A Case of Dilated Cardiomyopathy Associated With Chronic Toluene Exposure.

A 56-year-old woman working in a factory for the past 34 years presented with dilated cardiomyopathy of unknown etiology. She was exposed daily to toluene at work, without adequate protective equipment. A public health department investigation reported that toluene exposure among workers at her factory was more than 3 times the established limit. Toluene inhalation is associated with cases of cardiac arrhythmias, vasospasm, and cardiomyopathy. Occupational exposure to cardiotoxic substances should be investigated in patients with idiopathic cardiomyopathy. This case report highlights an association between a case of dilated cardiomyopathy and chronic exposure to toluene.

Une femme de 56 ans, employée dans une usine pendant 34 ans, a reçu un diagnostic de cardiomyopathie dilatée de cause inconnue. Au travail, elle était exposée quotidiennement au toluène, sans équipement de protection adéquat. Une enquête effectuée par le département de santé au travail de la santé publique a révélé que les travailleurs de cette usine étaient exposés à une concentration de toluène supérieure à 3 fois la limite établie. L'inhalation de toluène a déjà été associée à des cas d'arythmies cardiaques, de vasospasmes et de cardiomyopathies. La possibilité d'une exposition professionnelle à des substances cardiotoxiques devrait être examinée chez les patients atteints de cardiomyopathie idiopathique. Cet article met ainsi en évidence un cas de cardiomyopathie dilatée associé à une exposition chronique au toluène.

[Occupational medicine, witness to social evolution]. / La médecine du travail : témoin de l'évolution sociale.

Occupational medicine, witness to the industrial and economic evolution of societies, has observed over time the link between diseases and occupational exposures. Nowadays, the transformation of societies brings out new risks, modulated by technical and organizational changes, and our knowledge of their impact on health is constantly evolving. The role of the occupational physician has not changed: he must question and observe in order to know and understand. Its purpose is the same, to prevent workers from falling ill because of their work. It remains essential to pay particular attention to the search for professional factors that may have influenced the disease since the identification and management of the cause is often the best treatment.

La médecine du travail, témoin de l'évolution industrielle et économique des sociétés, s'est intéressée au fil du temps au lien entre les maladies et les expositions professionnelles. De nos jours, la transformation des sociétés fait émerger de nouveaux risques, modulés par les changements techniques et organisationnels, et nos connaissances de leurs impacts sur la santé sont en constante évolution. Le rôle du médecin du travail n'a pas changé : il doit questionner et observer pour connaître et comprendre. Son but reste le même, éviter que les travailleurs ne tombent malades à cause de leur travail. Il demeure primordial d'accorder une attention particulière à la recherche de facteurs professionnels ayant pu influencer la maladie puisque l'identification et la gestion de la cause représentent bien souvent le meilleur traitement.

Multi-exposures to suspected endocrine disruptors in electronic waste recycling workers: Associations with thyroid and reproductive hormones.

Electronic waste recycling (e-recycling) exposes workers to substances such as flame retardants and metals. Some of them are known or suspected endocrine disruptors that could affect hormonal homeostasis and eventually result in adverse health outcomes. Our aim was to measure biological concentrations of organophosphate ester (OPE) metabolites, polybrominated diphenyl ethers (PBDEs), mercury, lead and cadmium in e-recycling workers, and to explore associations with thyroid and sexual hormones. In a cross-sectional study, end-of-shift blood and urine spot samples were collected from 23 women and 77 men in six e-recycling facilities and one commercial recycling facility. Urinary concentrations of 15 OPE metabolites and mercury, and blood concentrations of 12 PBDE congeners, lead, cadmium, and thyroid (thyroxine [T4], triiodothyronine [T3], thyroid stimulating hormone [TSH]) and sexual (testosterone [T], estradiol, Follicle Stimulating Hormone [FSH], Luteinizing hormone [LH]) hormones were measured. E-recycling workers had higher concentrations of BDE209, all OPE metabolites, and lead than commercial recycling workers. In e-recycling workers, plasma geometric mean concentration of BDE209 was 18 ng/g lipids (geometric standard deviation [GSD]: 2.8) vs.1.7 ng/g lipids (GSD: 2.8) in commercial recycling, and urinary geometric mean concentration of diphenyl phosphate (DPhP), a major metabolite of triphenyl phosphate, was 1.7 ng/ml (GSD: 2.5), vs. 0.95 ng/ml (GSD: 2.0). In men, a two-fold increase in BDE209 was associated with 3.1% (95% Confidence interval: 0.07, 6.1) higher levels of total T4, and a two-fold increase in tert-butyl diphenyl phosphate (tb-DPhP) was associated with 18% (-29, -4.7) lower total T, 18% (-27, -6.9) lower free T and 13% (-25, 0.70) lower free T/estradiol ratio. In women, a two-fold increase in BDE153 was associated with 10% (-17, -3.2) lower free T3. To our knowledge, this is the first study to show associations between OPE metabolites and sex hormones in adults. Although some of our results are not conclusive and need replication, they suggest that prudent avoidance should be applied in risk management of flame retardants.

Ethics and the compensation of immigrant workers for work-related injuries and illnesses.

This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers (n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees' compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers' claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers.