Association of physical job demands, smoking and alcohol abuse with subsequent premature mortality: a 9-year follow-up population-based study.

This study assessed the relationships of physical job demands (PJD), smoking, and alcohol abuse, with premature mortality before age 70 (PM-70) among the working or inactive population. The sample included 4,268 subjects aged 15 or more randomly selected in north-eastern France. They completed a mailed questionnaire (birth date, sex, weight, height, job, PJD, smoking habit, alcohol abuse (Deta questionnaire)) in 1996 and were followed for mortality until 2004 (9 yr). PJD score was defined by the cumulative number of the following high job demands at work: hammer, vibrating platform, pneumatic tools, other vibrating hand tools, screwdriver, handling objects, awkward posture, tasks at heights, machine tools, pace, working on a production line, standing about and walking. The data were analyzed using the Poisson regression model. Those with PM-70 were 126 (3.81 per 1,000 person-years). The leading causes of death were cancers (46.4% in men, 57.1% in women), cardiovascular diseases (20.2% and 11.9%), suicide (9.5% and 7.1%), respiratory diseases (6.0% and 4.8%), and digestive diseases (2.4% and 4.8%). PJD3, smoker, and alcohol abuse had adjusted risk ratios of 1.71 (95% CI 1.02-2.88), 1.76 (1.08-2.88), and 2.07 (1.31-3.26) respectively for all-cause mortality. Manual workers had a risk ratio of 1.84 (1.00-3.37) compared to the higher socio-economic classes. The men had a two-fold higher mortality rate than the women; this difference became non-significant when controlling for job, PJD, smoker and alcohol abuse. For cancer mortality the factors PJD3, smoker, and alcohol abuse had adjusted risk ratios of 2.00 (1.00-3.99), 2.34 (1.19-4.63), and 2.22 (1.17-4.20), respectively. Health promotion efforts should be directed at structural measures of task redesign and they should also concern lifestyle.

Comparison of potential adjustment variables representing primary intellectual level in epidemiological studies on neurotoxicity.

BACKGROUND: Primary intellectual abilities (PIA) are a confounder in epidemiological studies on neurotoxicity. A good measure of this confounder should be independent of age as PIA is an intrinsic ability. Furthermore, as PIA is related to health endpoints, any measure of PIA should reveal this association. This study is aimed at comparing vocabulary test, diploma and age at end of schooling properties as measures of PIA in a non-exposed population of workers. METHODS: The design was a cross-sectional study of 413 non-exposed workers (203 women and 210 men) selected from a health check-up center. The effect of age on the vocabulary score was assessed using an analysis of covariance adjusted for diploma. Relationships between neuropsychological performances and vocabulary score, diploma and end of schooling age were, respectively, assessed using multiple linear regressions adjusted for age and gender. RESULTS: Vocabulary score increased significantly with age, both for men and women. The increase was 0.14 word per year for women, and 0.18 word per year for men. The explained variance of the models evaluating the relationships between age at end of schooling, diploma, vocabulary test, and neuropsychological performances was quite similar for the three measures of PIA. CONCLUSIONS: Vocabulary score was found to be age-related, even after adjustment for diploma. No difference was found between these three variables in terms of their relationship to neuropsychological endpoints. Moreover, the literature shows that vocabulary test performances are influenced by exposure to neurotoxic agents. These results suggest that vocabulary score could be of interest for participants of similar ages and similar diplomas. Otherwise, the other two variables would be better PIA measures in neurotoxicology studies.

Cancer mortality among municipal pest-control workers.

OBJECTIVES: This epidemiological study was carried out in order to investigate the hypothesis of a relationship between cancer occurrence and occupational exposure in a population of municipal pest-control workers exposed to a wide range of pesticides and other chemicals. METHODS: The study was designed as a mortality historical cohort study. The cohort comprised all subjects ever employed in a municipal pest-control service between 1979 and 1994. The follow-up period lasted from 1979 to 2000. The mortality rates of pest-control workers were compared with those of a regional population. A job exposure matrix was developed, which took into account four types of chemicals: formaldehyde, ethylene oxide, insecticides and rodenticides. RESULTS: None of the 181 subjects of the cohort, leading to 3,107 person-years, was lost to follow-up. Thirty-nine of them died, and all the causes of deaths were ascertained. The standardized mortality ratios (SMRs) for all causes of deaths and for all cancer causes were significantly greater than unity: 1.61 (1.14-2.20) and 2.24 (1.39-3.43), respectively. Non-significant excesses were observed for most cancer sites, except for lung cancer, which had a low SMR. We obtained significant excesses for cancer in workers with more than 20 years of employment [SMR = 2.42 (1.43-3.82)]. Cancer mortality tended to increase insignificantly with formaldehyde and rodenticides exposures, whereas no clear patterns were observed for ethylene oxide and insecticides. However, significant excesses were observed for the highest exposure levels of formaldehyde, insecticides and rodenticides. CONCLUSIONS: This study showed a statistically significant excess of cancer mortality in a population of municipal pest-control workers exposed to a wide variety of chemicals. These cancer sites might be related to occupational activities, since they tended to be more frequently observed when duration of employment increased.

Evaluation of the French version of EUROQUEST: a questionnaire for neurotoxic symptoms.

BACKGROUND: EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents in occupational epidemiological studies. This paper was aimed at assessing (i) the internal consistency of the French version of EUROQUEST, (ii) its sensitivity to age, educational level and exposure, (iii) and its convergent validity by examining relationships between declared symptoms and results from psychometric tests on the same mental functions. DESIGN: Data from four cross-sectional studies were selected: 180 workers exposed to toluene, mixed solvents or anaesthetic gas, and 588 non-exposed ones. The internal consistency of the questionnaire was assessed by computing Cronbach's alphas. Sensitivity to age, educational level and exposure were assessed with multiple linear regression models. Relationships between EUROQUEST scores and correspondent neuropsychological tests were assessed with Pearson's correlation coefficients. The relationships between EUROQUEST domain specific scores, age and educational level were evaluated for men and women from the Reference group. Most of the analyses were performed in men and women separately. RESULTS: The results of the Cronbach's alphas computed for each EUROQUEST domain, showed a reasonable internal consistency for the questionnaire. For both women and men, memory problems and sleep disorders increased significantly with age. A significant association between EUROQUEST scores and exposure to neurotoxic agents was found for workers exposed to anaesthetic gas only. In addition, EUROQUEST memory symptoms from the Reference population were found to be correlated with two memory neuropsychological tests, both for men and women. CONCLUSION: Our results showed a high internal consistency and a good convergent validity on assessed domains. Moreover, they showed a significant sensitivity to age, educational level and highlighted sensitivity to anaesthetic gas exposure.

Neurobehavioral disturbances arising from occupational toluene exposure.

BACKGROUND: Neurotoxicity of long-term exposure to toluene is known at higher levels than 50 ppm and is suspected at lower levels. METHODS: A cross-sectional study carried out in two printing plants on 129 blue collar workers explored such a low level exposure of toluene. With 231 samples of ambient air, toluene concentration was estimated from 0 to 18 ppm in Plant A (offset) and from 2 to 27 ppm in Plant B (heliogravure). Outside any period of acute exposure, the workers answered a self-administered questionnaire on neurotoxic symptoms, EUROQUEST, and performed six psychometric tests on a computer-assisted version of battery NES. RESULTS: After adjustment for confounders, we found significant relationships only between present exposure and Digit Span Forwards (DSF) performance (decrement is 1 digit for 40 ppm, P=0.04) and Digit Span Backwards (DSB) performance (decrement is 1 digit for 25 ppm, P=0.01). Neurotoxic symptoms were not significantly correlated with current exposure. No association was found between estimated cumulative exposure and either psychometric performances or neurotoxic symptoms. CONCLUSION: In this study, low present exposure levels to toluene were associated with decrements of memory test performances.