Toxic Occupational Exposures and Membranous Nephropathy.

BACKGROUND AND OBJECTIVES: Membranous nephropathy is a rare autoimmune kidney disease whose increasing prevalence in industrialized countries pleads for the involvement of an environmental factor in the development of the disease. In addition, the predominance of men in membranous nephropathy, classically attributed to biologic or genetic differences between men and women, could also be due to different occupational exposures. To support this hypothesis, we sought to describe the toxic occupational exposures of patients with membranous nephropathy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this observational epidemiologic study, we compared the occupations and toxic occupational exposures of 100 patients with membranous nephropathy with those of the general population, consisting of two cohorts of 26,734,000 and 26,500 French workers. We then compared the characteristics of patients exposed to an occupational toxic substance with those of unexposed patients. RESULTS: Patients with membranous nephropathy worked more frequently in the construction sector than the general population (33% versus 7%, P<0.001). This difference remained significant by age and sex. They were also more frequently exposed to toxic substances, such as asbestos (16% versus 5%, P<0.001), lead (9% versus 1%, P<0.001), or organic solvents (37% versus 15%, P<0.001), than the general population. The predominance of men in the subgroup of patients occupationally exposed to toxic substances was not observed in unexposed individuals (organic solvents: 80% men versus 41%, P<0.001; asbestos: 90% men versus 55%, P=0.004). In addition, patients with phospholipase A2 receptor 1 (PLA2R1) epitope spreading were more frequently exposed to asbestos and organic solvents than patients without epitope spreading (32% versus 7%, P=0.02 and 74% versus 43%, P=0.02, respectively), with a dose-dependent effect. CONCLUSIONS: Patients with membranous nephropathy were more frequently exposed to certain occupational toxic substances, such as asbestos and organic solvents, than the general population. This occupational exposure was more frequent in men and in patients with PLA2R1 epitope spreading. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Immunopathological Analysis in a French National Cohort of Membranous Nephropathy (IHMN), NCT04326218. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_10_25_CJN02930322.mp3.

Psychological Distress and Tobacco Use Among Hospital Workers During COVID-19.

Background and Aims: This work aims to assess the impact of the COVID-19 pandemic on hospital workers' psychological parameters and attitudes toward substance use, before and during the French COVID-19 lockdown. Methods: An online survey was proposed to the staff of the University Hospital of Nice and Sainte-Marie psychiatric hospital in France from May 18 to June 6, 2020 assessing changes in daily habits, psychological distress and changes in substance use, including smoking. Results: A total of 702 respondents (80.3% female) filled out the survey. Overall, most of the workers reported increased stress, irritability, sadness, decreased motivation, and a worse quality of sleep after the beginning of the COVID-19 lockdown. Additionally, hospital workers who were more likely to use tobacco during the COVID-19 lockdown reported increased sadness (OR = 1.23, p < 0.001), loss of motivation (OR = 0.86, p < 0.05), alcohol consumption (OR = 3.12, p < 0.001), lower incomes (OR = 1.69, p < 0.05), living alone (OR = 1.77, p < 0.001) and doing less physical activity (OR = 0.36, p < 0.001). Conclusion: During the first lockdown, significant psychological changes (sadness, distress, irritability) associated with changes in tobacco use and physical activity were reported. Such results should encourage hospital leaders to implement dedicated policies to better accompany hospital workers' psychological distress.

Development and Validation of the Workplace Decisional Balance Scale for Exercise (WDBex) in a French Sample.

OBJECTIVE: Despite positive effects of physical activity programs in the workplace, an appropriate measurement instrument to capture employees' decisional balance to exercise is lacking. This study sought to develop and validate a decisional balance scale for exercise adapted to the workplace. METHODS: Four complementary studies were carried out, with a total sample of 2398 French volunteer employees, to develop a preliminary version and examine its dimensionality, temporal stability, and construct validity. RESULTS: The Workplace Decisional Balance scale for Exercise (WDBex) consists of 21 items with two subfactors, respectively composed of 12 items (facilitators) and nine items (barriers); for each subfactor, three dimensions (ie, physical, psychological, and logistic) were distinguished and presented satisfactory psychometric properties. CONCLUSIONS: This instrument constitutes a reliable and valid instrument for studying the psychosocial determinants of physical activity engagement in the workplace and for developing health promotion strategies.

Worksite Physical Activity Barriers and Facilitators: A Qualitative Study Based on the Transtheoretical Model of Change.

Background: Many of the studies on worksite physical activity (PA) have investigated either the effectiveness of PA programs for employees and the work-related outcomes or health promotion interventions to increase PA. However, studies on barriers and enabling factors for participation are scarce and have generally not been theoretically grounded. The purpose of this qualitative study was to identify worksite PA barriers and facilitators from the perspective of the transtheoretical model of change (TTM). Methods: Thirty employees (15 females and 15 males; Mage = 44.70; SD = 5.20) were recruited to participate in semi-structured interviews lasting from 60 to 90 min. Participants came from several organizations that offered PA programs and were at different exercise stages of change. They were invited to describe: (a) general information on the place of PA in their daily lives and in the workplace, and the reasons for (b) worksite PA participation or (c) non-participation. The interview transcripts were analyzed both inductively and deductively with reference to the exercise stages of change. Results: Three categories of barriers and facilitators related to physical, psychological and environmental dimensions were identified. For all exercise stages of change combined, psychological and environmental barriers were significantly more reported than physical barriers, whereas physical and psychological facilitators were more cited than environmental facilitators. Further qualitative analysis suggested that these categories differed with the exercise stage of change. At the precontemplative and contemplative stages, all types of barriers predominated (e.g., physical constraints due to the workstation, fear of management disapproval, time constraints). At the preparation stage, physical, and psychological needs emerged in relation to worksite PA (e.g., need to compensate for sedentary work, stress regulation). At the action and maintenance levels, physical, psychological, and environmental facilitators were reported (e.g., enhanced physical condition, workplace well-being, social ties). At the relapse stage, specific life changes or events broke the physically active lifestyle dynamics. Conclusion: This study identified the contribution of different types of worksite PA barriers and facilitators according to the exercise stage of change. The identified facilitators are consistent with the general TTM processes of change, while being specific to the workplace. Practical strategies are discussed.

[Physical exercise health promotion in the workplace: participative experimentation in a private company]. / Promotion de la santé par l'activité physique sur les lieux de travail : expérimentation participative dans une entreprise privée.

CONTEXT: The objective of this study was to identify collaborative processes involved in a physical activity health promotion project in companies, conducted through a participatory approach in a cross-sectoral partnership, and to estimate the preliminary effects in terms of employee health. METHODS: Action research was conducted in an industrial company comprising 240 employees over a 2-year period. This research was based on 4 criteria: description of the actors' network, the opportunities and constraints of the project, the implementation of physical activities, the participation of employees in the various activities, the impacts observed (after 3 months of activities) on physical parameters and quality of life. RESULTS: Six work groups selected two activities : muscle-development exercise and Taïchi. We evaluated muscle strengthening activity. The participation rate in the activity was 16%. A higher age, female gender and being a manager or employee rather than a worker were significantly associated with participation. A tendency towards increased physical and mental scores of SF12 was observed. We identified two major barriers: logistic and communicational. CONCLUSION: The participatory approach, based on a cross-sectoral partnership, is the determining element of the project's success in a context of local opportunities. Two factors were identified to perpetuate this dynamic and improve the system: rationalization of the structuring of the service and greater resources, particularly financial resources.