Occupational exposure factors for mental and behavioral disorders at work: The FOREC thesaurus.

BACKGROUND: Mental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) linked with the onset of mental and behavioral disorders. METHODS: The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker's point of view using the FOREC thesaurus. RESULTS: We recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus. CONCLUSIONS: We built the first thesaurus of "Organizational, Relational, Ethical and other Contributing Factors" (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs.

Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P).

OBJECTIVE: The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service. The aim of this work is to demonstrate the contribution of RNV3P to national health surveillance. METHODS: Data from consultations are recorded in standardised occupational health reports and coded using international or national classifications. Programmed health surveillance is carried out through annual follow-up of annual referrals to experts for pre-selected disease-exposure associations, as well as incidence estimations for the well characterised working population followed by the occupational health service. Hypotheses on new emerging diseases are generated using statistical methods employed in pharmacosurveillance and by modelling as an exposome to analyse multiple exposures. RESULTS: 58,777 occupational health reports were collected and analysed from 2001 to 2007. Referrals to the 30 university hospital centres increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling. Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products. Estimation of incidences by the occupational health services showed different patterns in different sectors of activity. The methods for detecting emerging diseases are presented and illustrated using the example of systemic sclerosis, identifying new exposures and new sectors of activity to be investigated. CONCLUSION: The RNV3P collects data from two complementary samples: 30 university hospital centres (workers or former workers) and an occupational health service (current workers). This dual approach is useful for surveillance and for hypothesis generation on new emerging disease-exposure associations.

[The National Occupational illness surveillance and Prevention Network (RNV3P) and health monitoring]. / Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P) et veille sanitaire.

The National Occupational Illness Surveillance and Prevention Network (RNV3P) established in 2002 as a network of experts from 29 university hospitals as well as occupational physicians records and monitors occupational health problems (OHPs) based on Soccupational health consultations in university hospitals in mainland France and in occupational medical health services (approximately 5000 OHPs/year for patients seen in hospital consultations). The OHP data are collected systematically according to a standardised code which is attributed based on main variables of interest: disease and co-morbidity (CIM-10), 1-5 impact codes (INRS), an occupational code (ILO) and a code for the type and domain of professional activity (NAF-93). For certain problems recorded, the clinician also reports a degree of imputance for attributing the level of certainty for the problem's relationship to the S main illness (weak, probable, strong). At present, 30,000 OHPs diagnosed and recorded in occupational illness consultation centers have been recorded in the information database and have been utilised for epidemiological surveillance. The surveillance activity of the network is carried out on two levels. First, a planned epidemiological health activity is programmed which focuses on estimating the incidence of illness--predefined problems. In a parallel fashion, research is developed to explore the tools which can be used to highlight emerging illness and develop methodologies to detect the relationships of unknown problems to the incidence of these illnesses--including those that present a communicable nature (either temporarily or over the long term), in certain professions or sectors.

[Main carcinogens and epidemiology of occupational cancers]. / Principaux cancérogènes et épidémiologie des cancers professionnels.

Recent epidemiological studies estimate that the number of occupational cancers is high, as more than 3800 and up to 7000 cases occur each year in France in men. Attribuable fraction to occupational factors varies widely from one site of cancer to another. Respiratory cancers (lung and pleura) are by far the most frequent of occupational cancers with an attributable fraction of 13 to 29% for lung cancer in men according to the international literature, and an attributable fraction of 85% for pleural mesothelioma. Previous occupational exposure to asbestos is the most frequent occupational exposure for these cancers. Many occupational agents have been identified as etiological factors of cancer for different sites. Attention should be paid to these aetiologies and primary prevention programmes should be held at work in order to avoid residual occupational exposure.