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The establishment of causal relationship between a previous exposure and a disease is based on medical and scientific data. In France, three procedures operate for the recognition and the compensation of the diseases related to occupational exposure, to asbestos and to nuclear weapons tests. A suspicion of link is enough for the victim to initiate proceedings. The physician of each patient had to identify the exposure that could further the occurrence of their disease, to advise and to make the social allocations easier, and to certify the disease but not the link or exposure.

sick-leave in the course of pregnancy play a role under estimated according to several studies.They bring to light the existence of risk factors concerning the physical load for contractions, sick-leave, hospitalizations and prematurity.The data obtained on the totality of the wage earners of the AP-HP allow to avoid all the possible bias and to determine the potential impact of a policy of reduction of the physical loadThe data of four years could be analyzed.The used database is PILOT RH, intranet application restoring information extracted from GIPSIE who was until 2008 the institutional software of management of the careers of all the workers of the AP-HP.In 2008,3 937 women having had a maternity leave (ML) accumulated 132 360 days of ordinary sick-leave (OL) (that is 33,6 days on average) without inclusion of the 15 days accepted for "pathological pregnancy" (PP) and "post pregnancy leave". Ordinary sick-leave of all the 53 132 women amounts to 11.5 days by agent. But, the set apart of the women having had a ML reduces the number of days of sick-leave to 9,7 days This difference weighs for 15.6 % of the total of the absenteeism OL. The results are similar on the four years. The analysis by occupational catégory, for 2008, shows that the average number of days of sick-leave, after exclusion of women having had a ML, decreases with the physical load of the posts estimated by the study PRESST-NEXT :ancillary staff 19.9 days, nursing aids 13.7 days, registered nurses 8.2 days, specialized nurses 7.7 days, medico - technical workers 5.7 days and head nurses 5.1 days. For the women having had a ML, the average number of days of ordinary sick-leave, is the most raised for nursing aids (41.9 days) followed by the ancillary staff (36 days) and the registered nurses (36 days) and slightly less for the specialized nurses (28.3 days). On the other hand, in the professions having least physical load the women have less than 25 days of ordinary sick-leave the year of their pregnancy :medico-technical workers 21.3 days, head nurses 23.1 days and administration staff 23.7 days.The results are similar on the four years. For the nurses, it is 25.5% of total ordinary sick-leave that are attributable to the women having had a pregnancy, and 34.4 % if we add OL and 15 days of official "pathological pregnancy".An intervention to reduce the physical load in test hospitals could be led.The reduction of sick-leave in the course of pregnancy can be a fast indicator of evaluation of the efficiency of the investments. The improvements will benefit to all the agents, in the medium term, with a reduction of the risks of musculoskeletal disorders. Such an action also allows to maintain the employability of the older employees and to integrate) persons into situation of handicap in a work which has for them a strong sense and which they do not want to give up.

Hand is frequently the site of work accidents or occupational diseases. The musculoskeletal upper limb is the first recognized occupational disease and carpal tunnel syndrome is the most common of them. The most common location of occupational dermatoses is the hand. Their causes are often multifactorial, involving chemical irritants, physical, allergens and endogenous factors (mainly atopic dermatitis). Occupational exposure to microtrauma and iterative use of vibrating tools may also be the cause of hypothenar hammer syndrome and acrosyndromes. The frequent chronicity and functional impairment induced by these attacks can cause lasting disabilities, an inability to source workstation. Occupational physician is a focal point for helping to maintain the position and the prevention of socioprofessional disinsertion. Many pathologies of the hand related to professional activity may benefit from a statement in occupational disease and thus allow the patient to obtain compensation and employment protection. Prevention of occupational hand diseases should be made by all health actors, especially in occupations and industries at risk.

Resume Objectifs Depuis une decennie, le deficit en medecins du travail a incite les pouvoirs publics a multiplier les voies de formation au metier de medecin du travail. Les enseignants de medecine du travail ont observe un effet secondaire de ce dispositif sous la forme d′une reorientation de certains internes a l′issue de leur formation vers d′autres specialites. L′objectif de cette etude etait de dresser un bilan de ce dernier phenomene et d′obtenir l′avis des anciens internes sur leur formation. Methode Un questionnaire portant sur la formation recue et l′exercice professionnel actuel a ete adresse a 338 internes ayant obtenu le diplome d′etudes specialisees (DES) de medecine du travail en 2002, 2003, 2004 dans chacune des regions de France. Resultats Au total, 253 reponses ont ete obtenues (taux de reponse de 75 %). Les medecins, dans leur grande majorite, etaient satisfaits de leurs conditions d′exercice, mais 9 % des anciens internes avaient quitte la discipline a l′issue de la formation et 8 % envisageaient de le faire. Les medecins jugeaient que l′enseignement pratique (stages) et l′enseignement theorique les avaient correctement prepares a leur exercice professionnel pour respectivement 76 % et 62 % d′entre eux. Discussion Le pourcentage de medecins ayant quitte la specialite a l′issue de leur DES, ou envisageant de le faire, est similaire a celui observe dans d′autres specialites. Certains medecins expriment des incertitudes sur leur avenir professionnel, en particulier en fonction de l′evolution de la discipline secondaire a la reforme de la medecine du travail. Les medecins interroges dans cette etude apparaissent tres majoritairement satisfaits de leurs conditions d′exercice et de leur formation.

The prevalence of sleep disorders increases with age and reaches 20 to 40% of those older than 60 years. We set up a health education program to help the elderly to improve their sleep. It includes a preliminary 9-day evaluation with a sleep diary and wrist actigraph, a day of group cognitive behavioral therapy, and a follow-up assessment, again with sleep diary and actigraph.Of the 26 study participants (9 men and 17 women, mean age: 68+/-1 years), 14 had insomnia with night awakenings of 1 hour or longer or a sleep latency of 30 minutes or longer or both (group 1). The other 12 (group 2) also complained of insufficient sleep.In the weeks following cognitive behavioral therapy, group 1 improved their total sleep time by an average of 24 to 33 minutes, with reduced night-time awakenings and sleep latency and no change in their time spent in bed. Those in group 2 also increased their total sleep time by 18 to 47 minutes, by spending more time in bed and maintaining a sleep efficiency close to 88%.This study showed that cognitive behavioral therapy coupled with individual sleep evaluation improves sleep duration in elderly people who complain of insufficient sleep. These beneficial effects were accompanied by positive assessments of both subjective sleep quality and morning energy.

Many occupational cancers in France are not notified to social insurance. However, they must be searched for, because identification of an occupational exposure to carcinogenic chemical or process allows compensation for impairment and handicap. Due to the latency of the disease, screening and diagnosis of occupational cancers relies upon general practitioners. The patient notifies by himself his occupational disease to the social insurance. He joins a medical certificate that any physician can deliver. Recognition of the occupational origin of the disease depends on social status of the victim. The notification of the occupational disease has also consequences for prevention: identification of new carcinogenic substances or processes, adjustment of the legislation.

Background : New recommendations (2010) have changed the post-occupational medical follow-up for asbestos exposed workers. Main objective : To estimate the prevalence of lung asbestos related diseases in a medically followed- up population. Methods : A bicentric descriptive retrospective study, in two CCPP of Ile-de-France, over followed-up patients between 2011 and 2013. Results : 624 patients got followed-up. They were mostly men (93,9%), active (85,7%), with an average of age of 54,7 years +/-7,9. They were mostly classified in the intermediary cumulated exposure level (78,2%). 433 initial computed tomography (CT) scans were analyzed. The asbestos related diseases prevalence among followed-up patients is 8% (n=51) (mostly pleural plaques, n=46). Nodules were found on 46,4% of realized CT scans. Only one lung cancer was diagnosed (0,8% of followed-up patients), with a mean for the nodules follow-up of 12,7 months+/-7,3 and the average of 1,72 extra CT scan per patient. Conclusion : These results need caution due to the limited size of the sample and the recruitment way. However, this work provides elements about the concrete realization and the limits of the actual follow-up.; Contexte : De récentes recommandations (2010) ont modifié le suivi post-professionnel des travailleurs exposés à l’amiante. Objectif principal : Evaluer la prévalence des pathologies pulmonaires attribuables à l’amiante dans une population ayant bénéficié du dépistage. Méthodes : Etude descriptive rétrospective bi-centrique, portant sur deux Centres de Consultations de Pathologies Professionnelles d’Ile-de-France, sur des patients dépistés entre 2011 et 2013. Résultats : 624 patients ont bénéficié du dépistage. Il s’agit en majorité d’hommes (93,9%), d’actifs (85,7%), avec une moyenne d’âge de 54,7 ans +/-7,9. Ils ont été classés en majorité en niveau d’exposition cumulé intermédiaire (78,2%). 433 examens de tomodensitométrie (TDM) initiaux ont été analysés. La prévalence des pathologies attribuables à l’amiante chez les patients dépistés est de 8% (n=51) (en majorité des plaques pleurales, n=46). Des nodules ont été retrouvés sur 46,4% des examens TDM réalisés. Un seul cancer broncho-pulmonaire a été diagnostiqué (0,8% des patients suivis), avec une moyenne de suivi des nodules de 12,7 mois +/-7,3 et 1,72 TDM supplémentaire en moyenne par patient. Conclusion : La taille limitée de l’échantillon et le mode de recrutement nécessitent d’interpréter les résultats avec précaution. Néanmoins ce travail apporte des éléments sur la réalisation concrète et les limites du dépistage actuel.