ete tires au sort a partir du fichier du personnel (appariement sur sexe et âge). Une analyse en regression logistique conditionnelle a permis d’identifier les facteurs de risque d’accidents de trajet. Resultats Si 78 % des accidents concernent un usager de voiture, 16 % surviennent avec un deux-roues, et 4 % en tant que pieton. Le taux d’incidence moyenne est de 443 accidents pour 100 000 salaries, sans difference selon le sexe. Il varie selon le grade, allant de 234 accidents pour les infirmieres anesthesistes, de bloc et les sages-femmes a 628 accidents pour les agents de service. L’etude cas temoins (358 cas et 1280 temoins) a montre un risque accru en lien avec les km parcourus. Apres ajustement sur ce facteur, le risque est plus eleve pour les agents de service par rapport aux administratifs OR (IC95 %) : 1,9 (1,11–3,25). Les accidents surviennent plus frequemment au retour de jour de repos. Les horaires de nuit ne sont pas associes a un sur-risque d’accident. Discussion/Conclusions Pour la periode 2012–2016, le registre du Rhone des accidents de la route retrouve une incidence annuelle moyenne des victimes d’un accident de trajet toutes gravites de 127 pour 100 000, soit 3 fois moins que l’incidence moyenne dans notre population. Les differents rythmes de travail ne semblent pas associes a un risque d’accident de trajet. La distance et l’inactivite la veille sont des facteurs de risque, tout comme l’appartenance a certaines categories de personnels.

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

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

Évaluation des risques induits par le changement climatique sur la santé des travailleurs; L’Anses a été saisie le 28 octobre 2013, par la Direction générale de la santé (DGS) et la Direction générale du travail (DGT), pour réaliser une expertise sur les impacts potentiels liés au changement climatique sur la santé et la sécurité des travailleurs. Cette saisine s’inscrit dans le cadre du renforcement de la gestion des risques professionnels induits par le changement climatique, action prévue par le 1er Plan national d’adaptation au changement climatique (PNACC) présenté en juillet 2011.

We reviewed the comments on our publication sent by S.M.J. Mortazavi and would like to clarify some of the concerns from this reader, especially those due to misunderstanding of our study methods.

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

Resume Avec le developpement et le deploiement des nouvelles technologies sans fil depuis une vingtaine d’annees, un nombre croissant de systemes de communication et d’interconnexions entre objets utilisent les ondes electromagnetiques dans le domaine des radiofrequences. Ainsi, il existe de nombreuses sources de radiofrequences dans notre environnement quotidien (telephone mobile, antennes relais, Wi-Fi, etc.). Parmi celles-ci, le telephone mobile est de loin la principale source d’exposition. Concernant la question des effets sanitaires des radiofrequences, il n’est pas possible aujourd’hui d’etablir un lien de causalite entre les quelques effets biologiques decrits et d’eventuels effets sur la sante qui en resulteraient. Le risque de gliome n’est, quant a lui, pas significativement modifie par l’utilisation des telephones mobiles en population generale pour des durees d’observation de moins de 15 ans. Cependant, les donnees disponibles actuellement ne permettent pas d’exclure, parmi les utilisateurs « intensifs », une augmentation d’incidence faible des gliomes ou un risque qui se manifesterait pour des durees d’induction superieures a 15 ans. Face aux incertitudes qui entourent l’evaluation des risques lies aux radiofrequences, certaines personnes souhaitant reduire leurs expositions se dotent de dispositifs « anti-ondes ». Cependant, l’efficacite des dispositifs dits « anti-ondes » est loin d’etre etablie, leur usage pourrait meme etre contre-productif. Afin de maitriser les niveaux d’exposition aux radiofrequences, l’ANSES recommande aux utilisateurs intensifs de telephonie mobile de privilegier des telephones mobiles affichant un faible niveau de DAS et d’utiliser un kit mains-libres.

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

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

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

Introduction The International Agency for Research on Cancer classified radiofrequency (RF) electromagnetic fields (EMF) as possibly carcinogenic based on limited evidence in human studies of cell phone use and in animal experiments, while occupational evidence was found inadequate due in part to limitations in exposure assessment. This study assesses possible associations between occupational exposure to RF or intermediate frequency (IF) EMF in INTEROCC participants using novel exposure assessment methodologies. Methods A plausible index of cumulative exposure to RF and IF EMF was calculated using a source-exposure matrix and detailed interviews on work with or nearby EMF sources, both overall and in specific exposure time windows. Conditional logistic regression was used to investigate associations with glioma and meningioma risk. Results Only ~10% (n=769) of participants (n=7,330) were ever exposed to RF and ~1% (n=44) to IF EMF sources. Overall, there was no positive association between exposure to RF or IF EMF and glioma or meningioma risk, and the majority of odds ratios (ORs) were th ) for both RF electric fields and IF magnetic fields in the 1–4 year exposure time window for glioma, but were not statistically significant. Conclusions Lifetime occupational RF and IF exposures based on our index were not associated with the risk of glioma or meningioma. Further work should include more exposed participants and examine alternative exposure or dose indices such as those incorporating thresholds on biological effects or combinations of static and RF magnetic fields.

Background Brain tumouraetiology is poorly understood. Based on their ability to pass through the blood-brain barrier, it has been hypothesised that exposure to metals may increase the risk of brain cancer. Results from the few epidemiological studies on this issue are inconsistent. Methods We investigated the relationship between glioma risk and occupational exposure to five metals - lead, cadmium, nickel, chromium and iron- as well as to welding fumes, using data from the seven-country INTEROCC study. A total of 1800 incident glioma cases and 5160 controls aged 30–69 years were included in the analysis. Lifetime occupational exposure to the agents was assessed using the INTEROCC JEM, a modified version of the Finnish job exposure matrix FINJEM. Results In general, cases had a slightly higher prevalence of exposure to the various metals and welding fumes than did controls, with the prevalence of ever exposed ranging from 1.7% and 2.2% for cadmium up to 10.2% and 13.6% for iron among controls and cases, respectively. However, in multivariable logistic regression analyses, there was no association between ever exposure to any of the agents and risk of glioma with odds ratios (95% confidence intervals) ranging from 0.8 (0.7–1.0) for lead to 1.1 (0.7–1.6) for cadmium. Results were consistent across models considering cumulative exposure or duration, as well as in all sensitivity analyses conducted. Conclusions Findings from this large-scale international study provide no evidence for an association between occupational exposure to any of the metals under scrutiny or welding fumes, and risk of glioma.

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

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

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

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

Resume Contexte Ces dernieres annees, l’utilisation de plus en plus importante du telephone portable chez les adolescents et plus recemment chez les enfants, a suscite un interet considerable quant a de possibles effets sanitaires des ondes radiofrequences. L’etude MOBI-KIDS s’inscrit dans ce contexte : elle a pour objectif d’evaluer le risque potentiel de tumeur cerebrale chez l’enfant et l’adolescent lie a l’exposition aux champs electromagnetiques generes par les telephones mobiles et par d’autres sources d’exposition dans leur environnement. Methode L’etude MOBI-KIDS est une enquete epidemiologique internationale prospective de type cas/temoins. Sont consideres comme cas les sujets âges de 10 a 24 ans residant dans une des zones geographiques de l’etude et pour lesquels une tumeur cerebrale primitive incidente a ete diagnostiquee au cours de la periode d’etude. Pour chaque cas, 2 temoins apparies sur l’âge, le sexe et la zone geographique de residence sont recrutes parmi les patients hospitalises pour appendicite, pathologie frequente dans la tranche d’âge etudiee. Le recueil des donnees est realise par l’intermediaire d’un questionnaire detaille administre lors d’un entretien en face-a-face. Les releves des communications sont parallelement demandes aux operateurs avec le consentement des participants a l’etude. Discussion L’etude internationale MOBI-KIDS dans son ensemble, et notamment en France, represente une occasion unique d’analyser la relation entre le risque de tumeur cerebrale et l’exposition aux radiofrequences et aux extremement basses frequences emises par les telephones mobiles et par d’autres sources importantes d’exposition dans l’environnement des jeunes.

Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors; the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative departement of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3; 1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5; 1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5; 0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility); external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.

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

Contexte : Evaluer le comportement des dispositifs medicaux implantables actifs face a des sources emettrices de rayonnements electromagnetiques est aujourd’hui un veritable enjeu. Du fait de la multiplication des systemes de telecommunications et devant un manque de connaissances sur la mesure des effets electromagnetiques, l’objectif de cette etude est d’investiguer la realite du risque de perturbation des implants medicaux actifs par des champs electromagnetiques aupres des professionnels de sante. Methodes: une enquete par autoquestionnaire postal, adressee a pres de 5000 medecins de 5 specialites medicales (cardiologie, endocrinologie, orl, urologie et neurologie) a ete realisee. Le questionnaire a permis de recueillir l’existence et le nombre d’incidents annuels observes par les medecins, de recueillir des informations sur les conditions dans lesquelles les incidents recenses ont pu se produire ; d’identifier les sources electromagnetiques a l’origine des dysfonctionnements ; de connaitre les modes de gestion et de resolution de ces incidents. Un entretien telephonique a permis de mieux caracteriser les incidents recenses.Resultats : 1188 medecins ont accepte de participer a l’etude. 16% des medecins ont observe des dysfonctionnements d’implant : les ¾ de ces derniers evaluent la frequence des dereglements a moins d’un incident par an, essentiellement en cardiologie. Cela peut representer cependant plus d’une centaine d’incidents par an. La gravite des incidents apparait moderee (inconfort ou symptomes passagers), necessitant cependant frequemment une reprogrammation de l’implant ou plus rarement un remplacement. Cependant, quelques incidents graves ont ete signales. Les sources d’interferences electromagnetiques incriminees provenaient essentiellement de deux types d’appareils d’equipement : les systemes electroniques de securite (portiques antivol ou d’aeroports) et les appareils de rayonnements electromagnetiques utilises en medecine. Il faut noter la faible remontee des incidents au niveau des instances de sante publique, ce qui ne leur permet pas de suivre les incidents et de jouer leur role d’alerte et de surveillance.Conclusion : Meme s’il reste mineur, le risque d’interference entre champs electromagnetiques et implants medicaux est reel et implique de maintenir une vigilance. Il est plus particulierement lie aux portiques antivols ou de controles aux aeroports, mais les autres sources sont susceptibles d’etre egalement a l’origine d’incidents.

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

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

In many major cities, bicycle usage is on the increase and cycling safety is becoming a critical issue. Most of the existing studies are based on police data which understate both single-bicycle accidents as well as cyclist victims. In France, an estimation based on a road trauma database reveals that cyclists are 8 times more likely to be injured per hour spent on the road compared to motorists. To give a full picture of cycling accidents, as well as to understand how cyclist behavior interacts with other factors in causing accidents, we sur-veyed all injured cyclists in the period 2009-2011, as identified in a medical database of road trauma victims in a French territorial 'départment' (the Rhône, capital city Lyon). Using classification methods we build a typology of 17 recurring configurations of cycling collisions and single-bicycle accidents: 7 concern utilitarian riding (commuting ...), 3 concern recreational riding and 7 concern cycling as a sporting activity. A Multiple Correspondence Analysis (MCA) is then used to check the consistency of this typology, and to gain additional insight on road user behavior by projection of supplementary variables. External factors contributing to cycling accidents, such as 'bad weather' (13%) or 'riding at night' (14%), roadway configuration such as 'cycling infrastructure' (16%) or 'intersections' (25%), and cyclist behavior such as 'alcohol consumption' (5%) or 'speed' (25%) are discriminatory variables that interact in many accident configurations. This study shows how road user behavior-influences each step in the chain of events leading to an accident. In the discussion of study results, some recommendations are made to public authorities aimed at improving cyclist safety.; Dans de nombreuses villes de taille importante, l'usage du Îlo est en augmentation. le sécurité en Îlo devient donc une priorité. La plupart des études existant sur le sujet sont basées sur les données policières qui sous-estiment les accidents de Îlo survenus seuls, de même que le nombre de victimes d'accidents coroprels chez les usagers de Îlo. En France l'estimatioon de ce nombre de victimes à partir d'un Registre detraumatisés de la route donne des chiifres 8 fois plus éleÎs que les données policières pour donner une image plus complète des accidents à Îlo, et pour mieux comprendre comment les habitudes de conduite des cyclistes interagissent avec d'autres facteurs ds la survenue des accidents, nous avons envoyés un questionnaire à toutes les victimes d'accidents de Îlo enregistrées dans le Registre du Rhône sur la période 2009-2011. Nous avons construit une typologie de 17 configurations d'accidents cyclistes : 7 regroupent les accidents survenus sur un ttrajet utilitaire, 3 concernent les accidents lirs de sorties récréationnelles, et 7 concernent les accidents survenus lors d'une activité sportive. A côté des facteurs extérieurs comme le mauvais temps (13%) ou la conduite nocturne (14%), les configurations des infrastructures cyclistes (16%) ou les intersections (25%), les facteurs comportementaux comme la consommation préalable d'alcool (5%) ou la vitesse (25%) sont des variables qui interviennent ds de nombreuses configurations d'accidents cyclistes.

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

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

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

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

Background Use of cell phones has increased dramatically since 1992 when they were first introduced in France. Certain electromagnetic fields (at extremely low frequency) have been recognized as possibly carcinogenic by the International Agency for Research on Cancer. Given the use of radiofrequency technology in cell phones, the rapid increase in the number of cell phones has generated concerns about the existence of a potential health hazard. To evaluate the relationship between the use of cell phones and the development of tumors of the head, a multicentric international study (INTERPHONE), coordinated by the International Agency for Research on Cancer, was carried out in 13 countries. This publication reports the results of the French part of the INTERPHONE study. Methods INTERPHONE is a case-control study focused on tumors of the brain and central nervous system: gliomas, meningiomas and neuromas of cranial nerves. Eligible cases were men and women, residents of Paris or Lyon, aged 30–59, newly diagnosed with a first primary tumor between February 2001 and August 2003. The diagnoses were all either histologically confirmed or based upon unequivocal radiological images. Controls were matched for gender, age (± 5 years) and place of residence. They were randomly drawn from electoral rolls. Detailed information was collected for all subjects during a computer-assisted face-to-face interview. Conditional logistic regression was used to estimate the odds ratio (OR) for an association between the use of cell phones and risk of each type of cancer. Results Regular cell phone use was not associated with an increased risk of neuroma (OR = 0,92; 95% confidence interval = [0.53–1.59]), meningioma (OR = 0,74; 95% confidence interval = [0.43–1.28]) or glioma (OR = 1.15; 95% confidence interval = [0.65–2.05]). Although these results are not statistically significant, a general tendency was observed for an increased risk of glioma among the heaviest users: long-term users, heavy users, users with the largest numbers of telephones. Conclusion No significant increased risk for glioma, meningioma or neuroma was observed among cell phone users participating in Interphone. The statistical power of the study is limited, however. Our results, suggesting the possibility of an increased risk among the heaviest users, therefore need to be verified in the international INTERPHONE analyses.

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

Aim: To validate short term recall of mobile phone use within Interphone, an international collaborative case control study of tumours of the brain, acoustic nerve, and salivary glands related to mobile telephone use. Methods: Mobile phone use of 672 volunteers in 11 countries was recorded by operators or through the use of software modified phones, and compared to use recalled six months later using the Interphone study questionnaire. Agreement between recalled and actual phone use was analysed using both categorical and continuous measures of number and duration of phone calls. Results: Correlations between recalled and actual phone use were moderate to high (ranging from 0.5 to 0.8 across countries) and of the same order for number and duration of calls. The kappa statistic demonstrated fair to moderate agreement for both number and duration of calls (weighted kappa ranging from 0.20 to 0.60 across countries). On average, subjects underestimated the number of calls per month (geometric mean ratio of recalled to actual = 0.92, 95% CI 0.85 to 0.99), whereas duration of calls was overestimated (geometric mean ratio = 1.42, 95% CI 1.29 to 1.56). The ratio of recalled to actual use increased with level of use, showing underestimation in light users and overestimation in heavy users. There was substantial heterogeneity in this ratio between countries. Inter-individual variation was also large, and increased with level of use. Conclusions: Volunteer subjects recalled their recent phone use with moderate systematic error and substantial random error. This large random error can be expected to reduce the power of the Interphone study to detect an increase in risk of brain, acoustic nerve, and parotid gland tumours with increasing mobile phone use, if one exists.

Introduction:Whereas air pollutants have been measured in incinerator working areas, few studies have focused on the effects of these pollutants on the lung function of incinerator workers. In France, a study was performed among workers at two urban incinerators, aimed at identifying a link between exposure to different pollutants in incinerator plants and respiratory lung function impairments. Methods: A follow-up of lung function was carried out on 83 incinerator workers from two incinerator plants, comparing them with a group of 76 non-exposed workers recruited by the same occupational physician. Workers’ lung functions were measured during their yearly occupational medical examination, for 3 years. The American Thoracic Society quality criteria were used to control the quality of the flow–volume curves. Results: Base-line lung functions were lower among incinerator workers than among non-exposed workers. The few significant differences were indicative of obstructive symptoms. During the first year the differences observed between the two groups were close to the significant threshold value of 5% for FEF75/ PV and FEF25–75/PV. During the third year significant differences covered three parameters: FEF50/PV, FEF25–75/PV and FEF25–75/FVC. After smoking habits (pack-years), medical history of allergy or lung diseases and the examination centres had been taken into account in a linear regression, the reduction of FEF75/PV in the first year and FEF25–75/FVC in the third year was linked to exposure in incinerator plants. There was no significant association between exposure and the differences observed in the FEF25–75/PV in the first year or in the FEF50/PV and the FEF25–75/PV in the third year. Conclusion: This analysis of incinerator workers’ lung functions has identified some lung impairments among workers exposed to incinerator air pollutants compared to non-exposed workers, thus indicating possible obstructive disorders among incinerator workers. However, these impairments are moderate and in accordance with the low levels of airborne pollutants identified in a previous study.

The influence of pregnancy in multiple sclerosis has been a matter of controversy for a long time. The Pregnancy in Multiple Sclerosis (PRIMS) study was the first large prospective study which aimed to assess the possible influence of pregnancy and delivery on the clinical course of multiple sclerosis. We report here the 2-year post-partum follow-up and an analysis of clinical factors which might predict the likelihood of a relapse in the 3 months after delivery. The relapse rate in each trimester up to the end of the second year post-partum was compared with that in the pre-pregnancy year. Clinical predictors of the presence or absence of a post-partum relapse were analysed by logistic regression analysis. Using the best multivariate model, women were classified as having or not having a post-partum relapse predicted, and this was compared with the observed outcome. The results showed that, compared with the pre-pregnancy year, there was a reduction in the relapse rate during pregnancy, most marked in the third trimester, and a marked increase in the first 3 months after delivery. Thereafter, from the second trimester onwards and for the following 21 months, the annualized relapse rate fell slightly but did not differ significantly from the relapse rate recorded in the pre-pregnancy year. Despite the increased risk for the 3 months post-partum, 72% of the women did not experience any relapse during this period. Confirmed disability continued to progress steadily during the study period. Three indices, an increased relapse rate in the pre-pregnancy year, an increased relapse rate during pregnancy and a higher DSS (Kurtzke's Disability Status Scale) score at pregnancy onset, significantly correlated with the occurrence of a post-partum relapse. Neither epidural analgesia nor breast-feeding was predictive. When comparing the predicted and observed status, however, only 72% of the women were correctly classified by the multivariate model. In conclusion, the results for the second year post-partum confirm that the relapse rate remains similar to that of the pre-pregnancy year, after an increase in the first trimester following delivery. Women with greater disease activity in the year before pregnancy and during pregnancy have a higher risk of relapse in the post- partum 3 months. This is, however, not sufficient to identify in advance women with multiple sclerosis who are more likely to relapse, especially for planning therapeutic trials aiming to prevent post-partum relapses.

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

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

Associations between cellular telephone use and risk of brain tumors have been examined in a number of epidemiological studies including INTERPHONE. Although results revealed no positive associatio...

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