From occupational medicine to occupational health: evolution of the concepts / De la médecine du travail à la santé au travail : évolution des concepts

From occupational medicine to occupational health: evolution of the concepts, what current approach? The evolution of occupational medicine since 1946 shows the evolution of health at work consideration both in the companies and in the society. Directed at first towards an insurance-related approach, she becomes more and more an actor of prevention within health policies. Related to the transformation of working conditions, to increased scientific knowledge thanks to epidemiology, toxicology, ergonomics, psychodynamics at work, the application of European directives relative to the improvement of health and safety at work has been a determining factor for the evolution of the system in France, which had been set up in 2011. The implementation of the multidisciplinary teams and the recent laws consolidate the major role of "health at work" in primary prevention.

De la médecine du travail à la sante au travail : Evolution des concepts, quelle démarche actuelle ? L'évolution de la médecine du travail depuis 1946 illustre l'évolution de la prise en compte de la problématique santé-travail tant dans les entreprises que dans la société. Orientée au départ vers une approche assurantielle, elle devient de plus en plus un acteur de prévention au sein des politiques de santé. Liée à la transformation des conditions de travail, à des connaissances scientifiques accrues grâce à l'épidémiologie, la toxicologie, l'ergonomie, la psychodynamique du travail, l'application des directives européennes relatives à l'amélioration de la santé et de la sécurité au travail a été un élément déterminant pour l'évolution du système en France, mis en place en 2011. La mise en place des équipes pluridisciplinaires et les lois récentes confortent le rôle majeur de la « santé au travail ¼ en prévention primaire.

Atopic dermatitis: professional orientation.

Atopic dermatitis is often exacerbated by the working environment. In order to reduce the risk of allergy, young people must receive better medical guidance when they choose a career. This is all the more relevant for young atopic patients.

Influence of delta-aminolevulinic acid dehydratase gene polymorphism on selected lead exposure biomarkers in a cohort of ex-smelter workers.

Lead (Pb) body burden and toxicity may be influenced by genetic polymorphisms. The aim of this study was to investigate the influence of G177C delta-aminolevulinic acid dehydratase (ALAD) polymorphism (rs1800435) on selected Pb exposure biomarkers in a population of workers highly exposed to this metal in the past. A cross-sectional survey was conducted between 2007 and 2009 within the cohort of ex-employees of a smelter in the north of France that closed down in 2003. A questionnaire was completed by each participant and blood samples enabled determination of Pb levels and ALAD polymorphism. Five parameters estimating the Pb body burden and its variations were studied: last blood lead level (BLL) during activity, cumulative blood Pb index, BLL at the time of the study, and absolute and percent changes in BLL after cessation of metal exposure. Multiple regression models were used to evaluate links between ALAD polymorphism and the selected Pb exposure biomarkers. Two hundred and four men were included. At the time of inclusion, the median age was 53.5 yr. The median duration of Pb exposure was 25 yr and the median latency since end of exposure was 5.6 yr. The frequency of ALAD-2 allele was 9.3%, with 34 subjects being heterozygous (ALAD1-2) and 2 homozygous (ALAD2-2). According to genotype, there was no significant difference for any of the five selected Pb exposure biomarkers. These results lend support to the notion that ALAD polymorphism exerts no marked impact on Pb body burden.

[Dental status and related factors in an occupational health service in Northern France]. / Santé dentaire et facteurs associés dans un service de santé au travail du Nord (France).

BACKGROUND: Few data are available concerning the dental health of adults in France. This study was designed to describe dental status, oral health behaviour and factors associated with caries among workers followed by an occupational health service in Northern France. METHODS: A representative sample of workers was selected between May and July 2006. Data were collected by occupational health physicians using a questionnaire completed during a face-to-face interview and a dental examination. After descriptive analysis of the variables, two groups were defined according to the degree of caries as assessed by the Significant Caries Index. Factors associated with the degree of caries were investigated using logistic regression adjusted to age. RESULTS: 420 workers with a mean age of 34.6(±10.4) years were included. The mean DMFT (Decayed Missing Filled Teeth) score and the mean number of decayed teeth were 8.9 (± 6.5) and 1.3 (±2.8), respectively. Three independent factors associated with high caries rates were identified: level of education less than Baccalaureate (ORa = 1.85; p < 0.05), regular consumption of sweet snacks and/or sweet drinks (ORa = 2.01; p < 0.05) and a last dental visit motivated by pain or a reason other than preventive care (ORa = 1.89; p < 0.05). CONCLUSION: This study showed a high need for care and oral health education in this population of workers. More oral health education programmes should be set up in the adult working population by occupational health services.

A case study on co-exposure to a mixture of organic solvents in a Tunisian adhesive-producing company.

OBJECTIVES: to assess environmental and biological monitoring of exposure to organic solvents in a glue-manufacturing company in Sfax, Tunisia. METHODS: Exposure of volunteer workers, in the solvented glue-work-stations, in the control laboratory and in the storage rooms of the finished products, was assessed through indoor-air and urine measurements. Informed consent of the workers was obtained. RESULTS AND DISCUSSION: The exposure indexes were found with high values in the solvented workshop as well as in the control laboratory and were respectively, 8.40 and 3.12. These indexes were also correlated with hexane and toluene indoor air concentrations. As to urine, the obtained results for the 2,5-hexandione and hippuric acid, metabolites of hexane and toluene, respectively, were in accord with the indoor-air measurements, with an average of 0.46 mg/l and 1240 mg/g of creatinine. CONCLUSION: This study assessed for the first time biological exposure to organic solvents used in Tunisian adhesive industries. Although values are likely to underestimate true exposure levels, some figures exceed European and American occupational exposure guidelines.

[Job retention and health issues: an example of personalized assistance in northern France]. / Maintien au travail et maladie : un exemple d'accompagnement individualisé en région Nord.

"Santé Emploi Info Service" (Health and Employment Information Service) is a regional information service aimed at providing support and assistance to people who are struggling to perform their job effectively or to return to work as a result of a health problem. Through personalized assistance and follow-up, the service aims to help individuals to avoid professional exclusion, to provide accessible information, and to encourage networking between healthcare professionals and services specializing in job retention and vocational rehabilitation. In total, 1,392 calls have been received since the service opened in 2006, with most calls dealing with employment, income and legal matters and a range of psychological counseling issues. More than half of the proposed solutions have proved successful. The regional service (a unique initiative in France) is supported by Lille Regional Hospital and helps individuals suffering from health problems to overcome obstacles to job retention and vocational rehabilitation. The service also provides specifically-tailored information about legal procedures relating to professional integration and vocational rehabilitation.

Illicit drugs, testing, prevention and work in France: ethical and legal issues.

The use of illicit drugs in the workplace raises issues pertaining to prevention and safety and the responsibility of the various members of staff. It also brings into question the interface between work and private life. If employees are in theory responsible for their own safety and risk heavy penalties in the event of the consumption of illicit drugs in the workplace, such behaviour has to be proved. In reality, the worker can only be partially and marginally held liable, given the fact that the employer is prohibited from infringing on their rights and liberties (restrictions on the searching of their personal belongings and lockers as well as on the carrying out of breath testing and saliva testing under restrictive conditions). Employers have for their part a broader range of responsibilities and, above all, an absolute obligation to achieve specific goals in terms of health and safety resulting in the need to take action. In accordance with the International Labour Organization recommendations, European and national legislation, the employer has to implement a suitable preventive policy. However, where is the balance between prevention and repression? Very few studies have raised these issues and our aim is to precisely situate the place of drug testing in the employer's repressive arsenal in France and to try to answer the legal and ethical issues raised. Thus, for example, repression can only be acceptable when it deals with moderate and non-addicted users, or it could be tantamount to discrimination.

Factors related to return to work by women with breast cancer in northern France.

INTRODUCTION: Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France. OBJECTIVES: This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work. METHODS: 379 women with breast cancer aged 18-60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work. RESULTS: During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work. CONCLUSION: The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment.

Prevalence of psychoactive substances in truck drivers in the Nord-Pas-de-Calais region (France).

A previous study conducted in 1995 showed that psychoactive drug use by workers was higher in safety/security workstations than in the rest of the labour force. In order to verify this finding, we conducted a new study in 2003-2004 in the Nord-Pas-de-Calais region, restricted to truck drivers. The aim of this study was to allow harmonizing the professional practice of the occupational physicians, proposing drug prevention and drug testing policies, validating the analytical methods and the guidelines in case of positive testing results. One thousand truck drivers were studied. Urines were tested for amphetamines, cannabinoids, cocaine, opiates, benzodiazepines, buprenorphine and methadone by immunoassay. Urine ethanol determinations were performed by an ADH method. Positive urines for drugs of abuse, methadone or buprenorphine were then tested by gas chromatography or liquid chromatography coupled to mass spectrometry. Out of the 1000 drivers, cannabinoids were detected in 85 cases, opiates in 41 cases, amphetamines in 3 cases and cocaine in only one case. Buprenorphine was detected in 18 cases, methadone in 5 cases and benzodiazepines in 4 cases. Urine ethanol was positive in 50 cases. We found only one case with 6-monoacetylmorphine. Other positive opiates were metabolites of antitussives. The relatively low number of benzodiazepine positive urines could be explained by the lack of sensitivity of the test we used. All these results confirm those of the previous study for cannabinoids and ethanol in safety/security workstations. Positive results for methadone and buprenorphine are eight times higher than in the general population. In conclusion, the authors think that it will be of a great interest to test urine of truck drivers for other classes of psychoactive drugs, using a liquid chromatography-mass spectrometry method.

[Agricultural occupational diseases regulatory system]. / Réglementation des maladies professionelles en agriculture.

In the agricultural social security scheme, as well as in the general scheme, occupational diseases are recognized in tables referring to a presumption of origin or, on a case-by-case basis, through a supplementary plan seeking the advice of a multidisciplinary specialized committee. In agriculture, occupational diseases have their specific tables; their hazards are close to those of the general scheme but of course, tasks are adapted to the reality of agricultural exposures. The regulatory system is identical, in terms of declaration, recognition procedures and especially resort to the supplementary plan. Like farm employees, which have been covered since 1955 (publication date of the first tables in the agricultural social security scheme), farmers also receive benefit payment since 2002.

Neck, shoulder, and hand and wrist pain among administrative employees: relation to work-time organization and psychosocial factors at work.

OBJECTIVE: We sought to analyze the associations between work-time organization, psychosocial factors at work, and musculoskeletal pain of the neck, shoulders, and wrists and hands among administrative employees. METHODS: We analyzed the pain felt in a population of 762 employees during the 7 days before the survey at any of the three sites studied (multiple logistic regression). RESULTS: We found no associations between work-time organization and neck or shoulder pain. Wrist and hand pain increased with irregular schedule (odds ratio "OR" = 2.01; 95% confidence interval "95% CI" = 1.19-3.41) and lack of advance (at least 8 days) notice of schedule (OR = 1.90; 95% CI = 1.03-3.50). Of the psychosocial factors, only high psychological demand was associated with a significant increase in the prevalence of pain, in the neck and the shoulders (respectively: OR = 1.86, 95% CI = 1.23-2.82; OR = 1.88, 95% CI = 1.17-3.03). CONCLUSION: Prevention by improved psychosocial constraints at work must continue.

[Occupational dermatitis in construction and public workers]. / Dermatoses professionnelles dans le bâtiment et les travaux publics.

Construction workers perform a large variety of duties concerned with building, repairing, and wrecking buildings, bridges, dams, roads, railways and so on. The work may include mixing, pouring and spreading concrete, asphalt, gravel and other materials. Despite the increasing mechanization of construction and the more frequent use of precast concrete sections, contact with wet cement still occurs, particularly in small jobs. The work is hard physical labor, often under difficult conditions, including hot, cold, and wet weather. Occupational diseases of the skin in the construction have paralleled industrial development.

[Claim, recognition and compensation of occupational dermatitis]. / Déclaration, reconnaissance et réparation des dermatoses professionnelles.

Occupational dermatitis are very frequent with important social and economic implications. Detection of an occupational factor must be systematic because it may require prevention and a compensation may be due to the patient. The general practitioner will be assisted either by the occupational physician or by specialised services to help the patient to take the necessary administrative steps.