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1.
J Trauma Stress ; 27(4): 430-7, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25158636

ABSTRACT

Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium-term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium-term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.


Subject(s)
Accidents, Occupational/psychology , Chemical Industry , Drug Utilization/statistics & numerical data , Explosions , Mass Casualty Incidents/psychology , Psychotropic Drugs/therapeutic use , Adult , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/therapeutic use , Databases, Factual , Female , France , Humans , Hypnotics and Sedatives/therapeutic use , Longitudinal Studies , Male , Middle Aged , Sex Factors , Surveys and Questionnaires
2.
Arch Cardiovasc Dis ; 105(1): 33-9, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22369916

ABSTRACT

Besides the 'classic' cardiovascular risk factors (high blood pressure, dyslipidaemia, metabolic syndrome and diabetes), the work environment is playing an increasingly significant role in cardiovascular morbidity and mortality. Several elements contribute to the effect of the work environment: physical factors, chemical factors, shift work and psychosocial factors. The effects of psychosocial factors on the aetiology and progression of cardiovascular disease have been confirmed by several studies. Identification of these work-related psychosocial factors must be taken into account when evaluating cardiovascular risk factors, in order to ensure better prevention.


Subject(s)
Cardiovascular Diseases , Stress, Psychological/complications , Workplace/psychology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/psychology , Humans , Incidence , Risk Factors , Stress, Psychological/epidemiology , Stress, Psychological/psychology
3.
Soc Psychiatry Psychiatr Epidemiol ; 47(8): 1309-19, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22020864

ABSTRACT

OBJECTIVES: The aims of this paper were (1) to analyze the prevalence of symptoms of post-traumatic stress disorder (S-PTSD) in a population of workers 1 year after an industrial disaster; and (2) to assess the role of factors of vulnerability such as the occupational impact of a disaster and economic conditions. METHODS: A cross-sectional survey assessing the relationships between socio-occupational category, impact on employment and S-PTSD was conducted by the self-administered impact of event scale-revised. RESULTS: The prevalence of S-PTSD in workers in the peripheral zone (<3 km around the explosion site) was 12% in men and 18% in women. Factors significantly associated with S-PTSD in men were non-managerial socio-occupational category: employees (ORa = 4.3; [2.3; 7.8]), factory workers/laborers (ORa = 3.7; [1.8; 7.6]), intermediate professions (ORa = 3.3; [1.9; 5.9]), and artisans (ORa = 3; [1.3; 7.7]); and layoff (ORa = 2.6; [1.5; 4.5]) or unusable workplace after the explosion (ORa = 1.8; [1.1; 2.8]). In women, factors significantly associated with S-PTSD were the socio-occupational categories of employees and factory workers (ORa = 2.2; [1.4; 3.5]), artisans (ORa = 2.7; [1.3; 5.7]) and intermediate professions, (ORa = 1.5; [1; 2.3]) and reporting of an occupational accident (ORa = 1.5; [1.1; 2.2]). CONCLUSION: Impact on the workplace and socioeconomic conditions were associated with S-PTSD. The epidemiological approach in disaster situations needs to be improved, particularly in the social and occupational dimension when economically active populations are involved. Vulnerable subgroups, defined by occupational impact and low socioeconomic category, should be taken into account.


Subject(s)
Accidents, Occupational/psychology , Employment , Explosions/statistics & numerical data , Occupational Diseases , Stress Disorders, Post-Traumatic/epidemiology , Workplace/psychology , Accidents, Occupational/statistics & numerical data , Adult , Aged , Chemical Industry , Cross-Sectional Studies , Disasters , Female , France/epidemiology , Humans , Logistic Models , Male , Mental Health , Middle Aged , Occupational Diseases/epidemiology , Prevalence , Quality of Life/psychology , Risk Factors , Socioeconomic Factors , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires , Young Adult
4.
Soc Psychiatry Psychiatr Epidemiol ; 44(9): 784-91, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19252759

ABSTRACT

INTRODUCTION: On September 21, 2001, the AZF petrochemical factory near Toulouse (France) exploded. A cross-sectional survey of Toulouse workers took place in 2002 and then, a cohort follow-up began in 2003. The aim of this paper is to study the associations between various factors describing exposure to the disaster, and anxiety and depressive symptoms, assessed at cohort inclusion 2 years afterwards. METHODS: In 2003, 3,006 people were included in the cohort. Psychological distress was measured by the GHQ28 at inclusion. Factors related to exposure to the disaster, such as personal distance from the site, physical injury, immediate psychological symptoms, and material and social effects, came from the 2002 cross-sectional survey. The links between mental health symptoms and exposure were studied in multivariate analyses by logistic regression. RESULTS: The prevalence of psychological distress was 47% at inclusion in the cohort. It varied according to sex and occupational class: blue-collar workers and self-employed people were most highly affected. Factors such as a history of depression, injury to a close friend or family member, sick-leaves and immediate psychological symptoms were associated with psychological distress 2 years later. These associations differed according to sex. CONCLUSION: This study shows links between the industrial disaster and psychological distress 2 years afterwards. The results about risk factors differ according to sex, and identify particularly vulnerable populations. It should guide preventive interventions in such situation.


Subject(s)
Disasters/statistics & numerical data , Explosions/statistics & numerical data , Mental Disorders/epidemiology , Accidents, Occupational/psychology , Accidents, Occupational/statistics & numerical data , Adult , Chemical Industry/statistics & numerical data , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , France/epidemiology , Health Status , Humans , Longitudinal Studies , Male , Mental Disorders/diagnosis , Middle Aged , Prevalence , Quality of Life , Risk Factors , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Surveys and Questionnaires
5.
J Epidemiol Community Health ; 61(2): 103-7, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17234867

ABSTRACT

BACKGROUND: A major explosion occurred in the AZF chemical factory in Toulouse in September 2001. A comprehensive programme of epidemiological surveillance was set up. OBJECTIVES: To present an overview of the programme and discuss the methods and potential utility of post-disaster epidemiology. The programme had three objectives: (1) to analyse comprehensively the short-term and long-term effects of air, water and secondary soil pollution on health; (2) to identify health problems needing special attention; and (3) to investigate the long-term direct and indirect effects on the population's health. METHODS: The programme was organised through three committees: (1) a scientific committee, (2) an executive programme committee and (3) an institutional committee which aimed to facilitate exchanges between the epidemiologists, the regional authorities, the population and the media. As the catastrophe was an industrial disaster that had a major effect on workers and companies, and also caused severe damage to many schools and buildings all over the city, routine and ad hoc surveillance systems were used and three specific ad hoc questionnaire surveys in workers, schoolchildren and the general population were planned. RESULTS AND CONCLUSIONS: Although the routine surveillance systems had limitations, several sources provided useful information for public health decisions and were found to be concordant with ad hoc epidemiological studies. Defining a victim was central to the choice of a programme design based on an approach either to victims of the disaster or to the entire population in the surrounding region. Anticipation and preparation for such disasters are thus required.


Subject(s)
Accidents, Occupational , Chemical Industry , Data Collection , Environmental Pollution/analysis , Explosions , Public Health , Public Policy , Disaster Planning , Epidemiologic Studies , France , Hazardous Substances , Humans
6.
Intensive Care Med ; 30(1): 38-44, 2004 Jan.
Article in English | MEDLINE | ID: mdl-12923617

ABSTRACT

OBJECTIVE: To identify factors to improve the identification of brain dead patients in intensive care units (ICUs). DESIGN AND SETTING: Prospective study conducted in 79 ICUs in 54 hospitals. PATIENTS: All hospitalized patients with a Glasgow Coma Scale (GCS) score less than 8. MEASUREMENTS AND RESULTS: During the study period hospital staff completed a form for each patient with a GCS less than 8. Hospital information units provided us with statistics from the discharge forms. The characteristics of the hospitals were also recorded. We included a total of 792 patients with a GCS less than 8; 120 of these patients were diagnosed as being clinically brain dead (15.1%). These patients accounted for 11.8% of the comatose patients in ICUs, 11.7% of the deaths occurring in ICUs, and 3.3% of the deaths that occurred in the hospital during the study period. Two multivariate linear regressions were performed to predict the number of clinically brain dead patients in the ICUs. The regression analyses included causes of death or causes of coma, and hospital characteristics. The presence of a coordination team and the number of transplant coordinators were positively associated with the number of brain dead patients in both models. The number of patients carried to the ICU by a mobile emergency unit was also positively associated in the model with causes of coma. CONCLUSIONS: Increasing the number of hospital coordinators and collaboration with mobile emergency units should lead to the identification of more brain dead patients among comatose patients in ICUs.


Subject(s)
Brain Death/diagnosis , Coma/diagnosis , Coma/mortality , Critical Illness/mortality , Hospital Mortality , Patient Admission/statistics & numerical data , Causality , Cause of Death , Coma/etiology , Glasgow Coma Scale , Humans , Linear Models , Multivariate Analysis , Paris/epidemiology , Population Surveillance , Predictive Value of Tests , Prospective Studies , Respiration, Artificial/statistics & numerical data , Severity of Illness Index , Tissue Donors/statistics & numerical data , Tissue and Organ Procurement/organization & administration , Waiting Lists
7.
Hypertension ; 39(6): 1119-25, 2002 Jun.
Article in English | MEDLINE | ID: mdl-12052852

ABSTRACT

To analyze the health disparities relative to the prevalence of arterial hypertension and its therapeutic control in the active French population, in relation to occupational categories (OC), a population of 17 359 men and 12 267 women was assessed from January 1997 to April 1998. The initial phase was a cross-sectional analysis of a cohort study designed to assess the incidence of arterial hypertension in a French working population. Information was collected by the worksite physician during the annual examination. Blood pressure (BP) was measured using a validated automatic device. Among subjects with a BP > or =140/90 mm Hg, patients not treated with antihypertensive drugs were invited to have an additional BP measurement, 1 month later. Overall prevalence was 16.1% for men and 9.4% for women. Both prevalence and therapeutic control of high BP were related to OCs in this study. Prevalence of hypertension was higher and maintenance of therapeutic control lower among lower OCs. In contrast, awareness of high BP and the proportion of hypertensive subjects under current treatment were not related to OCs. Educational level and low OC were significantly related to prevalence of high BP after adjustment for obesity, excessive alcohol consumption, and sedentary lifestyle in women only. A poor BP control under treatment was related to high alcohol intake and low OC in men. In women only, however, low educational level was related to high prevalence of hypertension and poor BP control under antihypertensive treatment. Inequalities in hypertension prevalence persist, with prevalence being higher among lower OCs. Social disparities were not observed, however, in awareness of their condition among hypertensive subjects and among patients for receiving versus not receiving any treatment for hypertension. In contrast, BP control under antihypertensive treatment was lower among lower OCs.


Subject(s)
Hypertension/epidemiology , Adult , Alcohol Drinking/adverse effects , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Cohort Studies , Cross-Sectional Studies , Female , France/epidemiology , Humans , Hypertension/etiology , Hypertension/therapy , Male , Obesity/complications , Prevalence , Risk Factors , Socioeconomic Factors
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