Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers.

OBJECTIVES: The aim was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low-radiation helical chest CT scan with chest radiograph for the biennial screening of bronchopulmonary cancer, according to the size of detected nodules. MATERIAL AND METHODS: The screening procedure consisted of biennial chest radiograph and monodetector chest CT scan, given to 972 individuals who had been highly exposed to asbestos. A total of 2555 screening procedures were performed. The study focuses on the 1230 screening procedures for which a 2-year follow-up period was available. RESULTS: Twenty-four cases of bronchopulmonary cancer were diagnosed. CT scan detected 20 cancers, 12 of which had not been detected by chest radiograph. Sensitivity of chest radiograph and CT scan were, respectively, 33% and 83%, lesions measuring over 2 mm in diameter being considered as suspect. The specificity of chest radiograph and CT scan were, respectively, 95% and 78%. Calculation of the differential false positive/true positive (FP/TP) ratio and the receiver operating characteristic curve, performed for both chest radiograph and CT scan, facilitated the determination of the best possible compromise between specificity and sensitivity, according to the diameter threshold applied for considering a nodule as suspect. CONCLUSIONS: Although this study confirms the superior sensitivity of chest CT scan compared with conventional chest radiograph, the associated loss in specificity leads to a recommended diameter of 5 mm as the threshold for considering non-calcified lesions as "suspect", for the surveillance of asbestos-exposed individuals.

Aerial dispersal of meticillin-resistant Staphylococcus aureus in hospital rooms by infected or colonised patients.

The aim of this study was to assess to what extent patients with meticillin-resistant Staphylococcus aureus (MRSA) at respiratory sites shed viable MRSA into the air of hospital rooms. We also evaluated whether the distance from the patient could influence the level of contamination. Air sampling was performed directly onto MRSA-selective agar in 24 hospital rooms containing patients with MRSA colonization or infection of the respiratory tract. Samplings were performed in duplicate at 0.5, 1 and 2-3 m from the patients' heads. Clinical and environmental isolates were compared using antimicrobial resistance patterns and pulsed-field gel electrophoresis. MRSA strains were isolated from 21 out of 24 rooms, in quantities varying from between 1 and 78 cfu/m3. In each of the 21 rooms, at least one of the environmental isolates was identical to a clinical isolate from the patient in that room. There was no significant difference in MRSA counts between the distance from the patient's head and the sampler. This study demonstrates that most patients with MRSA infection or colonisation of the respiratory tract shed viable MRSA into the air of their room. The results emphasise the need to study MRSA in air in more detail in order to improve infection control recommendations.

[Characteristics of patients suffering from multiple sclerosis according to professional situation]. / Caractéristiques des personnes atteintes d'une sclérose en plaques selon la situation professionnelle.

AIM: To describe the health and professional status of multiple sclerosis patients of working age and to compare a group of patients in work (group T1) with a group of unemployed patients (group T2). MATERIALS AND METHODS: A case-controlled study was performed. In the course of a specific consultation with a neurologist, demographic, medical and professional data were gathering using a questionnaire. Descriptive and comparative statistical analyses were then performed. RESULTS: A total of 76 patients were included in the study: 54 were in work (group T1) and 22 were unemployed (group T2). Hence, the employment rate was 71%, with an average time since disease onset of nine years at the time of the study. Low educational level (p=0.02), disease progression (p=0.0001), the presence of motor symptoms (p=0.01), cerebellar symptoms (p=0.02) or cognitive symptoms (p=0.03), a worse EDSS (p=0.0001) and a job requiring force (p=0.05) or manual dexterity (p=0.05) were found to be negative factors. Employment in the public sector (p=0.003) or large companies (p=0.03) were found to be protective factors. Access to the workplace was better for currently employed patients (p=0.03). CONCLUSION: This study shows that differences exist within the MS patient population according to the professional situation. It underlines the importance of clinical and demographics variables as determinants of differences in employment status. Not surprisingly, unemployed patients are more likely to have been classified as handicapped workers. Factors linked to work-induced constraints did not emerge from the survey because the questionnaire items were not appropriate for addressing this latter issue.

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.

A cross-sectional study of the health effects of work schedules on 3212 hospital workers in France: implications for the new French work schedules policy.

This study was designed to investigate the effects of work schedules on the health of hospital workers at the Assistance Publique-Hôpitaux de Paris (AP-HP). Out of 40 hospitals, 17 volunteered to participate in this study. The Standard Shiftwork Index and a questionnaire concerning physicians' work schedules were used. Ten thousand questionnaires were distributed anonymously to hospital workers between March and April 1999. Professional categories comprised head nurses, nurses, nursing auxiliaries, hospital agents, midwives and full time physicians. Departments included internal and geriatric medicine, general paediatrics, orthopaedic and general surgery, operating and emergency rooms, and anaesthesiology and intensive care units. 3250 questionnaires were returned. Demographics for the respondents were: 79.2% female, average age 38.1 +/- 9.1 years old. Eleven work schedules were identified. One fourth of the personnel had fixed morning work schedules. The highest level of job satisfaction was found in personnel working in paediatrics while dissatisfaction was strongest in the gerontology and, emergency room personnel. General Health Questionnaire (GHQ) scores were high for head nurses, operating room nurses and junior doctors as well as for personnel with rotating and flexible shifts. This study will be used to make recommendations concerning the reduction of working time for French hospital workers.

Work schedules in health care in France: very few changes between 1991 and 1998, according to national data.

It is important to know whether working time schemes offer, following the adoption of the 1990 ILO Night Work Convention, a better use of the actual knowledge in moderating the adverse effects of shiftwork for both sexes. The last two national studies on a representative sample, about working conditions in France (1991, 1998), show an increase of night work among female nursing staff. Long hours of work are becoming more common for nurses. The percentage of women health care workers not working the same number of days every week increased, with work weeks of 7 days or more. Few positive aspects exist such as a reduction in the proportion of those having to work 17 Sundays or more and a reduction of shifts beginning before 7 a.m. for female nurses. New negotiations, starting in 2001, should be an opportunity for improvements.

Nosocomial pertussis in healthcare workers from a pediatric emergency unit in France.

OBJECTIVE: After pertussis was diagnosed in July 1997 in a 55-year-old nurse (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiated to determine if other healthcare workers (HCWs) from the same unit also had pertussis. DESIGN: Interviews were conducted to assess symptoms occurring in the previous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs of the unit. The IgG response to pertussis toxin was determined using Western blot assay. SETTING: Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospital. RESULTS: There was a total of 10 (5 confirmed and 5 probable) cases of pertussis identified in this outbreak. Nine HCWs (15%) had results suggesting recent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a positive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis. CONCLUSION: Pertussis should be considered a threat to HCWs who are in contact with children. For HCWs, diagnosis of pertussis should be made on a clinical basis, giving greater importance to sensitivity of diagnosis criteria, and on early bacterial identification by culture of the organism or by polymerase chain reaction. RECOMMENDATIONS: In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provided with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with acellular pertussis vaccines warrants further investigation.

Assessment of bibliographic databases performance in information retrieval for occupational and environmental toxicology.

OBJECTIVE: To determine the efficiency of the major bibliographic databases by assessing the percentage of references among the total literature available that can be retrieved from each database. We also evaluated the best database combinations to carry out an exhaustive search. METHODS: BIOSIS, EMBASE, MEDLINE, NIOSH-TIC, and TOXLINE were searched on two topics: allergy to latex and asbestos and mesothelioma, in the title, abstract, or keywords (textwords). This search was performed for the years 1994 and 1995. All the records were classified by journal and author's name and were verified for each record whether or not it was indexed in each database. Statistical analysis was performed with chi 2 test. RESULTS: 777 articles in 510 issues were found. The efficiency of each database (percentage of articles recovered) and of combinations varied between 11% and 63% for one database and between 42% and 86% for a combination of two databases. The reasons why these differences exist between databases, and within a database, between two different subjects or two different years are reported. CONCLUSION: Firstly, it is not advisable to assert that a bibliography is complete when only one database is searched. Secondly, the efficiency of the databases may be quite different. Finally, it is suggested that the best way to be as exhaustive as possible is to search two or more databases-for example, in EMBASE and TOXLINE, or to a lesser extent EMBASE and MEDLINE. This seems to be the best compromise solution between time consumed for searching and efficiency.

[Vaccination in adults]. / Vaccination de l'adulte.

The vaccinal status of adults is not well known but there are reasons to think it is fair from satisfactory. On the occasion of far away travels or premarital or antenatal special examinations, or systematically, every medical doctor should check his patients' state of immunization, regarding the main infectious hazards. Some situations need special attention: patients suffering from chronic visceral diseases, or elderly; people traveling to endemic countries (the case of diphtheria testifies to the development of new hazards all over the world); people with special leisure activities (such as hunting or fishing), or at risk behaviours (alcohol, tobacco, or some sexual practices). The occupational health physicians have to check the conformity of the vaccinations with the law, and to convince employees and employers to invest in the vaccinal protection for what is not compulsory but medically recommended.

Blood superoxide dismutase and plasma malondialdehyde among workers exposed to asbestos.

Blood superoxide dismutase (SOD) and plasma malondialdehyde (MDA) (an indicator of lipid peroxidation [LPO]) were determined in 97 randomly selected asbestos exposed workers (age range: 25-60 years, mean duration of exposures 19.8 +/- 8.3 years) and in 42 healthy male controls. MDA, SOD, and MDA/SOD ratio in asbestos exposed workers were significantly higher than in controls. Among both the controls and exposed workers neither age nor smoking was related to SOD or MDA levels. SOD was significantly positively correlated with MDA among the exposed workers. Such correlation was not observed among the controls. SOD but not MDA was significantly positively correlated with the duration of exposure to asbestos. Mean levels of SOD or MDA in exposed workers with radiographic signs of lung fibrosis or pleural thickening did not differ significantly from those without such signs. The results confirm the possible involvement of LPO and development of anti-oxidant mechanism(s) of prolonged exposure to asbestos in humans. However, SOD seems not to be the essential anti-asbestos-induced LPO. Relation between these factors and lung fibrosis is still unclear.

Relative cardiac cost and physical, mental and psychological work load among a group of post-operative care personnel.

Continuous registration of heart rate and careful minute-by-minute observation of all physical, mental and psychological job-related events was carried out in a group of nine post-operative care personnel. The relative cardiac cost (RCC) correlated significantly with the observed work events. The magnitude of participation of physical, mental and psychological work elements in the changes in RCC varied in the investigated subjects according to the type and magnitude of the different work events. However, collective data on the group indicated that changes in RCC were related mainly to physical effort and to a lesser, albeit significant, extent to psychological reaction. The results indicate the possibility of using the heart rate in monitoring working conditions and, probably, in guiding their improvement.

Risk of spontaneous abortion among nurses handling antineoplastic drugs.

The purpose of the study was to evaluate the frequency of spontaneous abortion in two groups of women. One group consisted of women regularly involved in the preparation of cancer chemotherapy perfusions and therefore considered to be exposed to cytostatic agents; the other consisted of women not occupationally exposed to such agents. The study was carried out in four French hospitals. Four hundred and sixty-six women were involved; 534 pregnancies were described in which 139 were exposed and 357 were unexposed. The results showed that the frequency of spontaneous abortion was 26% for the exposed pregnancies and 15% in the unexposed ones (odds ratio 2.0). These results do not seem to be due either to the classic risk factors of spontaneous abortion (age, cigarette consumption during pregnancy, pregnancy order) (adjusted odds ratio 1.7) or to possible errors concerning the retrospective evaluation of prior gynecologic and obstetric history.

Low prevalence of byssinotic symptoms in 12 flax scutching mills in Normandy, France.

The concentrations of airborne dust and bacteria were determined in 12 flax scutching mills and in two milk processing plants in Normandy, France. A total of 308 of 340 flax workers and 111 of 113 milk processors volunteered to answer a respiratory questionnaire. Personal exposure to airborne dust in the scutching mills varied from 22.2 mg/m3 to 144 mg/m3 and areal concentrations from 8.92 mg/m3 to 47.1 mg/m3. The concentration of Gram negative bacteria ranged from 3970 (colony forming units) cfu/m3 to 67,900 cfu/m3 and that of total bacteria from 12,900 cfu/m3 to more than 600,000 cfu/m3. In all, 20% of the flax scutchers were found, on the basis of the questionnaire, to suffer from persistent cough and 25% from chronic phlegm production. The corresponding figures among milk processors were 3.6% and 4.5%. Unexpectedly, only 12.5% of the scutchers appeared to suffer from byssinotic symptoms even though they were heavily exposed to airborne dust and bacteria. The low prevalence of byssinosis might be due to self selection of the workforce or a relatively low concentration of the causative agent despite high airborne contamination.

Respiratory health assessment by questionnaire of 2024 workers involved in man-made mineral fiber production.

A respiratory health questionnaire was administered to the workers producing man-made mineral fibers in three glasswool and two rockwool plants in France, in order to detect adverse effects resulting from fiber exposure. The mean ages of the 2024 male participants ranged from 32 to 41 years. The standardized questionnaire was filled in by the industrial physicians: occupational history, smoking habits, respiratory symptoms (cough, phlegm, dyspnea, asthma), irritative complaints of the upper airways (nasal fossae and sinuses, pharynx and larynx) were all recorded. Multiple unconditional logistic regression was used to test for a relationship between possible explanatory variables and these symptoms. The prevalence of respiratory symptoms (cough, phlegm, dyspnea) was strongly correlated with age and increased markedly among current smokers. Having adjusted for these confounding factors, significantly elevated Odds Ratios (ORs) for cough and phlegm were observed among the workers of one plant (51% of the whole study population) who had been exposed to fibers for a long time. In the same plant, the ORs for complaints of nasal fossae and sinuses increased significantly with the duration of fiber exposure, and one elevated OR was observed for pharyngeal and laryngeal symptoms. These findings were not consistent with the results observed in the four other plants (49% of the study population), since ORs for all these symptoms were either low or not significantly increased according to the duration of fiber exposure. This lack of similarity among plants could be explained either by differences in interviewers, age, seniority and tobacco consumption, or by secular changes in the industrial processes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sero-epidemiologic study of the risk of hepatitis B among hospital staff]. / Etude séro-épidémiologique du risque d'hépatite à virus B en milieu professionnel hospitalier.

A sero-epidemiologic survey about risk of hepatitis was conducted with antibody to hepatitis B core antigen in a large hospital between 1981 and 1984. Among 2363 volunteers for vaccine in health care personnel, 285 were sero-positive (12.0%). Seropositivity increases with age and duration of employment in hospital. It is also associated with occupational category and hospital sector of activity. Using logistic regression method for analysis of risk factors, duration of employment was found as being the predominant one. Other factors included in the model were activity in pediatric wards, health care schools, intensive care units, surgical wards, medical staff and paramedics (low risk), surgeons, anesthetists and laboratory housekeepers (high risk). Nevertheless, operational target group for vaccine cannot be clearly defined. It was concluded that indications for vaccine should be extended to all health care hospital personnel.

[The relevance of chest X-rays and respiratory function tests to the assessment of occupational hazards in asbestos factory workers (author's transl)]. / Expertise de dossiers d'ouvriers d'une filature d'amiante. Place de la radiographie et de l'exploration fonctionnelle (70 cas).

The authors have analyzed the medico-legal records of 70 workers from an asbestos factory, who developed pneumoconiosis, sometimes after prolonged exposure. X-ray films were interpreted (though not without some difficulty) according to the I.L.O. classification criteria. Respiratory function tests included spirometry, gas exchange determination and blood gas measurements. There was a correlation between the duration of occupational exposure and the onset of chest lesions visible on X-ray films (pleural thickening, pulmonary fibrosis and later, pleural calcifications) and a closer correlation between these and the results of the two main respiratory function tests: vital capacity and fractional global and arterio-alveolar CO uptake coefficient (DuaCO). It appeared, however, that lung function impairment sometimes preceded radiological abnormalities, and this should be taken into consideration when assessing the financial compensation due to workers exposed to asbestos.