Documents Goldberg, Marcel 32 results

"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

"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."

"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 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."

"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."

"Objectifs - Décrire les liens entre emploi atypique et troubles dépressifs en France à partir des données de l'Enquête décennale santé 2003.
Méthode - Les données étudiéesconcernent 11 895 actifs au travail. Les symptômes dépressifs ont été mesurés par l'échelle CES-D. L'emploi atypique a été décrit par le statut d'emploi (contrat à durée limitée ou indéterminée, à son compte) et par l'expérience du temps partiel au cours de la vie professionnelle, en distinguant les temps partiels subis ou choisis.
Résultats - Les femmes occupent plus souvent un emploi atypique que les hommes, en termes de contrat à durée limitée et de temps partiel. Pour les deux sexes, le temps partiel subi est associé à une fréquence accrue de symptômes dépressifs, alors que ce n'est pas le cas pour le temps partiel choisi. Par ailleurs, le fait d'être en contrat à durée limitée est associé à la symptomatologie dépressive chez les femmes.
Discussion - Cette étude montre des liens entre les emplois atypiques et la symptomatologie dépressive. Elle souligne par ailleurs l'intérêt de distinguer le temps partiel subi et le temps partiel choisi. L'interprétation de ces résultats est cependant limitée par le caractère transversal de l'enquête."

"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."

"Objectif - Réaliser une étude de mortalité prématurée (survenant avant 65 ans) sur une cohorte constituée à partir de l'Échantillon démographique permanent de l'Insee (échantillon représentatif de la population française au 1 %), composée de 97 981 hommes, dont 12 788 s'étaient déclarés travailleurs de la construction au recensement de 1968.
Méthodes - Comparaison externe : ratios standardisés de mortalité calculés en utilisant la population générale masculine française comme référence. Comparaison interne : risques relatifs de mortalité prématurée par cause calculés pour l'ensemble des travailleurs de la construction en utilisant comme référence les 85 193 travailleurs des autres industries au recensement de 1968.
Résultats - Parmi les travailleurs de la construction, 1 908 décès ont été observés au cours de la période d'étude (1974-1999) et on observe, par comparaison externe et interne, une surmortalité significative par cancer, en particulier par cancer de l'appareil respiratoire, et par chute accidentelle, et une sous-mortalité par maladies infectieuses. L'analyse par catégorie socioprofessionnelle indique que ces résultats sont essentiellement observés chez les ouvriers.
Conclusions - En dépit du rôle possible de facteurs extraprofessionnels (alcool, tabac, alimentation) et des limites potentielles de l'étude, une surmortalité est montrée dans le secteur de la construction pour des causes attribuables à des facteurs de risque professionnels connus."

"STUDY OBJECTIVE:
Although perceived health status is an indicator widely used in epidemiological studies, its relation to various diseases is not well known. The objective of this study is to examine these relations in detail.
DESIGN - Marginal models used for a longitudinal study of the association between three health scales and 47 diseases among 12 164 men and 44 diseases among 4415 women.
SETTING:
French Gazel cohort during the period from 1991 to 1996.
MAIN RESULTS:
The general health status scale was significantly associated with 43 diseases among men, and 31 among women. Some of these significantly associated diseases were physical (for example, cancer and cerebrovascular accident) and others, psychological (for example, depression). The mental fatigue scale was more specifically associated with psychological disorders, including sleep problems, depression, and nervous diseases. Moreover, modifications in subjects' assessment of their health from one year to the next were generally associated with modifications in reported diseases.
CONCLUSION:
Although the mechanism that relates the presence of a disease to perceived health status remains in question, these results show clearly that there is a close association between these two domains that justifies the use of perceived health as a proxy for self reported diseases."