[Neighbourhood noise pollution in housing]. / Pollution sonore de voisinage dans l'habitat.

NEIGHBOURHOOD NOISE POLLUTION IN HOUSING. The discomfort caused by environmental noise in home living space is very frequently observed in our time, its consequences are underestimated. The genesis of this nuisance lies in the poor quality of buildings, which are subject to a series of regulations and obligations that are often not respected, as well as incivism and non-compliance with Public Health Code decrees governing noise emissions from various activities. Physician practitioners or specialists are sometimes solicited by their patients on the repercussions on their health and on the action to be taken to obtain a reduction of this nuisance.

GESTION DE LA POLLUTION SONORE LIÉE AU VOISINAGE. La gêne provoquée par les bruits de l'environnement dans l'espace de vie à domicile constitue une doléance fréquente en milieu urbain. Dans la genèse de ces nuisances interviennent la mauvaise qualité des constructions soumises à une série de réglementations et d'obligations souvent non respectées, et l'incivisme et le non-respect des décrets du code de la santé publique régissant les émissions sonores de diverses activités. Les médecins ou spécialistes sollicités par leurs patients doivent en connaître les conséquences cliniques, socio-comportementales et économiques souvent sous-estimées, et la conduite à tenir pour obtenir une réduction de ces nuisances.

Wellbeing and occupational risk perception among health care workers: a multicenter study in Morocco and France.

BACKGROUND: The study analyzes health care workers' (HCWs) occupational risk perception and compares exposure to occupational risk factors in Moroccan and French hospitals. METHOD: Across nine public hospitals from three Moroccan regions (north, center and south), a 49 item French questionnaire, based on the Job Content Questionnaire, and 4 occupational risks subscales, was distributed to 4746 HCWs. Internal consistency of the study was determined for each subscale. Confirmatory factor analysis was conducted on the Moroccan questionnaire. Psychosocial job demand, job decision latitude and social support scores analysis was used to isolate high strain jobs. Occupational risks and high strain perception correlation were analyzed by univariate and multivariate logistic regression. A comparative analysis between Moroccan and French (Nantes Hospitals) investigations data was performed. RESULTS: In Morocco, 2863 HCWs (60 %) answered the questionnaire (54 % women; mean age 40 years; mean work seniority 11 years; 24 % physicians; 45 % nurses). 44 % Moroccan HCWs are at high strain. Casablanca region (1.75 OR; CI: 1.34-2.28), north Morocco (1.66 OR; CI: 1.27-2.17), midwives (2.35 OR; 95 % CI 1.51-3.68), nursing aides (1.80 OR; 95 % CI: 1.09-2.95), full-time employment (1.34 OR; 95 % CI 1.06-1.68); hypnotics, sedatives use (1.48 OR; 95 % CI 1.19-1.83), analgesics use (1.40 OR; 95 % CI 1.18-1.65) were statistically associated to high strain. 44% Moroccan HCWs are at high strain versus 37 % French (Nantes) HCWs (p < 0.001). CONCLUSION: Moroccan HCWs have high strain activity. Moroccan HCWs and more Moroccan physicians are at high strain than Nantes HCWs. Moroccan and French's results showed that full time workers, midwives, workers using hypnotics, and analgesics are at high strain. Our findings underscore out the importance of implementing a risk prevention plan and even a hospital reform. Further research, with an enlarged study pool will provide more information on psychosocial risks (PSR) and HCWs' health.

Psychosocial and occupational risk perception among health care workers: a Moroccan multicenter study.

BACKGROUND: International studies on occupational risks in public hospitals are infrequent and only few researchers have focused on psychosocial stress in Moroccan Health Care Workers (HCWs). The aim of this study was to present and analyze Moroccan HCWs occupational risk perception. Across nine public hospitals from three Moroccan regions (northern, central and southern), a 49 item French questionnaire with 4 occupational risks subscales, was distributed to 4746 HCWs. This questionnaire was based on the Job Content Questionnaire. Psychosocial job demand, job decision latitude and social support scores analysis were used to isolate high strain jobs. Occupational risks and high strain perception correlation were analyzed by univariate and multivariate logistic regression. RESULTS: 2863 HCWs (60%) answered the questionnaire (54% women; mean age 40 years; mean work seniority 11 years; 24% physicians; 45% nurses). 44% of Moroccan HCWs were at high strain. High strain was strongly associated with two occupational categories: midwives (2.33 OR; CI 1.41-3.85), full-time employment (1.65 OR; CI 1.24-2.19), hypnotics and sedatives use (1.41 OR; CI 1.11-1.79), analgesics use (1.37 OR; CI 1.13-1.66). CONCLUSION: Moroccan HCWs, physicians included, perceive their job as high strain. Moroccan HCWs use of hypnotics, sedatives and analgesics is high. Risk prevention plan implementation is highly recommended.

Relevance of both individual risk factors and occupational exposure in cancer survival studies: the example of intestinal type sinonasal adenocarcinoma.

OBJECTIVES/HYPOTHESIS: Wood dust is a well-established risk factor for intestinal type sinonasal adenocarcinoma. The 5-year overall survival has varied from 20% to 80% according T1-T4 stages; 5-year survival according to histologic subtype has varied from 20% to 50%. To date, no study has evaluated whether environmental, occupational, and personal risk factors have any impact on both overall and cancer-specific survival. We aimed to determine whether exposure to carcinogenic risk factors besides wood exposure can influence the survival of patients with sinonasal ethmoid carcinoma. STUDY DESIGN: Retrospective cohort study of the association of survival data and occupational and personal carcinogenic risk factors. METHODS: All patients hospitalized for ethmoid adenocarcinoma at the Nantes University Hospital between 1988 and 2004 were included . Data concerning TNM classification, histology, type and quality of tumor resection at the macro- and microscopic level, and occupational and personal exposure to carcinogens were collected. Statistical analysis was conducted using univariate and multivariate linear regression. RESULTS: A total of 98 patients were included with a response rate of 98%. Data showed 86% of patients had been exposed to wood dust. The 5-year survival was 62%. We first identified four factors that independently influenced overall survival: diplopia (P = .0159), spread to the orbit (P = .0113), bilateral involvement (P = .0134), TNM stage (P < .001). When the analysis included all occupational environmental factors (wood dust, solvent, and metals exposure) as well as personal risk factors, the length of exposure to metals (P = .0307) and tobacco exposure (P = .0031) also were found to influence 5-year overall survival. We identified high prevalence of colon cancer (4%) and double cancer (18%). CONCLUSIONS: We showed exposure to both environmental (tobacco) and occupational (metal dust) factors could influence survival in the diagnosis of a cancer. Our study suggests that screening for colon cancer should be offered to wood dust workers. A prospective multicentric study should be necessary to confirm our results.

Occupational diseases due to cooling fluids.

Contact dermatitis to cutting fluids is a very frequent cause of occupational skin disease, with different mechanisms for those caused by irritation or allergies. The different allergens in question are many and complex. Different batteries of patch tests are available but the interpretation of the relevance of positive tests is not simple. The aim of this work is to make clearer the investigative methods and the interpretation of the relevance of the results of patch tests, for more effective prevention.

[Contribution of occupational medicine to social medicine]. / L'apport des connaissances en médecine et santé au travail a l'ensemble de la population.

Occupational medicine has always been part of social medicine, but focuses on the part of the population in paid employment. Investigations of occupational diseases have identified several toxic chemicals that can affect other sectors of society: examples include cancers due to sawdust, asbestos, benzene, as well as carcinogens, mutagens and reproductive toxins. Better knowledge of the risks posed by epoxy resins, cements, formaldehyde, lead, toluene and other chemical agents has helped to understand certain diseases in the population. Knowledge of musculoskeletal disorders due to repetitive work has been of help in other areas; gradual resumption of appropriate activity seems to be the best basic treatment. Studies of mental overload and its consequences in the workplace (suicide, depression, etc.) have implications for human relations in society as a whole. Multidisciplinary networking helps to regularly take stock of findings in occupational medicine that may be applicable to social medicine.

Evaluation of the tuberculin skin test and the interferon-gamma release assay for TB screening in French healthcare workers.

INTRODUCTION: Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-gamma Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients. METHODS: Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST >/= 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered. RESULTS: All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST >/= 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation. CONCLUSION: The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.

Gene expression profiling in sinonasal adenocarcinoma.

BACKGROUND: Sinonasal adenocarcinomas are uncommon tumors which develop in the ethmoid sinus after exposure to wood dust. Although the etiology of these tumors is well defined, very little is known about their molecular basis and no diagnostic tool exists for their early detection in high-risk workers. METHODS: To identify genes involved in this disease, we performed gene expression profiling using cancer-dedicated microarrays, on nine matched samples of sinonasal adenocarcinomas and non-tumor sinusal tissue. Microarray results were validated by quantitative RT-PCR and immunohistochemistry on two additional sets of tumors. RESULTS: Among the genes with significant differential expression we selected LGALS4, ACS5, CLU, SRI and CCT5 for further exploration. The overexpression of LGALS4, ACS5, SRI, CCT5 and the downregulation of CLU were confirmed by quantitative RT-PCR. Immunohistochemistry was performed for LGALS4 (Galectin 4), ACS5 (Acyl-CoA synthetase) and CLU (Clusterin) proteins: LGALS4 was highly up-regulated, particularly in the most differentiated tumors, while CLU was lost in all tumors. The expression of ACS5, was more heterogeneous and no correlation was observed with the tumor type. CONCLUSION: Within our microarray study in sinonasal adenocarcinoma we identified two proteins, LGALS4 and CLU, that were significantly differentially expressed in tumors compared to normal tissue. A further evaluation on a new set of tissues, including precancerous stages and low grade tumors, is necessary to evaluate the possibility of using them as diagnostic markers.

Occupational dermatitis to epoxydic and phenolic resins.

Contact dermatitis to epoxydic and phenolic resins are the most frequent contact dermatoses due to plastics, in particular in the form of airborne dermatitis. The chemical formulas of the various components of these resins and their additives are complex and the patch tests available in the trade are insufficient and often arrive at a late stage in the progress of industry, in particular in advanced technologies like aeronautical engineering, shipbuilding or the new floor and wall coverings in buildings. This article is a review of the actions to be taken with these allergies, as well as with regards to their diagnosis, prevention and medico-legal compensation.

[Occupational dermatitis in the agriculture-food industry environment]. / Dermatoses professionnelles dans le milieu agro-alimentaire.

The agricultural and food professions are those that touch agriculture, but also the restoration, the kitchens, and the employees of slaughterhouses. Various occupational skin diseases touch these salaried employees or craftsmen: eczemas or contact hives with plants or meats and fleshes of animals and all chemical substances that are added: pesticides, food additives and various preservatives. Irritation contact dermatitis or real skin burns are observed with housekeeping products imposed by the sanitary norms, increasingly powerful, but as increasingly caustic. Infectious illnesses transmitted from the animal to the man are sometimes observed especially among the breeders and employees of slaughterhouses.

[Prevention of occupational dermatitis]. / Prévention des dermatoses professionnelles.

The prevention of the occupational skin disease is essential to avoid some clinical complications and to preserve job. The suppression of the responsible factor is rarely possible at work, but when it is possible, it is efficient. The practice of real orders of prevention is the best way to proceed, writing individual and collective prevention prescriptions, which have to be very precise and adapted to every case during one sufficient time to get a good adherence of the patients. The implementation of the prevention consists of a set of advices on the prevention measures carrying on the environment, the processes or the work tools, the bad habits, and advices about the professional gestures to avoid and about the convenient information on the manner to use the means of individual prevention (gloves, protective creams and moisturizers) recommended and adapted to each work sequence.