Documents Goldberg, Marcel 32 results

"Objective: To analyze the role that biomechanical strains and psychosocial work factors play in occupational class disparities in low-back pain in the GAZEL cohort.Methods: Recruited in 1989, the GAZEL cohort members were employees of the French national company in charge of energy who volunteered to enroll in an annual follow-up survey. The study population comprised 1487 men who completed questionnaires in 1996 (past occupational exposure to manual material handling, bending/twisting, and driving), 1997 (psychosocial work factors), and 2001 (low-back pain using a French version of the Nordic questionnaire for the assessment of low-back pain). Associations between low-back pain for >30 days in the preceding 12 months and social position at baseline (four categories) were described with a Cox model to determine prevalence ratios for each category. We compared adjusted and unadjusted ratios to quantify the contribution of occupational exposures.Results: The prevalence of low-back pain for >30 days was 13.6%. The prevalence of low-back pain adjusted for age was significantly higher for blue-collar workers and clerks than for managers. The number of socioeconomic disparities observed was significantly reduced when biomechanical strains were taken into account; adjusting for psychosocial factors had little impact.Conclusion: In this population, occupational exposures - especially biomechanical strains - played an important role in occupational class disparities for persistent or recurrent low-back pain."

"Objectives This study aims to estimate the association between repeated measures of occupational risk factors and the incidence of lateral epicondylitis in a large working population.Methods A total of 3710 workers in a French region were included in 2002–2005, and among them 1046 had a complete follow-up in 2007–2010. At both stages, occupational health physicians assessed the presence of lateral epicondylitis and workers self-reported their occupational exposures. Poisson models were performed to assess the incidence rate ratios (IRR) separately by sex using multiple imputed data.Results The annual incidence rate of lateral epicondylitis was estimated as 1.0 [95% confidence interval (95% CI) 0.7–1.3] per 100 workers among men and 0.9 (95% CI 0.6–1.3) among women. Workers aged >45 years had higher incidence than those aged <30 years (significant at 10%). Among men, high physical exertion combined with elbow flexion/extension or extreme wrist bending (>2 hours/day) was a risk factor, with an age-adjusted IRR of 3.2 (95% CI 1.5–6.4) for workers exposed at both questionnaires [3.3 (95% CI 1.4–7.6) among women].Conclusions This study highlights the importance of temporal dimensions for occupational risk factors on the incidence of lateral epicondylitis. Further research should evaluate the risk associated with the duration and repetition of occupational exposure on the incidence of lateral epicondylitis."

"Objective: Carpal tunnel syndrome (CTS) represents one of the most significant and costly health problems occurring in the working population. An estimation of the potential impact of CTS prevention programs in the workplace would be useful for public policy. The aim of this study was to assess the work-related population-attributable fraction (PAF) of CTS in industrial sectors and occupational categories at high risk of CTS in the general population.
Methods: All cases of CTS occurring in patients living in a French region were included prospectively between 2002–2004. Using a mailed questionnaire, we gathered medical and occupational history from 815 women and 320 men. We calculated the age-adjusted relative risks and PAF of CTS in relation to industrial sectors and occupational categories.
Results: The PAF for women was higher in lower-grade, white-collar workers (24%, 95% CI 19–29) than blue-collar workers (19%, 95% CI 15–22). The PAF was higher for the service industries sector (16%, 95% CI 8–22) than manufacturing (10%, 95% CI 7–13) or agricultural (5%, 95% CI 3–7) sectors. The PAF was high for men in blue-collar workers (50%, 95% CI 41–57) and in the construction (13%, 95% CI 9–18) and manufacturing industries (17%, 95% CI 10–23).
Conclusion: The study suggested that 5-50% of CTS cases might be avoided in the whole population if totally effective intervention programs were implemented in specific occupational categories or industrial sectors."

"Objective
Most suicides occur among individuals of working age. Risk is elevated in some occupational groups, however relations between long-term occupational trajectories and suicide are not well known. We describe career-long occupational trajectories and examine their influence on suicide.
Methods
Data come from GAZEL, a French cohort study set among employees of a large national utilities company. Occupational grade was obtained from company records from the time of hiring (1953‒1988). Group-based trajectory models were used to define occupational trajectories over a mean time period of 25.0 (standard deviation 6.5) years. Causes of mortality, coded using the International Classification of Diseases, were recorded from 1993‒2014 and studied using Cox regression models.
Results
Of the 20 452 participants included in the study, 73 died by suicide between 1993‒2014. Results suggested an increased risk of suicide [hazard ratio (HR) 2.57, 95% confidence interval (CI) 1.08–6.15] among participants with persistently low occupational grade compared to those with higher occupational grade and career development. After adjustment for all covariates, especially psychological factors, this association was reduced and no longer statistically significant (HR 2.02, 95% CI 0.82–4.95).
Conclusions
Persistently low occupational grade could be related to an elevated risk of suicide. This association partly reflects psychological and health characteristics, which can influence occupational trajectories and be reinforced by unfavorable work conditions."

"Background:
Disinfectants and cleaning products (DCPs) are important asthma risk factors among healthcare workers. However, healthcare work involves heterogenous cleaning tasks and co-exposure to many chemicals. These multidimensional aspects have rarely been considered. We aimed to identify patterns of occupational exposure to DCPs and study their associations with asthma.
Methods:
CONSTANCES is a French population-based cohort of ≈220,000 adults. Current asthma and asthma symptom score were defined by questionnaire at inclusion (2012-2021). Healthcare workers completed a supplementary questionnaire on their current/last held occupation, workplace, and cleaning activities that were used in unsupervised learning algorithms to identify occupational exposure patterns. Logistic and negative binomial regression models, adjusted for potential confounders, were used to assess associations with asthma outcomes.
Results:
In 5512 healthcare workers, four occupational exposure clusters were identified: Cluster1 (C1, 42%, reference), mainly characterized by low exposed nurses and physicians; C2 (7%), medical laboratory staff moderately exposed to common DCPs (chlorine/bleach, alcohol); C3 (41%), nursing assistants and nurses highly exposed to a few DCPs (mainly quaternary ammonium compounds); and C4 (10%), nurses and nursing assistants highly exposed to multiple DCPs (e.g., glutaraldehyde, hydrogen peroxide, and acids). Among women (n = 3734), C2 (mean score ratio [95% CI]: 1.31 [1.02; 1.68]) and C3 (1.18 [1.03; 1.36]) were associated with higher asthma symptom score, and an association was suggested between C3 and current asthma (odds ratio 1.22 [0.99; 1.51]).
Conclusion:
In a large population of healthcare workers, four DCP exposure patterns were identified, reflecting the heterogeneity of healthcare jobs. Two patterns, including one characterized by laboratory workers, were associated with greater asthma symptoms in women."

Open Access

"Objective De Quervain's disease (DQD) is a significant cause of musculoskeletal pain among workers. The aim of this study was to assess the relative importance of personal and occupational risk factors for DQD in a working population. Methods A total of 3710 workers from a French region were randomly included in the cross-sectional study between 2002–2005. There were 45 subjects with DQD (of these, 5 subjects had a bilateral condition), diagnosed by 83 trained occupational physicians performing a standardized physical examination. Individual factors and work exposure were assessed by a standardized physical and a self-administered questionnaire. Statistical associations between DQD and individual and occupational factors were analyzed using logistic regression modeling in the whole sample and among women.Results The prevalence rates of uni- or bilateral DQD for the whole, male and female working populations were 1.2% [95% confidence interval (95% CI) 0.9–1.6], 0.6% (95% CI 0.3–0.9) and 2.1% (95% CI 1.4–2.8), respectively. Personal risk factors for DQD were mainly age (1.1 for 1-year increase in age) and female gender [odds ratio (OR) 4.9, 95% CI 2.4–10.1]. Work-related factors were workpace dependent on (i) technical organization (OR 2.0, 95% CI 1.0–4.0), (ii) repeated or sustained wrist bending in extreme posture (OR 2.6, 95% CI 1.3–5.3) and (iii) repeated movements associated with the twisting or driving of screws (OR 3.4, 95% CI 1.7–7.1). No association was found with psychosocial factors. Conclusions Personal and work-related factors were associated with DQD in the working population; wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors."

"Pour répondre à une demande des pouvoirs publics concernant l'impact sanitaire de l'exposition à l'amiante contenue dans les véhicules automobiles dans la population des mécaniciens, une évaluation quantitative du risque d'apparition de cancer (cancer du poumon et mésothéliome de la plèvre) dans cette population a été effectuée. Pour réaliser cette évaluation dans le cadre du bref délai imparti un recensement des données disponibles a été effectué. La population des mécaniciens automobiles a été sélectionnée à partir des données du recensement 1999 (Insee), par classe d'âge de 5 ans, sur les secteurs d'activité (NAF) et les professions et catégories sociales (PCS) dans la population active. Les calculs de risque ont ainsi été effectués chez 242 360 hommes âgés de 16 à 60 ans exerçant le métier de mécanicien automobile. L'exposition à l'amiante des mécaniciens est essentiellement associée au travail sur les organes friables antérieurs à 1997 (freins à disque et à tambour ; garnitures d'embrayage). Les mesures d'empoussièrement disponibles correspondant aux interventions sur ces organes étaient d'une très grande variabilité. Aucune donnée caractérisant le temps consacré à ces interventions par les mécaniciens au cours d'une semaine de travail n'existait. C'est pourquoi, des profils hebdomadaires d'exposition ont été simulés à partir de différents niveaux associés aux tâches et de données issues de l'enquête SUMER 1994. Les modèles appliqués sont habituellement utilisés par les autorités sanitaires internationales pour évaluer les effets cancérogènes du chrysotile. Les scénarios d'exposition introduits dans les calculs combinent différents niveaux attachés aux tâches effectuées avec deux périodes, différentes répartitions des proportions de mécaniciens exposés et deux dates d'extinction du parc automobile. L'un des scénarios explorés est apparu comme le plus réaliste : il suppose que tous les mécaniciens ont été exposés à l'amiante, que cette exposition se situait entre 0,06 et 0,25 fibres/ml hebdomadaires en moyenne pour la période antérieure à 1997 (date d'interdiction de commercialisation de véhicules neufs contenant de l'amiante) et entre 0,01 et 0,06 pour la période allant de 1998 à 2010.
Selon ce scénario, le nombre de décès par cancer (cancer du poumon et mésothéliome) dû à l'exposition à l'amiante qui surviendraient (vie entière) dans cette population de mécaniciens serait de 604 décès d'ores et déjà "fixés" par l'exposition subie antérieurement à 2003 et inévitables, et 42 décès supplémentaires seraient constatés si aucune mesure ne venait modifier l'état du parc automobile."
(Résumé des auteurs)

"OBJECTIVES:
An epidemiological surveillance system for work-related musculoskeletal disorders (MSDs) was implemented in 2002 in France's Pays de la Loire region to assess the incidence and prevalence of MSDs in the general and working populations, identify levels of exposure to occupational risk factors and investigate the proportion of cases attributable to work exposure.
METHODS:
The program combines (1) surveillance of sentinel health events in the general population (carpal tunnel syndrome (CTS) was the sentinel event for upper limb MSDs), (2) assessment of the prevalence of the main upper limb MSDs and their risk factors in the workplace based on a network of occupational physicians and (3) registration of the notification of work-related diseases (WRDs).
RESULTS:
1168 incident cases of CTS were included over a 3 year period. The estimated incidence of CTS was 1.00 per 1000 person-years in those aged 20-59 years (0.60 in men and 1.40 in women). The incidence rate was higher in employed than unemployed persons in the year of diagnosis (0.6 per 1000 vs 0.3 in men and 1.7 vs 0.8 in women). The occupational physician network noted high prevalence rates: 11% of men and 15% of women had at least one of the six main upper limb clinically-diagnosed MSDs. The WRD survey showed that MSDs represented 65% of notified WRDs.
CONCLUSION:
The Pays de la Loire program plays a significant role in informing the authorities and the public about the state of current MSDs. It is planned to extend it to a routine national surveillance program."

"Background Father's occupational position, education and height have all been used to examine the effects of adverse early life socioeconomic circumstances on health, but it remains unknown whether they predict mortality equally well.Methods We used pooled data on 18?393 men and 7060 women from the Whitehall II and GAZEL cohorts to examine associations between early life socioeconomic circumstances and all-cause and cause-specific mortality.Results During the 20-y follow-up period, 1487 participants died. Education had a monotonic association with all mortality outcomes; the age, sex and cohort-adjusted HR for the lowest versus the highest educational group was 1.45 (95% CI 1.24 to 1.69) for all-cause mortality. There was evidence of a U-shaped association between height and all-cause, cancer and cardiovascular mortality robust to adjustment for the other indicators (HR 1.41, 95% CI 1.03 to 1.93 for those shorter than average and HR 1.36, 95% CI 0.98 to 1.88 for those taller than average for cardiovascular mortality). Greater all-cause and cancer mortality was observed in participants whose father's occupational position was manual rather than non-manual (HR 1.11, 95% CI 1.00 to 1.23 for all-cause mortality), but the risks were attenuated after adjusting for education and height.Conclusions The association between early life socioeconomic circumstances and mortality depends on the socioeconomic indicator used and the cause of death examined. Height is not a straightforward measure of early life socioeconomic circumstances as taller people do not have a health advantage for all mortality outcomes."

"The main aim of this study was the analysis of occupational lung cancer risk factors in the French national electricity and gas company (Electricite de France-Gaz de France (EDF-GDF)). A case-control survey nested in a cohort of male employees was undertaken. The study population consisted of all male staff who were active at EDF-GDF between January 1, 1978, and December 31, 1989. During this period, 310 cases of lung cancer were identified in the cancer register set up by the medical department of the company. For each case, four agematched controls who were free of cancer at the time of occurrence of the case's lung cancer were randomly selected. Occupational exposures to 21 chemical agents were assessed for each subject using a job exposure matrix. The associations between lung cancer and the different agents were estimated using conditional logistic regression analysis. After adjustment for various occupational confounding factors, the analysis showed increased lung cancer risks linked to exposure to crystalline silica (highest exposure class: odds ratio = 2.27; 95% confidence interval: 1.10, 4.68) and creosotes (highest exposure level: odds ratio = 2.14; 95% confidence interval: 1.06, 4.31), with significant dose-response relationships for both exposures."